The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer

Trismus is a post-radiotherapy complication that affects survivors of head and neck cancers. It is described as the reduction of mouth opening to less than 35 mm. The condition is a progressive process; hence early intervention is crucial to prevent further damage and weakness to the elevator muscles of the mandible. Here, we report a 40-year-old woman with known squamous cell carcinoma of the maxillary sinus in stage T3N0M0 who had undergone upper right partial maxillectomy with subsequent 33 fractions of radiotherapy (66 Gy; intensity-modulating radiotherapy). Five months post-radiotherapy, the patient showed interest in replacing her missing teeth to restore her oral functions and facial appearance. At her post-radiotherapy visit in the dental assessment clinic, she showed a mouth opening of 12 mm. The TheraBite® Jaw Motion Rehabilitation System™ and wooden tongue depressors were alternatively used for 6 weeks (4-5 stretches/day; each stretch held for 15 s). Mouth opening gradually increased to 20 mm. Consequently, a definitive obturator prosthesis was fabricated using computer-aided design and computer-aided manufacturing technologies with the 3Shape D900 model scanner. These were challenging and time-consuming steps, but acceptable facial appearance and mouth opening were restored for the patient. This case suggests that Therabite® Jaw Motion Rehabilitation SystemTM and wooden tongue depressors help to increase mouth opening significantly if used together and alternatively.

The role of dental care providers in the management of patients prescribed bisphosphonates: brief clinical guidance

Dental care providers are likely to see patients who take bisphosphonates for various medical conditions, including osteoporosis, bony metastatic tumors, multiple myeloma, breast cancer, and prostate cancer. Bisphosphonates accumulate in areas of high bone turnover, leading to suppression of bone turnover and the aging of keratocytes. These adverse effects predispose the maxillary and mandibular bone to development of medication-related osteonecrosis of the jaw (MRONJ), specifically among oncology patients treated with intravenous bisphosphonate therapy. Studies have shown that stopping bisphosphonate therapy, temporarily (drug holiday) or permanently, is not significantly effective. The effectiveness of a drug holiday is likely limited due to the pharmacologic activity of bisphosphonates and their persistent, long-term effect on bone. Therefore, patients should not be discouraged from taking bisphosphonates for an existing medical condition. A dental health assessment by an oral surgeon, a dental specialist, or a well-trained general dental practitioner is highly recommended prior to treatment with bisphosphonate. The evaluating clinician must attempt to eliminate or mitigate risk factors to prevent the development of MRONJ. It is crucial for dental care providers to recognize the clinical signs and symptoms of MRONJ, including its radiographic appearance. In cases of any suspicious oral lesion, early referral to an oral surgeon is crucial. It is better to avoid dental extractions during the active period of treatment and to treat the tooth carefully with nonsurgical root canal treatment instead. This review provides brief clinical guidance for dental care providers regarding management of patients prescribed bisphosphonates and ways to help minimize patients' risk of developing MRONJ.

Barriers to special care patients with mental illness receiving oral healthcare. A cross sectional study in the Holy City of Makkah, Saudi Arabia

Objectives:

To assess barriers to patients with mental illness receiving oral healthcare in Makkah city, Saudi Arabia.

Methods:

This was a 3-month cross-sectional study from the Department of Psychiatry at Al-Noor, Specialist Hospital in Makkah city, Saudi Arabia, between January 2017 and April 2017. A structured questionnaire with closed-ended questions was considered. A total of 161 psychiatric patients were recruited, made up of 81 male (50.3%) and 80 female (49.7%) participants. Simple descriptive statistics were used to define the characteristics of the study variables, through a form of counts and percentages. The chi-square test was also used to evaluate the distribution of the nominal variables.

Results:

Of the 161 psychiatric patients, 51 were aged 26-35 years old (31.7%). Most participants (n=73) had psychological development disorders (45.3%). Ninety-one (56.5%) were unemployed, and among them, 25 (15.5%) reported problems with access to oral health and dental care. Participants also suffered from dry mouth (64%) and dental anxiety (23%).

Conclusions:

This study suggested that dental anxiety is considered the major barrier to dental care, followed by the cost of dental treatments and accessibility. Most belonged to the group of psychological development disorder and reported having the most barriers to oral healthcare.

To what extent should dental implant placement be adopted as a standard for diabetic patients?

Diabetes mellitus (DM) is considered one of the major chronic diseases in the world. Long-term hyperglycemia considerably affects the body tissues, and consequently, can lead to morbidity and mortality. Moreover, many oral complications have been observed with DM but little consideration in relation to the placement of dental implants has been investigated. Dental research has analyzed the relation of dental implants and bone osseointegration in diabetic patients. Theoretically, an impaired immune system and delayed wound healing of these patients might decrease the success rate of implant placement; however, with noticeable advances in evidence-based dentistry and statistically significant results, successful implant treatment could be achieved significantly in well-controlled diabetic patients.

Appraisal of antimicrobial prescribing practices of governmental and non-governmental dentists for hospitals in the western region of Saudi Arabia

OBJECTIVE

To scrutinize the knowledge, attitude, and antimicrobial practices in Saudi Arabian Dentistry.

METHODS

In this cross-sectional survey of dentists, a self-administered questionnaire comprising of 61 questions was dispersed to the participants randomly, which included their professional profile, awareness of the current scope of antimicrobial resistance, prescribing practice, frequency of antimicrobial prescription, and sources of continuing education of antimicrobials. The study took place in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between February and April 2013.

RESULTS

Knowledge and awareness concerning specific antimicrobials, with specific oral cavity lesion was 78% for the students and interns, 80% for residents, and 95.3% for specialists. Approximately 89% of the students, interns and residents, and 98.4% of the specialists endorsed indiscriminate use of antibiotics. In addition, 93.4% of students, 90% of interns and residents, and 90.6% of specialists agreed that lack of health education is one of the contributors to overuse of antimicrobials. Moreover, 91.9% of the interns, 80% of residents, and 75.5% of specialists preferred amoxicillin + clavulanate as their first choice; however, a wide variation in the dosage frequency, and duration was observed.

CONCLUSION

Participants are well aware of the significance of antimicrobial resistance, and considered that judicious use of antimicrobials is highly imperative to restrain this fiery predicament. Divergence was demonstrated between specialists and residents in prescribing practices. Institutional antimicrobial guideline was not interesting to all the respondents. This highlights the need for incessant instructive intervention in order to accomplish the prime objective of retreating antimicrobial resistance.