Mouth Pain Research Articles

Evaluation of success criteria for temporomandibular joint arthrocentesis.

ObjectivesThe aim of this study was to use four sets of success criteria to evaluate the outcomes of arthrocentesis treatment with hyaluronic acid injection in patients with internal derangement (ID) of the temporomandibular joint (TMJ).Materials and MethodsThe study included 40 patients diagnosed with unilateral Wilkes stage III TMJ dysfunction. Clinical parameters, including maximum mouth opening (MMO) and pain during function, were evaluated preoperatively, 6 months, and 1 year after TMJ arthrocentesis. Outcomes were assessed and compared using four sets of success criteria from the following: the American Association of Oral and Maxillofacial Surgeons (AAOMS; MMO ≥35 mm and visual analogue scale [VAS] score ≤3), Murakami et al.'s criteria (MMO >38 mm and VAS score <2), Emshoff and Rudisch criteria (MMO ≥35 mm and >50% pain reduction), and patient self-reports (self-evaluation of treatment as successful or unsuccessful).ResultsSignificant improvements in MMO and pain reduction during function were observed between the preoperative period and 6 months and 1 year postoperatively (P<0.01). The success rates of treatment determined using AAOMS (52.5%), Emshoff and Rudisch criteria (57.5%), and self-reported patient criteria (40.0%) were similar. Application of the Murakami et al. criteria reported the lowest success rate (12.5%).ConclusionThe AAOMS and Emshoff and Rudisch criteria are consistent with patient expectations and can be used to assess treatment efficacy.

A Study to Assess the Oral Health Status and Knowledge on Oral Health Hazards among Tobacco Consuming Adults in Nanchiyampalayam, Dharapuram in view of Preparing a self Instructional Module

Health is a state of complete physical, mental and social and spiritual wellbeing and not merely the absence of disease or infirmity. Wellness is the condition in which an individual functions at optimum levels. Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual's capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing. Dental problems can occur at every stage of life. But some problems happen at a particular stage and age. And particularly in the period of adults, some of the common dental problems faced by adults. They are tooth decay, teeth discoloration and gum diseases. Use of tobacco is a risk factor for oral cancer, oral mucosal lesions, periodontal disease and impaired healing after periodontal treatment, gingival recession, and coronal and root caries. Available evidence suggests that the risks of oral diseases increase with greater use of tobacco and that quitting smoking can result in decreased risk. The magnitude of the effect of tobacco on the occurrence of oral diseases especially oral cancer is high, with users having many times the risk of non-users. Tobacco use is generally perceived as an adult problem. The diseases widely caused by tobacco are mostly seen to afflict the older population, yet tobacco use most often starts in youth, vast majority start consuming tobacco before the age of 25 years. Tobacco use has injurious effects on oral health. The oral health is an important aspect of community health. To plan important interventions it is necessary to find out the prevalence and factors associated with them. This study was aimed to assess the oral health status and knowledge on oral health hazards among tobacco consuming adults in Nanchiyampalayam, Dharapuram in view of preparing a self instructional module. The research approach used for the study was descriptive approach. The Non-experimental descriptive research design was used for this study. The conceptual frame work of the study was based on The Health Belief Model (Rosen Stock 1974 And Becker And Maiman 1975)”. Non probability purposive sampling technique was used to select the 100 samples. The tool used for the study was the oral health assessment tool modified from Kayser-Jones et al. (1995) by Chalmers (2004) for assessing the oral health status and knowledge regarding oral health hazards was assessed by using a structured interview schedule. At the end of the data collection self instructional module regarding effects of tobacco use on oral health was distributed to the samples. Severe cases were instructed to go for further treatment. The collected data were analysed and tabulated by using descriptive and inferential statistics. The data analysis revealed that the mean and standard deviation scores of level of oral health status were 6(SD±3.12) and the mean and standard deviation scores of level of knowledge were 13(SD±5.16) respectively. The‘t’ value was 4.202 which was significant at P<0.05 level of significance. There was a low positive correlation r=0.4 between the oral health status and the level of knowledge on oral health hazards among tobacco consuming adults. There was no significant association of the level of oral health status among tobacco consuming adults with their selected demographic variables except for the age of the adults (χ2=6.81). There was no significant association of the level of knowledge among tobacco consuming with their selected demographic variables except for the age of the adult (χ2=13.09), education (χ2=39.57), monthly income (χ2=16.25), frequency of consuming tobacco (χ2=12.66), and the duration of consuming tobacco (χ2=24.04). The study revealed that even though the adults had good knowledge on hazards of tobacco consumption on oral health they had poor oral health status. The findings of the study support the need for conducting educational programme to increase the knowledge of adults on tobacco consumption and its related problems. Educating the youth and adults with correct information regarding hazards of tobacco consumption can help them to avoid/stop the bad habits and develop a healthy life style.

A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study.

Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide. A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health. Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing. There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.

A KAP study of oral health status among adults in a rural area of Jammu District

Background: Oral health is an integral part of general health and well being. It is important to know about the factors which having a bearing on oral health so that preventive measures can be taken. A research activity was planned to assess the oral health status and oral health practices of people in a rural community of Jammu region as very little is known about the knowledge and oral health practices of adults residing in this area.Methods: A cross sectional study for a period of four months was conducted in a village Tanda of R.S.Pura block of Jammu district. 324 adults above the age of 20 years (145 males and 179 females) were interviewed face to face with the help of a questionnaire consisting of questions from WHO technique of self assessment of oral health along with some more questions exploring the knowledge, attitude and local oral health practices.Results: The overall results showed adequate knowledge but poor attitude regarding oral health. Out of 324 subjects studied, 41.7% paid dental visits on having pain in teeth, gums or mouth and only 3.0% visited dentist routinely. 85.6 % of participants reported using brush and toothpaste but only 24.0% of all respondents brushed twice a day and only 16.7% of the respondents changed their tooth brush within three months.Conclusions: Oral health awareness, by promoting community based programs should be undertaken at periodic intervals for better oral health and hygiene.

Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy

PurposeManual therapy has been used for the treatment of patients with temporomandibular disorders (TMD) with mouth-opening limitations. However, the curative effect of manipulation differs among researchers, and its necessity remains controversial. The purpose of this study was to confirm the efficacy of manipulation using a randomized controlled trial (RCT). MethodsA total of 61 TMD patients who had mouth-opening limitation (upper and lower middle incisor distance ≤35mm) were selected. They were divided into two treatment groups: conventional treatment (n=30) and conventional treatment plus manipulation (n=31). The conventional treatment included two types of self-exercise: cognitive behavioral therapy for bruxism and education. Mouth-opening limitation, orofacial pain, and temporomandibular joint (TMJ) sounds were recorded from baseline to 18 weeks after baseline. These parameters were statistically compared between the two treatment groups by using analysis of variance (ANOVA) and Scheffe’s test to assess mouth opening distance and pain; TMJ sounds were compared using Mann–Whitney U test. ResultsNo statistical difference was observed between the two treatment groups except for mouth-opening limitation after treatment at the first visit. Subgroup analyses, stratified according to the pathological type of TMD, indicated a similar trend. ConclusionsThe efficacy of manipulation seems to be limited, in contrast to our expectations, and improved execution of therapeutic exercises has a similar effect to that of manipulation during long-term observation. The advantage of manipulation was observed only during the first treatment session. The RCT was registered in the University Hospital Medical Information Network in Japan (UMIN-CTR: 000010437).

Management of Primary Sjögren's Syndrome.

OBJECTIVE: Review the clinical manifestations and treatment of primary Sjögren's syndrome. DATA SOURCES: Articles indexed in PubMed, Scopus, and the Cochrane Library in the past 10 years using the key words "Sjögren," "Sjögren's syndrome," "Sjögren's disease," and "Sjögren's syndrome AND treatment." Primary sources were used to locate additional resources. STUDY SELECTION AND DATA EXTRACTION: Forty-six publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS: The literature included practice guidelines, review articles, original research articles, and prescribing information for the manifestations, diagnosis, and treatment of primary Sjögren's syndrome. CONCLUSION: Primary Sjögren's syndrome is a chronic autoimmune disease with various clinical manifestations, notably dry eye, dry mouth, fatigue, and inflammatory musculoskeletal pain. Most patients are under the care of a dentist, ophthalmologist, and rheumatologist. There is currently no cure; therapy is tailored for each patient to reduce symptoms, avoid complications, and improve quality of life. Respondents to a recent survey conducted by the Sjögren's Syndrome Foundation reported using more than eight medications and treatments for their symptoms; more than 60% of respondents were older than 60 years of age. Pharmacists familiar with recommended treatment options can provide advice and counseling to Sjögren's syndrome patients on multi-drug regimens prescribed by different health care practitioners.

Management of Primary Sjögren's Syndrome.

OBJECTIVE: Review the clinical manifestations and treatment of primary Sjögren's syndrome. DATA SOURCES: Articles indexed in PubMed, Scopus, and the Cochrane Library in the past 10 years using the key words "Sjögren," "Sjögren's syndrome," "Sjögren's disease," and "Sjögren's syndrome AND treatment." Primary sources were used to locate additional resources. STUDY SELECTION AND DATA EXTRACTION: Forty-six publications were reviewed and criteria supporting the primary objective were used to identify useful resources. DATA SYNTHESIS: The literature included practice guidelines, review articles, original research articles, and prescribing information for the manifestations, diagnosis, and treatment of primary Sjögren's syndrome. CONCLUSION: Primary Sjögren's syndrome is a chronic autoimmune disease with various clinical manifestations, notably dry eye, dry mouth, fatigue, and inflammatory musculoskeletal pain. Most patients are under the care of a dentist, ophthalmologist, and rheumatologist. There is currently no cure; therapy is tailored for each patient to reduce symptoms, avoid complications, and improve quality of life. Respondents to a recent survey conducted by the Sjögren's Syndrome Foundation reported using more than eight medications and treatments for their symptoms; more than 60% of respondents were older than 60 years of age. Pharmacists familiar with recommended treatment options can provide advice and counseling to Sjögren's syndrome patients on multi-drug regimens prescribed by different health care practitioners.

A retrospective study on mandibular coracoid fractures

This study aimed to analyze the treatment for mandibular coracoid fractures retrospectively. A retrospective study on 37 patients with mandibular coracoid fractures treated at Department of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University from January 2010 to December 2015 was conducted. Eleven patients were treated conservatively, and 26 patients underwent surgical restoration and internal fixation. Mouth opening and pain degree were used as indicators to analyze treatment results. The 37 cases of coracoid fractures accounted for 3.18% of the total mandibular fractures. The average age of patients was 38.05 years. Satisfactory results were obtained in both treatments. A considerable change in the degree of mouth opening before and after 6 months was found in the two groups. The pain degree before treatment and 1 day after operation, 1 day and 4 weeks after operation, and 4 weeks and 6 months after operation indicated that the two groups did not significantly differ. However, substantial changes between the two groups were found before treatment and 6 months after operation. Conservative treatment is recommended for patients with linear, temporalis muscle-located, and non-displaced coracoid fractures. Surgical treatment is recommended for patients with large fractures and those with accompanying zygomatic arch and mandible fractures.

The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: A systematic review and meta-analysis.

The aim of the systematic review was to analyse the available evidence in order to assess the efficacy of dextrose prolotherapy in improving outcomes in temporomandibular joint (TMJ) hypermobility patients as compared to placebo. An electronic search of PubMed, Scopus, CENTRAL and Google scholar databases was performed for English language papers published up to February 2018. Randomised clinical trials (RCTs) and controlled clinical trials (CCTs) comparing dextrose prolotherapy with placebo for TMJ hypermobility were included. Three RCTs were included in the review. Frequency of subluxation/dislocation was reported by two trials which found no difference between dextrose and placebo. A statistical significant difference in reduction of MMO with the use of dextrose prolotherapy was seen on pooling of data (random: MD=-3.32, 95% CI -5.26 to -1.28; P=0.0008; I2 =0%). A statistical significant difference in pain reduction was also seen with dextrose as compared to placebo (random: MD=-1, 95% CI -1.58 to -0.42; P=0.0007; I2 =0%). Within the limitations of the study, dextrose prolotherapy may cause significant reduction in mouth opening and pain associated with TMJ hypermobility. Conclusions with regard to reduction of episodes of subluxation/dislocation cannot be drawn. There is a need of more high-quality RCTs with larger sample size and homogenous prolotherapy protocol to draw stronger conclusions on the effect of dextrose prolotherapy in patients with TMJ hypermobility.

Oral Glucosamine Hydrochloride Combined With Hyaluronate Sodium Intra-Articular Injection for Temporomandibular Joint Osteoarthritis: A Double-Blind Randomized Controlled Trial

Temporomandibular joint (TMJ) disorders occur in many people and osteoarthritis (OA) is a severe form of this disease. Glucosamine has been used to treat OA of the large joints for many years and has been proved effective. A double-blinded randomized controlled trial was designed to investigate the effectiveness and safety of oral glucosamine hydrochloride pills combined with hyaluronate sodium intra-articular injection in TMJ OA. One hundred forty-four participants with TMJ OA were randomized to 4 hyaluronate sodium injections and oral glucosamine hydrochloride (1.44g/day) for 3months (group A) or 4hyaluronate sodium injections and oral placebo for 3months (group B). All participants were followed for 1year. Eighteen participants were lost to follow-up. The intention-to-treat analysis showed that group A had similar maximal interincisal mouth opening and pain intensity during TMJ function at months 1 and 6 (P>.05). However, during long-term follow-up, group A had significantly greater maximal interincisal mouth opening compared with group B at month 12 (41.5 vs 37.9mm; P<.001). For pain intensity, group A showed obviously lower visual analog scale scores than group B at month 6 (20.6 vs 29.2mm; P=.007) and month 12 (17.4 vs 28.6mm; P=.001). Twenty-four participants had gastrointestinal tract side effects, fatigue, and rash. Of these, 23 had slight side effects that were not correlated with glucosamine. There was no significant difference between the 2 groups (P>.05). The results of this study suggest that, compared with hyaluronate sodium injection alone, glucosamine hydrochloride pills added to hyaluronate sodium injection had no meaningful effect on TMJ OA in the short-term but did relieve the pain caused by TMJ OA and improved TMJ functions in the long-term.

Dietary Intake, Attitudes toward Healthy Food, and Dental Pain in Low-Income Youth.

Few studies have examined the relation between food consumption and related attitudes and dental pain among children. The objective of this study is to examine the associations of healthy and unhealthy food items, attitudes toward healthy food, and self-efficacy of eating healthy with dental pain among children. A cross-sectional analysis was performed using child survey data from the Texas Childhood Obesity Research Demonstration (TX CORD) project. Fifth-grade students ( n = 1,020) attending 33 elementary schools in Austin and Houston, Texas, completed the TX CORD Child Survey, a reliable and valid survey instrument focused on nutrition and physical activity behaviors. All nutrition questions ask about the number of times food and beverage items were consumed on the previous day. Dental pain was reported as mouth or tooth pain in the past 2 wk that made their mouth hurt so much that they could not sleep at night. Mixed-effects logistic regression models were used to test the association between 10 unhealthy food items, 9 healthy food items, 2 health attitudes, and self-efficacy with dental pain. All models controlled for sociodemographic variables. In total, 99 (9.7%) students reported dental pain. Dental pain was associated with intake of the following unhealthy items: soda, fruit juice, diet soda, frozen desserts, sweet rolls, candy, white rice/pasta, starchy vegetables, French fries/chips, and cereal (adjusted odds ratio [AOR], 1.27-1.81, P < 0.01). The intake of other vegetables (AOR, 1.56; P < 0.01), a healthy item, and the attitude that healthy food tastes good (AOR, 1.59; P = 0.04) were also positively associated with dental pain. The attitude of eating healthier leads to fewer health problems (AOR, 0.50) and self-efficacy for healthy eating (AOR, 0.44) were negatively associated with dental pain ( P < 0.01). Interventions should focus on improving oral health by reducing intake of unhealthy foods and educating children and families on the importance of diet as a means of reducing dental caries. Knowledge Transfer Statement: The results of this study can be used to inform researchers on potential food items and psychosocial measures to examine in low-income, minority populations for longitudinal research. These results would also be useful to educators who could incorporate oral health care and nutrition education into school curriculums.

Mandibular coronoid process hyperplasia: a case report

ABSTRACT Coronoid Process Hyperplasia is a rare condition characterized by the increase in size of a histologically normal bone. It can be confused with Temporomandibular Joint Dysfunction, due to the presence of major signs/symptoms, including the limitation of mouth opening, pain, and facial asymmetry. Although several theories have been proposed, the etiology remains unknown. The recommended treatment is mandibular coronoidectomy. In the present study, the importance of computed tomography to reach the proper diagnosis and the surgical treatment plan is demonstrated.

Development of a patient-specific temporomandibular joint prosthesis according to the Groningen principle through a cadaver test series

ObjectivesPatients suffering from osteoarthritis, ankylosis (e.g. post-trauma or tumour) in the temporomandibular joint (TMJ) can present with symptoms such as severely restricted mouth opening, pain or other dynamic restrictions of the mandible. To alleviate the symptoms, a total joint prosthesis can be indicated, such as the Groningen TMJ prosthesis. This was developed as a stock device with a lowered centre of rotation for improved translational and opening capacity. This study aimed to improve the design of the prosthesis, and produce a workflow for a customized Groningen TMJ prosthesis, in order to make it more accurate and predictable. MethodsThe fossa and mandibular components of the Groningen TMJ prosthesis were customized. A series of five human cadavers was operated and bilateral TMJ prostheses were placed using custom cutting and drilling guides. Placement accuracy was evaluated based on post-operative CT data. ResultsA total of N = 10 prostheses were placed and analysed. The average Euclidean distance deviation from planned to actual position was 0.81 mm (SD 0.21). All prostheses were placed according to the routine surgical approaches and had an excellent alignment with the bony structures. ConclusionThe newly developed custom Groningen TMJ prosthesis can be placed with great accuracy and is the first step for improving TMJ total joint replacement surgery.

The effectiveness of Zataria extract mouthwash for the management of radiation-induced oral mucositis in patients: a randomized placebo-controlled double-blind study.

Oral mucositis (OM) is a common debilitating complication of chemoradiotherapy treatment of head and neck cancers. This randomized placebo-controlled double-blind clinical trial study was performed to evaluate the effectiveness of Zataria multiflora (ZM) extract mouthwash in the prevention and reduction of OM related to local radiotherapy in the treatment of head and neck cancer patients. Sixty-three patients with head and neck cancers, who underwent a conventional fractionated radiotherapy regimen, were entered into the study. Patients gargled the ZM mouthwash or a placebo before the beginning of the treatment three times daily and before each radiotherapy session. The assessment of OM was conducted according to WHO and Oral Mucositis Assessment Scale. The OM intensity trends in the ZM group during these weeks of treatment were detected 3.152 times less frequently than in the placebo group. A twofold decrease in the incidence of grades 3-4 OM was observed in the ZM group compared to the placebo. The use of the ZM mouthwash affected the incidence of grades 3-4 OM to a relative risk ratio of 0.432. The pain score was significantly decreased in the ZM group compared to the placebo group. The present study revealed that ZM mouthwash effectively decreases the severity of OM and mouth pain in patients with head and neck cancer treated with radiotherapy. The use of ZM mouthwash effectively decreases the severity of oral complications induced by ionizing radiation in patients during radiotherapy and resulted in high oral quality care. Graphical abstract ᅟ.

Transoral Endoscopic Thyroidectomy: Review of 81 Cases in a Single Institute.

To evaluate the clinical efficacy and safety of transoral endoscopic thyroidectomy (TOET). A total of 81 patients with thyroid nodules underwent TOET in our department from November 2011 to September 2015. The surgical outcomes, cosmetic results, and complications were evaluated. Seventy-nine patients were performed TOET successfully, and 2 cases were transferred to open thyroidectomy due to intraoperative CO2 embolism. The average operation time was 89.0 ± 38.6 minutes, and intraoperative blood loss was 29.3 ± 27.6 mL. Two cases experienced transient perioral numbness, and 2 cases experienced transient opening mouth pain. Two cases had transient increased saliva when swallowing. Transient anterior cervical region discomfort was found in 3 cases, and postoperative anterior cervical region infection was found in 4 cases. Other complications were not observed in any case. The average postoperative length of stay was 4.77 ± 2.61 days, and the mean follow-up period was 39.1 ± 22.6 months. During the follow-up period, there were no long-term complications or recurrent patient, and all the patients were satisfied with the cosmetic effect. TOET is a safe and effective procedure with a low incidence of complications and perfect cosmetic effect for patients with thyroid diseases.

Prevalence of and factors associated with dental anxiety among medical and dental students of the Northern State Medical University, Arkhangelsk, North-West Russia

ABSTRACTThe objective was to assess the prevalence of and factors associated with dental anxiety (DA) in medical and dental students in North-West Russia. This cross-sectional study included 422 medical and 285 dental undergraduate Russian students aged 18–25 years from the Northern State Medical University in Arkhangelsk. Corah’s Dental Anxiety Scale (DAS) was applied to measure DA. Information on socio-demographic and socioeconomic factors, oral health behaviour and general and oral health was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess caries experience, Simplified Oral Hygiene Index, and Gingival Index. DAS score ≥13 was found in 13.7% and 2.2% of medical and dental students, respectively. Female sex (incidence rate ratio [IRR] = 1.11, p = 0.013), lower education of mother (IRR = 1.13, p = 0.001), and poor self-assessed oral health (IRR = 1.15, p < 0.001) were associated with DA in medical students. Corresponding factors in dental students were female sex (IRR = 1.16, p = 0.001), irregular dental visits (IRR = 1.19, p = 0.001), infrequent tooth-brushing (IRR = 1.17, p = 0.007), pain in mouth (IRR = 1.09, p = 0.031) and number of missing teeth (IRR = 1.13, p = 0.007). The prevalence of high DA was lower in dental students than in medical students. DA was associated with sex, mother’s education, poor oral health behaviour and self-assessed and clinically assessed oral health.

Oral manifestations in diabetic patients under treatment for ischemic heart diseases: A comparative observational study

Objective: To assess the oral and dental manifestations in the nondiabetic and diabetic groups who were under treatment for ischemic heart disease (IHD) patients. Materials and Methods: A total of 167 IHD patients who were under treatment for IHDI s were considered for the study. After seeking permission from various hospitals in and around Bhimavaram, both inpatients and outpatients-files were screened-for presence of IHD from the available data. After selecting the study population, patients were checked for absence of diabetes and grouped accordingly. Subjective symptoms such as dry mouth, taste changes, and tongue or mucosal pain were evaluated and recorded as present or absent in the pre – prepared proform and dental assessment consisted of decayed, missing, filled, teeth (DMFT) index and Community Periodontal Index (CPI). Results: Subjective oral manifestations of dry mouth, taste changes, and tongue or mucosal pain showed statistically higher score in the diabetic group with a P value of

Toxic Epidermal Necrolysis Associated with Tetracycline Eye Ointment: A Case Report

Toxic epidermal necrolysis (TEN) is a rare but potentially life threatening severe cutaneous adverse reaction with widespread epidermal detachment and mucosal erosions usually induced by medications. Tetracycline eye ointment is not known to cause TEN and recent literature search found no published articles that associate tetracycline (TTC) eye ointment and TEN. However, the Eritrean National Pharmacovigilance Centre has received one serious cutaneous reaction immediately following application of TTC eye ointment. The aim of this case report is therefore to describe this unusual and interesting adverse drug reaction, it’s possible explanations and treatment outcomes of the event. This is a case of 15 years old female patient admitted to hospital with a presentation of body skin desquamation, fever and malaise, eye and mouth pain with redness. Notably, this case study is designed for the peculiarity of its occurrence with a single dose instillation of tetracycline eye ointment purchased as an over the counter drug. As a result, patient developed generalized skin lesion with about 80% skin involvement. Though TEN is usually drug induced, it can also be explained with some etiological factors which can induce similar reaction such as infections as well as malignancy. Clinical and laboratory investigation report however show that the patient had no prior history of infection, history of allergy and other drugs intake. Taking into account the above facts complemented with the low disease background incidence, possible biological mechanism and the plausible time to reaction onset (4 days), this case is possibly associated with TTC eye ointment. The availability of tetracycline eye ointment without prescription in Eritrea makes this association alarming as it can amplify the occurrence of TEN. Hence, further studies are required to substantiate the association.

ANTISYNTHETASE SYNDROME: COURSE OF A RARE DISEASE ON EXAMPLE OF CLINICAL CASE

Systemic disorders of connective tissue refer to rare and poorly studied diseases. This group of diseases associated with the variable course and makes it interesting for either medical scientists and researchers or practitioner. Herein we report a case of antisynthetase syndrome with interstitial lung disease complicated by pulmonary thromboembolism. The patient is 71 year old female, who suffered from severe dyspnea, dry cough, intermittent wheezing. Also she had dry eyes, dry mouth, muscle weakness and intermittent pain in large joints, and low grade fever. Physical examination revealed a characteristic heliotrope eye rash, V sign, «mechanic’s hand», peripheral muscles atrophy, dry eyes and mouth, fine crackles to auscultation in basal parts of lungs, soft S1 and S2 heart sounds. Her biochemical profile showed increased creatinekinase, LDH, AsAT, and AlAT Her immunology results were positive to ANA, anti-ds-DNA, anti-ss-A, anti-ss-B and anti-Jo-1 autoantibodies. Based on the obtained data, antisynthetase syndrome was established. It was detected, that progressive dyspnea had been caused by interstitial lung disease and pulmonary thromboembolism. It was confirmed by chest CT-scan and pulmonary angiography. Treatment in this case is mainly symptomatic. It was prescribed glucocorticoids, immunosuppressant, and anticoagulants. This case illustrates the course of the antisynthetase overlap syndrome and difficulties of it management due to the lack of treatment standards and reliable data of the medicine effectiveness.

Oral rehabilitation of a patient with systemic lupus erythematosus using implant-supported fixed dentures: A case report with review of important considerations

Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with a variety of oral manifestations (dry mouth, reduced salivary flow, painful mucosal lesions and restricted mouth opening, impaired oral hygiene maintenance), as well as possible far-reaching systemic implications. In the context of SLE, oral rehabilitation with dental implants might be the most appropriate solution. However, a lack of available literature, as well as the absence of treatment protocols, often leads to unsatisfactory management of these patients. The aim of this paper was to describe oral rehabilitation of a patient with SLE using dental implants and fixed dentures in both jaws. Case outline. A 66-year-old female patient, who had suffered from SLE for over 30 years, was referred for oral rehabilitation as her chief complaints related to the existing mobile partial dentures in the jaws and poor chewing ability. Proposed oral rehabilitation with fixed dentures supported by six dental implants in the maxilla and four dental implants in the mandible, as well as prosthetic restoration of the mandibular teeth, was accepted by the patient. During the follow-up period of three years, no biological complications were observed related to the performed treatment. Conclusion. Dental implants might be the most suitable treatment modality for oral rehabilitation of patients suffering from SLE.