Patient Age & Gender. Maxillofacial osteonecrosis (NICO) has been microscopically confirmed in patients as young as 14 years of age and as old as 94, and has been reported in both genders.  However, three-fourths of patients are 35-64 years of age and three-fourths are women.  These age and gender predilections are similar for patients with pain and those without pain.

Location of Lesions. Jawbone sites most often involved, in decreasing order of frequency, are the mandibular molar/retromolar areas, the maxillary molar/tuberosity areas, and the maxillary cuspid/lateral incisor areas (Table 1). Third molar (wisdom tooth) sites account for 45% of all jawbone involvement.  The vascular inflow of the mandible is quite different from the maxilla and one would not, therefore, expect even distribution of a vascular disease , but osteonecrosis is generally a disease of infarction and thrombosis of small vessels ischemic damage is more likely to occur in the distal portions

Most maxillofacial lesions are in old extraction sites, but another common presentation is a radiographically successful endodontic procedure which continues to be painful after therapy, even after extraction.  While the great majority of facial cases occur in the alveolar bone, i.e. the bone containing the teeth, osteonecrosis can affect the walls of the sinuses, walls of the external ear canal (malignant otitis externa), and the TMJ  or jaw joint (avascular necrosis of the condyle).

Multiple Sites are Often Involved. One-third of NICO patients have more than a single quadrant involved, not necessarily at the same time, and 10% have lesions in all four quadrants.  This is not unexpected, as it has long been known that 50-80% of hip cases eventually involve the opposite femoral head.  In our experience, the more generalized the condition, the more likely the jawbone patient is to suffer from multiple risk factors, including hyperthrombotic disorders

Read more about this at http://www.maxillofacialcenter.com/NICOclinical.html

Gum Disease Links to Heart Disease and Stroke

Researchers have found that people with gum disease are almost twice as likely to suffer from coronary artery disease.

Heart Disease

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Read more about this at http://www.perio.org/consumer/mbc.heart.htm

Questions & Answers: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth

On April 7, 2011, the U.S. Food and Drug Administration (FDA) warned the public about the use of over-the-counter (OTC) products containing benzocaine, an ingredient used to reduce pain in the mouth and gums. Benzocaine use may cause a rare, but serious condition where the amount of oxygen that can be carried through the blood stream is greatly reduced. This condition is called methemoglobinemia. FDA is particularly concerned about the use of OTC benzocaine products in children for relief of pain from teething because of the serious outcomes, including death, that may be associated with methemoglobinemia, as well as the difficulty parents or consumers may have in recognizing the signs and symptoms of methemoglobinemia when using these products at home. Furthermore, symptoms of methemoglobinemia may not always be evident or attributed to the condition.

Parents and caregivers should not use OTC benzocaine products on children under two years of age, except under the advice and supervision of a healthcare professional. If benzocaine products are used, it should be used sparingly and only when needed, but not more than four times a day.

Read the remaining portion of the report at http://www.fda.gov/Drugs/DrugSafety/ucm250029.htm.

In an extraordinary development that will change the global debate about amalgam, the United States government has announced that it supports a “phase down, with the goal of eventual phase out by all Parties, of mercury amalgam.” This statement – a radical reversal of its former position that “any change toward the use of dental amalgam is likely to result in positive public health outcomes” – is part of the U.S. government’s submission for the upcoming third round of negotiations for the world mercury treaty.*

While couched in diplomatic hedging – remember it is still early in the negotiations – this new U.S. position makes three significant breakthroughs for the mercury-free dentistry movement:

1. The U.S. calls for the phase-out of amalgam ultimately and recommends actions to “phase down” its use immediately. Incredibly, the government adopted three actions that the World Alliance for Mercury-Free Dentistry and Consumers for Dental Choice

proposed at the negotiating session in Chiba, Japan. Our key ally, The Mercury Policy Project, laid the groundwork for this success at a World Health Organization meeting in 2009!

2. The U.S. speaks up for protecting children and the unborn from amalgam, recommending that the nations “educate patients and parents in order to protect children and fetuses.”

3. The U.S. stands up for the human right of every patient and parent to make educated decisions about amalgam.

What does this mean? Our position – advocating the phase-out of amalgam – is now the mainstream because the U.S. government supports it. Who is the outlier now? It’s the pro-mercury faction, represented by the World Dental Federation and the American Dental Association. With the U.S. continuing its leadership role in this treaty, we will broadcast the U.S. position to other governments around the world, encouraging them to support amalgam “phase downs” leading to phase-outs not only globally, but within each of their countries.

We applaud the U.S. government. But tough work lies ahead. For example, we must demonstrate to the world that the available alternatives – such as composites and the adhesive materials used in atraumatic restorative treatment (“ART”) – can cost less than amalgam and will increase access to dental care particularly in developing countries.

For now though, let’s mark this watershed in the mercury-free dentistry movement: the debate has shifted from “whether to end amalgam” to “how to end amalgam.”

Charles G. Brown

National Counsel, Consumers for Dental Choice

President, World Alliance for Mercury-Free Dentistry

5 April 2011

The ADA’s Dental Mercury Hygiene Recommendations were published in: J AM Dent Assoc, Vol 134, No.11, 1498-1499; © 2003, American Dental Association. You can access the article online at http://jada.ada.org/cgi/content/full/134/11/1498.

Engel P. Dr. Med.dent. Lyss_Strasse 24, 2560 Nidau, Switzerland.

Lichtenberg HJ. Journal of Orthomolecular Medicine. 1993; 8: pp.145-148.

Jones L. The Bulletin of the New Zealand Psychological Society. 97, 29-33. 1999.

Zalups RK. Pharmacol Rev. 2000 Mar; 52(1):113-43. 10699157 PubMed