Systemic sclerosis (SSc) is a multisystem disease of unknown aetiology characterised by microangiopathy, dysregulated immune function and tissue remodelling, which commonly involves the oral cavity. Orofacial manifestations of SSc contribute greatly to overall disease burden and yet are regularly overlooked and under-treated. This may reflect a pre-occupation amongst rheumatology clinicians on potentially life-threatening internal organ involvement, but is also a consequence of insufficient engagement between rheumatologists and dental professionals. A high proportion of SSc patients report difficulty accessing a dentist with knowledge of the disease and there is recognition amongst dentists that this could impact negatively on patient care. This review shall describe the clinical features and burden of orofacial manifestations of SSc and the management of such problems. The case is made for greater collaborative working between rheumatologists and dental professionals with an interest in SSc in both the research and clinical setting.
Alveolar osteitis (dry socket; AO) is a well-recognised complication following tooth extraction where accelerated breakdown of the clot within the socket results in increased localised inflammation and severe discomfort for the patient. Conventional treatment is quick and simple, with different medicated packing available for topical treatment. Recent literature on the subject advises against some approaches to treatment, and strengthened evidence that appropriate perioperative management may significantly reduce the incidence of AO. It is the purpose of this article to review these findings and summarise what current evidence suggests to be the best approach for treatment and prevention of AO, as well as identifying key risk factors.
Clinical relevance Scientific rationale for studyThe use of antibiotics, and chlorhexidine, in the practice of dentistry are both topical subjects in the UK due to increasing concern over antibiotic-resistance and chlorhexidine anaphylaxis. The aim of this article is to provide a detailed background to the subject, and present the most up-to-date interpretation of appropriate perioperative care with regard to AO.
Principal findingsAntibiotics are not indicated in the management of AO. When used appropriately, chlorhexidine can be an effective and cost-efficient preventative measure and treatment option.
Practical implicationsRoutine use of perioperative chlorhexidine mouth rinses is recommended.
Differential diagnosis of cystic lesions in the floor of the mouth is of paramount importance, as the recommended surgical techniques vary depending on the anatomical position of the lesions. The intraoral approach is preferred for those lesions that do not extend beyond the mylohyoid muscle boundaries; this leads to a satisfactory cosmetic and functional outcome.
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