It is common for practitioners to misdiagnose the cause of facial cutaneous sinus tracts, failing to recognise that many have an odontogenic cause. Chronic infection around the apex of a dental root can drain to the mouth or less commonly to the skin via a sinus tract. Dental symptoms are not always present and this confuses the clinical picture further. Failure to identify an odontogenic cause may result in unnecessary and ineffective treatment. Elimination of dental infection via tooth extraction or root canal treatment leads to resolution of the cutaneous sinus. We present a series of cutaneous draining sinuses of dental origin that resolved rapidly following dental treatment and hope to highlight the importance of including odontogenic infection in the differential diagnosis of such a lesion in the head and neck.
A close case study series of alendronate-associated osteonecrosis of the jaws (AONJ) is presented. A consistency of case definition with a minimal reporting requirement was attempted as recommended by the task force of the American Society for Bone and Mineral Research. A hierarchy of evidence focussing on 7 categories of interest was included for each case. A further 7 categories were added by the authors and completed where possible. The patients were drawn from a discrete population of 900,000 from the south-east of Scotland. The prescribing of drugs to this population was monitored by a government agency, the Information Services Office of the National Health Service of Scotland. The daily or weekly standard doses of alendronate prescribed to this population were recorded, thus allowing a calculation of the drug patient years (DPYs). The number of cases of AONJ, when computed against the cumulative year-on-year DPYs for alendronate, suggests an incidence of AONJ per DPYs of <0.004% for age-related or hormone-related osteoporosis. This increased to >0.1% when alendronate was prescribed as a prophylaxis against glucocorticosteroid-induced osteoporosis.
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