Xerostomia and hyposalivation impair oral function and quality of life. Current therapies are largely palliative, and systemic sialogogues are often limited by side effects or contraindications. Intraductal salivary gland irrigation (IDSGI) has emerged as an alternative, being a minimally invasive outpatient technique aimed at relieving oral dryness by flushing and stimulation of the major salivary glands with saline or corticosteroid solutions. This technique has been described for various disorders of the salivary glands (e.g. Sjögren’s syndrome, sialadenitis), and substantial objective and subjective benefits following intraductal irrigation have been reported. The present article describes and critically appraises this technique by presenting three randomly chosen patient cases with documented hyposalivation and severe xerostomia. The patients were all treated by intraductal irrigation of their major salivary glands using sterile saline. Before and after therapy, unstimulated and stimulated whole-saliva flow rates, salivary pH, and subjective dryness using a visual analogue scale (VAS) were measured. The procedure was well tolerated with no complications by all three patients included. After one month, unstimulated and stimulated salivary flow rates increased in two cases and one patient previously treated with sialogogues showed no improvement in salivary flow rates. However, all three patients showed a decreased VAS for dryness by 30-50% with subjective improvement persisting also on later check-ups. The cases presented suggest that IDSGI represents a simple and safe outpatient procedure that can improve salivary flow and xerostomia as an adjunct to other conservative measures, particularly when systemically acting sialogogues are ineffective or contraindicated.
Klinische Beurteilung und Entscheidungsfindung in der Zahnmedizin sind variabel und von Unsicherheiten geprägt. Unterschiedliche diagnostische Gewichtungen, therapeutische Konzepte und patientenbezogene Präferenzen können selbst bei vergleichbaren Ausgangslagen stark divergierende Behandlungspläne erzeugen. Leitlinien geben Orientierung, garantieren jedoch keine einheitliche Umsetzung - insbesondere dort, wo medizinische Ziele mit ästhetischen und komfortbezogenen Zielsetzungen sowie vermeintlichen Qualitätsansprüchen zusammentreffen. Anhand eines Fallbeispiels werden erhebliche Unterschiede in Umfang und Kosten zweier Planungen dargestellt: Die Erstmeinung sah eine mehrphasige Gesamtrehabilitation vor, während die Zweitmeinung eine schrittweise, bewusst risiko- und erhaltungsorientierte Strategie verfolgte. Unabhängige Drittmeinungen aus dem universitären Setting konvergierten ebenfalls in Richtung des letzteren Vorgehens. Zur Einordnung dieser Behandlungsbandbreite wurde ein dreistufiges heuristisches Modell vorgeschlagen, das zwei Ebenen verbindet: Analytisch ordnet es die Optionen nach ihrer Begründungsbasis; normativ kennzeichnet es einen Bereich, in dem eine erhöhte ethische Rechtfertigungslast besteht. Heuristisch ist dabei im Sinne einer Faustregel bzw. eines pragmatischen Orientierungsrahmens für die Entscheidungsfindung zu verstehen: 1) "Need" bezeichnet indikationsbasierte, medizinisch erforderliche Versorgung, 2) "Want" beschreibt legitime, präferenzsensitive Optimierungen innerhalb vertretbarer Grenzen und 3) "Greed" zielt als normativer Warn- und Grenzbegriff auf Konstellationen ab, in denen Leistungsumfang und Kosten über eine ausreichend transparente Zusatznutzenbegründung hinaus ausgedehnt werden. Das Modell dient nicht der Klassifikation in „richtig“ oder „falsch“, sondern der vergleichbaren Darstellung von Nutzen–Risiko–Kosten, Alternativen, Irreversibilität und Folgekosten im Shared-Decision-Making.
Fibrodysplasia ossificans progressiva is a rare genetic disorder characterized by progressive heterotopic ossification, which may lead to severe functional impairment. Orofacial involvement can result in marked restriction of jaw movement up to extra-articular temporomandibular ankylosis, severely complicating oral hygiene, diagnostics and dental treatment. This case report describes a 25-year-old male patient with advanced fibrodysplasia ossificans progressiva and complete jaw immobility with a maximum interincisal opening of 0 mm. He presented himself with daily dental pain, poor oral hygiene and recurrent swelling episodes. Conventional dental radiography was not feasible. Computed tomography revealed a permanent dentition except tooth 38, marked crowding and several malpositioned, non-occluding posterior teeth without obvious periapical pathology, marked periodontal bone loss or gross carious lesions. After interdisciplinary planning, including anesthesiologic consultation and expert advice in fibrodysplasia ossificans progressiva care, removal of the posterior teeth was performed to improve oral cleanability, reduce the risk of inflammatory complications in inaccessible posterior regions, facilitate nutrition within the existing limitations and improve emergency access for suction in case of vomiting. Local injection techniques were avoided because of the risk of iatrogenic heterotopic bone formation. The procedure was performed under general anesthesia with awake fibreoptic nasotracheal intubation and standby tracheostomy, using a strict soft-tissue-sparing approach and meticulous avoidance of positioning trauma. The patient was monitored for two nights and recovered without complications. At 11-month follow-up, he remained free of dental pain and recurrent swelling episodes and reported improved food intake with a weight gain of 8 kg. This case highlights the importance of preventive dentistry, strict indication for invasive procedures, multidisciplinary planning, airway preparedness, maximal trauma avoidance and long-term dental follow-up in specialized centers.
The threat of antibiotic resistance has been a global public health issue. This problem is often aggravated by inappropriate antibiotic administration, including those after the third molar surgery. Thus, systemic antibiotic use in third molar surgery should be considered strictly. The use of antiseptics after third molar surgery, such as chlorhexidine, may help prevent postoperative complications; therefore, its use should be encouraged. This study aimed to determine whether chlorhexidine is beneficial in preventing alveolar osteitis without systemic antibiotics. This review was conducted to determine whether chlorhexidine is beneficial in preventing alveolar osteitis (AO) and was designed according to the PICO model. Alternating combinations of keywords were used, including "third molar surgery," "chlorhexidine," "mouthwash," "wound dressing," and "irrigation" to search PubMed, Cochrane Library, and Scopus. Clinical studies of third molar surgery that reported clinical outcomes after postoperative chlorhexidine supplementation without systemic antibiotic prescription were included. Twelve studies were included in the meta-analysis. The incidence of alveolar osteitis (AO) in the chlorhexidine group was significantly lower than that in the control group (9.58% vs. 16.8%, P < 0.0001). Chlorhexidine reduced the risk of AO by 42.9%. The use of chlorhexidine can effectively prevent AO and should be considered good clinical practice to mitigate antimicrobial resistance.
Fibrodysplasia ossificans progressiva is a rare genetic disorder characterized by progressive heterotopic ossification, which may lead to severe functional impairment. Orofacial involvement can result in marked restriction of jaw movement up to extra-articular temporomandibular ankylosis, severely complicating oral hygiene, diagnostics and dental treatment. This case report describes a 25-year-old male patient with advanced fibrodysplasia ossificans progressiva and complete jaw immobility with a maximum interincisal opening of 0 mm. He presented himself with daily dental pain, poor oral hygiene and recurrent swelling episodes. Conventional dental radiography was not feasible. Computed tomography revealed a permanent dentition except tooth 38, marked crowding and several malpositioned, non-occluding posterior teeth without obvious periapical pathology, marked periodontal bone loss or gross carious lesions. After interdisciplinary planning, including anesthesiologic consultation and expert advice in fibrodysplasia ossificans progressiva care, removal of the posterior teeth was performed to improve oral cleanability, reduce the risk of inflammatory complications in inaccessible posterior regions, facilitate nutrition within the existing limitations and improve emergency access for suction in case of vomiting. Local injection techniques were avoided because of the risk of iatrogenic heterotopic bone formation. The procedure was performed under general anesthesia with awake fibreoptic nasotracheal intubation and standby tracheostomy, using a strict soft-tissue-sparing approach and meticulous avoidance of positioning trauma. The patient was monitored for two nights and recovered without complications. At 11-month follow-up, he remained free of dental pain and recurrent swelling episodes and reported improved food intake with a weight gain of 8 kg. This case highlights the importance of preventive dentistry, strict indication for invasive procedures, multidisciplinary planning, airway preparedness, maximal trauma avoidance and long-term dental follow-up in specialized centers.
