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      Manejo Multidisciplinario del paciente diagnosticado con el Síndrome de Sjögren

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          Abstract

          El Síndrome de Sjógren (SS) es una exocrinopatía autoinmune crónica que afecta primariamente a las glándulas salivales y lagrimales y ocasionalmente algunos pacientes pueden presentar afección extraglandular. Entre las principales manifestaciones bucales se encuentran la xerostoma, mucositis, glositis, queilitis, candidiasis atrófica y ulceras crónicas producidas por el flujo salival disminuido. Entre otras alteraciones se incluye la enfermedad periodontal, principalmente la gingivitis. Dependiendo de la severidad de la enfermedad podemos encontrar un número elevado de caries cervicales. Se presenta por primera vez una revisión de las diferentes alternativas de tratamiento tanto local como sistémico para las manifestaciones bucales del síndrome, así como, el manejo multidisciplinario dirigido hacia el tratamiento periodontal, caries dental y protésico.

          Translated abstract

          Sjogren Syndrome (SS) is a chronic autoimmune exocrinopathy that primarily affects salivary and lacrimal glands. Occasionally, could present extraglandular involvement. The most common oral findings include mucositis, glossitis, cheilitis, atrophic candidiasis and non specific chronic ulcers mainly produced by the severe decreased salivary flow rate. Other manifestations include periodontal disease mainly gingivitis and cervical caries. A current review of the different modalities of treatment of the oral manifestations both local and systemic is presented for the first time. Additionally, an updated multidisciplinary approach focused on periodontal, preventive and prosthetic is presented.

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          Most cited references102

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          A mixed-bacteria ecological approach to understanding the role of the oral bacteria in dental caries causation: an alternative to Streptococcus mutans and the specific-plaque hypothesis.

          For more than 100 years, investigators have tried to identify the bacteria responsible for dental caries formation and to determine whether their role is one of specificity. Frequent association of Lactobacillus acidophilus and Streptococcus mutans with caries activity gave credence to their being specific cariogens. However, dental caries occurrence in their absence, and the presence of other bacteria able to produce substantial amounts of acid from fermentable carbohydrate, provided arguments for non-specificity. In the 1940s, Stephan found that the mixed bacteria in dental plaque produced a rapid drop in pH following a sugar rinse and a slow pH return toward baseline. This response became a cornerstone of plaque and mixed-bacterial involvement in dental caries causation when Stephan showed that the pH decrease was inversely and clearly related to caries activity. Detailed examination of the pH (acid-base) metabolisms of oral pure cultures, dental plaque, and salivary sediment identified the main bacteria and metabolic processes responsible for the pH metabolism of dental plaque. It was discovered that this metabolism in different individuals, in plaque in different dentition locations within individuals, and in individuals of different levels of caries activity could be described in terms of a relatively small number of acid-base metabolic processes. This led to an overall bacterial metabolic vector concept for dental plaque, and helped unravel the bacterial involvement in the degradation of the carbohydrate and nitrogenous substrates that produce the acids and alkali that affect the pH and favor and inhibit dental caries production, respectively. A central role of oral arginolytic and non-arginolytic acidogens in the production of the Stephan pH curve was discovered. The non-arginolytics could produce only the pH fall part of this curve, whereas the arginolytics could produce both the fall and the rise. The net result of the latter was a less acidic Stephan pH curve. Both kinds of bacteria are numerous in dental plaque. By varying their ratios, we were easily able to produce Stephan pH curves indicative of different levels of caries activity. This and substantial related metabolic and microbial data indicated that it is the proportions and numbers of acid-base-producing bacteria that are at the core of dental caries activity. The elimination of S. mutans, as with a vaccine, was considered to have little chance of success in preventing dental caries in humans, since, in most cases, this would simply make more room for one or more of the many acidogens remaining. An understanding of mixed-bacterial metabolism, knowledge of how to manipulate and work with mixed bacteria, and the use of a bacterial metabolic vector approach as described in this article have led to (1) a more ecological focus for dealing with dental caries, and (2) new means of developing and evaluating anti-caries agents directed toward microbial mixtures that counter excess acid accumulation and tooth demineralization.
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            Biofilms, a new approach to the microbiology of dental plaque.

            Dental plaque has the properties of a biofilm, similar to other biofilms found in the body and the environment. Modern molecular biological techniques have identified about 1000 different bacterial species in the dental biofilm, twice as many as can be cultured. Oral biofilms are very heterogeneous in structure. Dense mushroom-like structures originate from the enamel surface, interspersed with bacteria-free channels used as diffusion pathways. The channels are probably filled with an extracellular polysaccharide (EPS) matrix produced by the bacteria. Bacteria in biofilms communicate through signaling molecules, and use this "quorum-sensing" system to optimize their virulence factors and survival. Bacteria in a biofilm have a physiology different from that of planktonic cells. They generally live under nutrient limitation and often in a dormant state. Such "sleepy" bacteria respond differently to antibiotics and antimicrobials, because these agents were generally selected in experiments with metabolically active bacteria. This is one of the explanations as to why antibiotics and antimicrobials are not as successful in the clinic as could be expected from laboratory studies. In addition, it has been found that many therapeutic agents bind to the biofilm EPS matrix before they even reach the bacteria, and are thereby inactivated. Taken together, these fundings highlight why the study of bacteria in the oral cavity is now taken on by studying the biofilms rather than individual species.
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              Acids produced by human dental plaque metabolism in situ.

              D Geddes (1975)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aov
                Acta Odontológica Venezolana
                Acta odontol. venez
                Facultad de Odontología -UCV (Caracas )
                0001-6365
                September 2009
                : 47
                : 3
                : 122-130
                Affiliations
                [1 ] Universidad Central de Venezuela Venezuela
                Article
                S0001-63652009000300017
                968869d9-6aec-41f9-98a7-76903d4522d1

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0001-6365&lng=en
                Categories
                DENTISTRY, ORAL SURGERY & MEDICINE

                Dentistry
                Síndrome de Sjögren,Tratamiento,multidisciplinario,Xerostomía
                Dentistry
                Síndrome de Sjögren, Tratamiento, multidisciplinario, Xerostomía

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