бооксхн шытл ытотахн зтсхн hellenic stomatological review TOMO 57 IANOYAPIO - MAPTIO 2013 ISSN

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1 бооксхн ENTY O K EI TO AP. A. 520/92 ёблхшытно т A с KЬ IKO 6705 бооксхн шытл ытотахн зтсхн TOMO 57 Я TEYXO 1 IANOYAPIO - MAPTIO 2013 шытл ытотахн зтсхн E I THMONIKO ENTY O ME EёNIKH ANA NЬPI H EK 431/2 ык 5 Aappleзхо т 2005 T E X з шнтсы х н ы зкл с шытс Eсхнfi оотахнfi K ы отат Eappleхшыклтсхнрс бзхт хнрс ыт Eсхнт K сызт Tбнлкз шк TA E HNIKA TOMATO O IKA XPONIKA TO IA IKTYO To хтхнкыхнfi л т охт ык EOO н х к сы ныхн Eappleхызтapple ы с Eооксхнрс ытл ытотахнрс Xзтсхнрс, бныхлрсы ых с ыfiыкыб ык ш а зтск кобнызтсхн ыб стота, appleтй шхшб, к ызхлксх н тшк ыт appleбзхт хнт с а сбы х appleтнобхшыхн кобнызтсхн, лб с зыкшк ы с ыб рс шыт х хны нfi ыfiappleт ык Eооксхн O тсых ызхн Oлтшappleтс. Hобнызтсхн Eappleхнтхс с н х Aappleтшыто Eappleхшыклтсхнрс Eза шхрс шык хб сшк hellenic stomatological review HELLENIC DENTAL ASSOCIATION VOLUME 57, ISSUE 1, JANUARY - MARCH 2013 ISSN TPIMHNIAIA EK O H E HNIKH O ONTIATPIKH OMO ON IA ISSN TOMO 57 IANOYAPIO - MAPTIO 2013

2 Eооксхн O тсых ызхн Oлтшappleтс бооксхн шытл ытотахн зтсхн I IOKTHTH : Eооксхн O тсых ызхн Oлтшappleтс TOMO 57, TEYXO 1 IANOYAPIO - MAPTIO 2013 ISSN EPIEXOMENA IEYёYNTH YNTA H : I.. Tт ы YNTAKTIKH E ITPO H:. т ыш. Zбз т -B о к H. K зн. торк A. Kтшхрск. ат з т. Mтсыт зк X. мхл. apple ах сст ок. нбоо зк. T злappleт B. Tтapple ыштаот-ёблбо. Tх й E IME HTE YNTA H : M. Aсы сх т, E.T. зл нк E IME EIA EK O H : бохс Mapple лapple к Y EYёYNO EKTY Ь H : TypeProduct B. & E. Mapple лapple к E E Eappleхнт зт 31 & бхз хр Tко.: (210) IA HMI EI - HMO IE XE EI : M. Mтзй схт -. нfiан Tко.: (210) Fax: (210) T ытл ытотахн Xзтсхн б с х ыт бapple шк- лт бappleхшыклтсхнfi сыappleт ык Eооксхн O тсых ызхн Oлтшappleтс appleт бн бы х с ыз лкст. Eы шх шс зтл : 0,01 e с зтл бм ыбзхнт 40 $ EK OTH : A с шхт K ыш нк, зfiб зт E.O.O. E PA EK O H : ёблхшытно т 38 - A с KЬ IKO : 6705 Tко.: (210) Fax: (210) EPEYNHTIKH EP A IA Я ушнтappleк appleтой зл н шыкс сыхлбырappleхшк стшкл ы с ыт шыfiл ыт. Aс зтлхн лбо ык шб 458 шбсб. E.-M. K ота зт, K.I. Tfiшхт н х A. но т ст ёema K INIKOY EN IA EPONTO Я Kохсхн сыхлбырappleхшк appleы ы хср т appleбзappleо ш applefi т тсытшытх б. зтш шк appleбзхшы ыхнт н х х охтаз йхн с шнfiappleкшк. M. ыкз т, N. то зтс нк,. з ан шнт н х E. ы зт EN IA EPOY A EPI TЬ H Я H х ы ыхн Oшыбта сбшк шыкс appleзтблйыбл ыхн бхзтзахн. зтш шк appleбз appleы шк н х с шнfiappleкшк ык х охтаз й. X. то т, A. Z appleapple,. B а т ык н х. T злappleт BIB IO PA IKH ANA KO H H Я Mбы лfiш бшк лбшба л ыхнрс о шытныы з с н х лбы йтз атсх с ах ыкс с appleо шк ы с appleбзхт тсыхнрс хшырс. ё. Kтс ок, E. бappleбо шк

3 Hellenic Dental Association Hellenic Stomatological Review PROPRIETOR: Hellenic Dental Association CONTENTS VOLUME 57, ISSUE 1 JANUARY - MARCH 2013 ISSN EDITOR -IN- CHIEF: J. G. Tzoutzas EDITORIAL BOARD: G. Douvitsas F. Zervou-Valvi H. Karkazis G. Polyzois A. Kossioni P. Lagouvardos G. Mountouris H. Paximada L. Papagiannoulis D. Sakellari F. Tzerbos V. Topitsoglou-Themeli D. Tziafas PRODUCTION SUPERVISORS: M. Antoniadou, E.T. Farmakis COPY EDITOR: Evelin Babai PRODUCTION - PROMOTION: TypeProduct V. & E. Babai Ltd 32 Epikourou Str., Athens Hellas Phone#: (3210) Fax#: (3210) ADVERTISEMENTS - PUBLIC RELATIONS: M. Morfoniou - S. Gogas Phone#: (3210) Fax: (3210) Hellenic Stomatological Review is the official publication of the Hellenic Dental Association, published trimonthly. Annual subscription 40 $ USD PUBLISHER: Athanasios Katsikis President of the Hellenic Dental Association CLINICAL INTEREST Я Clinical management of epulis fissuratum: Case presentation and Literature Review. M. Sotiriou, N. Polychronakis, F. Fragiskos and E. Stavrou RESEARCH PAPER Я Drug abuse and overuse in the management of oral diseases. Retrospective study in 458 patients. E.-M. Kalogirou, K. I. Tosios and A. Sklavounou CASE REPORT Я The Distraction Osteogenesis in pre-implant surgery. A case report and review of the literature. C. Souliou, C. Zappi, G. Bagdouti and F. Tzermpos LITERATURE REVIEW Я Mesenchymal stem cell transplantation and gene transfer for periodontal tissue regeneration. T. Kondylis, E. Pepelassi HEADQUARTERS 38 Themistokleous Str., Athens, Phone#: (3210) Fax#: (3210)

4 YNTAKTIKH E I A H Kз шк н х шых клтшхб шбх H Oхнтстлхн Kз шк н х ы apple збонfiлбс ык, б с х с лбсfiлбст с клхтзат с шт з appleзт о л ы шыкс х н скшк ык Eappleхшыклтсхн appleокзтйтз, ыкс сы оо а applefi б с н х ыкс тл о обхытза ы с рз с н х ы с йтз с appleт apple з атс лбы тс ык сршк. H Oхнтстлхн Kзхшк appleт л шы бх ыкс Eоо н ы ыкс ыбобы appleбсы бы, бх клхтз- а шбх шт з appleзт о л ы шыкс тл о хбм а а ык збс н х н ы шс appleбх л ох- шы шыкс apple з а а клтшхб шб с шб анзхы Eооксхн н х хбс Eappleхшыклтсхн сыapple. Oх шнто б мбн скш с appleзхс applefi о а зfiсх лб ытс appleбзхтзхшлfi бapple нзх шыбз ыкс - мкл ск шнто н х ыкс с окыхнfiыкы appleт apple зтшх шыкнб шыкс appleзfiш шк шб лба о бзбскыхн appleзтаз лл ы, ыкс fiот н х appleхт appleто appleотнк Nтлхн н х Tappleхн х хн ш, ах ыкс appleт то н х ыкс х н скшк бзбскыхнрс appleз ытнfiоо с, ыкс блappleотн fiот н х appleбзхшшт- ы з с Nfiл с н х х ы мб с шык х хн ш ык шсбза ш бзбскыхнт appleзтш appleхнт ыкс appleзтл бх бappleхшыклтсхнт бмтappleохшлт. й шб л охшы л зх н х ыкс с л сыокшк шытх б с ык хбст х охтаз й, л ш ы с кобнызтсхнрс х охткнрс, оfiа х нтapple ык зкл ыт fiыкшк о шк ы с шл- ыхнрс ш шб с лб анзхыт бн тыхнт т нт ыт бм ыбзхнт. K ы ы appleзры зfiсх appleт к нз шк н сб ыкс блй схш ык, тх бооксхн клтшхб шбх -ыто хшытс шыт рзт ы с O тсых ызхнрс Eн fiшб с- бхм с с лкс бappleкзб тсы х т ыб appleтштыхн, т ыб appleтхтыхн н х ыт ыт хfiых apple з б нfiл к бйб зб асршк н х бappleхшыклтсхнрс шытх б с applefi apple збот шб бзбскыхн н х шааз йхн з шык- зхfiыкыб. Mх шбхз fiл applefi абатсfiы appleт шс кш с нытыб, лбзхн applefi ы тappleт м бх с с йбзт с apple з н ы, б- appleкз ш с шкл сыхн ых бappleх fiшбх appleтоорс Eооксхнрс Eappleхшыклтсхнрс бсы apple с. Mх з хн х apple шы шк б с х fiых ы ыбобы зfiсх бс apple з тс appleо тс шт з н скыз шб лба об бappleхшыклтсхн тл б ах збс н х клтшх- б шбх, fiapple бмбо мбх шыт рзт ы с сбappleхшыклх нрс Mборс E, appleзтнкз мбх с с шб с, бмбо мбх шыт рзт ыт Eсхнт шы л ыт Yаб, х нытзхн х ызх, Mтстаз й б н х абсхн с анк клхтза хт- аз йхнрс шклбх л ы с. з ооко к apple ыкшк appleтоорс apple сбappleхшыклх нрс нзхырс ах ыкс с анк apple змк хбсрс клтшхб шб с шы хтаз йхн шклбхрл ы ы с нзхсfiлбс с, лбы н скшб ыт бс х й зтс ы с шааз й с appleзт м с -нз Aааоfi- й с - Eappleхшыклтсхн сыapple, ы тappleт х ытс н appleтхт шсыбобшы з ыкы н х з шнтсы х н х з бхтбыкл - с шб н appleтх лк с Hобнызтсхн K ы рзкшк н х Aс ыкшк. T от к бapple ызхбы с шыто ык бхш т с т х ныхнт appleзтш appleхнт -н зх бхш а ахнрс л с- шыт рзт ы с AEI, бх appleо тс клхтза шбх н бшыр х йтз н х зскыхшлт шыкс apple з а а аз appleыт бappleх- шыклтсхнт оfiат applefi с т н х мхfiотат бappleхшы лтсб, бср сы бы ст с шб лfi л охшы appleок зхнfi тх apple зтшх шбх шб с зх, лapplefiшх, Hлбз б, Kохсхн зтсыхшы зх, лб йтст бappleхшыклтсхнfi охнfi, лб з - ны з бйкзлтшл ск асршк н х блappleбхз. T бappleхшыклтсхн appleбзхт хн тс бapple шк appleокаб applefi ыкс сыокшк appleокзтйfiзкшк л ш ыт х хны т, applefi fiappleт т н б бappleхшы лтс, лappleтзб с сыо шбх тappleтыб appleтыб шлappleокз л ыхн асршк -fi х fiapple apple сытыб ко appleтхfiыкы н х мхтappleхшы - лб лкоfi с apple зныт нтшытоfiахт н х лб appleбзхтзхшл ск ыкс с анк с шанбнызрсбх - сыapple шыт рзт ык лбо ык ыт, appleт о ат н хзfi лбы лбы ыз appleтсы х шб лба от зт н х ыбз шыхт fiант, б- ст окыхн зыfiл. Oх бappleхшыклтсхнт бн fiыб, appleз appleбх с шсбза шт с ах ыкс сыхлбырappleхшк н х бapple ошк ыт ыт appleзт о л ыт, хfiых к аз appleы асршк appleт бх appleтшыб ык ш ст ык appleтоо appleо нз шк н х бappleбмбза ш applefi appleтхн оот нзхы, appleтыбоб ыкс appleобfiс мхfiappleхшык лтзй appleокзтйfiзкшк ах н б бappleхшы лтс, тх б Eооксхн клтшхб шбх б с х к appleхт б appleбappleык тзй асршк ах ытс б хшкытappleтхкл ст Eapple аабол ы O тсы ызт, appleт бс бх ыт зfiст н х ш н х ык с ыfiыкы с appleбзхкаб ы х шых Hобнызтсхн Bх охт нб ах с бсклбз б бapple бл ы с ык н клбзхс шнкшк ыт обхытза л ыfi ыт. I.. TZOYTZA хбсы сы мк

5 T Eооксхн ытл ытотахн Xзтсхн шыт х ныт O ка б ах ыкс с ыкш ыт окнызтотаб шыб Eлй с бы х к шбо Eappleхо м ыб ыкс бсfiыкы Eн fiшбх Eлй с бы х к шбо Eappleхо м ыб ы Eооксхн ытл ытотахн Xзтсхн. Eappleхо м ыб ыт ыт appleт ш бс х й збх Eappleхо м ыб ыкс бза ш appleт ш бс х й збх ршыб бсыто ах appleт нбшк бны apple шк ык бсfiыкы appleт ш бс х й збх сыл шбх н х л то ы бзрс Mтс с, ы ыхшыхнрс з с н х Oза стота зт сылкшк сылкшк сылкшк сылкшк ш л тот зт ш л тот зт ш л тот зт ш л тот ы бз лтс б ampere A angstrжm Aф barm b calorie cal candela cd coulomb C counts per minute cpm counts per second cps curie Ci degree Celsius фc disintegration per minute dpm disintegration per second dps electron Volt ev equivalent Eq farad F gauss G gram g henry H hertz Hz hour h inch in international unit IU joule J kelvin K kilogram kg liter/litre I or L meter, metre m minute min molar M mole mol newton N normal (concentration) N ohm Ь osmol osmol pascal Pa pound lb pound per square inch psi revolutions per minute rpm second s square centimeter cm 2 volt V watt W week wk year yr ы ыхшыхнт fiзтх correlation coefficient r probability p degrees of freedom df standard deviation SD mean x Standard error mean not significant NS of the mean SE number of Student s test t test observations n variance F с шлfi appleзтбл ы с tera- (10 12 ) T centi- (10-2 ) c giga- (10 9 ) G mili- (10-3 ) m mega- (10 6 ) M micro- (10-6 ) лm kilo- (10 3 ) k nano- (10-9 ) n hecto- (10 2 ) h pico- (10-12 ) p deca- (10) da femto- (10-15 ) f deci- (10-1 ) d atto- (10-18 ) a SEM: TEM: ESEM: CSEM: AFM: SPM: EELS: EDS: EPMA: XRF: XRD: FTIR: Scanning Electron Microscopy Transmission Electron Microscopy Environmental Scanning Electron Microscopy Confocal Scanning Electron Microscopy Atomic Force Microscopy Scanning Probe Microscopy Electron Energy Loss Spectrometry Element Dispersive Spectroscopy Electron Probe Microanalysis X-ray Fluorescence analysis X-ray Diffraction Fourrier Transformation Infrared Spectroscopy

6 O H IE IA TOY Y PA EI T TOMATO O IKA XPONIKA б с х к бapple шклк бappleхшык- лтсхн н тшк ык Eооксхн O тсых ызхн Oлт- шappleтс н х шыfi т тс ык шсб бappleхшыклтсхн бск- л з шк ыт оокс O тсых ызт н х ыкс appleзтркшк ык O тсых ызхн Eappleхшы лк шытс Eооксхнfi рзт. х ыкс appleз ал ы шк ыт шнтappleт ыт клтшхб тсы х: 1. K зх л ы : узз шб лтзй с шнfiappleкшк, appleт йтзт с бapple н хз н х лйхобаfiлбс л ы н х appleт аз йтсы х лб appleзтызтapple ык сы ныхн Eappleхызтapple applefi шс ойт лб бх хн шб т асршбх ыт л ыт. 2. Eappleхшыклтсхн зз appleт шы остсы х applefi шс ойт : T зз ы лappleтзб с с нтс шб л applefi ых apple з - н ы н ыкатз б : ) Aс шнтapple шбх (л зх 3 шааз йб ) ) Eзбскыхн бза ш б ( бхз л ыхн лбо ыб, Kохсхн лбо ыб, Eза шыкзх н лбо ыб, Eappleх клхтотахн лбо - ыб, Kохсхнтшы ыхшыхн лбо ыб, Kохстapple тотахн лбо - ыб ) а) Eс х й зтшб appleбзхappleыршбх ) з ныхн л ы, б) Eapple аабол ыхн л ы бappleхшыклтсхн ыбнлкзх л с, шы) ё л ы клfiшх Yаб, ) ё л ы шыз ыкахн, к) Eнapple х быхн ё л ы н х х) ёбл ыхн бсfiыкыб. 3. з лл ы appleзт ык сы ныхн Eappleхызтapple : T аз лл ы appleт клтшхб тсы х лбы applefi анзхшк ык сы ныхн Eappleхызтapple йтзт с: ) нз шбх ах клтшхб- л с зз н х ) шанбнзхл с бз ы л ы ш быхн лб бappleхшыклтсхн л ы н х appleт стсы х apple сы шбх applefi ык шы ок ык оокотаз й. 4. сытлб appleз ыfiыappleб клтшхб шбх : ё йтзт с appleз ыfiыappleб бза ш б бз л ы, б тс ны шк лба о ыбзк applefi о мбх н х клтшх- б тсы х ыт шсытлfiыбзт с ыfi applefi мхтоfiакшк ык сы ныхн Eappleхызтapple. 5. бзхо бх зз с: Oх appleбзхо бх ы йтзт с зз Eоо с с ш- с ой с appleт тс клтшхбб appleзfiшй ы шб appleбзхт хн ыт бм ыбзхнт. ны шк зз с: Oх с шнтapple шбх б appleз appleбх с мбappleбзст с ых о мбх (25 ныотаз йкл сб шбо - б ) н х ых 100 х охтаз йхн apple з appleтлapple лб бм збшк бх хн л ы appleт ш бы тсы х лб шхн бappleхшы лб. Oх бзбскыхн бза ш б н х ы appleз ныхн л ы б appleз appleбх с appleбз стс ых о мбх (10 шбо б ) н х ых 40 apple з appleтлapple. T зз appleт йтзт с бс х й зтшб appleб- зхappleыршбх б appleз appleбх с appleбз стс ых о мбх (4 шбо б ), бср ы бapple аабол ыхн л ы appleз appleбх с appleб- зхтз тсы х шых о мбх (20 шбо б ). ыкс ны шк ы с apple з apple с зз с шлappleбзхо л сбы х н х к х охт- аз й appleт appleз appleбх с б с х бapple н хзк н х с бх лбшк ш шк лб ыт х appleз ал ыбfiлбст л. сы мк нбхл с с: T зз appleт appleт оотсы х ах клтш бшк appleз appleбх с б с х аз лл с шык сбтбооксхн клтыхн, лб лтстытсхнfi ш шыкл, н р бapple шк н х шыкс ааохн аоршш. H сы ныхн Eappleхызтapple х ыкзб ыт х- н л с бо амбх ыкс нз бх ы с ааоfiй с с fiз с н х х ыappleршб с appleбсfiлбск шб бapple аабол ы б х ызхнт лбы йз шы. O хтз ы ыт appleбзхт хнт бх ыт хн х- рл с ызтappleтappleтх шбх ао шшхн ыт нб лбст, з fiл с оотхршбх ыт йт ыт шааз й. Oх бза ш б ы appleз appleбх с б с х appleокнызтотакл сб шб хappleоfi х шыкл, лб аз лл ытшбхз Arial, Tahoma Verdana лб appleбзхрзхт applefi ых т appleобз. б х х ыбзк шбо з тс тх бм бсfiыкыб : к шбо - ы ыот, к appleбз ок к н х тх о мбх нобх х, ыт нб лбст ык бза ш, к appleбз ок к шыкс ааохн н х тх о мбх нобх х шыкс ааохн, тх х охтаз йхн apple з appleтлapple, тх об - сыб, тх apple с нб н х тх бхнfiсб. об тх шбо б зхлт - сы х лб ыкс с ы з шбхз. зтнбхл ст с мхтappleтхкт с тх бнто б ык ш а зт- ск ыб стота н х appleзт appleтйа с ы с шй ол ы с н ы ыкс appleокнызтоfiакшк нз сбы х ш с apple з ыкык к appleт то ык бза ш бх ызхappleот с шст бfiлбск applefi CD fiappleт ы нб лбс appleз appleбх с б с х appleокнызтотакл с шб appleзfiаз л- л Word шб з ны зб 12 шыхалрс. Aapplefi ытс I ст зхт ыт 2010 тх бза ш б appleт оотсы х н х кобнызтсхн шыкс хб сшк оокотаз й ы с E X бо ы ыот: бзхо л сбх: ) ытс ы ыот ык бза ш, ) ыт fiстл н х ытс ы ыот ыт (ы с) шааз й ( с), а) ыт зл apple fiappleт appleзт з бы х к бза ш, ) ыт с к бза ш бх с нтхс б шб н appleтхт шс зхт н х appleтхт, б) ыт fiстл, хб сшк н х ыко й ст ыт шааз й ах ыкс оокот- аз й, шы) ыт з ныкзхшыхнfi ык бза ш ( шбх ыт 2 4), ) х с appleка зкл ыт fiыкшк ык збс. бз ок к н х о мбх нобх х : H appleбз ок к appleз appleбх с бх ны шк л зх 200 о мбх. ых бзбскыхн бза ш б, к appleбз ок к appleз appleбх с appleбзхо л сбх ыт шнтapplefi бза - ш, ыт охнfi, ык лбт тота н х ы шлappleбз шл ы. Oх о мбх - нобх х apple з ы бсы х лб ыкс appleбз ок к н х appleз appleбх с б с х 3-10 лблтс л стх fiзтх лхнз йз шбх. Oх о мбх ы appleз appleбх с сыхшытх т с шыт хбсб fiзт обмхнтаз йкшк appleт с й зтсы х шыт Index Medicus н х Dental Index н х с блappleбзх тсы х шыт нб лбст ык appleбз ок к. Kб лбст: T зз appleт йтзт с с шнтapple шбх appleз appleбх с appleбзхо л стс л сыхappleзтш appleбыхн бхш а - а н х н ыfiappleхс с с й зтсы х ыбнлкзх л сб х охтаз - йхн fiоб тх applefi бх appleт йтзт с ыт шанбнзхл ст л. T от, appleз appleбх с apple з ы бы х лх нзхыхн с ошк ы с applefi б с ырс applefi ыт шааз й н х с н ы о абх шб шанбнзхл с шлappleбз шл ы. Oх бзбскыхн бза ш б appleз appleбх с appleтыбот сы х applefi ы нбй о х : Eхш а а, Yохн н х M т т, Eз л ы -Aappleтыбо шл ы, ыкшк н х лappleбз шл ы. ы applefiотхapple б к ы с з с ыт нб лбст х лтзйрсб- ы х ш лй с лб ых apple хы шбх ыт ззт. Bх охтаз йхн apple з appleтлapple : Oх х охтаз йхн apple - з appleтлapple шыт нб лбст, fiapple н х шыт apple с нб н х шых бх-

7 нfiсб лб ых об сыб ыт, appleзтш хтз тсы х лб з х- нт зхлт шб apple з сбшк. Tбоб б нfiл ы шклбхр- стсы х лбы ыкс apple з сбшк appleт apple з бх ык х охтаз йхн apple з appleтлapple. H з лкшк ы с х охтаз йхнрс apple з appleт- лappleрс а сбы х н ы мтсы зхлfi н х лб ык шбхз appleт бл- й с тсы х шыт нб лбст. об тх х охтаз йхн apple з appleтлapple appleт с й зтсы х шыт нб лбст н ы зт сы х шыт х охтаз йхнfi н ы отат appleт з бх шб х х ыбзк шбо лбы ыт нб лбст. зхс applefi н б х охтаз йхн apple з appleтлapple шытс н ы отат, appleзткаб - ы х т сы шытх т зхлfi appleт шклбхркнб шыт нб лбст н х шытс тappleт т сыхшытх б к х охтаз й. ыт х охтаз йхнfi н ы отат appleзткат сы х ы тсfiл ы ы с шааз й с (appleзры ыт бappleрслт н х лбы ыт fiстл, нтотб нfiл н х ыт бappleрслт ыт бapplefiлбст шааз й н.т.н.), ы бы х с н х н ы шыхал (:) т ы ыот ыт ззт, ыбоб, ыт appleбзхт хнfi шб шсытлтаз й, ыт ыт, ыт appleзfiшклт (;), т ыfiлт ыт appleбзхт хнт, шб apple з сбшк ыт ыб т, с н х н ы шыхал н х тх шбо б ыт ззт (appleзрык, apple о н х ыбобы ). Oх шсыл шбх ы с ы ыо с appleбзхт хнрс appleз appleбх с аз йтсы х ш лй с лб ыт Dental Index н х Index Medicus. х ых шсыл шбх ы с бооксхнрс appleбзхт хнрс apple з бх ш быхнfi н ы отат ыт IATPOTEK. з appleбх с appleтйб абы х абсхн к зкшхлтappleт кшк appleбзхо б- с (abstracts) х охтаз йхн apple з appleтлapple, fiapple бapple шк клтш быб apple з ыкз шбх н х appleзтш appleхн бappleхнтхс - с б. T Eооксхн ытл ытотахн Xзтсхн appleз appleбх с шсытлтаз йт сы х ш с Eоо. ытл. Xзтс. ааоfiй с Hel Stom Rev. Eза ш б appleт тс а сбх бны ах клтш бшк, оо б клтшхб кн с нfiлк, лappleтзт с с с йбзт с шык х охтаз й. ыкс appleбз appleы шк ы шклбхрсбы х шыт appleб- зхт хнfi н х к йз шк applefi клтш бшк шб apple з сбшк. E с н х бйfiштс шык х охтаз й блappleбзх тсы х зз applefi appleбзхт хн лб о ыхстабс аоршш appleт бх ытappleхн х х- хыбзfiыкыб ( бзл схн, н с хс хн, оохн ), т ытсх- шлfi ы с о мб с б с х б ск ы с шааз й с. з бхал ыт тзт ызfiappleт аз й ы с х охтаз йх- нрс сбы х apple з н ы : бзхт хнfi: Aс й зтсы х ы бappleрсл н х ы з хн ы с тстл ы с fiо с ы с шааз й с л зх мк (fiы с б с х appleб- зхшшfiыбзтх нтотб к с бхмк et al, шы бооксхн зз аз йтлб н х шс. ), т ы ыот ык бза ш, к ш- сытлтаз й ыт appleбзхт хнт, ыт ыт, т ыfiлт, ыт ыб т, к appleзрык н х к ыбобы шбо ык клтш бшк... Papagiannoulis L, Kakaboura A, Eliades G: In vivo Vs in Vitro anticariogenic behavior of glass-ionomer and resin composite restorative materials. Dent Mater 2002; 18 (8): Bх о н х ооб лтстаз й б : Aс й зтсы х лб ык шбх- з ы бappleрсл н х з хн ы с шааз й с, т ы ыот ыт х о т, т зхлfi н тшк, к applefiок н тшк. Aнтотб т бн fiык, ыт ыт ( с - н ы ыбоб ) нх к шбо... Ryge GM: Dental Corrosion. 2nd ed. New York. Harper and Row. 1985: 204. Aс к х охтаз йхн apple з appleтлapple appleтыбоб нбй о хт бсfi х о т appleт бх аз йб applefi оот шааз й, к с йтз а сбы х бм : Johnston AJ: Corrosion Resistance of Amalgams. In: Goldman AK, Johns KO, eds. Restorative Materials, Baltimore. Williams and Wilkins Co., Iшытшбо б : strategy concerning mercury, fiapple ыfi блй с бы х ыкс... (клбзтлкс с ыкшк ). H сы ныхн Eappleхызтapple appleбсл бх шыт шааз йб ы с бза шхрс fiых н оfi б с х, шых н ы ых лбсб бза ш б с шлappleбзхо л стсы х шых х охтаз йхн apple з appleт- лapple, бйfiштс х й шы сы х, appleтхтыхн Eооксхн зз ш быхн лб ыт л. Aааохн appleбз ок к: бзхо л сбх, шыкс Aааохн аорш- ш, ы тсfiл ы ы с шааз й с н х ытс ы ыот ык бза - ш. ых с шнтapple шбх appleз appleбх с apple зтшх тсы х шытх б ах fiо ы нбй о х appleт appleбзхо л стс н х ы шлappleбз шл ы. ых бзбскыхн бза ш б appleз appleбх с с й збы х к бхш а а т шнтapplefi, ы охн н х к л т т, ы appleтыбо шл ы ы шлappleбз шл ы н х к ш ыкшк. H ны шк ы с appleбзхо б с appleз appleбх с нл сбы х лбы м ы с о мб с. с нб : ныотаз йт сы х шб зхшы шбо appleт appleбзхо л сбх н х ык об сы. H об сы appleз appleбх с б с х ш сытлк н х н ы ытappleхшыхн. Aзхлт сы х лб з хнт зхлт appleт с й зтсы х шыт нб лбст. Oх бappleбмка шбх ы с шсытлтаз йхрс, н р н х ооб хбнзхс шбх, а - стсы х шыт ы от ыт apple с н. Eхнfiсб : T ш л ы, ы х аз лл ы н х тх й ытаз - й б appleз appleбх с бappleхшс appleытсы х шыт appleз ыfiыappleт н х с б с х ко бнз сбх. Oх об сыб ы с бхнfiс с аз йтсы х лб ытс мтсы зхлfi ыт шб мб зхшы шбо н ы ыкс appleт то ык бза ш. Yapple з бх с ыfiыкы бны apple - шк а зрл с бхнfiс с лбы applefi шсбссfiкшк лб ыт хбсы сы мк н х ыкс кобнызтсхн appleтшыто ба- зрл с й ытаз йхрс. Oх бхнfiсб appleз appleбх с тс ш з б лб с ошк ыто хшытс 300 dpi, с тс ык лтзй з б с JPG н х с лкс блappleбзх тсы х шык зт ыт н ы ыхбл ст нбхл - ст. Eйfiштс шых бхнfiсб блй с бы х ыт appleзfiш appleт ыт apple ш тсыт, к сы ныхн Eappleхызтapple, н ы ык клтш бшк, н о appleыбх ыкс appleбзхт ы с тй олрс лб л зк ы хс ах оfiат шб шлт appleзтш appleхнрс б тл с с. H нз шк ы с бза шхрс а сбы х applefi т нзхы appleт тс бappleхобаб applefi ыкс Eappleхызтapple сы мк. H сы ныхн Eappleхызтapple ыт бзхт хнт х ыкзб ыт хн л с appleзтыб - сбх ызтappleтappleтх шбх с appleтзз appleыбх ы зз appleт бс б с х аз лл с ш лй с лб ых т ка б ах ыт шааз йб. Oх шааз йб тс ыкс appleт з шк л ыappleтаз йх- н хfiз шк л ш шб 2 б тл б applefi ыкс appleтшыто ыт тнхл т. Mбы ыкс шыкот ыкшк б а стсы х бны лбы то ыт нбхл ст. T клтшхбл с зз, бхнfiсб н х х аз лл ы appleт- ыбот с х хтныкш ыт appleбзхт хнт. х ыкс с клтш бш ыт б с х apple з ыкык к бх ык сы ныхн Eappleхызтapple н х ыт шааз й. Eappleхш л сшк: х ыкс apple з о бappleхшыклтсхн бза - ш ах клтш бшк appleз appleбх с бappleхшс appleыбы х х б - шк ы с шааз й с fiых к бза ш бс бх н ы ыбб шб оот бappleхшыклтсхнfi сыappleт appleбзхт хнт ы appleт, fiых бс appleб- зх тсы х ыт шхб appleзты шбх applefi ооб бappleхшыклтсхн клтшхб шбх appleокс ы с тзхшлрс, сfiл с, н сfiс с н х х ы мб с н х fiых ыт й ытаз йхнfi охнfi б с х хт лб- ы ш б шк оо с с й збы х ш йр к appleка, н - р бapple шк н х fiых appleокзт сы х тх appleзт appleт шбх ыт..39 ык 1к Aappleзхо т 2009 з. EK 55.

8 INSTRUCTIONS FOR AUTHORS HELLENIC STOMATOLOGICAL REVIEW is the official peer-reviewed open access electronic publication of the Hellenic Dental Association and aims at providing Greek and international dentists with ongoing up-to-date scientific information in all fields of dental science. The Journal publishes the following types of articles: 1. Focus articles: Review articles addressing contemporary and controversial topics proposed by the Editorial Board and written by colleagues with expertise on the particular topics. 2. Original articles: These articles may fall into one of the following categories: (a) Reviews (up to 3 authors), (b) Research papers (Experimental studies, Clinical studies, Laboratory studies, Epidemiological Studies, Clinicostatistical studies, Clinopathological studies), (c) Interesting case reports, (d) Practice-related topics, (e) Scientifically-documented professional issues, (d) Public Health issues, (e) Strategy-related topics, (f) Educational issues and (g) Specific issues. 3. Letters to the Editorial Board: The letters must be approved by the Editorial Board prior to publication and may pertain to: (a) critical reviews of published articles and (b) specific queries on sciencerelated topics, answers to which are provided in the correspondence section. 4. Short reports: These original papers or findings should not exceed words and are published as soon as possible after undergoing a review process by the Editorial Board. 5. Reviews from published articles: These reviews focus on Greek colleagues articles recently published in international journals. Article length: Reviews should not exceed words (25 typed pages) and should have no more than 100 references, with the exception of special issues related to basic sciences. Research papers and practice-related topics should not exceed words (10 pages) and have no more than 40 references. Any articles on important case reports should not exceed words (4 pages) while articles addressing professional issues should be no more than words (20 pages). The reference list is included in the total word count and must be timely and pertinent to the topic under discussion. Text structure: The manuscripts submitted for publication must be written both in modern Greek, using the monotonic system and in English. The Editorial Board reserves the right to check the accuracy of the English terms and phrasings, consulting with professional medical translators. The Copy Editor of the Journal reserves the right to proceed to linguistic modifications without distorting, though, the authors style. Particularly for the English speaking authors, manuscripts may be submitted only in English language with an extensive (300 words) Greek summary. In this case the scientific editorial board will undertake the preparation of the summary applying the appropriate Greek terminology. All papers submitted must be double spaced, typed in Arial, Tahoma or Verdana font with margins on both sides. The title page, the summary and key words, the main text of the paper, the English summary and key words, the references, the legends, the tables and the figures appear on separate pages. All pages are numbered in the above order. Starting January 2010 all manuscripts are also submitted electronically at Title page: This page includes the following information: (a) title of the paper, (b) name and title of the author(s), (c) institution, (d) whether the paper has been previously presented at a conference and, if yes, details, (e) name, address and telephone of the corresponding author, (f) type of paper (based on 2 or 4), (g) possible source of financing for research. Summary and key words: The summary should be no longer than 200 words. In research papers the summary includes the purpose, the material, the methodology and the conclusions and it is followed by key words which normally include 3-10 key terms or short phrases. The particular words must be in accordance with the international lexicographical terminology as it appears in Index Medicus and Dental Index and must be included in the summary. Main text: Literature reviews should include a comprehensive introduction followed by a summarization of all the views relevant to the topic under discussion, based on specific references. Finally, the author is expected to provide a critical analysis of these views and reach clear conclusions. Research papers should comprise the following chapters: Introduction, Materials and Method, Findings-Results, Discussion and Conclusions. As regards the remaining types of articles, the text should follow an appropriate layout to meet the article demands. References: Any references in the text, the tables and the figure legends are cited by arabic numerals in brackets. Any dots or commas appear after the bracketed reference. The references are numbered consecutively in the order of appearance. All references mentioned in the text are included in the reference list which appears on a separate page after the end of the text. Every reference in the list should be preceded by the number it is identified with in the main text.

9 The reference list should be organised in the following sequence: names of the authors (surname, first name followed by a comma, then surname of the next author and so on), colon (:), title of the article, period (.), abbreviation of the journal, year, semi colon (;),volume, issue in brackets, colon and pages (first page and last page separated by a slash). Titles of Greek journals should be abbreviated in accordance with the IATROTEK list. The use of summaries, unpublished comments or personal communications as references should be avoided. Hellenic Stomatological Review should be abbreviated as Hel Stom Rev. Papers accepted for publication, though not published yet, can be included in the reference list. In this case, the phrase under publication in brackets is added. If the the reference list contains articles from journals using a language of latin origin with language-specific features (German, Scandinavian, French), the authors are responsible for word stress. An example of correct reference presentation is as follows: Journals: The authors surnames and initials appear first (unless there are more than six authors in which case the fifth name is followed by et al), followed by the title of the paper, the journal abbreviation, the year, the volume, the issue and, finally, the first and last page of the publication. E.g. Papagiannoulis L, Kakaboura A, Eliades G: In vivo Vs in Vitro anticariogenic behavior of glassionomer and resin composite restorative materials. Dent Mater 2002; 18 (8): Books and other monographs: The authors surnames and initials appear first followed by the title of the book, the number of publication and the city of publication. Next comes the publisher, the year (colon) and the page. E.g. Ryge GM: Dental Corrosion. 2nd ed. New York. Harper and Row. 1985: 204. If the reference corresponds to a chapter from a book written by another author, it should appear as follows: Johnston AJ: Corrosion Resistance of Amalgams. In: Goldman AK, Johns KO, eds. Restorative Materials, Baltimore. Williams and Wilkins Co., Websites: E.g. strategy concerning mercury, as it appears in (search date). The Editoral Board strongly encourages the authors to include references to high quality Greek articles related to the topic under discussion, if possible. English summary: It includes the names of the authors and the title of the paper in English. In literature reviews the summary should present data on all the chapters it includes as well as the conclusions. In research papers the summary includes the introduction, the aim, the materials and methods, the results, the conclusions and the discussion. A summary should be 250 to 300 words long. Tables: They are typed on a separate page including the legend. The legend should be concise and comprehensive. The tables are numbered with Arabic numerals which are also used for citation in the text. Any explanations of the abbreviations or other clarifications appear at the end of the table. Illustrative material: Any figures, diagrams and photographs should be attached to the manuscript and be high-resolution files. Figure legends are numbered consecutively on a separate page during the submission process of the paper. Colour images are possible to print. Authors should contact the Editor-in-Chief and send the colour images electronically. The images should be scanned at a minimum resolution of 300 dpi, in JPG format and should not be included in the main document submitted for publication. In case a patients face is visible in the image the Editorial Board anonymises it, prior to publication, through a black band across the eyes to protect patient confidentiality. The review process is assigned to two reviewers selected by the Editorial Board. The Editorial Board of the Journal reserves the right to suggest revisions or reject articles which have failed to comply with the instructions for authors. It is the authors responsibility to check for typographical errors within 2 weeks from the submission date of the manuscript. After the paper has been formatted in columns no modifications are accepted. Copyrights to all published articles, images and diagrams are assigned to the Journal. Permission by the Editorial Board and the author(s) is necessary prior to any republication. Note: Any paper submitted for publication must be accompanied by a written statement by the author(s) certifying that the paper has not been submitted to any other scientific journal, does not contain unchanged sentences from other scientific publications excluding definitions, laws, rules and regulations and that the illustrative material is the same as the original or a redesign, otherwise the source must be clearly stated.

10 Eзбскыхн Eза ш Research Study ушнтappleк appleтой зл н шыкс сыхлбырappleхшк стшкл ы с ыт шыfiл ыт. Aс зтлхн лбо ык шб 458 шбсб. E. M. K ота зт*, K. I. Tfiшхт **, A. но т ст*** Drug abuse in the management of oral diseases. Retrospective study in 458 patients. E.M. Kalogirou*, K.I. Tosios**, A. Sklavounou*** EPI HФH Eхш а а : H шнтappleк тз акшк й зл н с шыт р- зт ык ытл ытота бappleх б хрсбы х applefi б тл - с бооксхнрс лбобырс ы ыбобы 25 зfiсх appleт н ы бхнс тс apple к й зл нбыхн н ы зкшк ш- с н шыбзб ык х ас шк, лб шлбсб шс appleбх- б нfiл н х ах ык ы с шбсрс шб тзхшл сб appleбзхappleыршбх, бср бappleх з сбх тхнтстлхн ыт х- т, оо н х ык клfiшх аб. нтapplefi : H н ы аз й ы с appleбзхappleыршб с й зл нб- ыхн н ы зкшк шб стш л ы ыт шыfiл ыт шб зтсхнfi х шыкл ыбшш з с бырс н х к ш анзхшк ы с б тл с с ырс лб ы бз л ы appleзткат лб- с с лбобырс. Yохнfi н х M т т : 458 й нботх шбсрс, applefi ыт SUMMARY Introduction: The unnecessary dispensing of drugs in Oral Medicine is confirmed by data from Greek research over the past 25 years, which show that drug abuse often delays the diagnosis with adverse effects that burden not only the patients but also the public health system financially. Purpose: To record the cases of drug abuse in oral diseases during a four year period and to compare the results with those of previous studies. Materials and Methods: The records of 458 patients, from a total of 2,662 patients who were referred to the Department of Oral Pathology and Medicine, Dental School, University of Athens during the years , were retrospectively collected on the basis that * Mбы appleы х н йтхы ызх A н нот ** Eapple нтзт K какы *** K ка ызх Eза шы зхт ытл ытота, O тсых ызхн то, Eсхнfi н х K appleт хшызх нfi сбappleхшы лхт Aксрс. M зт ы ык бза ш бх с нтхс б шыкс 1 к Hлбз ыт O тсых ызхнт ооfiат Aыыхн (26/01/2013), лб л зл н шыкс O тсых ызхн. Eс б мбх, сыбс б мбх н х сбappleх лкыб appleзтбны шбх. * Graduate student ** Assistant Professor *** Professor Department of Oral Pathology and Medicine, Dental School, University of Athens. This study was partly presented at the 1st seminar of Attica Dental Association (26/01/2013): Drugs in dentistry. Indications, contraindications and adverse side effects. бооксхн шытл ытотахн зтсхн 57: 9-17, 2013 apple збо йк 28/6/ бнз к 26/9/2013 Hellenic Stomatological Review 57: 9-17, 2013 paper received 28/6/ accepted 26/9/2013 9

11 Eзбскыхн Eза ш Research Study ш стот 2662 шбсрс appleт appleзтш о с шыкс Kохсхн ык ытл ытота ык O тсых ызхн то ыт сбappleхшыкл т Aксрс н ы ы ык , бappleх- о кн с с зтлхн лб нзхы зхт fiых шыкс apple зт ш сfiшт с йбзfiы с о к й зл нт й зл н с ах ык бз appleб ыт шытл ыхнт стш л ыт appleзхс ыкс appleзтш обш ы с шбсрс шыкс Kохсхн. Aappleтыбо шл ы : ушнтappleк о к й зл н с appleзхс ыкс ыбнлкз шк ык ыбохн х ас шк шклбхркнб шыт 77% ы с шбсрс, лб ш сfiыбзк н ыкатз ы сых- шкappleыхн. Tкс б ск хн хтоfiакык шсы атаз - йкшк шых appleбзхшшfiыбзб appleбзхappleыршбх йбз с тх - ытззхсто заатоfiатх. ыкшк н х шлappleбз шл ы : H й зл нбыхн н - ы зкшк шыт рзт ык ытл ытота бс блй с - бх ы шк лб шк лб ыкс apple зт т ы с бырс. Tт абат- сfi ыfi бappleх ообх ыкс бapple аз appleскшк ыт т тсых - ызхнт н х х ызхнт нfiшлт, ршыб к бз appleб с - appleбы х ык х ас шк н х тх шбсб с лкс бappleх - з стсы х applefi ых сбappleх лкыб бс забхб ы с й з- л н с. мбх нобх х : н ы зкшк й зл н с, стш л ы шыfiл ыт, хн хтоfiакык шсы атаз йкшк. EI A Ь H K ы зкшк, о с шл ск, нзхык н х оfiахшык лк-х ызхн з шк й зл н с, хн хтоfiакык шсы - атаз йкшк н х шнтappleк appleтой зл н б с х fiзтх appleт сы с нот с ыкс скш ык х ызхн нтхсfiыкы ах ык шсб р м сfiлбск ы шк з шк й зл нбых- нрс шнб шл ы с з с бхмк. Tкс скш ы б- appleхыб стс бappleх клхтотахн шытх б applefi ых H A, fiappleт ыт 2010 ахсfiы с н ы зкшк й зл н с applefi appleто - ыб н б л с, зхлfi appleт мбapple з шб нfiл н х ыт з шыб с зн ыхнрс н х apple з хшкшхтаfiс с тшхрс 1. Eappleхappleо тс, с й збы х fiых ы ыбобы зfiсх, с н х т зхлfi ы с бappleхшн б с шы ыл л ы бappleбхаfiсы с appleбзх- шы ыхнрс apple з л сбх шы бзfi, ыт appleтштшыfi appleт тйб об- ы х шб бappleхappleотн applefi о с шл ск о к й зл н с - м кнб н ы 44% 1. H й зл нбыхн н ы зкшк йбсfi бappleх з сбх ыкс аб ы с шбсрс, б ыб оfiа ыт нхс - ст ы с apple збсбзабхрс н х ык ы fiс шс забх ы с й зл нбыхнрс шнб шл ы с, н р н х ыт абатсfi- ыт fiых н шыбзб к х ас шк ыт шытл ыхнт стш л - ыт, н х йбы зт т каб шыкс тхнтстлхн бappleх зсшк шбсрс н х клтш с ы лб с. H н ы зкшк ы с й зл н с бс й сбх сбappleкз шык ыкс т тсых ызхн нтхсfiыкы. бх appleтотахшыб fiых appleбзхш- шfiыбзт applefi ыт 40% ы с т тсых ызхнрс шбсрс appleт о л стс й зл н бappleх з сбы х applefi ых сбappleх лк- ыб бс забх ыт, appleтштшыfi appleт м сбы х н ы appleто шб appleбзхappleыршбх fiappleт к о к ыт й зл нт бс а сбы х 10 the patients had already taken medications for the treatment of their oral disease before attending the clinic. Results: Unnecessary drug abuse before the documentation of the final diagnosis was recorded in 77% of the patients and antiseptics were the drugs most commonly overused. ENT specialists more frequently bore the responsibility for irrational drug prescription. Discussion and conclusions: No decline in the rate of drug abuse in Oral Medicine is observed over the years. Awareness of both the dental and medical community is required so that treatment follows accurate diagnosis and patients are free of the medications side effects. Key Words: drug abuse, oral diseases, irrational prescription. INTRODUCTION Abuse, misuse, overuse, non medical use of drugs or irrational drug prescription and unreasonable polypharmacy are synonymous terms reflecting the medical community s concern about the increasing tendency for drug use without any indication; a concern that is raised because of epidemiological data from the U.S.A., where in 2010 medication abuse occurs among 7,000,000 people every month, a number which surpasses the users of cocaine, heroin or hallucinogens 1. Although the number of drug-related visits in the Emergency Departments remained stable during the recent years, a 44% increase in drug overuse-related visits to the Emergency Departments was recorded 1. Drug abuse not only affects patients health, because of medications side effects or synergy or even a delay in the diagnosis of their oral disease, but also affects both the patients and the public health system financially. Dentistry could not be unaffected by medications abuse. It has been estimated that more than 40% of dental patients taking drugs suffer from the medications adverse reactions, a percentage that increases significantly in cases of non medical drug use 2. It is also reported that 5% of visits to the Greek Hospitals are estimated to have occured as a result of medications side effects, while that ratio among the elderly approximates even 20% 2. A wide variety of drugs are used in the management of oral diseases, including antiseptics, analgesics-antipyretics, non steroidal anti-inflammatory drugs, antibiotics, antivirals, antifungals and corticosteroids (topical or systemic), drugs for the central nervous system, antihistamines, healing drugs, immunosuppressive-immunomodulatory drugs, antineoplastic drugs and saliva substitutes for the treatment of xerostomia. Drug abuse has been presented in three previous Greek studies, all conducted at the Department of Oral Pathology and Hellenic Stomatological Review 57: 9-17, 2013

12 Eзбскыхн Eза ш Research Study лбы applefi х ызхн т ка 2. Aс й збы х, бapple шк, apple ыт 5% ы с бхш а арс шы стштнтлб шыкс Eоо тйб - обы х шб apple збс забхб й зл н с, appleтштшыfi appleт appleзт- шбаа бх л зх н х ыт 20% шыкс ыз ык кохн 2. х ыкс сыхлбырappleхшк apple шб с ык шытл ыхн нтхоfi- ыкы зкшхлтappleтхт сы х х йтзб н ыкатз б й зл - н с, нз сыхшкappleыхн, с оакыхн - сыхappleзбыхн, лк- шыбзтбх сыхйобалтср к, сых хтыхн, сыххн, сых- лнкых шхн н х нтзыхнтшыбзтбх (ытappleхн шшыкл ых- н ), й зл н ах ых apple шбх ыт нбсызхнт сбзхнт шшы л ыт, сыххшы лхсхн, бappleто ыхн, стштн ы - шы оыхн - стштызтappleтappleтхкыхн, сыхсбтappleо шл ыхн н х appleтн ы шы ы ш охт ах ыкс сыхлбырappleхшк ык мкзт- шытл. H н ы зкшк й зл н с бх appleтыapple б шб ызбх appleзткат лбсб лбо ыб applefi ытс бооксхнfi рзт, fi- об applefi ыкс Kохсхн ык ытл ытота ык O тсых ызх- н то ыт Eсхнт н х K appleт хшызх нт сбappleх- шыкл т Aксрс, ыfiшт ах шанбнзхл сб н ыкатз б й зл н с, fiapple ы сыхшкappleыхн 3 н х ы сыхлнкых шх- н 4, fiшт н х шыт ш стоfi ыт 2. ыкс бза ш ык Mapple тappleт от3 ыт 1987 apple зтшх шык- нб к з шк н х к н ы зкшк ытappleхнрс сыхшкappleыхнрс applefi 100 шбсб шб шстохнfi б ал appleбз appleт 1000 шб- срс. ык лбо ык ы с но т ст н х з нт4 ыт 1989 н ы аз йкн с 80 appleбзхappleыршбх шбсрс applefi шстохнfi б ал appleбз appleт 1000 шбсрс, тх тappleт тх appleзхс applefi ыкс appleзтш обш ыт шыкс Kохсхн ык ытл ытота б - с н сбх з шк сыхлнкых шхнрс й зл н с лбы applefi apple з сбшк т тсых ызт х ызт, лб хн ыт appleз - ыт то. ыкс appleхт appleзfiшй ык збс ы с X ыках сск н х шс. 2 ыт 2007 шанбсызркн с 217 appleбзхappleыршбх - шбсрс applefi ш стот appleбз appleт 1000, тх тappleт тх б с н сбх з шк н appleтхт й зл нт, шых appleбзхшшfiыбзб appleбзхappleыр- шбх сых хтыхнт, сыхшкappleыхнт сыхлнкых шхнт, ах ыкс сыхлбырappleхшк ыт шытл ыхнт ыт стш л ыт. H оfiахшык з шк й зл н с applefi ыт шытл ытотах- нт шбсб тйб обы х оотыб шыкс хн хтоfiакык шсы атаз йкш ыт applefi ыт бз appleтсыб т тсых - ызт х ызт, н х оотыб шыкс о к ыт лбы applefi ш шы шк ыт й зл нтappleтхт appleз ыт то ы с х с ы с шбсрс 2-4. нтapplefi ык apple зт ш бза ш б с х к хбзб скшк ык appleх с хн хтоfiакык з шк й зл н с applefi шб- сб лб шытл ытотахн стш л ы, fiapple х лтзйркнб н ы ы ык , н х к ш анзхшк ы с шклбзхсрс б тл с с лб ы appleзткатл с с лбобырс appleт тс хбм б шыкс Eоо. Y IKO KAI MEёO O Aapplefi й н от шбсрс appleт бмбы шыкн с шыкс Kохсхн ык ытл ытота ык O тсых ызхн то ыт Eсхнт н х K appleт хшызх нт сбappleхшыкл т Aк- срс applefi ытс I ст зхт ыт 2008 н х ыт бн л зхт ыт 2011, бappleхо кн с с зтлхн 646 й нботх, шыт тappleт т с йбзfiы с о к й зл нт й зл н с ах ыт сfiшкл appleт appleтыбот шб ыкс хы appleзтш обш. Aapplefi ыт й н от ыт бм хз кн с 52, бм хы ш - Hellenic Stomatological Review 57: 9-17, 2013 Medicine of Dental School of the University of Athens, either with absolute regard to specific drug categories such as antiseptics 3 and antifungal 4, or to all medications for oral diseases 2. In 1987, Bazopoulou 3 reported the use and misuse of topical antiseptics by 100 patients out of a total sample of 1,000 patients. Sklavounou and Drikos 4 in 1989 recorded 80 cases over a total sample of 1,000 patients, who had already used antifungal for their oral disease either with a dental or medical prescription or on their own initiative. In the most recent study, Hatziyannis et al 2 in 2007 reported 217 cases over a total sample of 1,000 patients, who had used medications, most commonly antibiotics, antiseptics or antifungal, for the therapy of their oral disease. Drug overuse in Oral Medicine occurs due to either irrational dental or medical prescription, or because of the patients initiative or the pharmacist s recommendation 2-4. The purpose of this study is to investigate possible drug abuse among patients with oral diseases during the years and to compare those results with the relevant data of the previous Greek studies. MATERIALS AND METHODS Of the 2,662 records of patients that were examined at the Department of Oral Pathology and Medicine in Dental School of the University of Athens during the years , 646 records were retrospectively selected on the basis that the patients had already taken medications for the treatment of their oral disease before attending the clinic. Due to unclear information about either the exact cause of the drug intake or the drug formulation, 52 records were excluded. The remaining 594 records were analyzed with regard to the compatibility of the medication to the final diagnosis. Only the medication class was evaluated, but not the drug substance or the dosage regimen. In 458 out of the 594 (77%) records, there was no compatibility of the medication to the final diagnosis and those patients constituted the drug abuse group. Epidemiological data (sex, age), the year of examination and the drug or drugs category were recorded, as well as whether the medication was taken following the patients initiative or a doctor s recommendation. When there was a prescription, the specialty of the medical professionals was also recorded. RESULTS As far as the patients gender is concerned, there were 267 females and 191 males with a female to male ratio of 1.4:1. The age range was from 2.5 to 95 years, the mean age was ( 19) years, while almost half of the patients (204/458, 44,5%) were between their 50 th and 70 th year. 5% of the patients were under 18 years old. 66% of the patients (301/458) had taken only one kind of medication, while 2-5 different drug categories (polypharmacy) were taken by 34% (157/458) of the patients. 11

13 Eзбскыхн Eза ш Research Study йрс appleокзтйтзхрс ш быхн лб ыкс нзх хы ык з - шк ыт й зл нт ыт б т ыт шнб шл ыт. ыт applefiотхappleт 594 й н от бныхл кнб к шл ыfiыкы лбы м ыт й зл нт appleт б б окйб appleзхс applefi ыкс бм - ы шк ыт шбст н х ык ыбохн х ас шк. Aмхтот- а кнб лfiстс к н ыкатз ыт й зл нт н х fi х к й з- л нбыхн тш ыт тштотахнfi ш л. б 458 applefi ыт 594 (77%) й н от бс appleзт н б шлй с н х appleты обш с ых appleбзхappleыршбх й зл нб- ыхн н ы зкшк. K ы аз йкн с ы бappleх клхтотахн шытх б ы с шбсрс (й от, кохн ), ыт ыт бм ы шк, к н ыкатз ыт й зл нт ы с й зл н с appleт о - йкн с, ыт с о йкнб/о йкн с лбы applefi appleз ыт т- о ыт шбст applefi бхмк х ызт, н х шык б ыбзк appleбз appleы шк к бх хнfiыкы ыт х ызт. 189 (41.3%) of the patients were examined in the first two years of the study and 269 (58.7%) in the latter two. Figure 1 presents the drug categories that were taken by the 458 patients in detail. As shown, of the 680 drug formulations that were taken by all of the 458 patients, there was a clear preference for antiseptics (198/680, 29.1%), antifungals (178/680, 26.2%) and antibiotics (124/680, 18.2%) which were selected as a solution in almost 3/4 of the cases (500/680), equally by both genders. In particular, antiseptics represented the most commonly used category and in 57% of cases (113/198) they were chosen as monotherapy, while in the remaining cases, antiseptics were combined with 1-4 other medications, mainly with antibiotics and antifungals. A OTE E MATA Ь appleзт ыт й от ы с шбсрс, 267 ы с ас нб н х 191 с зб, с ота 1,4:1. Tт б зт ы с кохнхрс ы с 2,5-95 ык, т л шт fiзт кохн ы с ы 50,62 ( 19) - ык, бср ш б fiс тх лхшт шбсб (204/458, 44,5%) з - шнтсы с лбы м 50 т н х 70 т ыт кохн. Tт 5% ы с - шбсрс ы с с охнтх. Tт 66% ы с шбсрс (301/458) о л сб лfiст с б т й зл нт (лтстбз appleб ), б- ср шыт 34% (157/458) ахсfiы с шс шыхн о к 2-5 й зл н с х йтзбыхнрс н ыкатзхрс (appleтой зл н ). Aapplefi ыт шбсб 189 (41,3%) бмбы шыкн с шы appleзры т ык ык лбо ык н х тх 269 (58,7%) шы т ыбобы. ыт х аз лл 1 apple зтшх тсы х с оыхн тх н ыкат- з б й зл н с appleт зкшхлтappleтх кн с applefi ыт шбсб. apple й сбы х, лбы м ы с 680 шнб шл ы с appleт о йкн с шстохн applefi ыт 458 шбсб, ш й ы с к appleзты лкшк ах ы сыхшкappleыхн (198/680, 29,1%), ы сыхлнкых шхн (178/680, 26,2%) н х ы сых хтыхн (124/680, 18,2%) appleт бappleхо кн с о шк ш б fiс шы 3/4 ы с appleбзхappleыршб с (500/680), бм шт н х applefi ы т й о. Eх хнfiыбз, ы сыхшкappleыхн сыхappleзтшрappleб с ык ш сfiыбзк а а, шыт 57% (113/198) лтстбз - х аз лл 1: K ыкатз б ы с 680 й зл н с appleт о с тх 458 шбсб. 12 Figure 1: Categories of the 680 drugs of the 458 patients. According to patients statements, in 157 cases (34.3%) there was a dental or medical prescription, 21 (4.6%) patients had gone to 2-4 dentists or physicians, 155 (33.8%) patients had taken the medications on their own initiative, while in 125 (27.3%) cases, there were no relevant information. Medications were irrationally prescribed mainly by ENT specialists (178 cases), followed by dentists, oral pathologists, dermatologists, physicians and other medical specialists (figure 2). The total ratio of patients who had taken medications on their own initiative (33.8% or 155/458 cases) was equal to the partial percentages for the two genders (33.3% or 89/267 cases among females and 34.6% or 66/191 cases among males). No gender predilection was found in the percentage of patients who considered their oral disease as dental and thus went to a general dental practitioner, a dental specialist or an oral pathologist (14% or 64/458 cases among all the patients, 14.6% or 39/267 cases among females and 13.1% or 25/191 cases among males). In conclusion, table 1 presents a few representative examples of drug abuse from patients that were examined at the Department of Oral Medicine and Pathology of Dental School during the years Hellenic Stomatological Review 57: 9-17, 2013

14 Eзбскыхн Eза ш Research Study appleб, бср шых applefiотхappleб appleбзхappleыршбх шс шыкн с лб 1-4 оо й зл н, лб н зхт бнappleзтшрappleт ы сых- хтыхн н х ы сыхлнкых шхн. лй с лб ы fiш с й зтсы с applefi ыт шбсб, шб 157 appleбзхappleыршбх (34,3%) ы й зл н б с шсы ат- аз йкб applefi т тсых ызт х ызт, 21 (4,6%) appleб скн с шб 2-4 т тсых ызт х ызт, 155 (33,8%) шбсб о с н appleтхт й зл нт лб хн ыт appleз ыт- то, бср шб 125 (27,3%) appleбзхappleыршбх бс apple з с тх ш быхн appleокзтйтз б. ушнтappleк тз акшк й зл н с шшы кнб н ы н зхт оfiат applefi ыт ытззхсто за- атоfiат (178 appleбзхappleыршбх ) н х нтотт ш с т т- сы ызтх, шытл ытоfiатх, бзл ытоfiатх, apple тоfiатх н х оотх ( х аз лл 2). Tт шстохнfi appleтштшыfi ы с шб- срс appleт apple з с лб хн ыт appleз ыт то й зл н (33,8% 155/458 appleбзхappleыршбх ) ы с apple з appleо шхт лб ы бapple л зт appleтштшы ах н б й от (33,3% 89/267 appleб- зхappleыршбх шых ас нб, н х 34,6% 66/191 appleбзхappleыр- шбх шыт с зб ). бс apple змб х йтз лбы м ы с т й о с appleзт ыт appleтштшыfi ы с шбсрс appleт бр- зкш с ыт сfiшкл ыт т тсых ызхнfi н х appleб ск- н с шб н appleтхт абсхнfi бмбх хнбл ст т тсы ызт шб шытл ытоfiат (14% 64/458 appleбзхappleыршбх шыт ш стот ы с шбсрс, 14,6% 39/267 appleбзхappleыршбх шых ас - нб н х 13,1% 25/191 appleбзхappleыршбх шыт с зб ). T от, шытс apple с н 1 apple зтшх тсы х, бс бхныхн, тзх- шл с apple з б ал ы н ы зкшк й зл н с applefi ыт шбсб appleт бмбы шыкн с шыт х шыкл шыкс Kохсхн ык ытл ытота ык O тсых ызхн то. х аз лл 2: бзхappleыршбх тз акшк й зл н с лfiст applefi л бх хнfiыкы. YZHTH H H apple зт ш с зтлхн лбо ык н ы аз б ыкс н ы - зкшк й зл н с ах шытл ытотахн стш л ы н ы ык х знбх л ыбыз бы шб с бмбх хнбл ст шытл - ытотахнfi н сызт. T appleтыбо шл ы б стс apple к оfi- ахшык з шк й зл н с б с х ш сfi й хсfiлбст н х б х й сбы х ы шк лб шк лб ыкс apple зт т ы с бырс. Hellenic Stomatological Review 57: 9-17, 2013 Figure 2: Cases of medication administration by one specialty. DISCUSSION The present retrospective study recorded the drug abuse in oral diseases during a four year period in a center specialized in Oral Medicine and Pathology. The results indicate that irrational drug use is a common phenomenon with no tendency to decrease over the years. Comparing the results of the present study with those of the previous Greek studies, it is obvious that the rates of drug abuse remain constantly high. The irrational use of drugs in this research was estimated at 77% of patients, a higher proportion than in the study of Hatziyannis et al. 2 (72%) and Bazopoulou 3 (69%), but smaller than that recorded in the study of Sklavounou and Drikos and 4 (90%). It should be also noted that the studies of Bazopoulou 3 and Sklavounou and Drikos 4 referred to the drug abuse of a specific drug category. Furthermore, it seems that antiseptics, antifungals and antibiotics are the most overused drug categories, a finding that is in accordance with the results of the study of Hatziyannis et al. 2. Regarding the proportion of drug abuse attributed to the initiative of the patients in the present study, it was estimated at 34% and is almost more than double the 19% in the research of Hatziyannis et al. (19%) 2, but less than those of the studies of Sklavounou and Drikos 4 (51%) and Bazopoulou 3 (57%). It should be noted, however, that as all studies were retrospective, including the present one, and in that of Hatziyannis et al. 2 for a large number of patients there was no evidence about who was responsible for the medication administration (27% and 41%, respectively), which might affect the rates. The only encouraging element in the present study was that the percentage of polypharmacy (32%) was lower compared to previous studies, which was 52.5% 2, 72.5% 4 and 58% 3. According to the data of the present study, a great percentage of the irrational prescription was decided by ENT specialists, who alone or in combination with other medical specialties were responsible for drug abuse in 15.3% of cases (70 cases), which is clearly greater than 13

15 Eзбскыхн Eза ш Research Study с н 1: з б ал ы шнтappleк appleтой зл н applefi ыкс Kохсхн ык ытл ытота шыт х шыкл E к й зл н с Aapplefiй шк ах ы й зл н Tбохн х ас шк сыхшкappleыхнfi, сыхлнкых шхнfi, apple тоfiат обн applefi бapple зхшл сых хтыхнfi, ытappleхнfi аоршш нтзыхнтшыбзтбх сыхшкappleыхнfi, сыхлнкых шхнfi, з шытх б apple лйха хы л сб сыхшкappleыхнfi, сых хтыхнfi т тсы ызт н стныы зхнfi н зн с л Table 1: Examples of irrational polypharmacy from the data of the Department of Oral Medicine and Pathology during the years Medication type Decision for the drug Final diagnosis administration antiseptic, antifungal, antibiotic, general physician white coating topical corticosteroid on tongue antiseptic, antifungal, vitamins not available pemphigus vulgaris antiseptic, antibiotic dentist squamous cell carcinoma анз стсы ы appleтыбо шл ы ык apple зт ш лбо ык лб ы сы шытх ы с ызхрс appleзтабсбшы з с лбобырс - applefi ыкс Eоо, а сбы х блй с fiых ы appleтштшы й зл - нбыхн н ы зкшк ах шытл ытотахн стш л ы apple - з л стс шы бз ко. H оfiахшык з шк ы с й з- л н с шыкс apple зт ш збс appleтота шыкнб шыт 77% ы с шбсрс, appleтштшыfi лба о ыбзт applefi ыт сы шытх т шых бза ш б ы с X ыках сск н х шс. 2 (72%) н х ык Mapple тappleт от3 (69%), оо лхнзfiыбзт applefi ыfi appleт н - ы аз йкнб шык лбо ык ы с но т ст н х з нт4 (90%). ё appleз appleбх, х, с шклбх б fiых тх лбо ыб ык Mapple тappleт от3 н х ы с но т ст н х з нт4 - йтзт ш с шб н ы зкшк шанбнзхл ск н ыкатз й зл нбыхнрс шнб шл ы с. Eapple шк, й сбы х apple ы сыхшкappleыхн, ы сыхлнкых шхн н х ы сых хтыхн б с х тх н ыкатз б й зл н с лб ык лба о ыбзк н ы зкшк, б зкл appleт шлй сб лб ы appleтыбо шл ы ык бза - ш ы с X ыках сск н х шс. 2. Aс йтзхн лб ыт appleтштшыfi й зл нбыхн н ы зкшк appleт appleт fiкнб шб appleз ыт то ы с шбсрс, шыкс apple - 14 that recorded in the work of Hatziyannis et al. 2 and Bazopoulou 3 (7% and 6%, respectively). Although these data should be evaluated with caution, since they are derived from information provided by patients, they stress the necessity that patients with oral diseases be treated by a specialist in Oral Medicine. Studies investigating only the use of drugs in oral diseases, excluding odontogenic infections and periodontal diseases, are not found in the international literature. On the contrary, there are numerous publications about antibiotics for diseases of the dental pulp or periapical and periodontal tissues administrated by dentists. Regarding antibiotics, which hold the top spot internationally on dental prescribing 5, two types of studies have been conducted. The first category includes questionnaires with hypothetical cases of patients, which were sent to general dentists, asking them to identify in which cases, in their opinion, patients should take antibiotics A- mong those reviews, only Jaunay et al. 8 refer to oral mucosal diseases, and include in patients complaints Hellenic Stomatological Review 57: 9-17, 2013

16 Eзбскыхн Eза ш Research Study зт ш бза ш ыfi appleтота шыкнб шб 34% н х б с х ш б fiс appleбз хappleо шхт applefi ыт 19% шыкс бза ш ы с X - ыках сск н х шс. 2 (19%), оо лхнзfiыбзт applefi ы ы с бзбсрс ы с но т ст н х з нт4 (51%) н х ык Mapple тappleт от3 (57%). клбхрсбы х, шыfiшт, apple бappleбх- fiоб тх лбо ыб ы с с зтлхн, ыfiшт шыкс apple - зт ш, fiшт н х шб ы ы с X ыках сск н х шс. 2 шб - с лба от зхлfi шбсрс бс apple з с шытх б ах ыт appleтхт appleтй шхшб ык тз акшк (27% н х 41%, сы шытх- ), абатсfi appleт бс б тл с бappleкзб бх ы appleтштшы. Tт лfiст бс ззсыхнfi шытх б т шыкс apple зт ш лбо ык - ы с ыт appleтштшыfi appleтой зл н (32%) appleт ы с лбх - л ст шб ш шк лб ых appleзткат лбсб лбо ыб, шых тappleт - б ы с 52,5% 2, 72,5% 4 н х 58% 3. Mба от appleтштшыfi ык хн хтоfiакык шсы атаз йк- шк, ш лй с лб ы шытх б ык apple зт ш лбо ык, - ахсб applefi х ызт ЬP, тх тappleт тх лfiстх ыт шб шс- шлfi лб ооб х ызхн бх хнfiыкыб йбз с ыкс б - ск ык й зл нбыхн н ы зкшк шыт 15,3% ы с appleбзхappleыршб с (70 appleбзхappleыршбх ), appleтштшыfi ш йр лба о ыб- зт applefi ыfi appleт б б н ы аз йб шых бза ш б ы с X - ыках сск н х шс. 2 н х ык Mapple тappleт от3 (7% н х 6%, сы шытх ). Aс н х ы шытх б ы appleз appleбх с бныхлр- сы х лб бappleхй о мк, н р appleзт з тсы х applefi ых appleокзт- йтз б appleт стс тх шбсб, бappleхшкл стс ыкс с - анк сыхлбырappleхшк ы с шбсрс лб шытл ытотахн ст- ш л ы applefi бх хнт шытл ытоfiат. Mбо ыб appleт хбзбст с appleтнобхшыхн ыкс з шк й з- л н с шб стш л ы ыт шыfiл ыт, бм хзтл с с ы с т- тсытабсрс отхлрмб с н х ы с appleбзхт тсыхнрс сfiш с, бс сбз шнтсы х шык хбс х охтаз й. Aсы бы, apple з бх appleокрз клтшхб шб с ш быхн лб ыкс appleбз- тохн тз акшк сых хтыхнрс ах ых apple шбх ыт appleто- йт, ы с appleбзх нзтззххнрс н х ы с appleбзхт тсыхнрс х- шырс applefi т тсых ызт. Ь appleзт ы сых хтыхн, appleт н ы тс хбср ыкс appleзрык шк шыкс т тсых ызхн шсы атаз йкшк 5, тс хбм б т б к лбобырс. H appleзрык н ыкатз appleбзхо л сбх бз ыкл ытоfiах лб - appleтбыхн шбс зх appleбзхappleыршб с шбсрс appleт шы ок- н с шб абсхнт т тсых ызт, applefi ыт тappleт т кы - кнб с appleзтш хтз штс шб appleтхб, н ы ык асрлк ыт, appleбзхappleыршбх тх шбсб зк с сых хтыхн а а Mбы м ырс ы с клтшхб шб с, с йтз шб о - б ыт шытл ыхнт обсстаfiст apple з бх лfiст шыкс бз- а ш ы с Jaunay н х шс. 8, шыкс тappleт шых appleх с х- ы б appleзтш обшк шбсрс appleбзхо л стсы с ы тм ыз л ыхн онк н х к клхтза бз л ыт шб шб- сб appleт бс й хзт ш с ых т тсытшытх б ыт н ы ык х знбх ыт appleст. Aapplefi ыт 68 т тсых ызт appleт шллбыб с шыкс збс, ыт 17% тзкат шб сых- хтыхнfi ах ыкс сыхлбырappleхшк ыт ыз л ыхнт онт, бср ыт 19% шсы атаз йт шб сыхлнкых шхнfi ах ык шытл ы ых applefi т тсытшытх, з ы ыfi зтск ш шы шк ах appleтл нзсшк ык т тсытшытх н ы ык х знбх ыт appleст8. ык б ыбзк н ыкатз лбобырс кы кнб applefi абсхнт т тсых ызт ах зтсхнfi х шыкл applefi л сыбн б тл б с н ы аз тс ытс зхлfi ы с шбсрс Hellenic Stomatological Review 57: 9-17, 2013 the acute infected traumatic ulcer and denture stomatitis. Of the 68 dentists participating in that survey, 17% would provide an antibiotic for the treatment of traumatic ulcer, while 19% would prescribe an antifungal for the denture stomatitis without a simultaneous recommendation for removal of the denture during sleep 8. In the second category, general dentists were asked to record the number of patients to whom they prescribed any drug for a period of one to eleven weeks, while, in the event of an antibiotic, and to complete the drug type formulation and the administration instructions (dosage and duration of intake) Among these researches, examples of drug abuse in the field of Oral Medicine were found only in two studies from Norway 14, 16. In these studies, which were within 14 years, it appeared that the rates of irrational antibiotic prescriptions increased significantly for stomatitis (from 17% to 37%) and oral herpes simplex (from 10% to 21%) 14, 16. CONCLUSIONS In conclusion, drug abuse is a phenomenon repeated with the same frequency over the years. The delay in diagnosis and the patient s exposure to the risk of complications of drug abuse in Oral Medicine and Pathology requires, on the one hand, that the medical community be informed about the rational use of medicines and, on the other, the conscientiousness of dental and medical representatives, who will undertake to treat only the cases of patients in their field of knowledge and expertise. Contact details: Eleni-Marina Kalogirou 15

17 Eзбскыхн Eза ш Research Study шыт тappleт т тз акш с н appleтхт й зл нт, бср шыкс appleбз appleы шк fiappleт к шсы атаз йкшк йтзт шб шб сых- хтыхнfi, с шлappleокзрстс ыт б т ыт шнб шл ыт н х ых т ка б тз акшк ( тштота н х х знбх о - к ыт й зл нт) Aс лбш шых apple з apple с лбо - ыб, apple з б ал ы й зл нбыхн н ы зкшк шыт р- зт ык шытл ытота сбз шнтсы х лfiст шб т лбо - ыб applefi ык Nтз ка 14, 16. ых лбо ыб ы appleт б с зтсхн applefiшы шк 14 бырс, й скнб apple м кн с шк- л сыхн ы appleтштшы хн хтоfiакык шсы атаз йкшк сых хтыхнрс ах ык шытл ы ых ( applefi 17% шб 37%) н х ытс appleоfi зappleкы ыт шыfiл ыт ( applefi 10% шб 21%) 14, 16. YM EPA MATA лappleбз шл ыхн, к хн хтоfiакык тз акшк й зл - н с appleтыбоб с й хсfiлбст appleт бapple с о л сбы х лб ыкс х ш сfiыкы шыкс apple зт т ы с бырс. H н шы - зкшк шык х ас шк н х к нбшк ыт шбст шытс н с- ст ы с бappleхappleотнрс appleт шсбapple абы х к н ы зкшк й зл н с шык шытл ытота, бappleх ообх йбсfi ыкс б- скл з ш ык х ызхн нтхсfiыкы ах ыкс тзтотахн з шк ы с й зл н с н х йбы зт ыкс бшсбх кш ы с бнappleзтшрapple с ыт т тсых ызхнт н х х ызхнт р- зт, appleт с о л стс с бз appleб тс лfiст ых appleб- зхappleыршбх шбсрс appleт appleытсы х ы с асршб с н х ык бмбх нбш ыт. BIB IO PA IA 1. Oakley M, O Donnell J, Moore PA, Martin J: The rise in prescription drug abuse: raising awareness in the dental community. Compend Contin Educ Dent 2011; 32 (6): X ыках сск N, Tfiшхт K, Mapple тappleт от-kзн с т E, Kзн с к : Xтз акшк й зл н с н х appleтой зл н шытс рзт ык O тсых ызхн. Eоо ытл Xзтс 2007; 51 (4): Mapple тappleт от-kзн с т E: Tтappleхн сыхшкappleыхн. Xз шк н х н ы зкшк шб стш л ы ыт шыfiл ыт. Eоо ытл Xзтс 1987; 31: но т ст-aс зхнтappleт от A, з нт : A хн хтоfiакык з шк сыхлнкых шхнрс шб стш л ы ыт шыfiл ыт. O т- сытшытл зfiт т 1989; 43: Lewis MA: Why we must reduce dental prescription of antibiotics: European Union Antibiotic Awareness Day. Br Dent J 2008; 205 (10): Palmer NOA, Ireland RS, Palmer SE: Antibiotic prescribing patterns of a group of general dental practitioners: results of a pilot study. Primary Dent Care 1998; 5: Palmer NA, Pealing R, Ireland RS, Martin MV: A study of therapeutic antibiotic prescribing in National Health Service general dental practice in England. Br Dent J 2000; 188 (10): Jaunay T, Sambrook P, Goss A: Antibiotic prescribing practices by South Australian general dental practitioners. Aust Dent J 2000; 45 (3): Palmer NO, Martin MV, Pealing R, Ireland RS, Roy K, Smith A, Bagg J: Antibiotic prescribing knowledge of National Health Service general dental practitioners in England and Scotland. J AntimicrobChemother 2001; 47 (2): Salako NO, Rotimi VO, Adib SM, Al-Mutawa S: Pattern of anti- 16 Hellenic Stomatological Review 57: 9-17, 2013

18 Eзбскыхн Eза ш Research Study biotic prescription in the management of oral diseases among dentists in Kuwait. J Dent 2004; 32 (7): Al-Haroni M, Skaug N: Knowledge of prescribing antimicrobials among Yemeni general dentists. ActaOdontol Scand 2006; 64 (5): Kakoei S, Raoof M, Baghaei F, Adhami S: Pattern of antibiotic prescription among dentists in Iran. Iran Endod J 2007; 2 (1): Murti A, Morse Z: Dental antibiotic prescription in Fijian adults. Int Dent J 2007; 57 (2): Preus HR, Albandar JM, Gjermo P: Antibiotic prescribing practices among Norwegian dentists. Scand J Dent Res 1992; 100 (4): Dailey YM, Martin MV: Are antibiotics being used appropriately for emergency dental treatment? Br Dent J 2001; 191 (7): Demirbas F, Gjermo PE, Preus HR: Antibiotic prescribing practices among Norwegian dentists. ActaOdontolScand 2006; 64 (6): Mainjot A, D Hoore W, Vanheusden A, Van Nieuwenhuysen JP: Antibiotic prescribing in dental practice in Belgium. IntEndod J 2009; 42 (12): Vessal G, Khabiri A, Mirkhani H, Cookson BD, Askarian M: Study of antibiotic prescribing among dental practitioners in Shiraz, Islamic Republic of Iran. East Mediterr Health J 2011; 17 (10): хб сшк ах бappleхнтхс с : Eо ск-m з с K ота зт Hellenic Stomatological Review 57: 9-17,

19 ё л охсхнт с х й зтсыт Clinical Interest охсхн сыхлбырappleхшк appleы ы хср т appleбзappleо ш applefi т тсытшытх б. зтш шк appleбзхшы ыхнт н х х охтаз йхн с шнfiappleкшк. ыкз т*,. то зтс нк *, з. з ан шнт **,. ы зт** Clinical management of epulis fissuratum: Case presentation and literature review M. Sotiriou*, N. Polychronakis*, Fr. Fragiskos**, E. Stavrou** EPI HФH ыкс бза ш ы appleбзхаз йбы х л л т т х - ы зкшк ыт т ык appleзтшытлх н о н fiapple нзх р appleзтн appleыбх л ш лбы ык бхзтз- ахн й збшк appleы ы хср т appleбзappleо ш - applefi appleбзбны ыхн appleыбз ах т тсытшытх. H л т т ы appleбзхо л сбх ыкс н ы шнб ык т- охн т тсытшытх - appleзхс ыкс й збшк ык о - к - бapple с шыт тзхшыхнfi бнл аб т applefi а т ыт т- appleт т бх ызтappleтappleтхкб шбх ыт бappleхлкыт ыбохнт ш л ыт ык appleзтшытлх н о н, fiapple ыfi бх х лтзй б лбы ык бхзтзахн бapple л шк. H ытappleт ыкшк ык appleзтн ы шнб шл ск т тсыт- шытх а сбы х л ш лбы ык бхзтзахн й - збшк ык appleбзappleо ш н х ык шзз й ыт ыз - л ыт. SUMMARY The purpose of this study is to describe how the depth and shape of the vestibular sulcus was maintained, after the surgical removal of an epulis fissuratum, caused by overextended dentures. The hyperplastic lesion covered the anterior area of the residual ridges and the vestibular sulcus. The technique used entailed the construction of a complete denture, before the lesion was excised, on the modified working cast reflecting the final desirable sulcus shape, as expected to be after surgery. The denture was placed in situ immediately after the surgical excision of the epulis fissuratum to maintain the vestibular sulcus depth. Key Words: complete dentures, overextended denture, epulis fissuratum. мбх нобх х : тохн т тсытшытх б, appleбзбны ыхн appleыбз ах т тсытшытх, appleы ы хср к appleбзappleо ш applefi т тсытшытх. * apple нтзт какы хскы зтшбыхн O тсых ызх- н то ** с appleокз ы какы ытл ыхн н х с тappleзтш appleхн цбхзтзахн O тсых ызхн то * Assistant Professor, Removable Prosthodontics, Dental School, University of Athens ** Associate Professor, Oral & Maxillofacial Surgery, Dental School, University of Athens бооксхн шытл ытотахн зтсхн 57: 19-26, 2013 apple збо йк 12/3/ бнз к 19/3/2013 Hellenic Stomatological Review 57: 19-26, 2013 paper received 12/3/ accepted 19/3/

20 ё л охсхнт с х й зтсыт Clinical Interest EI A Ь H H appleы ы хср к appleбзappleо ш applefi т тсытшытх - appleбзappleо ш applefi т тсытшытх (epulis fissuratum) б с х - сы з шк ыт шытл ыхнт обсстаfiст шб л нзт зfiсхт лк схнfi бзбхшлfi 1-4. Oх appleбзappleо шыхнт хшыт м стсы х, apple збл ооfiлбстх лбы м ыт тз т ык т тсытшытх н х ыт appleзтшытлх нт обсстаfiст, appleзтн орсы ыкс н ы нз ыкшк appleтобхлл ы с ызтй н х ыкс с appleымк лх- нзт с 3. бх с йбзб fiых к ш сfiыкы блй схшк ык о к шб ытл appleт йтзт с т тсытшытх б нл сбы х applefi 5-10% 5, appleтштшы ы тappleт б с х лхнзfiыбз applefi ы appleт с й зтсы х шб сбрыбзб збсб шык Bз хо 16,7% 6 н х 29,4% 7. б appleзfiшй ык збс appleт appleз ал ытappleтх кнб шыкс Tтзн н х шб б ал 64 шбсрс ыт appleт- штшыfi ы с 4,2% 8, appleты обшл appleт б с х apple зfiлтхт лб apple о хfiыбзк лбо ык ы с Xie н х шс. 9, лб ыкс н ы ас т с б с х appleбзхшшfiыбзт бappleхззбapple шб ш шк лб ыкс с. б лбо ык fiappleт с о кнб лк ы т б ал шбсрс тх т- appleт тх с йбз с х йтз appleзт о л ы лб ых т тсытшытх- б, ыт appleтштшыfi ык блй схшк appleбзappleо ш applefi т т- сытшытх (epulis fissuratum) ы с 31,7% 10. AITIO O IA H н зх хы ык о к б с х ы appleбзбны ыхн appleыбз ах т тсытшытх хрс ы с тappleт с к бй злта шыт appleтнб - лбст хшыт бс б с х хн стappleтхкыхн 1-3, тоо йт- з н х лfiст к н н бй злта ык шк ык т тсыт- шытх лappleтзб с appleзтн о шбх ык о к 4, 5, 15, 16. H apple з с ыт йшхтотахнт ны шк ы с appleыбза с б с х - appleты обшл б ыб ык о с шл ск тзхт ыкш ыт н ы ык х знбх ык н ы шнб ы с т тсытшытх хрс б ыб ык appleтззfiйкшк ы с й ысх нрс нзтотйхрс лб бapple нfi- отт ыт хшл ы с appleыбза с шыт л о нт х- шыт 8, 15. Aс отат appleты обшл хшк ы с appleыбза с шыт appleтнб лбст хшыт лappleтзб с appleзтн о шбх к о с шл ск н мхс ш анобхшк ы с ыб скырс тсыхрс 13. K INIKH EIKONA H нохсхн бхнfiс ык appleы ы хср т appleбзappleо ш applefi т тсытшытх appleтхн ообх applefi л л зх appleтоо appleо с хappleот лбсб appleы appleт бсытapple тсы х шы appleзтшытлх н н- з fiзх ы с appleыбза с ык 4, 13 (Eхн. 1). O appleбзappleо шыхнfi хшыfi apple зтшх бы х ш б fiс apple сытыб шб йобалтср к н х знбы ш с шб бмбон л ск н ы шы шк н х б с х бн ск- ыт н х applefiшнокзт н ы ык ко йкшк 1, 12. Oх шбсб ш- с бс сыхо л стсы х ыкс apple змк ы с appleбзappleо шых- нрс ырс хшырс бappleбх, н ы ыт appleоб шытс, бс шст б т- сы х applefi applefiст. Mfiстс fiы с к л ыт мкб знбы тх шбсб з тс с скш т с (н знхстйт ) 2. б бо - хшыб appleбзхappleыршбх бх apple з ыкзкб с appleымк н знхс - л ы с шыт бон ыхнfi ыз л ык appleбзappleо ш 13, 17. ёepa EIA H бз appleб appleт appleзтыб сбы х, applefi ыт appleбзхшшты зт 20 INTRODUCTION Denture - induced fibrous inflammatory hyperplasia (epulis fissuratum) is a reaction of the oral mucosa to long-term mechanical irritation 1-4. Hyperplastic tissue appears between denture borders and the vestibular mucosa and this encourages trapping of food residues and microbial growth products 3. Reported incidence of such lesion in denture wearers is around 5-10% 5, but these rates are lower than reported in more recent studies from Brazil, i.e. 16.7% 6 and 29.4% 7. In a recent research study carried out in Turkey with a sample of 64 patients, the corresponding rates were 4.2% 8, similar to those of an older study by Xie et al. 9, with the mandible being more vulnerable than the maxilla. In a study analysing a non-randomised sample of patients reporting various denture issues, epulis fissuratum appeared in 31.7% of them 10. AETIOLOGY The lesion is mainly caused by overextended denture flanges 1-3, and/or an ill-fitting denture base 4, 5, 15, 16. Overextension of denture flanges may be due to either erroneous bordering during denture construction or alveolar ridge resorption, which allows the flanges to dig into soft tissues 8, 15. Flanges may dig into the underlying tissues in a similar way because of malocclusion of the artificial teeth 13. CLINICAL APPEARANCE Clinically, epulis fissuratum caused by dentures may present one or more folds in the vestibular sulcus, mainly around denture borders 4, 13 (Fig. 1). The hyperplastic tissue almost always appears to be inflammatory and often ulcerated; it is mobile and moderately hard on palpation 1, 12. Patients are not usually aware of such hyperplastic tissues because these usually cause no pain. Only when the lesion mass increases do patients start to show concern (cancer phobia) 2. In very few cases cancerous lesions have been observed on the ulcerated hyperplastic lesion 13, 17. Eхн. 1: Kохсхн бхнfiс appleы ы хср т appleбзappleо ш. Fig. 1: Epulis fissuratum - clinical appearance. Hellenic Stomatological Review 57: 19-26, 2013

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