Quarterly Dental Review 267

4. Side effects were reported by all authors in 33 to 90 per cent of patients receiving levamisole. Common side effects were nausea and vomiting, dysgeusia, hyperosmia and headache. Less common were diarrhoea, abdominal pain, sleepless- ness, dizziness, nervousness and depression. There was one case of leucopenia, which was reversed 4 days after treatment was stopped.

The conclusion drawn from examination of these studies was that the benefits of levamisole in the treatment of recurrent aphthous stomatitis are equivocal and the high incidence of unpleasant side effects must cause it to be considered an unsatis- factory form of treatment.

Interestingly, the isolated double-blind study on the use of tetracycline would suggest that this drug is both moderately effective and relatively free from side effects-confirming the clinical impression gained over many years of empirical use for oral ulceration.

A. M. Skelly

BENMER M. J. and BRADY F. A. Dental management of the irradiated patient, Int J. Oral Surg. 7 (1978) 208-220.

This is a useful revjew article In which the effects of radiation upon oral tissues and the management of the irradiated patient are discussed.

It is suggested that radical alveolectomies should be performed when a dental clear- ance in an irradiated patient is contemplated. Otherwise wearing dentures constitutes a risk of osteoradionecrosis as the bony base will be irregular due to poor bony res- orption. This concept would seem to be somewhat alien to British surgeons who consider a more conservative approach to be safer.

The authors also quote reports that dentures can be worn with little risk of osteoradlonecrosis provided that approxl- mately a year is allowed to elapse, after radiotherapy is completed and before dentures are Inserted, and also that the significance of reduced salivary flow In edentulous patrents when considering osteo- radionecrosis IS at present unclear,

Greater problems arise in dentate patients. If an implantation technique is used, un- sound teeth in close proximity to the Im-

plant should be extracted. External beam therapy, however, often exposes the bone and salivary tissue to high doses of radiation so a more aggressive approach towards extractions is necessary. The authors quote dosage levels of 6500-8000 rads for patients with squamous cell carcinoma but most British radiotherapists would probably accept 5400-5600 rads as satisfactory. It IS recommended that teeth in the field should be removed in segments rather than piecemeal to obtain a good closure. Such a procedure should be carried out regardless of whether the extractions are pre- or post- treatment.

Finally, management of osteoradio- necrosis and the general follow-up of the patient are discussed.

R. E. Hickman

ROED-PETERSON R. The treatment of miconazole in oral candidosis, Int J. Oral Surg. 7 (1978) 558-563.

Miconazole is a relatively new antifungal which has been used systemically and topically for the treatment of candidosis in various sites. The present study evaluates the effect of topical miconazole in the treat- ment of oral candidosis.

Eleven patients with candidal infection but no identified predisposing factors were used for the study. All the patients had been treated wlthout benefit with other anti- fungals in the past 3 months. Miconazole was given in the form of 250 mg lozenges sucked four times daily. The patients were revrewed fortnightly and the treatment stopped 14 days after smears and cultures became negative.

Five patients were cured after 2 weeks and 7 after 3. One patient was not cured after 13 weeks, at the end of which time treatment was stopped. One of the patients cured after 3 weeks had candida localized in the skin grafts at the commissures from which ‘leucoplakia’ had been stripped 4 years previously.

Most of the patients found the taste of the lozenges unpleasant and this may have contributed to the delay before cure in 4 patients. Six of the patients developed a recurrence and only 3 of these accepted further treatment.

R. E. Hickman