Cocaine abuse has increased in the past decade, with a rise in the reported cases of midpalatine perforations produced as a result. The vasoconstrictive and caustic effect of the drug can produce direct irritation and ischemia of the nasal and palatine mucosa, leading over the long term to the creation of an oronasal perforation secondary to maxillary bone destruction. The present study offers a systematic review of all the clinical cases of necrotic nasopalatine perforations attributed to inhaled cocaine documented in the PubMed literature database. The main clinical characteristics of the disorder and its different management options are examined. Likewise, emphasis is placed on the importance of a correct differential diagnosis with respect to other conditions also characterized by midfacial necrotic destruction. Of the 36 cases included in the study, 21 corresponded to females and 15 to males. Most of the lesions were located in the hard palate (77.7%) with only 5.5% being found in the soft palate. Combined hard and soft palate presentations in turn accounted for 16.6% of the cases. The mean diameter of the perforation was 19.32 ± 16.94 mm (95%CI: 11.81-26.83). The most frequent clinical manifestation was rhinolalia together with the regurgitation of solid food and liquids through the nares. Management consists of a combination of antibiotics, analgesics, prostheses (obturators), and surgical reconstructions of the defect.

Drooling is the uncontrolled leakage of saliva outside the mouth, generally as a result of difficulty in swallowing the saliva produced. Many factors contribute to drooling, though it is more commonly seen in children with brain paralysis -particularly those receiving anticonvulsivant medication. Drooling is also often seen in patients with lip sealing problems or malocclusions such as anterior open bite. Clinically, the affected patients can develop skin irritation or abrasions, problems of hygiene, unpleasant smell and -in the more severe presentations -the need to wear protectors or frequently change clothing. Treatment of this disorder is complex, and should be addressed from a multidisciplinary perspective, with planning on an individualized basis. Among the different existing managements, myofunctional therapy, behavioral change programs and drug treatments are the most widely used options, though there are also more invasive surgical techniques designed to reduce or cause submandibular saliva secretion to be rerouted towards posterior zones of the oral cavity. In any case, no scientific evidence-based management protocol has yet been established capable of affording favorable results in the majority of cases. The present study offers a review and update on the clinical and dental management aspects of drooling.