Endodontic treatment of a Patient with Huntington's disease

Huntington's disease is a lethal autosomal dominant disorder that affects men and women equally. The prevalence of Huntington's disease in North America is 5 to 10 per 100000 people. It is characterized by regular personality changes, dementia, and choreiform (dance-like) movements. Literature concerning dental treatment of patients who have been diagnosed with this type of disease is scarce. Continuous ingestion of medications to control the symptoms of this disease leads to xerostomia, which, maximized by unrestrained movements, often leads to progressive tooth decay, irreversible pulpitis, and tooth loss. Maintenance of teeth in patients with this type of disease is desirable and challenging. Like any patient, a comprehensive treatment plan needs to be developed with equal emphasis on restoration and home care. This case report illustrates how a morphologically difficult endodontic procedure can be successfully administered in a patient diagnosed with HD. Overall case success was attributed to a dental team approach and short-duration appointments to limit patient stress.

Implant-supported oral rehabilitation of a patient with pemphigus vulgaris: a clinical report

Pemphigus vulgaris (PV) is a rare mucocutaneous vesiculobullous disease characterized by the development of autoantibodies against the desmosomal proteins. Current treatment is largely based on systemic immunosuppression using systemic corticosteroids. Immunosuppressive drugs used in the treatment of the disease may increase the risk of infection and delayed healing, which are of concern in dental treatment procedures in this group of patients. The clinical outcomes of implants in PV have not been investigated. We present a case of PV rehabilitated with an implant-supported prosthesis with a 32-month follow-up and discuss the important points in the surgical and prosthodontic phases.

Permanent neurologic deficit after inferior alveolar nerve block: a case report

Permanent neurologic damage after an inferior dental nerve block is reported. Clinical manifestations included hemisensory syndrome, facial nerve palsy, hearing impairment, and ataxia. Possible mechanisms and preventive measures are discussed.

RAGE mRNA expression and its correlation with nuclear factor kappa beta mRNA expression in inflamed human periradicular tissues

Advanced glycation end products (AGEs) have been found to play a role in inflammation and vascular complications. The receptor for AGE (RAGE) is expressed on many cells and is up-regulated during inflammation. To date, RAGE expression or its correlation with nuclear factor kappa beta (NF-kappabeta) expression has not been demonstrated in inflammatory periapical lesions. In this study, periapical tissue was obtained from 38 patients and processed for RAGE and NF-kappabeta expression by using reverse transcriptase polymerase chain reaction. Various patient variables were examined as predictors for these novel protein expressions. The results demonstrated a statistically significant positive correlation between the expression of RAGE and NF-kappabeta (P = .001). When comparing whites and African Americans, a statistically significant difference was noted, with the African American group exhibiting a higher expression of RAGE (analysis of variance, F= 12.746, P = .002). A positive linear correlation of their presence was demonstrated in inflamed periradicular tissues. This study outlines the possible use of these proteins as potential markers for periapical inflammation.

Radiographic bone loss and the risk of medication-related osteonecrosis of the jaw (MRONJ) in multiple myeloma patients-A retrospective case control study

Risk factors for medication-related osteonecrosis of the jaws (MRONJ) include type and duration of antiresorptive drugs, dental trauma, local anatomy, systemic underlying conditions and therapy, smoking, and the presence of periodontal disease. However, there is a lack of studies elucidating the role of periodontal disease as risk predictor. In the present study, the dental charts of 100 multiple myeloma (MM) patients and 16 MM patients who developed MRONJ were studied. Information about age, gender, smoking history, diabetes, steroid drug intake, type and duration of bisphosphonate (BP) treatments, MRONJ status, missing teeth, periapical lesions, widening of the periodontal ligament, and periodontal status was collected. The periodontal status was determined as a percentage of missing bone at the mesial and distal surfaces of each tooth. Multivariable logistic regression was performed to identify risk factors associated with MRONJ. In the selected model, using the COX analysis, categorical bone loss percentage is significantly associated with MRONJ (P = 0.009), with hazard ratio 0.042 (high vs low) and 95% CI 0.004 to 0.453. Gender, steroid, Aredia BP type, and periapical are also significant in selected model. In conclusion, advanced alveolar bone loss and missing teeth were strongly related to the occurrence of MRONJ in MM patients.

Genome-wide Association Study Identified Chromosome 8 Locus Associated with Medication-Related Osteonecrosis of the Jaw

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious drug-related adverse event. To identify pharmacogenomic markers of MRONJ associated with bisphosphonate therapy, we conducted a genomewide association study (GWAS) meta-analysis followed by functional analysis of 5,008 individuals of European ancestry treated with bisphosphonates, which includes the largest number of MRONJ cases to date (444 cases and 4,564 controls). Discovery GWAS was performed in randomly selected 70% of the patients with cancer and replication GWAS was performed in the remaining 30% of the patients with cancer treated with intravenous bisphosphonates followed by meta-analysis of all 3,639 patients with cancer. GWAS was also performed in 1,369 patients with osteoporosis treated with oral bisphosphonates. The lead single-nucleotide polymorphism (SNP), rs2736308 on chromosome 8, was associated with an increased risk of MRONJ with an odds ratio (OR) of 2.71 and 95% confidence interval (CI) of 1.90-3.86 (P = 3.57*10-8 ) in the meta-analysis of patients with cancer. This SNP was validated in the MRONJ GWAS in patients with osteoporosis (OR: 2.82, 95% CI: 1.55-4.09, P = 6.84*10-4 ). The meta-analysis combining patients with cancer and patients with osteoporosis yielded the same lead SNP rs2736308 on chromosome 8 as the top SNP (OR: 2.74, 95% CI: 2.09-3.39, P = 9.65*10-11 ). This locus is associated with regulation of the BLK, CTSB, and FDFT1 genes, which had been associated with bone mineral density. FDFT1 encodes a membrane-associated enzyme, which is implicated in the bisphosphonate pathway. This study provides insights into the potential mechanism of MRONJ.

Bell's palsy associated with herpes simplex gingivostomatitis. A case report

Bell's palsy is a sudden, isolated, peripheral facial paralysis caused by various known and sometimes unknown factors. The case of an 18-year-old man who developed Bell's palsy after onset of primary herpetic gingivostomatitis is presented. Although Bell's palsy has already been associated with herpes simplex virus type 1, the described case is the first in the literature in which enzyme-linked immunosorbent assays for immunoglobulin G to herpes simplex virus type 1 and herpes simplex virus type 1 culture were both positive. The recent literature regarding the possible relationship between herpes simplex virus type 1 and Bell's palsy is reviewed and discussed.

Bacterial colonization of the parotid duct in xerostomia

Salivary flow rate and bacterial colonization of the parotid main duct were investigated in 17 patients referred for sialography and in 10 healthy controls. Cultures in the controls were negative whilst the patient group revealed bacterial colonization of the main duct, especially in those with the lowest flow rates. The implications of this finding in patients at high risk of endocarditis who will be undergoing sialography are discussed.

Oral changes in interleukin-2 treated patients: a preliminary report

Immunotherapy with high doses of interleukin-2 (IL-2) in patients with metastatic cancer is accompanied by multiorgan side effects. To determine the effect of this treatment on oral tissues, 5 cancer patients receiving a course of recombinant IL-2 (rIL-2) were followed. Oral pathology and subjective oral complaints were noted. Whole saliva parameters and routine blood and urine values were recorded daily before, during and after treatment. Mucositis and diminution of salivary flow occurred in all patients. Concomitantly, salivary sodium and protein were elevated.

Cicatricial pemphigoid with severe gingival and laryngeal involvement in an 18-year-old female

Cicatricial pemphigoid (CP), also known as mucous membrane pemphigoid, is an autoimmune vesiculobullous disease occurring mostly in elderly people and seldom occurring in individuals under the age of 20 years. It predominantly affects the mucosal surfaces, primarily the oral and conjunctival mucosa. Uncommonly, the upper aerodigestive tract is involved, which can lead to life-threatening complications. We present the case of an 18-year-old girl with desquamative gingivitis and severe laryngeal webbing and stenosis, caused by cicatricial pemphigoid. Airway management necessitated a tracheostomy and additional surgical procedure. The clinical, diagnostic, and therapeutic features of this disease are discussed, focusing on the oral and unique laryngeal manifestations.

Response to nitrous-oxide and oxygen among dental phobic patients

The present study evaluated the records of 27 patients (20 men, 7 women) who were treated under nitrous-oxide (N2O) and oxygen sedation due to extremely high dental anxiety. Corah's DAS and Kleinknecht's dental fear survey were completed by the patients. Patients who responded positively to the gas were categorised as N2O+ patients, whereas those who responded negatively were categorised as N2O- patients. A mean DAS score of 19.3 +/- 1.6 was observed for the entire population. No significant difference was found between N2O+ patients and N2O- patients in any DAS item, nor in the total scores (19.4 +/- 1.35 and 18.67 +/- 2.24 respectively). Only in answer to the question, 'Has fear of dental work ever caused you to cancel or not appear for an appointment?' were the scores of N2O- patients significantly higher than of N2O+ patients. No differences were found between patients who reported pain as the source for their dental anxiety and those who did not; between patients with gag reflex and those without, between patients who had never had any dental treatment and those who had, and between patients who required two or three appointments before administration of the gas with respect to successful treatment under N2O and oxygen sedation. Among the N2O- group, significantly more patients did not attend for two appointments or more. The results suggest that lack of keeping previous dental appointments may indicate patients' possible negative response to nitrous-oxide and oxygen sedation.

Isoflavones and gamma irradiation inhibit cell growth in human salivary gland cells

We studied the effects of isoflavones and irradiation on cell cycle in a human salivary gland cell line (HSG). Genistein and a soy isoflavone conjugate (NS) inhibited DNA synthesis. Cells deconjugated the glucoside form of isoflavones in NS to the aglycones genistein and daidzein. NS, genistein and IR increased phosphorylation of p53 and p21 CIP1 at serine 15 (phos-p53). Irradiation and NS also increased levels of p21 CIP1. In a cologenic survival assay, cells in log phase growth had high radio-sensitivity with 2 Gy causing a reduction in survival (SF2=0.45).

CONCLUSION

isoflavones and radiation may interact to sensitize cancer cells to radiation.

Obesity in children: a challenge that pediatric dentistry should not ignore--review of the literature

The link between childhood oral diseases and obesity is demonstrated by their increasing prevalence, potential cause and effect relationship, the significant deleterious effect on the child's present and future oral and systemic health, and the influence of obesity on conscious sedation. The purpose of this manuscript is to review the literature on the relationships between childhood oral diseases and obesity, and between obesity, breathing and conscious sedation. While some reports suggest a connection between caries and obesity others do not, and it is unclear if they correlate or they just coexist since they have common etiologic and/or facilitating factors. Deleterious effects of dental caries and obesity on the systemic condition are clear, may potentiate each other, and facilitate the development and progress of chronic or acute systemic conditions. Obesity may interfere with the possibility to sedate patients because of potential breathing problems, or modify the effect of the sedative agents. Health providers should be aware of the increasing challenge posed by the correlations between dental caries, obesity, oral and systemic diseases. Furthermore, pediatric dentistry should team with other health professions in order to cooperate in the prevention and treatment of these diseases.

The epidemiology of self-reported TMJ sounds and pain in young adults in Israel

OBJECTIVES

We investigated the prevalence of self-reported temporomandibular joint sounds (TMJS), masticatory muscle pain (MMP), and their interrelation in a young adult population.

METHODS

A large sample (n = 20,869) of young soldiers aged 18-21 years who attended dental clinics were asked about their experience of TMJ sounds and pain.

RESULTS

The overall prevalence of TMJS was 8.4 percent (8.9% in females and 8.2% in males) and for masticatory pain was 4.0 percent for both males and females (P < .001 under chi-square test). Twenty-five percent of patients reporting positive TMJS also reported positive MMP compared to 2 percent in the negative TMJS group (P < .001). Fifty-three percent of patients reporting positive MMP also reported positive TMJS, compared to 6.5 percent in the negative MMP group (P < .001).

CONCLUSIONS

The low prevalence of TMJ sounds and pain found in these study might be attributed to the different cultural and social environment, as well as to the uniformity in age of the study group.

Segmental odontomaxillary dysplasia: An underrecognized entity

BACKGROUND AND OVERVIEW

Segmental odontomaxillary dysplasia (SOD) is a characteristic developmental abnormality that demonstrates posterior maxillary enlargement, dental abnormalities, altered bone trabeculation, and possible cutaneous findings. Only 62 cases have been reported in the English-language literature.

CASE DESCRIPTION

The authors described 3 newly diagnosed cases of SOD, all found in the left posterior maxilla in adolescent female patients; they reviewed the literature to elucidate this rare entity.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Because of the complexity and variety of associated dental and craniofacial features, patients with SOD may seek diagnosis from various dental and medical providers. The signs of SOD are characteristic, yet the condition is largely underrecognized among health care professionals, which may lead to unnecessary treatment.

Aggressive periodontitis of the primary dentition associated with idiopathic immune deficiency: case report and treatment considerations

The present case, of a child with an idiopathic immune deficiency and aggressive periodontitis in the primary dentition, serves as an example for the treatment considerations in these cases. Extraction of all the primary teeth proved to be the most adequate treatment. It allowed the child to eat properly and prevented unwanted infections that could endanger the life of the child. The newly erupted permanent teeth have been subjected to careful oral hygiene, clorhexidine topical applications, and have mild gingival inflammation and no attachment loss.

The prevalence and treatment of dental caries among Israeli permanent force military personnel

A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education.

Prevalence of candidiasis and oral candidiasis in COVID-19 patients: a cross-sectional pilot study from the patients' registry in a large health center

OBJECTIVE

Candida albicans in considered to be a marker of immunosuppression in serious chronic condition such as HIV and cancer patients on immunosuppresion medications. The new COVID-19 pandemic has caused acute respiratory distress syndrome in many patients, which poses a risk of super-infections including Candida strains causing oral candidiasis as well as invasive fungal infections. The aim of the study was to examine the association between COVID-19 and oral and general candidiasis.

METHOD AND MATERIALS

The i2b2 data repository platform was used to analyze the interrelations between COVID-19, oral candidiasis, and total candidiasis in a hospital population. ICD diagnoses codes were used to generate queries on total numbers and demographic data on COVID-19, oral candidasis, total candidasis, and COVID-19 with each form of candidasis.

RESULTS

From the 889 patients diagnosed with COVID-19, 106 (12%) were diagnosed with candidiasis at large and 14 (1.6%) had oral candidiasis. The odds ratio (OR) for COVID-19 in the presence of oral candidiasis was 2.01 (95% CI 1.1870 to 3.4143, P = .094) and the OR for COVID-19 in the presence of candidiasis was 3.73 (95% CI 3.0419 to 4.5847, P < .0001 ). African American were disproportionally affected and comprised about 40% of the COVID-19/candidiasis groups.

CONCLUSIONS

Total candidiasis was significantly associated with increased risk for COVID-19, whereas oral candidiasis showed an insignificant trend. The dental practitioner should be aware of the importance of unexplained oral and systemic candidiasis as a potential harbinger of T and B cell immunosuppression associated with viral in-fections. COVID-19 may be a risk factor for total candidiasis.

Tumoral calcinosis associated with early onset periodontitis

A rare case of tumoral calcinosis (TC) with oral manifestations is presented in a 5-year-old child. The possible correlation between prepubertal periodontitis and TC is suggested and discussed.

The use of the CO 2 laser in oral surgery in the military

From 1987 to 1990, there were 122 soldiers treated with the CO 2 laser (Sharplan 1010) in the Laser Center of the Israel Defense Forces. A variety of benign oral lesions, vascular tumors, and other oral lesions were excised or vaporized. Twenty-four soldiers with impacted wisdom teeth and wide pericoronitis underwent operculectomy using the CO 2 laser. The CO 2 laser has the ability to perform accurate hemostasis surgery, with minimal postoperative pain and edema, and rapid healing, resulting in fast recovery without significant discomfort. These advantages are particularly important in the military since soldiers can return to their duties immediately after surgery.

Hyperbilirubinemic stain: location and extent in dental tissues

OBJECTIVE

The purpose of the present manuscript is to describe the location and extent of hyperbilirubinemic stain in a primary molar of a 3-year-old who was diagnosed with cystic fibrosis shortly after birth, subsequently developed liver disease and hyperbilirubinemia, and received a liver transplant at age 10-months.

STUDY DESIGN

Clinical and histological assessments were performed to evaluate the location and extent of hyperbilirubinemic stain in an extracted primary molar.

RESULTS

The clinical image, and macroscopic and microscopic histological examinations of a primary molar showed hyperbilirubinemic staining of enamel and of the coronal dentin that developed between birth and when the liver transplant took place, irregular dentin tubules, and an irregular cementum-dentinal junction.

CONCLUSIONS

The findings of the present manuscript indicate that hyperbilirubinemc staining of primary teeth affects dental hard tissues at the time of their calcification, and the clinical picture of the stain may be related to stained enamel and/or dentin, and underlying stained dentin visible through translucent unstained enamel.