Paranasal sinuses

Numerous conditions, including trauma, infection, neoplasia, and developmental problems, can affect the paranasal sinuses. Successful resolution of these problems is predicated upon a thorough diagnostic workup to ensure the most accurate presumptive diagnosis. Surgical intervention is enhanced by using approaches that allow wide access to sinus compartments. Rigorous postoperative management is also important to a successful outcome.

Ligature-induced marginal inflammation around osseointegrated implants and ankylosed teeth

The purpose of the investigation was to gain more understanding of marginal inflammatory reactions around osseointegrated implants. The significance of the lacking periodontal ligament of implants was examined in the initial breakdown phase of supporting tissues by comparing clinical and radiographic manifestations of ligature-induced marginal inflammation related to osseointegrated implants with those around ankylosed and normal control teeth in 8 cynomolgus monkeys (Macaca fascicularis). Bilateral extraction of the first and second mandibular molars was carried out initially, and 12 weeks later 2 implants were placed in each side. Ankylosis of the second maxillary molars was established by extracting and replanting the teeth after a drying period. When ankylosis and osseointegration were established, ligature-induced marginal inflammation was induced in the right or left side at random around implants, ankylosed teeth and normal control teeth (second maxillary premolar) for 7 weeks. Although the clinical manifestations as expressed by plaque score, gingival score, probing depth and attachment loss were quite similar, the radiographic features differed. Significant loss of bone height was limited to implants and ankylosed teeth and did not occur in relation to normal control teeth. Furthermore, the bone loss around implants was significantly greater than the loss around ankylosed teeth. Bone loss was limited to implants and ankylosed teeth; the study therefore suggests that the presence of marginal inflammation around implants and ankylosed teeth may have more serious implications than does marginal inflammation around teeth with a periodontal ligament. However, variations in microbiota and susceptibility of different jaw positions to periodontal breakdown may influence the results of this study.

Feline gingivitis-stomatitis-pharyngitis

Inflammatory conditions of the feline mouth are commonly encountered in small animal practice. Although the majority can be attributed to dental disease and a small percentage are due to autoimmune diseases, the eosinophilic granuloma complex, neoplasia, and other miscellaneous syndromes, many cases appear to be due to a gingivitis-stomatitis-pharyngitis complex, which is likely multifactorial in origin. Viruses, bacterial infection, diet, dental disease, oral conformation, genetic predisposition, hypersensitivities, immunoinsufficiencies, and other defects in oral defense mechanisms may all be contributory. The complexities of this syndrome have made it one of the most challenging diagnostic and therapeutic problems in feline medicine.

Clinical correlates of dental anxiety among older adults

Most studies of the relationship between dental anxiety and oral health status have used subjective rather than clinical indicators of oral health. In this paper we examine differences between older adults who are and are not dentally anxious using a broad range of clinical measures. The data show that dentally anxious individuals were more likely to be edentulous, and among the dentate, had more missing and fewer filled teeth. As a result, dentally anxious dentate subjects were more likely to need prosthodontic treatment. They were also more likely to need immediate treatment for the relief of pain and infection and periodontal care. There was evidence to suggest differences in patterns of dental treatment between those who were and were not dentally anxious and some evidence consistent with the hypothesis that aging influences the relationship between dental anxiety and oral health status.

The value of panoramic radiographic examination in patients with leukemia before medical management

Panoramic radiographs were completed for patients with leukemia before the start of medical management. The radiographs were taken as part of the patient admission evaluation. Patients were examined and followed throughout the course of their medical management. Panoramic radiographs did not identify pathologic conditions that were not identified clinically or that required management during medical therapy. The radiograph evaluation was of value in correlation with clinical findings and was required before dental treatment. It is concluded that panoramic radiograph evaluation of patients with leukemia is not indicated as part of their routine evaluation and should not be used to screen patients for occult pathosis. The use of these radiographs should be based on history and examination findings.

Referred otalgia

Referred otalgia is a challenging symptom, with the burden on the physician to identify the source. Only by careful patient history and physical examination can all causes in this extensive differential diagnosis be excluded. In the absence of primary otologic pathology, referred pain from a head and neck carcinoma must be considered foremost and ruled out.

A survey of disease changes observed on dental panoramic tomographs taken of patients attending a periodontology clinic

Dental panoramic tomographs (DPTs) were taken consecutively of 500 patients referred to a specialist periodontal department by general dental practitioners in order to assist in the diagnosis of the severity of the periodontal disease. Analysis of these DPTs showed 316 (63.2%) of these patients to have some form of dental abnormality unrelated to periodontal disease. The DPT was shown to be a valuable screening technique for clinical practice.

A simple questionnaire and clinical examination to help identify possible non-craniomandibular disorders that may influence a patient's CMD symptoms

A patient with craniomandibular disorder (CMD) symptoms may have CMD, a local or systemic disorder that mimics CMD, or CMD superimposed with a local or systemic disorder that exacerbates the CMD symptoms. When evaluating a patient with CMD symptoms, the practitioner needs to determine whether local or systemic problems contribute to the patient's symptoms. The author presents a simple questionnaire that can help identify some non-CMD problems that may contribute to the patient's symptoms. A discussion of each question and examples of possible non-CMD disorders are provided. The author also describes a clinical examination that may be used in conjunction with the questionnaire to help identify some non-CMD conditions.

[Root resorption]

Root resorption can be divided into two main categories: internal root resorption and external root resorption. Internal root resorption is a pathology that can lead to tooth destruction in the short term and must consequently be stopped as soon as possible by applying adequate canal treatment. Until now, despite many research studies, very little is known about its causes and the way this kind of resorption appears. There are many different forms of external root resorption and it has a very diverse etiology. An external root resorption can thus appear in case of orthodontic treatment or due to the pressure brought by cysts, tumours or impacted teeth. A trauma or an infection may also lead to the development of an external root resorption. Because they are so diverse, each of these forms of external root resorption requires a specific treatment. It should also be noted that internal root resorptions, and some forms of external resorption too, often respond favourably to a calcium hydroxide treatment.

Self-assessment of dental health among Danish noninstitutionalized psychiatric patients

This survey provides a description of the living conditions, dental health self-assessment, dental health behavior, and knowledge and attitudes to dental care in a population of noninstitutionalized psychiatric patients. A total of 84 individuals (70% of the persons selected) were interviewed using a pretested structured questionnaire. One of five participants did not perform oral hygiene as a daily routine and 45% had no regular dental visit habits. A proportion of about 40% reported symptoms from teeth or gingiva within the previous year. Despite an acceptable level of general knowledge on caries and periodontal problems, only a small proportion were aware of the caries-inducing potential of psychotropic drugs. People with more than five admissions to the psychiatric ward more often reported symptoms from teeth and gingiva; irregular dental visit habits were also related to number of admissions and to manic-depression. The survey indicates poor oral health among psychiatric patients compared with the general population and the need for specific oral care programs leveled at noninstitutionalized psychiatric patients is stressed.

The etiology, prevalence, and sequelae of infraclusion of primary molars

Dental infraclusion, teeth below the occlusal plane, is a common condition, especially in mandibular primary molars, with more than seventy references in the literature. Most claim infracluded molars do not exfoliate within normal time limits and must be extracted to prevent detrimental sequelae. The few documented studies on this topic suggest, however, that most infracluded teeth exfoliate normally; however, there is a tendency toward a delay of six months. The degree of infraclusion does not appear to correspond with exfoliation time. The frequent sequelae of severely infracluded teeth, space loss and molar tipping, may be prevented by either restoring the height of the affected tooth or by using space maintainers without extraction. The successors of infracluded molars reportedly develop normally and have few occlusal abnormalities.

Ankylosis of primary molars--a future periodontal threat to the first permanent molars?

Most infra-occluded and ankylosed primary molars with a permanent successor will exfoliate normally. Continuous supervision of occlusal development and radiographic control of normal root resorption have been recommended. The decreased height of the alveolar bone level at the site of the infra-occluded primary molar has been reported to normalize after the eruption of the permanent successor. However, opinions that infra-occlusion of primary molars entails a risk of future periodontal damage to the first permanent molars have been presented. The aim of this study was to perform a long-term follow-up of the alveolar bone level mesial to the first permanent molars after spontaneous exfoliation or necessary extraction of the infra-occluded second primary molars. The material consisted of 143 permanent molars adjacent to 119 infra-occluded primary molars and 24 normal contralateral primary molars in 68 individuals. The subjects were re-examined about 8 years after the exfoliation or extraction of the infra-occluded second primary molars. The subjects were examined both clinically and radiographically. Alveolar bone level mesial to the first permanent molars was measured in bite-wing radiographs. All but two permanent first molars showed a normal alveolar bone level mesially. In two first permanent molars where the primary molar was extracted, mesial approximal bone loss amounted to 4 and 3 mm, respectively, but no pocket formation was found. Infra-occlusion and ankylosis of primary molars does not constitute a general risk of future alveolar bone loss mesial to the first permanent molars. The general treatment recommendation to await normal exfoliation and eruption of successors remains valid.

Familial posterior open bite: a primary failure of eruption

Two sisters are presented in whom posterior open bites have developed. Orthodontic treatment was not successful in correcting this aspect of the malocclusion in the older sibling. The younger child developed the same defect, and consequently orthodontic treatment is not being considered.

When a patient with a bleeding disorder needs dental work. How you can work with the dentist to prevent a crisis

Patients with bleeding disorders need close cooperation between their physician and their dental practitioner to receive safe, comprehensive dental care. When indicated, physicians must advise a compromised treatment plan to avoid deep injections or surgical procedures that may initiate a bleeding crisis in patients at risk. The conditions most commonly seen that require special consideration are long-term use of antithrombotic agents, platelet dysfunction caused by chronic renal failure, and congenital clotting factor deficiencies. Even these patients may undergo a high-risk procedure, such as periodontal surgery, with adequate precautions and preparation.

Odontogenic cervical necrotizing fasciitis

Necrotizing fasciitis is a severe soft-tissue infection characterized by diffuse necrosis of fascia and subcutaneous tissue; initially, skin and muscle are usually spared. The trunk, abdomen, perineum, and extremities are the most commonly involved areas. The case of a 55-year-old man with a cervical necrotizing fasciitis from an infected tooth is presented. The medical history, etiology, anatomy, precipitating factors, clinical presentation, and therapy of this infection are discussed. Early recognition allows effective therapy with aggressive surgical intervention, broad-spectrum antibiotics, and supportive care. Misdiagnosis (eg, as cellulitis) and delayed surgical treatment can result in severe systemic toxicity and a mortality rate that approaches 40%.

Oral health care in pediatric AIDS

At the time of this writing, over 1500 cases of HIV infection in children under 13 have been documented. Estimates have been made that ten times that number exist. The oral manifestations of HIV infection in these children, the management of these problems, and access to care pose significant issues for the dentist who treats children. In Washington, D.C., in March of 1989, the Massachusetts Department of Public Health and the Office of Maternal Child Health funded a conference and workshop on oral complications of HIV infection in the pediatric population. This report uses information presented at the workshop and certain recent key papers to provide an overview of current knowledge about pediatric AIDS.

[Prosthetic valve endocarditis caused by Haemophilus parainfluenzae]

A case of endocarditis preceded by dental treatment without prophylactic antibiotics and caused by Haemophilus parainfluenzae in a patient with a biological heart valve prosthesis is described. This bacteria grows slowly in the usual blood culture media and, because of this, the etiological diagnosis was not established until after incubation for 11 days. Blood cultures from patients suspected of having endocarditis should be incubated for longer than the usual five to seven days. Close cooperation between the clinical microbiologist and clinicians is necessary so that important findings are not overlooked. Dental treatment of patients with heart valve prostheses should always take place under antibiotic prophylaxis.