[Oral squamous cell carcinoma in north-eastern Hungary. II. Etiological factors]

The purpose of this study is to determine the possible etiological factors of oral squamous cell carcinoma (OSCC) in North-Eastern Hungary. The medical records of 119 randomly selected patients with OSCC admitted to the Department of Maxillofacial Surgery of the Faculty of Dentistry, University of Debrecen were reviewed. The following risk factors were investigated: tobacco and alcohol consumption, dental status, rural vs. urban residence, and high risk HPV infection. The presence of HPV DNA has been evaluated by polymerase chain reaction from the tissue samples. Results were correlated with clinical data. At the time of diagnosis 65.5 percent of the patients were smokers. Under the age of 45 the rate was 86.4%. Smoking significantly correlated with younger age, male gender, advanced clinical stages and alcohol consumption. The majority of the patients (75.5%) consumed alcohol, 41.1% regularly over the acceptable range. Drinking habit significantly correlated with younger age, male gender and tumor site (gingiva, retromolar region, tongue). HR-HPV types were detected in 42.8% of samples tested. HPV DNA presence was not related to gender, clinical stage, histological grade or other risk factors. Authors found weak correlation between HR-HPV positivity, younger patient age and better 5-year survival rate. The dental status was acceptable only in 12.6 percent of the cases. There was a correlation between dental status and age, smoking and drinking habits. No significant urban-rural differences were found. In the study population the most important risk factor for developing oral cancer is tobacco smoking followed by alcohol consumption. Avoidance of tobacco smoking and a reduced amount of alcohol, together with healthy nutrition and regular dental care should be emphasized.

Meniere's disease may be caused by common intraosseous dental pathology--Diagnosis using the comparative compression sign

Meniere's disease has been ascribed to a disturbance of the vestibular apparatus or its connections within the Central Nervous System. Several hypotheses have been advanced regarding its aetiopathogenesis, but treatments based on these hypotheses have often not produced the desired results. Two cases are described where common intraosseous pathology within the lower half of the functional face, i.e. within the mandible and maxillae, was shown to be the cause of Meniere's disease. Together, these cases contributed to the chance discovery of the comparative compression sign which, when able to be elicited, may be considered pathognomonic for a dental origin of the condition. It is suggested that, in addition to other hypothesized causes involving the vestibular apparatus and the CNS, Meniere's disease and vertigo may also be caused by common, readily-identifiable intraosseous dental pathology. These unexpected findings open up a new field for future research.

Dental and periodontal status and risk for progression of carotid atherosclerosis: the inflammation and carotid artery risk for atherosclerosis study dental substudy

BACKGROUND AND PURPOSE

Dental and periodontal disease are potentially involved in the pathogenesis of atherosclerosis. We investigated whether dental and periodontal status is associated with the presence and future progression of carotid stenosis.

METHODS

We randomly selected 411 of 1268 participants from the prospective Inflammation and Carotid Artery Risk for Atherosclerosis Study and evaluated dental and periodontal status and oral hygiene at baseline measuring three World Health Organization-validated indices: DMFT (decayed, missing, filled teeth), SLI (Silness-Löe Index), and CPITN (community periodontal index for treatment needs), respectively. The degree of carotid stenosis was measured by duplex ultrasound at baseline and after median 7.5 months (range=6 to 9 months) to identify patients with progressive carotid stenosis.

RESULTS

DMFT (P<0.01), SLI (P=0.048), CPITN (P=0.007), and edentulousness (P=0.007) were associated with the baseline degree of carotid stenosis. Atherosclerosis progression was observed in 48 of 411 patients (11.7%). DMFT (adjusted odds ratio [OR]=1.11, 95% CI=1.01 to 1.22, P=0.032) and SLI (adjusted OR=1.77, 95% CI=1.09 to 2.79, P=0.021), but not CPITN (adjusted OR=1.51, 95% CI=0.89 to 2.45, P=0.16) were significant predictors of disease progression, irrespective of traditional cardiovascular risk factors and the baseline degree of stenosis. Edentulous patients had a significantly increased risk for disease progression as compared with patients with teeth (adjusted OR=2.10, 95% CI=1.06 to 4.16, P=0.33).

CONCLUSIONS

Dental status, oral hygiene, and particularly tooth loss are associated with the degree of carotid stenosis and predict future progression of the disease.

Severe odontogenic infections, part 2: prospective outcomes study

PURPOSE

The purpose of this study was to identify significant predictors of 4 outcomes in patients with severe odontogenic infections: abscess formation, penicillin therapeutic failure (PTF), length of hospital stay (LOS), and need for reoperation.

PATIENTS AND METHODS

We used a prospective case series study design and enrolled 37 consecutive patients admitted for severe odontogenic infection between March 1996 and June 1999. Treatment consisted of intravenous penicillin (PCN) or clindamycin in PCN-allergic patients, surgical incision and drainage, and extraction(s) as soon as possible. Study variables were categorized as demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications. The primary outcome variables were abscess formation, PTF, LOS, and reoperation. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables.

RESULTS

The sample consisted of 37 subjects (23 male, 14 female) with a mean age of 34.9 +/- 15.8 years. Multivariate analyses, controlling for confounding variables, indicated that culture of Peptostreptococci was a negative predictor of abscess formation. LOS was predicted by the number of infected spaces and duration of operation. There was no significant predictor of PTF or reoperation on multivariate analysis, although PCN-resistant organisms were isolated in all cases of PTF.

CONCLUSION

Increased LOS in severe odontogenic infections is predicted by the anatomic extent and severity of the infection and the occurrence of complications such as PTF and the need for reoperation. PTF is significantly associated with later identification of PCN-resistant organisms. The role of Peptostreptococci in abscess formation warrants further investigation.

[Cellulitis and phlegmons of dental origin in the CHU of Yaounde]

Cellulitis and phlegmons of dental origin in the CHU of Yaoundé. Cellulitis and phlegmons are frequent complications of teeth infections in tropics in general and particularly in Cameroon. They concern all ages and affect more men than women. These pathologies are more developed in disfavoured social classes. Their frequency is very high among pupils and students, whose the financial power depends on poor parents. Cellulitis and phlegmons are more induced by molar's infections. The upper and lower parts of the check were the most frequent. These pathologies disturb the life because of pain they entertained and they can modify life prognosis. They constitute emergencies for diagnosis and treatment.

Severe odontogenic infections

BACKGROUND

Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.

METHODS

All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.

RESULTS

Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1-16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.

CONCLUSION

Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.

Clinical evaluation of a resin-modified glass-ionomer liner for cervical dentin hypersensitivity treatment

PURPOSE

To evaluate the effectiveness of two agents for treating cervical dentin sensitivity associated with gingival recession or noncarious cervical lesions.

METHODS

44 patients with at least mild sensitivity affecting cervical dentin were enrolled in a longitudinal randomized clinical trial. A resin-based desensitizer or an experimental glass-ionomer was assigned to treat at most two teeth from each side of the mouth. Sensitivity was assessed by tactile and cold tests, measured with a Visual Analogue Scale at baseline, after treatment, and at 1 week, 1, 3, 6, and 12 months after treatment. Other noteworthy clinical observations were recorded.

RESULTS

Both treatments effectively reduced dentin sensitivity (mixed linear model analysis). Sensitivity score for the glass-ionomer was significantly lower than for the resin-based desensitizer after treatment and at all follow-up periods (P < 0.0001). Some overhanging margins were observed in the glass-ionomer group, which could accumulate plaque and cause gingivitis. Despite material loss from some teeth treated with the glass-ionomer, the follow-up sensitivity scores were still lower than baseline scores.

Recession occurrence in patients treated with fixed appliances--preliminary report

PURPOSE

The aim of the study was to evaluate the dependence of gingival recession, malocclusion and factors that may lead to recessions of the gingiva in patients applying for orthodontical treatment.

MATERIAL AND METHODS

The study involved 52 randomly selected patients treated with fixed appliances due to occlusal irregularities and dental abnormalities. Data obtained from the examination and selected parameters from cephalometric analysis were placed in a chart including ANB skeletal class and Wits parameter, lower incisor position IMPA, dental abnormalities, extractions due to orthodontical indications and recession etiopathic factors. Statistical analysis of obtained data was conducted using variance analysis. Statistically significant were assumed those calculations for which value of significance level p < or = 0.05.

RESULTS

Recession was observed in 18 patients of the 52 examined. Skeletal I class was found in 11 patients (61.12%) and in 8 cases Wits parameter corresponded with skeletal class III (44.4%). Among the patients examined normal incisor inclination was observed in 6 patients (33.33%), whereas 12 cases revealed inclination irregularities (66.66%). Clinical examination disclosed dental defects in 13 patients (72.22%) and in 12 cases recession etiopathic factors were recognized (66.66%). Statistically significant differences between periodontal biotype and gingival recession of 43, 31, 33 teeth were estimated.

CONCLUSIONS

Anatomical factors, malocclusion and dental irregularities were fund to be the main cause of the single and/or multiple recessions. Patients applying for orthodontic treatment due to occlusal abnormalities should remain under particular control in case of symptoms suggesting the incidence of recession, particularly when recessions are already present.

Dental transposition as a disorder of genetic origin

A sample of 85 dental transpositions in 75 subjects (27 male, 48 female; mean age at diagnosis 12.25 years) involving both maxillary and mandibular arches was analysed using dental panoramic radiographs and clinical records. Transposition affected the maxillary dentition (76 per cent) more frequently than the mandibular dentition (24 per cent). Unilateral transposition accounted for 88 per cent of cases, with the maxilla being involved more commonly than the mandible. Overall, the most common transposition involved the maxillary canine and first premolar (58 per cent). Considering the jaws in isolation, the canine and first premolar were the most commonly affected teeth in the maxilla (83 per cent) whilst in the mandible, the canine and lateral incisor teeth were most commonly transposed (73 per cent). No significant difference in symmetrical distribution of the unilateral transposition sample occurred. There was evidence of associated hypodontia in 41 per cent of the sample; however, if third molars were excluded, this figure decreased to 25 per cent. Peg-shaped maxillary lateral incisors were judged to be present in 27 per cent of subjects, whilst 41 per cent had retained primary teeth; all of these, except one, were primary canines. Overall, the majority of the sample (76 per cent) demonstrated at least one of the dental anomalies under investigation. Multivariate analysis showed associations between unilateral transposition, gender, and the presence of peg-shaped maxillary lateral incisors; whilst bilateral transposition was more closely associated with gender and the presence of retained primary teeth. There was a poor association between both unilateral and bilateral transposition and hypodontia. Together, these results suggest a mutifactorial aetiology to this disorder, with both genetic and environmental factors playing an important role.

The need for dental treatment in a group of patients undergoing treatment for malignancies other than of the head and neck

This paper reports the findings of an audit carried out to estimate the dental needs of patients undergoing oncology therapy for malignant disease at various sites of the body. All of the subjects were in-patients on an oncology ward. Over fifty percent of the patients had dental, periodontal or mucosal disease. It was concluded that there is a need to increase the dental service provided to cancer patients to allow further co-ordination between medical, dental and nursing staff for the prevention, management and resolution of oral complications of cancer therapy.

Case report: Alagille syndrome

The clinical case of a boy aged 6 years suffering from Alagille syndrome is described. This is a rare genetic disease characterised, from the hepatic point of view, by anomalies of the intrahepatic biliary ducts (in terms of number, histology and immunohistochemistry) with cholestasis; from the systemic point of view it is characterised by anomalies of various systems (heart, musculoskeletal system, eyes, face, kidneys and nervous system). The patient was referred for dental consultation by the Pediatric Cardiology Section, Sant'Orsola-Malpighi Polyclinic, Bologna City Hospital. Medical history indicated liver transplantation at 3 years; immunosuppressive treatment; heart disease with low risk of bacterial endocarditis (interventricular defect and systolic murmur). Objective examination revealed a dental formula compatible with his age, of a decided green colour (above all the permanent dentition) with numerous caries lesions on the posterior deciduous teeth. In agreeing the treatment plan with the cardiologist (treatment of caries and sealing the fissures and cracks in the permanent first molars) it was decided that antibiotic prophylaxis was not required since such conservative treatment is not at risk for bacterial endocarditis. The patient returned 15 min after the end of the second session with marked swelling of the right upper hemi-lip. Having excluded traumatic origin, a hypothesis was formulated of hypersensitivity to products used during the dental session, in particular talcum-coated gloves and latex rubber dam. The patient was referred immediately to the Dermatology Service, Sant'Orsola-Malpighi Polyclinic, for the appropriate dermatological tests (prick test and epicutaneous test) which confirmed the suspected diagnosis: urticaria from contact with latex materials. The clinical case described confirms the need for the dentist of an interdisciplinary approach in patients suffering from systemic diseases and/or syndromes.

[Risk factors and incidence of dental diseases in children in a large industrial town]

A relationship has been studied between somatic diseases, functional changes, and dental mortality in children living in urban areas having different levels of ambient air pollution. Visceral diseases have been ascertained to contribute to the development or deteriorate the course of various pathological tooth and jaw processes. Systemic diseases change the conditions of formation and maturation of dentins, which makes them less resistant. The relationship between the changes in the somatic and dental statuses of children is more pronounced when the ecological situation is poor.

Atypical facial pain--a diagnostic challenge

BACKGROUND

Facial pain is a relatively frequent cause of presentation to both general medical and dental practitioners. Although in the vast majority of cases the cause is dental disease or tempero-mandibular joint dysfunction, the remaining patients are often difficult to diagnose and treat.

OBJECTIVE

This article discusses the differential diagnosis of facial pain and presents three cases of atypical facial pain.

DISCUSSION

A detailed history, clinical examination, imaging and laboratory investigations may be required to establish the cause of atypical facial pain. An assessment of the patient's mental state is mandatory, as depression or psychological overlay is common. In a small number of cases, the diagnosis remains unclear despite detailed investigation. These patients may have their symptoms ameliorated by empirical pharmacological therapy.

Tramadol: does it have a role in emergency medicine?

Tramadol is a synthetic analgesic new to the Australasian market where its use is rapidly increasing. It is used extensively overseas, particularly in Europe where it has been popular since its introduction in Germany in the late 1970s. Tramadol has a dual mechanism of action: weak mu opioid receptor agonist and a reuptake inhibitor of serotonin and noradrenaline. Thus, it has distinct advantages and disadvantages compared to other available analgesics. Its use is advocated in a variety of acute and chronic pain states as well as some non-analgesic applications. The use of tramadol in an emergency setting is not well studied, with most published trials assessing its efficacy and tolerability in postoperative or dental models. This literature review concludes that tramadol does not offer any particular benefits over existing analgesics for the majority of emergency pain relief situations.

Microbiology of acute and chronic maxillary sinusitis associated with an odontogenic origin

OBJECTIVES

: To study the microbiology of sinusitis associated with odontogenic origin.

METHODS

: Aspirates of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection were processed for aerobic and anaerobic bacteria.

RESULTS

: A total of 66 isolates were recovered from the 20 cases of acute sinusitis (3.3/specimen), 16 aerobic and facultatives, and 50 anaerobic. Aerobes alone were recovered in 2 (10%) specimens, anaerobes only in 10 (50%), and mixed aerobic and anaerobic bacteria in 8 (40%). The predominant aerobic were alpha-hemolytic streptococci (5), microaerophilic streptococci (4), and Staphylococcus aureus (2). The predominant anaerobes were anaerobic Gram-negative bacilli (22), Peptostreptococcus (12), and Fusobacterium spp. (9). A total of 98 isolates were recovered from the 28 cases of chronic sinusitis (3.5/patient): 21 aerobic and facultatives and 77 anaerobic. Aerobes were recovered in 3 (11%) instances, anaerobes only in 11 (39%), and mixed aerobic and anaerobic bacteria in 14 (50%). The predominant aerobes were alpha-hemolytic streptococci (7), microaerophilic streptococci (4), and S. aureus (5). The predominant anaerobes were Gram-negative bacilli (41), Peptostreptococcus (16), and Fusobacterium spp. (12). Thirteen beta-lactamase-producing bacteria (BLPB) were recovered from 10 (50%) patients with acute sinusitis and 25 BLPB from 21 (75%) patients with chronic sinusitis. No correlation was found between the predisposing odontogenic conditions and the microbiological findings.

CONCLUSIONS

: These data illustrate the similar microbiology of acute and chronic maxillary sinusitis associated with odontogenic infection where anaerobic bacteria predominate in both types of infections.

[Clinical study of routes of onset of inflammatory diseases in the maxillary sinuses]

Pathways of the maxillary sinus diseases is an interesting issue investigated by many authors during the past decades. The goal of this research was to study the pathways of infection spreading into the maxillary sinuses and to compare them in relation to their frequency, underlying causes and general epidemiologic characteristics of the involved population. A total number of 150 adult patients of both gender suffering different diseases of maxillary sinuses were included into the study. Pathways rising maxillary sinuses diseases were diagnosed on the basis of standard clinical procedures including CT scean and MRI of the region. We found inflammatory processes to dominate the tumorous ones (107:43 patients). Rhinogenic type of sinusitis was the most frequent disease (72 patients) while odontogenic sinusitis (35 patients) was significantly less frequent. No case of traumatic or hematogenic maxillary sinusitis was found. Rhinogenic maxillary sinusitis is characterised by spontaneous onset while odontogenic one is mostly of arteficial origin after surgical procedures in the oral cavity (88% of patients). In contrast to rhinogenic type, odontogenic maxillary sinusitis is far more frequent in younger patients.

Descending necrotizing mediastinitis: trends in a developing country

Descending necrotizing mediastinitis is believed to be a rare and serious complication of odontogenic and oropharyngeal infections. It is associated with a high (up to 40%) mortality rate, which can be attributed to delays in diagnosis and inadequate surgical drainage. Between May 1999 and September 2002, we treated 7 cases at our institution in New Delhi, indicating that such fulminating infections are not so rare in developing countries. In our 7 cases, a high index of suspicion and early computed tomography helped us make a rapid diagnosis and initiate prompt treatment, which resulted in a favorable outcome in 6 cases (mortality rate: 14.3%).

[Familial expansive osteolysis otological and dental manifestations of genetic origin]

OBJECTIVES

Familial Expansive Osteolysis (FEO) ist a rare autosomal dominant bone dysplasia. The disease can show general and focal skeletal alterations, the latter having a predominantly peripheral distribution. Onset occurs after the second decade of life.

PATIENTS AND METHODS

We present the study, of 30 years, of a family consisting of 49 members covering five generations.

RESULTS

Among the 35 members studied, 18 have familial expansive osteolysis (FEO). The first clinical sign of the condition is transmission deafness at an early age. The features of the teeth has a unique and characteristic appearance. Thinning of the cortical bone leads to severe, painful, disabling deformities. Serum alkaline phosphatase, and urinary hydroxyproline and deoxipyridinoline are elevated. Calcium and parathyroid hormone are normal. Treatment with diphosphonates, calcitonin and vitamin D has been unsuccessful. We present the surgical technology and the results to short and long term of 13 interventions on 8 patients.

CONCLUSION

Progressive osteoclastic reabsorption accompanied by weak osteoblastic activity results in medullary expansion characterized by rarefaction of the bone marrow, which is replaced by fibrous tissue and fat. FEO is histologically similar to Paget disease, but the age of onset, the distribution of the bone lesions, the dental and middle ear alterations, and the clinical progression are different. These features also differentiate FEO from fibrous dysplasia, fibrocystic osteitis and imperfect osteogenesis. The gene responsible for FEO is located in the 18q21-22 chromosome region. Mutations in TNFRSF11A, the gene encoding receptor activator of nuclear factor-kappa-B (RANK), has been recently identified as the cause of FEO. A duplication of 18 base pairs in exon 1 of the TNFRSF11A gene suggests that this corresponds to the site of the anomaly and can be considered a "hot spot" for mutations.

[Comprehensive treatment of patients with chronic odontogenic perforative maxillary sinusitis]

The results of treatment of 244 patients with chronic odontogenic perforative maxillary sinusitis, using sparing sinusotomy show high effectiveness of the method. Number of complications, as well as period of disability decreased, economic effect were significant.

[Mistakes and complications in stomatologic practice leading to neuro-stomatological diseases]

There was described the results of mistakes and complications analysis in stomatological practice leading to neuro-stomatological diseases; their classification is proposed.

Addressing oral health disparities in settings without a research-intensive dental school: collaborative strategies

Research suggests that oral health is linked to systemic health, and those with poor oral health are potentially at greater risk for important diseases, including cardiovascular disease, stroke, diabetes mellitus, and adverse pregnancy outcomes. Asians and Pacific Islanders (APIs) in Hawaii have high rates of many such diseases. Studies in children in Hawaii have revealed disparities in dental health; for example, API children have significantly higher rates of cavities than other groups. Hence, conducting further study is vital in adults, particularly APIs, to assess oral health and its correlation to overall health outcomes. Given the lack of a dental school and the lack of fluoridated water in the state, the University of Hawaii's John A. Burns School of Medicine (ABSOM) has identified the need to assume a leadership role in creating effective community-based oral health research and treatment programs. With the support of the National Institute of Dental and Craniofacial Research, JABSOM fostered a collaborative relationship with the University of North Carolina at Chapel Hill School of Dentistry, a premiere research-intensive dental school, the Waimanalo Health Center, and the Hawaii State Department of Health. This partnership has worked together to implement a community-based approach to performing research designed to illuminate disparities and develop innovative strategies to promote oral health in Hawaii's diverse populations. We hope that this collaborative, culturally competent approach may serve as a model for use in other settings without a research-intensive dental school.

Virtual endoscopy in odontogenic sinus disease. Study technique and main pathological findings

The use of CT scans in dental pathology is an established technique. The potential applications of Dentascan are further enhanced by the use of virtual navigation software, resulting in endoscopy-like imaging of the maxillary sinus, thus optimising both the diagnostic and therapeutic approach to sinus pathology of dental origin. The aim of this paper is to illustrate the technical-methodological aspects of maxillary sinus virtual endoscopy with Dentascan software and to document the most important and frequent diseases.

Orofacial infections of odontogenic origin

The polymicrobial nature of the odontogenic infections as well as the variety of associated conditions are a consequence of the diversity of the buccal microbiota and the anatomical and functional complexity of the oral cavity. In addition to this, all these processes can give way to multiple complications which range from the local to the systemic level. The appropriate choice of antibiotic and posology is crucial in the successful management of these infections. Pharmacodynamics provides those parameters that make it possible to assess how antibiotics activity varies in time. As a general rule, the first step in the initial management of orofacial infections in adults, included odontogenic infections, will be the administration of 875 mg of amoxicillin and 125 mg of clavulanic every 8 hours. Therapeutic compliance is paramount to avoid resistance, therefore patient acceptance must be sought. In this sense, it has been proved that Augmentine Plus (2000/125) every twelve hours both as profylaxis and as treatment significantly decreases the rate of infective complications associated to extraction of the third molar.

Association of dietary habits with symptoms of temporomandibular disorders in Bangladeshi adolescents

The prevalences of signs and symptoms of temporomandibular disorder (TMD) in Bangladeshi adolescents and their associations with intake of various hard food items were investigated. A group of 1200 randomly selected high school students aged 12-17 years from three communities (rural, semi-urban and urban) completed a questionnaire on dietary habits and presence of TMD symptoms and were examined clinically. In bivariate analysis, no significant relationship was observed between TMD symptoms and eating of hard foods. However, in logistic regression analysis, clicking showed a significant correlation with consumption of hard vegetable and fruits more than three times per week (P < 0.05). A statistically significant correlation was also observed between consumption of all hard food items (at least one item in each of the four categories of hard food) more than 12 times per week and pain in the temporomandibular joint (TMJ) (P < 0.05). A positive association was found between pain in the TMJ and older age (15-17 years) (P < 0.001). The prevalence of pain in the TMJ was significantly higher in males (P < 0.01). Prevalences of clicking and pain in the TMJ were significantly higher in subjects living in a rural area than in subjects living in an urban area (P < 0.01 and P < 0.01, respectively). Subjects having one or more decayed, missing and filled teeth (DMFT) showed significantly higher prevalences of clicking (P < 0.01) and restricted mouth opening (P < 0.01). The results suggest that prevalence of TMD symptoms are related to prolonged consumption of hard food items.

Maxillary sinus disease of odontogenic origin

Odontogenic sinusitis is a well-recognized condition and accounts for approximately 10% to 12% of cases of maxillary sinusitis. An odontogenic source should be considered in patients with symptoms of maxillary sinusitis who give a history positive for odontogenic infection or dentoalveolar surgery or who are resistant to standard sinusitis therapy. Diagnosis usually requires a thorough dental and clinical evaluation with appropriate radiographs. Common causes of odontogenic sinusitis include dental abscesses and periodontal disease perforating the Schneidarian membrane, sinus perforations during tooth extraction, or irritation and secondary infection caused by intra-antral foreign bodies. The typical odontogenic infection is now considered to be a mixed aerobic-anaerobic infection, with the latter outnumbering the aerobic species involved. Most common organisms include anaerobic streptococci, Bacteroides, Proteus, and Coliform bacilli. Typical treatment of atraumatic odontogenic sinusitis is a 3- to 4- week trial of antibiotic therapy with adequate oral and sinus flora coverage. When indicated, surgical removal of the offending odontogenic foreign body (primary or delayed) or treatment of the odontogenic pathologic conditions combined with medical therapy is usually sufficient to cause resolution of symptoms. If an oroantral communication is suspected, prompt surgical management is recommended to reduce the likelihood of causing chronic sinus disease.

Dental and oral lesions in HIV infected patients: a study in Brazil

AIM

To determine the prevalence of dental and oral lesions, as well as treatment need, in a group of HIV sero-positive Brazilians. In addition, to test the association between oral manifestation of HIV infection and age, sex, mode of transmission and drug therapy.

METHOD

All HIV seropositive patients attending a dedicated dental clinic in Recife were invited to participate in the study. They were all examined by one trained and calibrated examiner and interviewed by one trained interviewer.

RESULTS

161 of 204 patients (78.9%) agreed to participate in this study. Most of the participants were male (76%), had acquired HIV sexually (74.5%), and were taking some form of antiretroviral therapy (70.8%). 33.5% had one or more oral manifestation of HIV. Candidiasis was the most common (28.6%), followed by hairy leukoplakia (9.3%), Kaposi sarcoma (2.5%), ulceration (2.5%), herpes simplex (1.2%), papiloma (0.6%), and 4.4% had periodontal disease. Only 1.2% reported xerostomia. There were no differences in the prevalence of oral manifestations of HIV infection between age groups, sexes, modes of transmission and types of drug therapy (P>0.05). The mean DMF-T score was 19 (SD 8) and 78.9% needed some form of dental treatment.

CONCLUSIONS

While the prevalence of oral manifestations of HIV/AIDS was low in this sample of HIV seropositive Brazilians, dental status was poor and need for dental treatment was high.

[Prevalence of dental anxiety in 144 patients with cardiovascular diseases before tooth extraction]

OBJECTIVE

To determine the prevalence of dental anxiety (DA) in patients with cardiovascular diseases before tooth extraction so as to provide psychotherapy.

METHODS

144 patients with cardiovascular diseases were asked to complete a questionnaire modified from Corah Dental Anxiety Scale (DAS) while awaiting for tooth extraction.

RESULTS

The incidence rate of DA in these patients was 7.6%. Anxiety level on anesthesia procedure was the highest. DAS score was higher among patients with the following factors: inactive perception, female, below 60 years old, experiences of painful tooth extraction, a documented history of single cardiovascular disease, under ECG monitoring for the first time and complicated tooth extraction.

CONCLUSION

DA existed in patients with cardiovascular diseases before tooth extraction and was related to many factors. Medical staff should take necessary measures to provide them with psychotherapy and nursing guidance before tooth extraction.

Oral health condition and saliva flow in southern Chinese with Sjögren’s syndrome

OBJECTIVE

To investigate the oral health condition and saliva flow of southern Chinese patients with Sjögren's syndrome (SS).

METHOD

51 SS patients (26 primary and 25 secondary cases) and 29 controls took part in this cross-sectional study. Stimulated whole and parotid saliva flow rates, pH, and buffer capacity, and xerostomia, oral mucosal lesions, oral hygiene status, dental and periodontal conditions, prosthetic status were assessed and compared between groups.

RESULTS

Stimulated whole saliva (SWS) flow was reduced in primary and secondary SS cases (p<0.001), pH and buffer capacity were also reduced in the primary SS group (p<0.05). SS patients had a greater prevalence of xerostomia than controls (p<0.001). Primary SS patients had a higher mean DMFT, more missing teeth, and more prostheses than secondary SS cases and controls (p<0.05). SWS flow correlated negatively with the number of filled teeth in both SS groups (p<0.05) and the number of decayed teeth in the primary SS group (p<0.05).

CONCLUSION

Despite good oral hygiene and regular dental check-ups, the oral health of southern Chinese with primary SS was significantly compromised compared with secondary SS cases and controls, most probably due to the combined effect of impaired salivary gland function and poorer saliva buffer capacity.

Leprosy: dental and periodontal status of the anterior maxilla in 76 patients

OBJECTIVE

To evaluate the presence of oral disease, as assessed by dental and periodontal indices, in the anterior maxilla of a group of 76 patients with leprosy, compared with a group of matched control subjects.

MATERIALS AND METHODS

The study included 76 patients with leprosy (age range 40-82 years; 39 males), resident in the sanatorium of San Francisco de Borja de Fontilles (Alicante, Spain). Clinical examination was carried out to evaluate the decayed missing and filled index, and the periodontal status in the anterior maxilla, using the Löe-Silness dental plaque index, mean periodontal probing depth and the average periodontal attachment loss.

RESULTS

In the leprosy patients, a large proportion of maxillary incisors and canines were missing. The mean plaque index in leprosy was 2.35 +/- 0.7, with a probing depth of 2.96 +/- 0.8, and an average attachment loss of 4.18 +/- 1.3, indices all statistically greater than in controls. There were no differences detected in the oral indices measured according to the presence or absence of facial destruction or the type of leprosy.

CONCLUSIONS

Patients with leprosy show a tendency to poor dental and periodontal health, unrelated to the presence of facial destruction or the type of leprosy.

Poor oral health is associated with coronary heart disease and elevated systemic inflammatory and haemostatic factors

OBJECTIVES

To assess the relationship between poor oral health and coronary heart disease (CHD) and systemic inflammatory and haemostatic factors in an Italian population.

MATERIAL AND METHODS

The study population consisted of 63 males aged 40-65 years with proven CHD and 50 controls matched for age, geographic area, and socioeconomic status. A detailed description of their oral status was given using four different dental indices (total dental index (TDI), panoramic tomography score, clinical periodontal sum score (CPSS), and clinical and radiographic sum score (CRSS)). Blood samples were taken for measurement of the following CHD risk factors: serum total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and glucose; a series of systemic markers of inflammation (C-reactive protein, leucocytes, fibrinogen, homocysteine) and a series of haemostatic factors (von Willebrand factor, fibrin D-dimer, prothrombinic fragment F1.2, plasminogen activator inhibitor type I (PAI-1), and serum antibodies) against oxidized LDL (anti-Ox-LDL).

RESULTS

Multiple logistic regression adjusted for all risk factors for CHD showed statistically significant relationships (p<0.01) between all dental indices and CHD. Significant relationships (p always <0.01) were found between CPSS and CRSS and leucocyte count. Significant relationships (p always <0.05) were also found between TDI and the von Willebrand factor, and between CPSS and the von Willebrand factor, anti-Ox-LDL, and PAI-1.

CONCLUSIONS

The present study suggests an association between poor oral status and CHD, and provides evidence that inflammatory and haemostatic factors could play an important role in this association.

The dental management of adult patients with haemophilia and other congenital bleeding disorders

The management of adult dental patients with congenital bleeding disorders has caused a considerable number of problems to the dental profession. There is a need to simplify the process and identify what can be safely carried out on a 'shared care' basis in General Dental Practice or the Community Dental Service. Particular problems are discussed with special reference to those requiring hospital care. The Scottish Oral Health Group for Medically Compromised Patients has developed this clinical guidance in conjunction with the Scottish Haemophilia Directors. It is important that dental care is easily available for this group of patients, especially those living at some distance from the regional centres. The aim is to simplify planning dental care for this group of patients and remove a number of myths concerning their management. The hospital departments, both medical and dental, must be available for advice and to arrange for treatment that is inappropriate outside a specialist hospital.

[Osteoplastic repair of perforations in combined treatment of patients with odontogenic maxillary sinusitis]

A method for osteoplastic repair of perforations of the maxillary sinus bottom using MK-9M glue composition was used in 31 patients. Morphological analysis of a life-time biopsy specimen obtained during re-operation was carried out. The method is recommended for the treatment of perforative maxillary sinusitis.

Detection of localized tooth-related factors that predispose to periodontal infections

The primary goal of periodontal therapy is to produce an environment that is conducive to oral health. This is achieved by eliminating the subgingival infection and implementing supragingival plaque control measures designed to prevent the re-colonization of the sulcus. Local etiologic factors, as described above, my prevent the removal of subgingival plaque, and may even contribute to destruction of the periodontal tissues. Thus, it is crucial to be able to recognize and, when possible, eliminate any plaque-retentive factor that could contribute to disease progression. Iatrogenic factors such as subgingival margins, restorative overhangs, overcontoured restorations and unpolished surfaces can be altered. Similarly, cervical enamel projections, enamel pearls and, in certain instances, palatal grooves can be removed or recontoured to enable the patient to access the area for good plaque control. There are some things that we cannot alter. Anatomic anomalies, particularly in posterior teeth, cannot be changed. However, awareness of potential anatomic variations and early detection of them may be able to prevent future attachment loss.

Oral diseases and conditions throughout the lifespan. I. Diseases and conditions directly associated with tooth loss

This is the first of two articles providing an overall view of oral diseases and conditions, taking the oral cavity and its organs and tissues as integrated parts of the human body. This article provides an overview of three oral diseases and conditions that are associated directly with loss of tooth structure or loss of teeth and reviews their risk factors and preventive and treatment interventions. Two of these conditions, dental caries and periodontal diseases (or their sequelae), remain the main cause of tooth loss in the U.S. Prevention, treatment, and control of these diseases require many hours of training during dental education and many hours of treatment in dental practice. The profession has fragmented into specialties based on diseases; as a result, many dentists fail to see them as integral elements of the human experience. As primary care specialists, dentists must be reminded that they need to make prevention the first choice, provide the best treatment possible based on available scientific evidence, and keep informed of new advances in research while always remembering that the oral cavity is an integral part of the human body. The changes and trends observed in the epidemiology of oral diseases will demand new skills in our dental graduates. Future dental graduates may achieve a solid understanding of oral diseases at both the biological and population level by using oral tissues and saliva to diagnose systemic diseases, relying on medical facilities to order laboratory tests, and diagnosing and treating patients in close collaboration with their medical colleagues.

Oral Health Conditions in Patients with Parkinson's Disease

BACKGROUND: Oral health conditions and related factors of patients with Parkinson’s disease (PD) have not been well elucidated. The aim of the present study was to investigate oral health conditions and related factors which may influence oral health conditions among patients with PD.

METHODS: We compared oral health conditions and related factors between 104 PD patients and 191 inhibitants (controls) who received dental health check-ups in Hokkiado, Japan. The unconditional logistic regression model was used for adjusting for sex and age. We also conducted stratified analysis by sex and age group using this model. The χ² test and the Cochran-Mantel-Haenzel test were used for simple and stratified analyses of knowledge of oral health among PD patients, respectively.

RESULTS: In the present survey, we found the following results. (1) PD patients had more complaints of chewing difficulties and denture discomfort than controls. (2) Fewer PD patients had their own teeth than controls regardless of sex. (3) Fewer PD patients cleaned their dentures every day than controls, regardless of sex or age. (4) More than half of the PD patients had problems with swallowing.

CONCLUSION: We found that PD patients had more complaints about their oral health and more problems in oral health behavior than the general population. These findings may provide useful information for the caregivers of PD patients to conduct oral health care as well as for making oral health plans for PD patients and for medical and welfare services.

[The role of scintigraphy in the diagnosis of mandibular bone changes]

Investigating the scintigraphic images of jaws may have a diagnostic value of bone alterations of dental origin. Anterior view of whole body bone scintigraphy revealed hot spot on jaws of 61% (279) of patients. Twenty-six patients (mean age 58.3 year) from all of those who had increased tracer uptake (ITU) in the maxillo-mandibular region were called back for dental examination. 279 out of 459 (61%) patients had ITU in the maxillo-mandibular region. Dental examination revealed the dental origin of ITU in all cases. In case of periapical pathosis tracer uptake showed 28.79% increase compared to the contralateral side. In marginal periodontitis 23.82% ITU was found. In case of loading due to prosthesis 13.06% ITU was observed. The mean DMF-T value was 26.36 +/- 4.52 (D = 4.12, M = 20.8, F = 1.44). The prosthetic index was 0.42 on the mandible. The above mentioned data mean very low oral health conditions of the patients included in this examination. The results show that bone scintigraphy is a valuable procedure in detecting tooth related jaw lesions. Bone scintigraphy provides very useful data on oral health of these patients. Enrolling of these patients into regular dental care is inevitable.

Dental infections and serum inflammatory markers in patients with and without severe heart disease

OBJECTIVE

The objective of this study was to investigate if patients with severe heart disease (CHD patients) present more signs of dental infections than patients without heart disease (non-CHD patients), if serum inflammatory markers differ between the groups, and if there is a link between these and the oral health parameters.

METHODS

We performed clinical and radiologic dental examinations and collected serum samples of 256 patients with New York Heart Association class II-IV heart disease (CHD patients) and 250 non-CHD controls. Serum samples were analysed using pertinent methods in the clinical laboratory of the hospital, and the differences in serum biomarkers between CHD patients and non-CHD patients were examined using various statistical methods. A modified dental index (MDI) was constructed and used in the analyses.

RESULTS

CHD patients were significantly more likely to be edentulous (34.8% vs. 14.8%) and retain less natural teeth than non-CHD patients (8.6 vs. 17) (P <.001). In CHD patients the remaining teeth and supporting tissues were more often diseased. High MDI scores were significantly associated with CHD status (OR 1.31, CI 1.16-1.48), as was gingivitis (OR 3.37, CI 1.66-6.86), while the presence of deep periodontal pockets was not. Serum C-reactive protein and fibrinogen concentrations and blood erythrocyte sedimentation rates were higher in the CHD group. Also, H. pylori and Chlamydia antibodies were significantly higher in the CHD group.

CONCLUSION

CHD patients presented with poorer oral health status than non-CHD patients. Serum inflammatory markers were significantly higher in the CHD patients compared to the non-CHD group. High MDI scores linked with risk of CHD.

[Bacteriological findings for endodontical and apical molar dental diseases in the horse]

In most cases the diagnosis of any molar dental disease in horses is made at an advanced stage, so that permanent restoration of the diseased teeth is not feasible. Complications such as bacteraemia and septicaemia due to infections as a result of dentogenous sinusitis and following dentosurgical procedures have been described in human medicine and in veterinary medicine. Twenty patients were available for examination from the Clinic for Horses of the School of Veterinary Medicine Hannover with molar dental disease in upper or lower jaw. As a result of this disease the infected tooth had to be removed surgically. The aim of this study was to determine the presence of and to identify microbes in 20 patients. Swab samples were taken from infected pulpa, from dental abscesses and from involved nasal sinuses. The samples were examined microbiologically and tested for aerobes and anaerobes at the same time. Infectious agents were found in 19 of 20 horses. In all, 27 different species of infectious agents were isolated, including both aerobic and anaerobic microbes. Fifteen patients (75%) showed a mixed flora. Further differentiation indicated a preponderance of the group of gram-negative obligatory anaerobic agents isolated from a total of 17 horses. In all these samples there was a high concentration of infectious agents of these genera, the most common of which were Prevotella spp (n = 16) and Fusobacterium spp. (n = 15). Pre-surgical antibacterial therapy is recommended to reduce the risk of intra- and/or post-surgical bacteraemia and its serious consequences. In light of these microbiological results and considering the high degree of resistance among all anaerobic microbes, all patients in this study were treated with Amoxicillin.

[Clinical laboratory characteristics, diagnosis, and treatment of acute odontogenic maxillary sinusitis]

Clinical laboratory characteristics of acute odontogenic maxillary sinusitis are presented. All the patients (n = 132) were examined in accordance with a special diagnostic protocol. Two variants of acute inflammatory process were distinguished: serous and destructive. Conservative and surgical methods of treatment are suggested, depending on the disease pattern and complications. The treatment efficiency is compared to the results of traditional treatment.

[Partsch's chronic granulomatous inflammation, the cutaneous manifestation of a dental cause]

Dentogenous inflammatory diseases can lead to typical dermatological facial symptoms with formation of cutaneous sinuses. Partsch's chronic granulomatous inflammation can result from conducted inflammation of a nonvital tooth via a chronic apical inflammation. In this rare disease, the granulomatous tissue perforates the bone, channels through the overlying skin, and drains via cutaneous or oral sinuses. A frequent localization of the cutaneous sinus is the skin inferior to the body of the mandible, and it is caused by an inflammation of the lower molars. Treatment consists of identifying the responsible teeth and eliminating the focus of infection. Chronically progressive periradicular granuloma and/or radicular cysts can be present with impressive dermatological symptoms. Therefore, X-ray examinations are necessary to exclude possible dentogenic causes in cases of badly healing processes of the face or neck.

[Video-assisted endoscopic sinus revision for treatment of chronic, unilateral odontogenic maxillary sinusitis]

BACKGROUND

The proportion of dental causes of maxillary sinusitis is estimated between 10% and 40%. The mechanisms are manifold and originate from the close relation of the side teeth and the maxillary sinus. In the past, the transantral approach was commonly used by maxillofacial surgeons as their first choice.

PATIENTS AND METHODS

Between 01/1999 and 10/2001 38 patients underwent endoscopic surgery controlled via the fossa canina. Apart from the mandatory treatment of the dental focus and the mucosal pathologies, a fenestration to the middle meatus of the nose was performed in 7 cases.

RESULTS AND CONCLUSION

The dental medical history, OPG, CT scans in coronary plane, endoscopic findings, and histology showed the commonly "silent" course of dental sinusitis. Typical findings in CT scans are unilateral basal maxillary opacities adjacent to the molar and premolar teeth. In 20% of the cases there was also a blockade of the infundibulum. All patients were reexamined 6-12 months postoperatively. The patients are free of symptoms, but sometimes suffer from headaches. An exact diagnosis and the clear separation of rhinogenic causes are vital points for the therapy of dental sinusitis. In cases of unilateral sinusitis, a comprehensive investigation by the maxillofacial surgeon should be recommended. Video-assisted endoscopic sinus revision is preferable to the transantral approach and is especially suitable for the treatment of mucosal retention cysts, the removal of foreign bodies, endoscopically controlled resections of apical roots, elevations of the sinus floor, and dental implants. If the ethmoidal infundibulum and maxillary ostium are open, no fenestration is needed. In cases of blockade, fenestration to the middle nose canal is indicated.

Healing of maxillary sinusitis of odontogenic origin following conservative endodontic retreatment: case reports

Because of the anatomical proximity, infection of posterior upper teeth can spread into the maxillary sinus. When confronted with a large persistent periapical lesion on a posterior maxillary root-treated tooth, the practitioner should question the quality of the previous endodontic treatment, evaluate the impact of the potential causes of failure and consider, in the majority of cases, the conservative non-surgical retreatment instead of extraction or periapical surgery of the dental element. This paper reports two cases of healing of extensive periapical bone destruction and of the co-existing sinus pathology of odontogenic origin after non-surgical endodontic retreatment of previously root-treated upper molars. Misconceptions concerning the role of epithelium in the periapical lesion are discussed. Also, emphasis is put on the need of precise radiological diagnosis, pre-operatively as well as post-operatively to ascertain healing and to avoid unnecessary delay in the appropriate management of these patients.