Spread of odontogenic infection originating in the maxillary teeth: computerized tomographic assessment

OBJECTIVE

The aim of this study was to investigate the pathways of infection originating in the maxillary teeth through the interpretation of computerized tomographic (CT) appearances.

STUDY DESIGN

CT images of 78 patients were analyzed with reference to lateral asymmetry of shape and density of fascial spaces and tissues.

RESULTS

Changes in the alveolar cortical plates were observed more frequently in the labial/buccal side than in the palatal side. The facial expression muscles were involved in 23 (19.4%) patients. Infection caused by anterior teeth often spread into the levator labii superioris and levator anguli oris muscles. Deep spread into the fascial space was found in 9 (11.5%) patients. Masticator space changes were predominantly seen in the patients with infection caused by molars. Maxillary sinus changes were found in 57 (71.3%) patients with infection originating in the canines, premolars and molars.

CONCLUSION

Infection spread characteristics are related to the causal teeth, and the pathways were clearly demonstrated on CT images.

Dental diseases and radionuclide imaging of the jaws

The aim of this study was to compare the results of radionuclide bone scans of the jaws with data obtained at the nuclear medicine department from a brief and feasible dental history, taking special account of cases with a positive scan and no recent dental events. Ninety-eight patients undergoing radionuclide bone scan as part of their diagnosis in non-dental, oncological and non-oncological diseases were imaged with 99mTc-labelled oxidronate. Superior and inferior halves of the mandible and maxilla (392 quadrants) were regarded as normal or having an abnormally high uptake. A recent (1 year) dental history was also obtained through a brief questionnaire and data were referred to each quadrant of the jaws. The association between the bone scan and dental disease was assessed by means of the chi-squared test. The overall results of scintigraphy and history coincided in 66 patients (46 with abnormal and 20 with normal findings; P = 0.002). Twenty-five patients had a positive scintigram without any known dental disorder. Results of scintigraphy and history coincided in 254 quadrants (78 with abnormal and 176 with normal findings; P < 0.001). Eighty-three quadrants had hot spots in the scintigram without any known dental lesion. It can be concluded that abnormal jaw scintigrams are frequent in patients without known dental disease, and this may indicate silent osteoblastic activity. These observations should be reported to the dentist for several reasons. First, they may reveal asymptomatic dental lesions. Second, the use of oral prostheses and implants is increasing and they require the support of healthy alveolar bone.

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.

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.

Strahlenexposition und dreidimensionale Darstellungsm�glichkeiten des SIREMOBIL Iso-C3D zur Planung chirurgischer Zahnsanierungen

BACKGROUND

Preoperative dental X-ray diagnostics of multimorbid, non compliant patients requiring dental surgery are often insufficient. The SIREMOBIL Iso-C(3D) has made intraoperative 3D imaging available, even for the facial skeleton. This modality was used intraoperatively in two patients referred for surgical dental treatment. Furthermore, radiation exposure of the SIREMOBIL Iso-C(3D), an orthopantomography and a complete dental status was compared.

MATERIAL AND METHODS

An Alderson-Rando phantom was exposed to ten cycles of the SIREMOBIL Iso-C(3D) using the fast mode (50 projections). In comparison 28 panoramic views of an Orthophos and 10 sets of 14 dental images using the Oralix DC with a quadrate mask were applied. Twenty-five anatomically defined TLD positions were analyzed. Furthermore, SIREMOBIL Iso-C(3D) was used in one patient by performing 100 projections and in a second patient by performing 50 projections. After DICOM-import in eFilm, axial, coronal, and sagittal reconstructions were evaluated by five examiners regarding defined criteria.

RESULTS

The radiation exposure level of the SIREMOBIL Iso-C(3D) was lower than in the complete dental status and only slightly higher in comparison with the orthopantomography, although the system requires the highest number of single projections. Quantitative evaluation of the visualization and recognition of defined structures proved to be very good and good in most points. However, limitations of the system became obvious regarding apical processes.

CONCLUSION

Because of the dosimetry results and the visualization of the relevant structures, in patients for whom preoperative images cannot sufficiently be performed, the intraoperative use of the SIREMOBIL Iso-C(3D) as a base examination is justified.

Optimisation of conditions of visualisation of dental crowns in dental radiography

Digital X-ray imaging systems are an alternative to conventional intraoral radiograms. In the paper there are discussed the possibilities of application of different digital radiography tools as well as density measurements in optimization of diagnostics of pathological lesions of teeth crowns. There were analyzed 1,491 digital intraoral radiograms obtained in 985 patients in the Digora Soredex digital radiography system. On all taken X-ray pictures there were evaluated the crowns of teeth in cases of primary and secondary caries, dental fillings, internal resorption, traumatic lesions of incisors as well as the relationships between deep carietic lesions and pulp horns as well as root furcation. An attempt was made to assess the possibilities of differentiation of cervical caries and cervical burn-out. In the paper there were presented the optimal options of digital radiography software in diagnostics of the discussed pathological lesions.

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.

CT features of alveolitis and sinusitis in horses

Sinusitis is a common disorder in horses and may result from trauma, dental diseases, or space-occupying lesions. Radiography can only provide a limited amount of information. Computed tomography (CT) has been documented as an alternative imaging method. Eighteen horses (mostly Warmblood) with signs of chronic sinusitis were examined preoperatively with CT to assist in diagnosis of the underlying cause. There was a group of common CT features in horses with dental disease and sinusitis. The first molar was the most frequently affected maxillary cheek tooth. Hypoattenuation of the cementum, destruction of the enamel, and filling of the infundibular cavity with gas were the most frequent CT findings associated with caries. Gas bubbles within the bulging root area or fragmentation of the root in combination with swelling of the adjacent sinus lining were the most important CT features of dental decay. CT findings associated with sinusitis included excessive thickening of the respiratory epithelium in the rostral maxillary sinus; the caudal maxillary sinus was less often involved. The infraorbital canal, the nasomaxillary duct, and the frontomaxillary aperture were usually involved. The maxillary bone, however, especially the facial crest, was involved in nearly every horse, being characterized by endosteal sclerosis, thickening, periosteal reaction, and deformation leading to facial swelling in chronic infections. CT images allowed identification of involvement of individual teeth more clearly to reveal the diseased one for treatment. Three-dimensional imaging allowed improved understanding of the extent and severity of the pathologic change.

[Magnetic resonance tomography, angiography, and spectroscopy in acute odontogenic inflammatory diseases]

Magnetic resonance characteristics of a focus of an acute odontogenic inflammation were determined. Clear-cut characteristics of signals in various scanning modes were obtained by magnetic resonance tomo- and angiography and the potentialities of imaging the structures adjacent to the focus of odontogenic inflammation were determined. Changes in the biochemical composition of focus of inflammation in disease of different severity were determined by magnetic resonance spectroscopy and autodiffusion of water molecules. Practical recommendations on the use of nuclear magnetic resonance for the diagnosis of perimaxillary odontogenic inflammations are offered.

Outcomes of digital X-ray mini-panel examinations for patients having mental retardation and developmental disability

OBJECTIVES

Severely and profoundly mentally retarded and developmentally disabled (MR/DD) patients are unable to communicate disease symptoms, and radiographic examinations are often difficult to perform on non-sedated patients. This clinical trial evaluated the impact on dental treatment planning of radiographic mini-panels for MR/DD patients.

METHODS

With Institutional Review Board approval and informed consent of the legal guardian of each patient, a digital series of six periapical radiographs was achieved without sedation on 72 MR/DD inpatients (the survey was attempted on 74 patients).

RESULTS

The average number of teeth included in each mini-panel was 20.4 compared with 22.2 teeth found clinically and 22.7 teeth determined combining both clinical and radiographic findings. Individual mini-panel images were judged technically excellent in 65% of cases, diagnostically satisfactory in 26% of cases and suboptimal in 9%. The radiographic panels were judged to affect treatment planning for more than 60% of the patients included in the trial. In 32% the detected condition was one or more periapical radiolucency. Several radiographic findings indicated potentially painful conditions that perhaps explained patient actions previously attributed to behavioural problems. Potential sources of dental pain and sepsis were treated by endodontic therapy or dental extractions on a case-by-case basis with or without general anesthesia. The trial also demonstrated a need that has translated into increased state allocations for dental treatment of MR/DD patients resident in the Commonwealth of Kentucky.

CONCLUSIONS

Dental inspections of MR/DD patients are incomplete if radiographs are excluded. Whilst the mini-panel approach could be considered incomplete, it is better than no radiographs at all. 91% of images were excellent to satisfactory in diagnostic quality and a majority of patients' treatments were modified because of the radiographic information.

Oral and clinical characteristics of a group of patients with Turner syndrome

OBJECTIVE

The loss of the X chromosome in girls with Turner syndrome (TS) affects the shape and the size of craniofacial structures. Few studies have been reported on female patients with TS in South America. Records of odontologic alterations of 23 Argentinian patients with TS were compared with those of 25 girls in a control group, and associations were made with medical indications.

STUDY DESIGN

Oral clinical diagnoses were completed with periapical, occlusal, panoramic, and orthopantomograms; urine and blood determinations were performed by conventional methods.

RESULTS

Blood phosphorus and calcium levels were altered, and osteoporosis was detected. In some patients, TS was associated with autoimmune thyroiditis. Control subjects had normal blood and urine values. The decayed, missing, and filled permanent surfaces index for temporary teeth was statistically higher for the control group. About 78% of the patients had hypoplasia, 65% had reduced root length and bifurcated roots, and 100% had high arch palate. Incisor asymmetry was also observed.

CONCLUSIONS

Medical and laboratory indexes are essentially indicative of hormone alterations. TS patients have a particular oral anatomy that could be closely related to an alteration in calcium and phosphorus metabolism.

Routine panoramic radiography of new adult patients in general dental practice: relevance of diagnostic yield to treatment and identification of radiographic selection criteria

OBJECTIVES

We sought to measure the diagnostic yield of relevance to treatment on routine panoramic radiographs taken of new adult (ie, 18 years and over) patients in general dental practice.

STUDY DESIGN

Routine panoramic radiographs (n = 1817) obtained from general dental practice were assessed and radiologic yield recorded using consensus viewing by 2 dental radiologists. A modified diagnostic yield of relevance to treatment for each radiograph was calculated by omission of findings that would have been identified on bilateral posterior bitewing radiographs and of radiologic findings of no relevance to treatment. Stepwise logistic regression analysis was used in attempt to identify clinical indicators of a high diagnostic yield of relevance to treatment.

RESULTS

The diagnostic yield of relevance to treatment was zero for the majority (56%) of patients. This figure rose to 71% when the symptom-free patients were considered. Five clinical indicators for panoramic radiography were identified, as follows: clinical suspicion of teeth with periapical pathologic conditions, presence of partially erupted teeth, clinically evident caries lesions, swelling, and clinically suspected unerupted teeth.

CONCLUSION

Routine panoramic radiography of adult dental patients is not supported by the results of this study. The use of clinical indicators to select patients may help to improve diagnostic yield.

Dental diseases and loss of teeth in a group of Finnish alcoholics: a radiological study

A total of 85 Finnish alcohol-dependent subjects and 53 controls were studied with panoramic radiography. The aim was to study the possible associations between prolonged alcohol consumption and dental health. The mean number of teeth, caries lesions, endodontic treatments, periapical lesions, marginal bone loss, and periodontal infrabony pockets was studied. The subjects met the diagnostic criteria of alcohol dependence as set out in DSM-IV and ICD-10. The control group comprised social drinking volunteers with an AUDIT score < or =8. For the final results the subjects were divided into groups on the basis of sex and age. The social backgrounds of the subjects were similar, except for employment and smoking. The results show significantly fewer teeth and more caries in the alcoholic group. There was a tendency for the alcoholics <45 years of age to have more endodontically treated teeth than the controls, but no difference in the number of periapical lesions in endodontically treated teeth was found. Horizontal bone loss and the presence of calculus were more frequent in alcoholic men than in alcoholic women. Significantly more horizontal bone loss was observed in the group of alcoholic nonsmokers than in nonalcoholic nonsmokers. In the nonsmoking groups alcoholics had significantly more periodontal destruction than the nonsmoking controls. We conclude that radiological dental health among individuals dependent on alcohol is weakened by more caries, more horizontal bone loss, and more numerous vertical infrabony pockets than social drinkers.

Effect of scenario and experience on interpretation of mach bands

The creation of the radiographic illusion known as a mach band at the intersection of two images of differing radiopacities can be misinterpreted as pathosis in certain situations. After reviewing instances where misinterpretation may occur, this study asked 33 fourth-year dental students and 40 dentists to interpret the same radiograph involving a maxillary central incisor under two different hypothetical scenarios: first, in the case of a patient requesting vital bleaching, and second, where a patient has received recent trauma to the mouth. Results showed that dental students are more susceptible than dentists to misinterpreting as a horizontal root fracture (a mach band illusion) what is known to be the junction of alveolar crestal bone and root. Furthermore when presented with a scenario of trauma, both students and dentists are more likely to mistake what is being seen as being a fracture line.

Interdental wiring in jaw fractures: effects on teeth and surrounding tissues after a one-year follow-up

Several authors have suggested that interdental wiring may have an adverse effect on the teeth and surrounding tissues. In the present study we examined 250 teeth that had been subjected to wiring and 142 adjacent teeth that had not been wired (controls). During the wiring period, and after a minimum of 1 year following treatment of the jaw fracture, the teeth and periodontal tissues were examined by periodontal probing, percussion sound test, mobility test, sensitivity test, and radiography. One tooth showed temporary increased mobility. Periodontal health was clinically and radiologically fully restored after a year in all teeth. Progressive caries was seen in 2 patients and was treated. Loss of sensitivity was seen in 3 teeth adjacent to the fracture site and in one tooth adjacent to a titanium cortical screw. However, these pulpal changes either recovered spontaneously or were treated endodontically. There were few late problems in the teeth and surrounding tissues. In 243 teeth (97%), completely healthy conditions were found in pulp and periodontium. There was no evidence of root resorption or dentoalveolar ankylosis. We conclude that late deleterious effects on the teeth and periodontal tissues from interdental wiring in the treatment of jaw fractures were uncommon 1 year after the removal of the interdental wiring.

The use of panoramic radiography in a dental accident and emergency department

OBJECTIVES

To determine the rate of appropriate requests for panoramic radiography (PR) in a Dental Accident and Emergency Department and the implications for patient dose.

METHODS

Two hundred and seventy-one requests for PR during July 1998 were assessed by two dental radiologists and categorised as appropriate or inappropriate based on established selection criteria. Incidental findings that might alter patient management were also noted.

RESULTS

One hundred and fifty-seven requests (58%) were considered appropriate and 114 (42%) inappropriate. The most common inappropriate request was to assess disease localised to one or two teeth. Dental students were involved in 186 requests and 76 of these (41%) were inappropriate. The estimated saving in collective radiation dose over the month of the study if appropriate radiographs had been taken, would have been approximately 540 microSv, a reduction of 70%. Three out of 114 (3%) inappropriate, PRS showed minor incidental findings.

CONCLUSIONS

A considerable proportion of requests for PR were inappropriate. In most of these cases, periapical radiographs would have provided more detail with less radiation dose. The large number of inappropriate requests involving dental students has implications for educators. The use of local selection criteria based on currently accepted guidelines would have reduced the dose substantially.

Delayed tooth eruption associated with an ameloblastic fibro-odontoma

Delayed eruption of a single primary tooth is an uncommon event. Excluding a previous traumatic insult, the presence of a pericoronal odontogenic cyst or neoplasm is the primary cause for this abnormality. This case report describes the clinical and radiographic features of an ameloblastic fibro-odontoma in a young child, who presented with delayed eruption of the primary mandibular canine and prominent buccal expansion. A differential diagnosis for mixed, radiolucent and radiopaque lesions of the jaws will be discussed.