Allergic stomatitis caused by self-polymerizing resin

This is a fully documented case, including biopsy and patch testing, of a patient who was hypersensitive to self-polymerizing polymethyl methacrylate. On two occasions, a 24-year-old woman with a history of multiple allergies developed allergic reactions to temporary acrylic dental restorations. The lesions disappeared upon removal of the restorations. Microscopic findings were consistent with an allergic reaction. Patch testing confirmed that the allergen was the monomer and indicated methods of processing the self-polymerizing resin to allow it to become essentially nonreactive in a sensitized patient.

Prevalence and intraoral distribution of coronal and root caries in middle-aged and older adults

This work describes the prevalence and intraoral distribution of coronal and root caries in 326 predominantly white, educated, middle-aged and older adults. Study participants were recruited from Tufts Geriatric Outreach Program, Nutritional Status Study (NSS), and the Forsyth Root Caries Study. Eighty-five percent of participants reported visiting their dentist in the last year. The median number of teeth was 21 in the 65+ age-group, and 40% of participants had coronal caries and 33% had root carious lesions. The mean coronal and root caries (DFS) was higher and the proportion of decayed surfaces to all decayed and filled surfaces (%D/DFS) was lower than in other comparable studies. A comparative analysis of intraoral distribution of coronal and root caries and their relation with age is discussed.

Root caries incidence and associated risk factors in middle-aged and older adults

Data from population-based longitudinal studies required to assess the incidence of root caries and associated risk factors are sparse in the literature. To this end, a group of 130 middle-aged and older adults were examined for root caries at baseline and at a follow-up visit between nine and 24 months (median: 16 months). Dental examinations were conducted by one examiner at a Tufts dental clinic using NIDR defined diagnostic criteria. Fifty percent of subjects in this study population developed one or more new root caries lesions over the follow-up period. Also, an annualised increment of 0.60 (SD: 0.72) decayed and filled surfaces per person was observed for the 45-59 year old group while the 70+ group showed an annualised increment of 1.38 (SD: 1.97) DFS in this study. Multivariate logistic regression analysis identified past root caries experience, high plaque score, and high number of teeth (> = 22) to be positively associated with new root caries (p < 0.05).

NECROTIZING SIALOMETAPLASIA

Nonhealing palatal ulcerations in two white male patients, one 50 and another 58 years of age, were clinically suspected of being malignant, even after the initial biopsies were negative. Second biopsies in each case confirmed the original opinions, but the lesions were diagnosed specifically as "necrotizing sialometaplasia". This is an interesting condition of uncertain etiology that can mimic cancer, both clinically and microscopically. The condition heals spontaneously. It should be considered in a differential diagnosis of suspicious lesions of the palate.

Artificial Pancreas: Clinical Study in Latin America Without Premeal Insulin Boluses

BACKGROUND

Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial.

METHODS

A 36-hour pilot study was performed on five T1DM subjects to validate the ARG algorithm. Subjects wore a subcutaneous continuous glucose monitor (CGM) and an insulin pump. Insulin delivery was solely commanded by the ARG algorithm, without premeal insulin boluses. This was the first clinical trial in Latin America to validate an AP controller.

RESULTS

For the total 36-hour period, results were as follows: average time of CGM readings in range 70-250 mg/dl: 88.6%, in range 70-180 mg/dl: 74.7%, <70 mg/dl: 5.8%, and <50 mg/dl: 0.8%. Results improved analyzing the final 15-hour period of this trial. In that case, the time spent in range was 70-250 mg/dl: 94.7%, in range 70-180 mg/dl: 82.6%, <70 mg/dl: 4.1%, and <50 mg/dl: 0.2%. During the last night the time spent in range was 70-250 mg/dl: 95%, in range 70-180 mg/dl: 87.7%, <70 mg/dl: 5.0%, and <50 mg/dl: 0.0%. No severe hypoglycemia occurred. No serious adverse events were reported.

CONCLUSIONS

The ARG algorithm was successfully validated in a pilot clinical trial, encouraging further tests with a larger number of patients and in outpatient settings.

Postanesthetic necrotic defect

An unusual defect was noted in a 10-year-old girl near the usual site of administration for an inferior nerve block. It was interpreted to be the result of a local anesthetic having been administered 2 months previously.

Oral scleral heterografts. A pilot study

This study showed that scleral heterografts in the oral cavity work. Such grafts demonstrate the following characteristics: (1) attach firmly to submucosal, periosteal, and bony tissues; (2) remain firm and fibrotic in nature, indicating the possibility of a stressbearing tissue; (3) show little or no scarring or contracture; (4) show minimal, or no- host antigenic response based on clinical acceptance; (5) appear to become vascularized and cellular, blending with adjacent collagen. As projected by this study, scleral heterografts might well be used to obliterate bony undercuts and perhaps to obtund cystic cavities and other major bony defects. Further studies of layering of the sclera are essential before any definitive result can be determined in large bony defects. In those areas in which no bone regeneration would be feasible, such as in the mylohyoid region of the mandible, this application does present a possibility for removing undercuts as opposed to removing overlying bone. The tenacity of adherence to submucosal tissues, periosteum, and bone makes scleral heterografting even more intriguing in the possible obliteration of oroantral fistulas. We might theorize that the sclera would not only attach to the buccal and palatal flaps but also show a rather firm and tenacious adherence to the bony walls of the antral defect. The availability of human bank sclera for use as presently made by periodontists and as pioneered by Klingsberg is somewhat limited. From our study, an extrapolation would indicate that, because of the comparably low and antigenicity of bovine sclera and human sclera, an investigation in this area should be completed in order to determine whether scleral heterografts can replace scleral homografts in human periodontal surgery. Sclera is easily preserved in anhydrous glycerine (as preserved by King and associates19) and can certainly be stored in banks. In our opinion, the final application of scleral heterografts, human or bovine, the role of antigenicity, and the ability of osteoblasts to invade either a single piece or layers of sclera warrant further study.

Intraoral-mucosal-xenogenous fascial grafting

Fascia obtained from the abdominal wall of a rat was transplanted into mucosal defects created in six dogs. In all of the dogs, the fascia was found to adhere firmly to the underlying tissue and surrounding epithelium. Biopsy specimens were taken at weekly intervals for 4 weeks. The defects healed without any apparent contracture and were covered by new epithelium. It appears that xenogenous fascia is a potentially useful graft material for intraoral soft tissues.

A case of a central odontogenic fibroma presenting a differential diagnostic problem

Central odontogenic fibromas are rare benign tumors. We are presenting a case of a 67-year-old female with a central odontogenic fibroma which posed considerable difficulty in microscopic interpretation. The differential diagnosis ranged from metastatic carcinoma to a benign odontogenic neoplasm. The final diagnosis was made through persisting on multiple pathologic consultations, which allowed for conservative rather than aggressive surgery. Follow-up evaluation has confirmed the benign diagnosis.

Evaluation of plasma cortisol during fasting test in patients with endogenous hyperinsulinemic hypoglycemia. Fifteen years experience

BACKGROUND

Endogenous hyperinsulinemic hypoglycemia (EHH) is a rare clinical condition. The aim of this study was to evaluate baseline plasma cortisol concentration and its concentration during hypoglycemic crisis in fasting tests (FT) performed in our center. Secondarily, the aim was to establish the relationship between baseline cortisol and the time of evolution of EHH.

MATERIAL AND METHODS

A retrospective, observational, descriptive study was carried out which included patients with hypoglycemic disorder with positive FT.

RESULTS

Of a total of 21 patients, 16 presented insulinoma, 1 nesidioblastosis, 2 malignant insulinoma and 2 EHH without pathological diagnosis. The time from the onset of symptoms to diagnosis was 2 years (Q1=1.5-Q2=5.5). The comparison between median baseline cortisol (BC)=11.8 mcg/dl (nmol/L 340.68) (Q1=9-Q3=14.1) and median cortisol during hypoglycemic episode (HC)=11.6 mcg/dl (nmol/L: 303.44) (Q1=7.8-Q3=16.1) showed no differences (Z=-0.08; P>.05). When correlating BC with HC, no significant relationship was observed (r=0.16; P>.05). When correlating the glycemic value in the crisis and the HC, a slight negative trend was found (r=-0.53; P=.01). In addition, we found that recurrent hypoglycemic disorder is associated with lower baseline cortisol values ​​the longer the time of its evolution.

CONCLUSION

We confirmed that cortisol values ​​remain low during hypoglycemic episodes, reinforcing the hypothesis of lack of response of this counterregulatory hormone in cases of recurrent hypoglycemia.