Showing papers in "Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology in 2003"

Meta-analysis of periodontal disease and risk of coronary heart disease and stroke.

Abstract: Objective. The purpose of this study was to analyze published studies and abstracts in order to provide a quantitative summary of periodontal disease as a risk factor for cardiovascular disease and to explore the possible causes for conflicting results in the literature. Study Design. We searched all published literature on the Medline literature search engine since 1980. An additional search was performed with bibliographic citations from each article. Nine cohort studies (8 prospective and 1 retrospective), in which relative risks (RRs), CIs, and P values were reported or could be calculated were included. Four researchers independently extracted RRs, CIs, and P values from each study and evaluated the degree of confounding adjustment. The combined result was calculated with weighted average, and sources of disparity were tested with regression analyses. Results. The summary RR was 1.19 (95% CI, 1.08 1.32), indicating a higher risk of future cardiovascular events in individuals with periodontal disease compared with those without. In an analysis stratified to individuals of ≤65 years of age, the RR was 1.44 (95% CI, 1.20 to 1.73). When the outcome was restricted to stroke only, the RR was 2.85 (95% CI, 1.78 to 4.56). In the metaregression analysis, the effects of residual confounding caused an overestimate of the results by 12.9% and, with a proxy for periodontal disease, caused an underestimate of 29.7%. Conclusion. Periodontal disease appears to be associated with a 19% increase in risk of future cardiovascular disease. This increase in RR is more prominent (44%) in persons aged ≤65 years. Although the increment of risk between subjects with or without periodontal disease in the general population is modest, at around 20% because nearly 40% of population has periodontal disease, this modest increase may have a profound public health impact. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:559-69)

Radiation absorbed in maxillofacial imaging with a new dental computed tomography device.

Abstract: Objective The purpose of this investigation was to measure the tissue-absorbed dose and to calculate the effective dose for the NewTom 9000, a new generation of computed tomographic devices designed specifically for dental applications. Comparisons are made with existing reports on dose measurement and effective dose estimates for panoramic examinations and other computed tomographic imaging modalities for dental implants. Study design Thermoluminescent dosimeters were implanted in a tissue-equivalent humanoid phantom at anatomic sites of interest. Absorbed dose measurements were obtained after single and double exposures. The averaged tissue-absorbed doses were used for the calculation of the whole-body effective dose. Results The effective dose for imaging of maxillomandibular volume with a NewTom 9000 machine is 50.3 μSv. Conclusion The effective dose with the NewTom 9000 machine is significantly less than that achieved with other computed tomographic imaging methods and is within the range of traditional dental imaging modalities.

Cell and tissue reactions to mineral trioxide aggregate and Portland cement.

Abstract: Objective. Mineral trioxide aggregate (MTA) is being widely used for root-end fillings, pulp capping, perforation repairs, and other endodontic procedures. MTA and Portland cement (PC) have many similar physical, chemical, and biologic properties. PC cement has shown promising potential as an endodontic material in several studies in vitro and in vivo. The purpose of this study was to compare the cytotoxic effect in vitro and the tissue reaction of MTA and Portland cement in bone implantation in the mandibles of guinea pigs. Study Design. Millipore culture plate inserts with freshly mixed or set material were placed into the culture plates with already attached L929 cells. After an incubation period of 3 days, the cell morphology and cell counts were studied. Adult male guinea pigs under strict asepsis were anesthetized, during which a submandibular incision was made to expose the symphysis of the mandible. Bilateral bone cavities were prepared and Teflon applicators with freshly mixed materials were inserted into the bone cavities. Each animal received 2 implants, one filled with ProRoot and 1 with PC. The animals were killed after 2 or 12 weeks, and the tissues were processed for histologic evaluation by means of light microscopy. Results. There was no difference in cell reactions in vitro. Bone healing and minimal inflammatory response adjacent to ProRoot and PC implants were observed in both experimental periods, suggesting that both materials are well tolerated. Conclusions. MTA and PC show comparative biocompatibility when evaluated in vitro and in vivo. The results suggest that PC has the potential to be used as a less expensive root-end filling material. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:483-9)

A comparison of a new limited cone beam computed tomography machine for dental use with a multidetector row helical CT machine.

Abstract: Objective. We sought to compare a new limited cone beam computed tomography (CT) machine for dental use (3DX) with the multidetector CT machine for image quality and skin doses. Study Design. Images of the right maxillary central incisor and the left mandibular first molar of an anthropomorphic phantom were taken by both the 3DX and the multidetector CT. A 5-point method was used to evaluate the depiction of cortical and cancellous bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura, and overall impressions. Furthermore, the skin doses for both modalities were compared. Results. The image quality of the 3DX was better than the multidetector CT for all items (P <.01). Moreover, the mean skin doses with the multidetector CT were 458 mSv per examination, whereas the doses with the 3DX were 1.19 mSv per examination. Conclusions. These results clearly indicate the superiority of the 3DX in the display of hard tissues in the dental area while substantially decreasing the dose to the patient. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:371-7)

pH and calcium ion release of 2 root-end filling materials

Abstract: Objective. The purpose of this study was to evaluate the pH and calcium ion release of 2 materials used for root-end fillings and perforation repair. Study Design. ProRoot and MTA-Angelus were placed in plastic tubes and immersed in glass flasks containing deionized water. After 3, 24, 72, and 168 hours, the water in which each had been immersed was tested to determine the pH changes and released calcium. Results. The values for pH and calcium ion release were slightly higher for MTA-Angelus than ProRoot. The calcium release and pH of both materials were initially higher. Conclusion. The results suggest that both materials release calcium and promote alkaline pH. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:345-7)

Reassessing the presence of Candida albicans in denture-related stomatitis.

Abstract: Objective. The aim of this study was to reevaluate the link between Candida albicans and denture-related stomatitis according to a modified Newton classification, which reflects the classic types of inflammation as well as the extent to which the tissue is affected. Study design. Two groups of denture wearers were evaluated for denture-related stomatitis. The presence and number of yeasts on the dentures, the identification of the Candida species present, and the amount of plaque coverage were determined. Putative risk factors were included in the study. Relations between these variables and stomatitis were analyzed statistically. Results. According to Newton's classification, the presence of yeast on the denture was not linked to whether subjects had stomatitis. But with our classification, higher prevalence of yeast carriers, yeast colony number, and plaque coverage were found on the dentures of individuals with the most extensive inflammation, regardless of Newton type. Among risk factors evaluated, wearing dentures at night and smoking were associated with the most extensive inflammation. We also demonstrated that the presence of C albicans as well as the cohabitation of different Candida species was more frequent in denture-related stomatitis. The differences were statistically significant. Conclusions. Statistical analysis of microbiologic data from different denture-related stomatitis categories according to our modified classification showed that the presence of yeast on dentures was significantly associated with the extent of the inflammation, rather than with the Newton type. Our findings suggest that the inflammatory process of stomatitis favors the colonization of Candida. These results could have new implications for diagnosis and management of the condition. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:51-9)

The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective study.

Abstract: Objectives The possible malignant transformation of oral lichen planus (OLP) is the subject of an ongoing and controversial discussion in the literature The main criticism of studies on this subject relates to the lack of sufficient data to support the initial diagnosis of OLP in cases that finally developed into squamous cell carcinoma We describe the possible premalignant character of OLP and oral lichenoid lesions (OLL) of a prospectively followed cohort of patients with detailed documentary data Study design A study group of 173 patients, 62 patients diagnosed with OLP and 111 patients with OLL, according to revised, modified World Health Organization diagnostic criteria, was followed up from 66 to 720 months (mean, 319 months) The expected number of patients with oral cancer in the group of patients with OLP and in the group of patients with OLL was estimated by comparing the number of patients, their ages, sex, and the length of follow-up to annual incidence rates of oral cancer for the general Dutch population, to explore the possibility of coincidental carcinomas The binomial test was used to determine whether the observed number of cases of cancer in the OLP group and the OLL group exceeded the expected numbers Results Three of 173 patients (17%), 2 men and 1 woman, developed squamous cell carcinomas of the oral mucosa during follow-up All malignant transformations occurred in the OLL group The annual malignant transformation rate, based on a mean follow-up of 319 months, was calculated as 065% per year A comparison of the expected against actual figures for the development of carcinomas revealed no increase in patients with OLP and a 219-fold increase in patients with OLL, with the latter not statistically significant, but with a P value of 083, suggesting at least a trend Conclusion Our results give support to the hypothesis that patients with OLL have an increased risk of oral cancer, but this increased risk was not detected in our sample of patients with OLP Before a final statement with regard to the premalignant character of OLP and OLL can be formulated, the present follow-up study should be prolonged and expanded with a larger number of patients Until then, we advise that patients with OLP and OLL should undergo biannual follow-up examinations Follow-up will be particularly important in patients with OLL who have atrophic/erosive/ulcerative lesions

Endodontic infection: some biologic and treatment factors associated with outcome.

Abstract: Objective We sought to investigate the simultaneous effect of apical periodontitis, instrumentation level, and density of root canal filling on endodontic treatment outcome. Methods For this study, 200 endodontically treated teeth with 441 roots were used. A follow-up examination was conducted 4 ± 0.5 years postoperatively. Data were subjected to univariate and multivariate analysis. Results Periapical pathosis had the strongest effect on treatment outcome (P Conclusion Diseased periapex, level of working length relative to the radiographic apex, and fair/poor density all affect the outcome of endodontic treatment.

Comparison of the effects of 2 doses of methylprednisolone on pain, swelling, and trismus after third molar surgery.

Abstract: Objective The aim of this study was to compare the effects of intravenous administration of 1.5 mg/kg and 3 mg/kg of methylprednisolone sodium succinate (MP) on pain, swelling, and trismus after third molar surgery. Study design Twenty-six healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, cross-over study. Either 1.5 mg/kg or 3 mg/kg of MP was administered by intravenous route 1 hour prior to the first operation. At the second operation the other dose was applied. Trismus was determined by measuring maximum interincisal opening and facial swelling was evaluated using a tape measuring method. Pain was determined using visual analogue scale and recording the number of pain pills taken. Results There was no statistically significant difference in trismus, facial swelling, and pain between the 2 groups. Conclusion No clinical benefit of the higher dose of MP was demonstrated.

The effect of chlorhexidine as an endodontic disinfectant

Abstract: Objective The purpose of this study was to establish whether addition of a 2% chlorhexidine rinse to a conventional treatment protocol enhances the rate of the successful disinfection of the root canal system in vivo. Study design Twenty-four teeth with infected necrotic pulps and resorbing apical periodontitis were treated with a conventional technique in which 1% NaOCl as irrigant was used. Half of the cases received an additional rinse with 2% chlorhexidine. Prereduced thioglycollate medium was used to take cultures that were incubated for 4 weeks. Results Cultivable bacteria were retrieved at the conclusion of the first visit in 1 out of 12 chlorhexidine cases whereas in the control group 7 out of 12 cases showed growth. This difference was significant ( P Conclusion The findings are clinically important.

Human papillomavirus in oral exfoliated cells and risk of head and neck cancer

Abstract: Background: Human papillomavirus (HPV) has been associated with the development of head and neck cancers. In this study, we investigated whether the risk factors for head and neck cancer in relation to HPV infection are different from those in the absence of HPV infection and whether HPV detected in oral exfoliated cells is an independent predictor of head and neck cancer risk. Methods: We conducted a case– control study in 201 head and neck cancer case patients and 333 control subjects, frequency matched for age and sex. Oral exfoliated cells and tumor tissue were evaluated for HPV using polymerase chain reaction and DNA sequencing to type HPV. Logistic regression was used to calculate odds ratios (ORs) for head and neck cancer with HPV infection and 95% confi dence intervals (CIs), adjusted for age, tobacco use, and alcohol consumption. Results: Oncogenic, or high-risk (HR), HPV types were detected in oral cells from 22.9% of case patients and 10.8% of control subjects. HPV16 was the most frequently detected type (19% versus 10% of case patients and control subjects, respectively). After adjusting for age, tobacco use, and alcohol consumption, the risk of head and neck cancer was statistically signifi cantly greater in individuals with HPV-HR types (adjusted OR 2.6, 95% CI 1.5 to 4.2) but not in individuals with nononcogenic HPV types (adjusted OR 0.8, 95% CI 0.4 to 1.7) compared with HPV-negative individuals. Compared with individuals who were HPVnegative and did not use alcohol or tobacco, there was a statistically signifi cant synergistic effect between detection of HPV-HR and heavy alcohol consumption (OR 18.8, 95% CI 5.1 to 69.5) but an additive effect between detection of HPV-HR and tobacco use (OR 5.5, 95% CI 2.1 to 14.1). HPV-HR types detected in oral exfoliated cells were predictive of HPV-HR types in tumor tissue. Conclusion: Infection of oral exfoliated cells with HPV-HR types is a risk factor for head and neck cancer, independent of alcohol and tobacco use, and acts synergistically with alcohol consumption. HPV testing of an oral rinse may be predictive of an HPV-related head and neck cancer. [J Natl Cancer Inst 2004;96:449 –55]

Efficacy of chlorhexidine- and calcium hydroxide–containing medicaments against Enterococcus faecalis in vitro

Abstract: Objective We sought to assess the efficacy of chlorhexidine (CHX) and calcium hydroxide, Ca(OH) 2 , against Enterococcus faecalis in vitro. Study design The effect of CHX (0.2% and 2% in gel or solution) and Ca(OH) 2 (alone or with 0.2% CHX gel) was evaluated by using the agar diffusion test and an in vitro human root inoculation method, to measure zone of inhibition or bacterial growth with optical density analysis, respectively. For optical density analysis, samples from infected root canals were collected after 7 days of medication and were cultured for 24 hours in brain-heart infusion to detect viable bacteria. Results In the agar diffusion test, CHX was effective against E faecalis in a concentration-dependent fashion, but Ca(OH) 2 alone had no effect. In the root canal inoculation test, CHX was significantly more effective against E faecalis than Ca(OH) 2 was ( P Conclusions CHX is effective against E faecalis in vitro. Further in vivo studies are needed to confirm the value of CHX in clinical treatment.

Amalgam-contact hypersensitivity lesions and oral lichen planus.

Abstract: Objective. The purpose of this study was to investigate the relationship between amalgam restorations and oral lichen planus. Study design. Eighty-one patients with oral lichenoid lesions were characterized clinically and skin patch tested for amalgam or mercury hypersensitivity. Thirty-three of these patients had amalgam fillings in contact with oral lesions replaced and were followed to determine the outcome. Results. Clinically, 2 patient groups were identified: (1) 30 patients with probable amalgam-contact hypersensitivity lesions (ACHLs) and (2) 51 patients with oral lichen planus (OLP) but no clear relationship with amalgam. Seventy percent of ACHL cases were patch test positive for amalgam or mercury compared with only 3.9% of OLP cases (P.0001). Amalgam replacement resulted in lesion improvement in 93% of ACHL cases. No such improvement was observed in the OLP cases treated (P <.001). Conclusion. OLP is a heterogeneous condition within which an ACHL subgroup can be identified. ACHLs, but not other OLP lesions, respond favorably to amalgam replacement. A strong clinical association between lesions and amalgam restorations plus a positive patch test result was a good predictor of lesion improvement on amalgam replacement. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:291-9)

Fibrin sealants and platelet preparations in bone and periodontal healing

Abstract: Fibrin sealants and platelet concentrates have been used alone or in association with bone substitutes to promote bone healing in orthopedic and oral surgery. Commercial fibrin sealants are homologous plasma-derived products that mimic the last step of a coagulation cascade, leading to a fibrin clot. They are used for topical hemostasis and tissue sealing and as melting agents for particulate bone substitutes. Infectious risk led to the development of autologous fibrin sealants from the patient's own plasma. However, their fabrication results in less reproducible or less satisfactory rheologic properties. The use of autologous products with high platelet concentrations, such as platelet-rich plasma, platelet concentrate, and platelet gels, has recently been suggested for combining the fibrin sealant properties with the growth factor effects of platelets. We describe the characteristics and limitations of fibrin sealants (commercial/autologous) and platelet preparations and review their effects on bone and periodontal healing as reported in experimental studies and clinical trials.

Oral lichen planus: progress in understanding its malignant potential and the implications for clinical management.

Abstract: Oral lichen planus (OLP) is an inflammatory lesion that has malignant potential, but few cases of OLP progress to malignancy. A diagnosis of OLP should be confirmed on the basis of historical, clinical, and histologic data. The presence of dysplasia in an OLP-like lesion increases the risk of malignant transformation, mandating management and close follow-up. A molecular assessment of OLP may provide the best evidence of malignant risk and will likely become available for clinical use. In addition, exfoliated cells may be examined for loss of heterozygosity and may become a valuable clinical tool for patient follow-up. The treatment of OLP should include elimination of tissue irritants and recurring exposure to oral carcinogens. If OLP is symptomatic, appropriate treatment with immunosuppressive medications, particularly corticosteroids, should be undertaken. For lesions with dysplastic changes, management may include attention directed to the inflammatory change and follow-up biopsies to assess residual histologic changes that may represent dysplasia. Dysplastic OLP may be best treated as other oral dysplastic conditions; thus, regular, more frequent follow-up is required.

Bending properties of rotary nickel-titanium instruments

Abstract: Objective We sought to compare the bending properties of different rotary nickel-titanium instruments and to investigate the correlation between their bending moments and their cross-sectional surface areas. Study design Resistance to bending was determined according to International Standards Organization publication 3630-1. The sample size was 10 files for each type, taper, and size. The cross-sectional surface area of all instruments was determined by using scanning electron microscope photographs of the cross section. The images were scanned and the area was calculated by using special software. Data were analyzed by using analysis of variance and the Student t test and the Newman-Keuls test for all pairwise comparisons. The strength of the correlation between the bending moment and the cross-sectional area was determined by computing the Pearson product moment correlation. Results Bending moments were significantly lower for ProFile and RaCe files than for all other files (P Conclusion Nickel-titanium files with tapers greater than .04 should not be used for apical enlargement of curved canals because these files are considerably stiffer than are those with .02 or .04 tapers.

Preoperative assessment of the relationship between the mandibular third molar and the mandibular canal by axial computed tomography with coronal and sagittal reconstruction.

Abstract: Objective We sought to evaluate the relationship between the mandibular third molar and the mandibular canal by using axial computed tomography with coronal and sagittal reconstruction for third molar surgery. Study design Forty-seven impacted third molars in 41 patients were found in close association with the mandibular canal during a panoramic radiographic assessment. The relationship between the mandibular third molar and the mandibular canal was evaluated by using computed tomography and compared in terms of operative exposure of the inferior alveolar nerve and postoperative labial dysesthesia. Results Twenty-four (51%) mandibular canals were buccal relative to the third molar, 12 were lingual, 9 were inferior, and 2 were between roots. At the time of the surgical procedure, the inferior alveolar nerve was visible in 7 patients. Postoperative lower lip dysesthesia occurred in 1 patient whose mandibular canal was in the lingual position. Conclusions Axial computed tomography with coronal and sagittal reconstruction provides useful information to surgeons regarding the relationship between the mandibular third molar and the mandibular canal.

A comparison of the shaping abilities of 4 nickel-titanium rotary instruments in simulated root canals.

Abstract: Objective. The purpose of this study was to compare the root canal shaping abilities of 4 nickel-titanium rotary instruments. Study design. ProFile, GT Rotary, Quantec, and ProTaper files were used to instrument 48 simulated curved root canals in plastic blocks with the crown-down technique. One operator prepared all the canals until reaching an apical canal size of #30. The instrumentation time, changes of canal dimension and curvature, canal aberration, and instrument deformation were evaluated. Data were analyzed by using one-way analysis of variance followed by the Duncan multiple range test. Results. The ProTaper took significantly less instrumentation time, removed more canal wall (especially at the inner side of the canal curve), lessened the canal curvature, and induced more instrument deformation than did the other instruments. Conclusion. Although ProTaper files cut more canal wall more quickly than the other instruments in the curved canal, they were also the instruments that most frequently became deformed. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:228-33)

C-kit expression in the salivary gland neoplasms adenoid cystic carcinoma, polymorphous low-grade adenocarcinoma, and monomorphic adenoma.

Abstract: Objective. Differentiating between adenoid cystic carcinomas (ACCs), polymorphous low-grade adenocarcinomas (PLGAs), and the monomorphic adenomas (including canalicular adenomas, trabecular adenomas, and basal cell adenomas) can present a diagnostic challenge, especially when examining tissue obtained from small incisional or fragmented biopsies. Recent studies have revealed that overexpression of the tyrosine kinase receptor protein c-kit occurs in a narrow subset of malignant neoplasms, including gastrointestinal stromal tumors, myeloid leukemias, seminomas, and ACCs. C-kit reportedly is not expressed in PLGAs. We compared the expression of the c-kit antigen in the malignant salivary gland neoplasms ACC and PLGA with its expression in salivary gland monomorphic adenoma (including canalicular adenoma and basal cell adenoma). Study design. Formalin-fixed paraffin-embedded sections of 49 salivary gland neoplasms (17 monomorphic adenomas, 17 PLGAs, and 15 ACCs) accessioned between 1989 and 2002 were retrieved from the files of the Department of Pathology, Long Island Jewish Medical Center, and were stained with an anti-c-kit polyclonal antibody. Results. C-kit reactivity was uniformly positive in the cytoplasm of luminal neoplastic cells in ACCs (15/15, 100%). Positive reactivity was also identified in the majority of PLGAs (16/17, 94%), with at least 25% of the tumor cells being positive. Similar reactivity was seen in monomorphic adenomas (16/17, 94%). Conclusions. In contrast to previous reports, we find that c-kit expression was not restricted to ACC but was expressed in all 3 tumor types evaluated (ACC, PLGA, and monomorphic adenoma). Therefore, c-kit does not appear to be a useful marker for distinguishing between either ACC and PLGA in equivocal cases, or in benign and malignant salivary gland neoplasms. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:586-93)

Rhinosinusitis: review from a dental perspective

Abstract: Patients often present to their dental providers with reports of posterior maxillary pain. The etiology of their symptoms may be either an acute or chronic situation, and the examining dentist's primary focus is usually to rule out dental pathosis. Rhinosinusitis should be an important consideration on the list of differential diagnoses when evaluating patients with posterior maxillary pain. The American Academy of Otolaryngology standardized the terminology for paranasal sinus infections in 1996 and offered guidelines for evaluation and treatment of sinusitis. This article highlights these guidelines for diagnosing and treating patients with rhinosinusitis. It also includes a review of sinus anatomy and of the special considerations for iatrogenic sinus exposure as well. Dental providers who understand the relationship between the maxillary sinus and the oral structures are better prepared to arrive at an accurate diagnosis. The astute dental provider will ensure a rapid and positive outcome for this group of patients with rhinosinusitis.

Detection of human papillomavirus-16 and HPV-18 DNA in normal, dysplastic, and malignant oral epithelium

Abstract: Objective. Our aim was to clarify the association of human papillomavirus (HPV) with oral carcinogenesis, especially its early stage. Study Design. Tissue specimens of normal mucosa, epithelial dysplasia, oral squamous cell carcinoma (OSCC), and OSCC cell lines were examined for the presence of HPV-16 and HPV-18 E6 DNA by means of the polymerase chain reaction test. Results. The detection rate of HPV-16 in epithelial dysplasia (31/51) was higher than that in normal mucosa (16/44) and in OSCC (30/86) and was statistically different from that in OSCC. The cases that progressed from epithelial dysplasia to carcinoma showed a significantly higher HPV-16 detection rate than the other cases in both epithelial dysplasia and OSCC. HPV-16 and HPV-18 were detected only at early passages of 2 of 10 OSCC cell lines. Conclusion. These results strongly suggest that HPV-16 may be involved in the early stages of the development of some oral carcinomas. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:594-600)

Intraosseous schwannoma of the mandible: a case report and review of the literature

Abstract: Schwannomas are benign neoplasms originating from the neural sheath and occurring most often in the soft tissues of the head and neck. Intraosseous schwannomas, however, are rare. The most common site of occurrence for these unusual lesions is the mandible. This article documents a case of an intramandibular schwannoma and provides a review of the literature on intraosseous schwannomas, with special attention to cases arising in the mandible and the maxilla.

Bilateral maxillary dentigerous cysts: A case report

Abstract: Dentigerous cysts are benign odontogenic cysts that are associated with the crowns of permanent teeth. They are usually single in occurrence and located in the mandible. Multiple cysts are reported in patients with conditions such as mucopolysaccharidosis and basal cell nevus syndrome. We present the radiologic findings of bilateral impacted maxillary cuspids with dentigerous cysts displacing the maxillary sinuses in a nonsyndromic patient, a condition that, to our knowledge, has not been previously reported.

Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature.

Abstract: Objectives. Necrotizing fasciitis of the head and neck is an uncommon, potentially fatal soft tissue infection characterized by extensive necrosis and gas formation in the subcutaneous tissue and fascia. The aims of this study were to describe the condition of this rare disease and to find factors affecting the mortality. Study Design. Nine of our new cases and 125 reported cases in the English-language literature with necrotizing fasciitis of dental origin were reviewed. Results. Two of our 9 patients had some form of systemic disease such as diabetes, cardiac insufficiency, renal failure, or cerebral infarction, whereas the other 7 had no particular general complications. A computed tomography examination was useful for detecting gas formation in the deep neck. All 9 patients underwent extensive debridement within 24 hours, and good results were obtained. In contrast, 24 of the 125 reviewed patients died despite therapy. Factors affecting the mortality were associated diseases such as diabetes or alcohol abuse, delay of surgery, and the complication mediastinitis. Conclusion. Necrotizing fasciitis is still a potentially fatal disease. Early and aggressive debridement may reduce mortality. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:283-90)

Endoscopic mechanical retrieval of sialoliths

Abstract: Objective. We sought to assess the efficacy of sialoendoscopic mechanical retrieval techniques for the treatment of obstructive salivary gland disease. This study documents the authors' long-term experience with mechanical retrieval techniques, the long-term results of the procedures, the technical issues, the techniques that have been used, and the advantages and limitations of these modalities. Study design. Mechanical endoscopic techniques were used in a large referral center from 1993 to 2001 to treat 217 salivary glands for salivary gland sialolithiasis. Results. We found that 189 of the 217 glands with salivary gland sialolithiasis became completely symptom- and stone-free, both endoscopically and by radiographs (overall success rate, 87%). In the submandibular gland group specifically, the success rate was higher, 89%. In the parotid group, it was 83%. Follow-up was continued for 40 months after treatment. No severe complications were noted. The endoscope used was the third-generation Sialoendoscope. Conclusion. The endoscopic mechanical retrieval of sialoliths is both safe and efficacious. This is an excellent method for the complete and certain removal of sialoliths, with minimal damage to the surrounding tissue. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:396-402)

Structural and functional injury in minipig salivary glands following fractionated exposure to 70 Gy of ionizing radiation: an animal model for human radiation-induced salivary gland injury

Abstract: This study explored the feasibility of developing an animal model for radiation-induced salivary gland injury with a radiation protocol identical to current clinical practice. Three male Hanford minipigs were subjected to fractionated daily irradiation with a total dose of 70 Gy; structural and functional measures were compared with those of a control group of minipigs. We found that irradiated submandibular and parotid glands were one-third to one-half the gross size of control glands. Whereas no pathologic changes were noted in control glands, irradiated glands consistently demonstrated significant parenchymal loss with extensive acinar atrophy and interstitial fibrosis, enlarged nuclei in remaining acinar cells, and ductal dilatation and proliferation. Stimulated salivary flow was reduced by 81% in irradiated animals compared with preirradiation flow (P <.001); salivary flow in the control group increased by 30% during the same period (P <.001). The observed radiation-induced structural and functional salivary gland changes are comparable in every respect to those observed following irradiation of human salivary glands.

Dental management of the (solid) organ transplant patient.

Abstract: The need to provide dental care for organ transplant candidates and recipients will increase in conjunction with the continued expansion of the use of organ transplantation. For the transplant candidate, dental care usually requires application of practice standards that fall within the scope of management of the severely medically compromised patient. There are, however, few guidelines and no clinical trials or outcomes assessments that address appropriate care for transplant recipients. Furthermore, despite the high rate of infectious complications among patients who have received organ transplants, there is little evidence that dental disease contributes to this risk. This article reviews the current status of dental care practices that have been recommended and presents a rationale that can be applied as the basis for guidelines and recommendations for the treatment of the organ transplant patient.

Low salivary flow and volatile sulfur compounds in mouth air.

Abstract: Objective The purpose of this study was to determine whether a reduction of salivary flow would influence the production of methylmercaptan (CH 3 SH) and hydrogen sulfide (H 2 S), which are volatile sulfur compounds (VSCs) known to cause oral malodor. Study design The VSCs in mouth air were measured by means of gas chromatography. Spitting and masticatory (stimulated) methods were used to determine the salivary flow rates of 174 patients. Results There was no significant correlation between the level of VSCs and salivary flow rate. However, subjects with extremely low resting salivary flow rates had significantly higher CH 3 SH and H 2 S concentrations and tongue-coating scores than those with higher resting salivary flow rates. Moreover, logistic analyses revealed that extremely low resting salivary flow, the increase in tongue coating, and a probing pocket depth greater than 4 mm were strong explanatory factors for the generation of VSCs, which could have caused oral malodor. Conclusions These findings suggested that an extreme reduction in resting saliva influenced the generation of CH 3 SH and H 2 S in mouth air.

Complications in bilateral mandibular distraction osteogenesis using internal devices.

Abstract: Objective We sought to evaluate the possibility of distraction osteogenesis as an alternative to conventional bilateral sagittal split osteotomy. Complications (intraoperative, intradistraction, and postdistraction) were evaluated retrospectively. Study design Seventy consecutive patients (40 males and 30 females, 11.2-37.3 years old; mean, 14.2 years) underwent distraction osteogenesis to lengthen the mandible. The surgical procedure was carried out with the patient under general anesthesia. After the osteotomy was performed, 2 intraoral monodirectional distraction devices were placed on the mandibular cortex in the third molar region. The rate of distraction was 1 mm/day. The different complications encountered during all phases of the distraction procedure were recorded. Results A total of 28 complications (40%) were recorded. In 10 patients (14.3%), the complications were technique- or device-related, or both, and occurred early in the learning period. Five patients (7.1%) had infection occur, and 3 patients (4.3%) had prolonged sensory loss in the distribution of the alveolar nerve. Severe complications occurred in 6 patients (8.6%). Rehospitalization was necessary in 5 patients (7.1%), 4 of whom (5.7% of the series) required further surgery under general anesthesia. Conclusion Distraction osteogenesis can be considered a safe and predictable procedure for lengthening the mandible, with a low incidence of major complications. The infection rate and the incidence of damage to the inferior alveolar nerve (2.1%) are low. Compliance of both patients and parents during the whole treatment period is of the utmost importance.

Marginal flap versus paramarginal flap in impacted third molar surgery: a prospective study.

Abstract: Objective A clinical prospective study was carried out to compare 2 flap designs—marginal and paramarginal—that are used during impacted third molar surgery Material and Methods Twenty-seven healthy patients (ages 17 to 31 years) who underwent surgical removal of 4 impacted third molars, including 54 lower and 54 upper, were included A marginal flap was used in 1 randomly chosen half of the jaw, and a paramarginal flap was used in the other half The influence of these flaps on wound healing, periodontal pocket depth of the adjacent second molar, pain, trismus, and swelling was studied Results Wound dehiscences developed in 8 paramarginal flap cases, whereas none occurred with the use of a marginal flap The buccal and distal probing depths of the adjacent second molar were significantly bigger in marginal flaps at 5 and 10 days after surgery However, the probing depth was similar with the use of both techniques at 3 months Pain, trismus, and swelling were similar with both techniques Conclusion We found no advantages to the use of a paramarginal flap instead of a traditional marginal flap for removing impacted third molars (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:403-8)