Diabetes mellitus and osteomyelitis of the jaws

The Diabetes Mellitus is a prevailing medical condition worldwide [6%] and also in Pakistan. Infection in the orofacial wounds of these patients is common. The aim of the study was to determine the effect of diabetes mellitus on the healing process of alveolar sockets/bone after tooth removal. Eighteen diabetic patients with chronic jaw bone infections were examined and managed in oral and maxillofacial surgery department of de, Montmorency College of Dentistry, Lahore from 2009 to 2013. All patients gave history of tooth extraction about two months earlier. Orthopantomograph [OPG] were used to confirm the diagnosis. Fourteen patients [77.77%] were on oral hypoglycemic agents, four did not know their diabetic status, four patients [22.22%] were on intermediate acting insulin. All patients were managed under general anesthesia for involucrum sequestrectomy followed by primary closure. One insulin dependent patient with radiated lower jaw developed osteomyelitis after tooth extraction and was also on bisphosphonate medication followed by breast cancer surgery. This patient was operated twice to resolve the osteomyelitis of the lower jaw in follow up six months. It was concluded that diabetes effects the healing of sockets after tooth removal

Treatment of odontogenic ameloblastomas and their long term follow up at tertiary centre

Fifty-two patients of ameloblastoma were operated with special emphasis on radiographic and histological appearance. The unicystic radiographico-histological [38] cases were managed conservatively with marsupialization followed by enucleation [Group A' 15 Patients] and enucleation with peripheral ostectomy [Group B' 23 Patients]. The radiographico-histological multicystic [solid] variety [Group C' 14 Patients] was treated aggressively by resection. In conservative treatment regimens Carnoy's solution was applied after enucleation of the tumour whereas, the patients of aggressive surgery were operated with minimum 5mm safety marginal clearance of the tumour. The recurrence rate with average four years follow up was 0.0% for resection, 13.33% for marsupialization followed by enucleation and 8.69% for enucleation with peripheral ostectomy. The results were encouraging for unicystic ameloblastoma treated patients [Group A' and B'], in best interest of jaw bone contour preservation

Temporomandibular disorders

Temporomandibular joint has been a subject of intense debate and interest for researchers since long. Temporomandibular disorders are one of the most intriguing and controversial subject in the world of dentistry. This study reviews the possible etiological factors and the management protocol for these disorders. The key to successful management is an appropriate diagnosis, for alleviating pain and restoring physiological functions. The choice of treatment provided to the patient depends on the degree of the problem. On time referral to an oral and maxillofacial surgeon is essential for the treatment of temporomandibular disorders to avoid complications

Pyogenic granuloma - review

Pyogenic granuloma is a common non-neoplastic soft tissue growth seen on a variety sites in the body including the oral cavity. It may also occur in pregnant subjects and is referred to as a granuloma gravidarum. Although the precise etio-pathogenesis is not established, it is regarded as a reactive lesion secondary to trauma or non-specific local irritation. Hormonal stimulation during puberty, pregnancy or oral contraceptive use may also be responsible. A variety of angiogenic factors may mediate exuberant endothelial proliferation. Mostly commonly it affects adolescents and young adults with preponderance in females. The most familiar site is anterior maxillary gingivae but may also affect the mandibular gingivae, lips, tongue and buccal mucosa. Conservative surgical excision is usually curative but recurrence is not unusual. Lasers and cryotherapy may also be employed. Granulam gravidarum, however, is best left untreated until parturition

Current concepts in central giant cell granuloma

Central Giant Cell Granuloma is a nonneoplastic intraosseous lesion, and constitutes a common nonodontogenic pathology to occur in the jaws. It is characterized histologically by cellular fibrous tissue containing multiple foci of haemorrhage, aggregations of multinucleated giant cells, and occasionally, trabeculae of woven bone. Various theories brand it from being a 'reactive' to hamartomatous to a neoplastic lesion. It has now been hypothesized that it is the mononuclear spindle shaped cell which controls the proliferative activity of this lesion, as opposed to the more frequently seen giant cell. It has an increased predilection for mandible and females, in younger age groups. Various radiological and histopathological differential diagnoses should be considered in case of giant cell lesions. Some of the lesions are thought to display a markedly 'aggressive' behaviour and a clinically 'aggressive' model of CGCG has been proposed. Smaller, 'nonaggressive' tumours generally respond very well to conservative enucleation or curettage but recurrence is seen to be common with 'aggressive' lesions. Various medical therapies including injections of intra lesional steroids, subcutaneous calcitonin and interferon have been proposed for the treatment of 'aggressive' lesions

Disorders of temporomandibular joint: a retrospective study

A retrospective study was conducted on 486 patients with temporomandibular joint disorders to evaluate the frequency of their occurrence. The most common disorders found were trauma followed by pain, dysfunction syndrome, osteoarthrosis, ankylosis, internal derangements and dislocations