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

Frequency and pattern of presentation of neuralgia inducing cavitational osteonecrosis

Neuralgia inducing cavitational osteonecrosis is a bone disease which leads to neuralgia like pain. The aims of this study were to document the frequency and pattern of presentation of neuralgia inducing cavitational osteonecrosis and differentiate it from trigeminal neuralgia. This case series was conducted from August 2011 to July 2012 at Punjab Dental Hospital, Lahore. Patients having facial neuralgia like pain were assessed by history, clinical and radiographic examination. From these patients, seventy patients with signs and symptoms of neuralgia inducing cavitational osteonecrosis [i.e. oro-facial neuralgic pain with intra-oral trigger zone, previous history of surgical intervention and radiographic evidence of cavitational osteonecrosis in the jaws] were included in the study for surgical debridement and curettage of necrotic bone. Out of seventy patients, 25 were male [35.7%] and 45 were female [64.3%]. Age range was of 18 to 70 years. Positive diagnosis of neuralgia inducing cavitational osteonecrosis was confirmed in 45.7% of cases. Most of the patients were from fourth and fifth decade of life. Mandibular posterior region was mostly involved [61.4%] followed by maxillary posterior region [30%]. Anterior maxilla was involved [7.1%] more than anterior mandible [1.4%]. NICO most often causes sharp, shooting pain and is frequently misdiagnosed as trigeminal neuralgia. Consequently, patients are prescribed unwarranted anticonvulsant drugs and/or a variety of surgical procedures without significant pain relief. Such patients should be diagnosed properly for effective management i.e. surgical debridement of involved region

Dental caries and pericoronitis associated with impacted mandibular third molars-a clinical and radiographic study

The most common impacted tooth is mandibular third molar and knowledge and assessment of its angulation pattern, position and depth in mandibular bone helps in better treatment planning and management of patients. The objective of this study was to enlist the frequency of dental caries and pericoronitis associated with different patterns of impacted mandibular third molars in different age groups and genders. A total of 250 patients with 393 impacted mandibular third molars seen in the Department of Oral and Maxillofacial Surgery, Punjab Dental Hospital, Lahore from October 2012 to March 2013 were included in the study. The age range of these patients was of 20 to 65 years. Patients were assessed by history, clinical and radiographic examination. Patterns of mandibular third molar impactions were assessed by using classification systems developed by Winter and Pell and Gregory on periapical radiographs. Pericoronitis was assessed by patient's history and clinical evaluation of mucosa surrounding the impacted mandibular third molars. Dental caries was assessed by clinical and radiographic evaluation. The most frequent pattern of impaction was mesioangular [37.6%], with Class II ramus relationship [53.2%] and Position A depth [62.8%]. Dental caries was seen in 38.53% of patients mostly associated with mesioangular, Position A, Class I molars. Pericoronitis was seen in 29.36% of patients mostly associated with distoangular, Position A or B, Class II molars. It was concluded that the patients having third molars with the unfavourable angulations, patterns and positions could be considered as the candidates for prophylactic removal of impacted mandibular third molars to prevent dental caries or pericoronitis. Moreover, early diagnosis of percoronitis and dental caries and proper management of third molar is necessary to prevent further consequences

Surgical removal of trans-alveolar mandibular 2[nd] premolar impactions by lingual approach

There is an abundance of literature on impacted teeth but only a few papers have addressed impacted premolars. A case of a young female with bilaterally impacted mandibular 2[nd] premolars in trans-alveolar position with their crowns facing lingually and roots buccally is reported. The patient was under orthodontic treatment for correction of malocclusion with an orthodontic plan for surgical removal of impacted mandibular 2[nd] premolars. Due to lingual position of crowns of these impacted teeth, it was decided to adopt lingual surgical approach rather than conventional buccal approach for their removal. The surgical approach with discussion on the various management options for management of impacted premolars is described here

Ellis-van Creveld syndrome with facial hemiatrophy.

Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive congenital disorder characterized by chondrodysplasia and polydactyly, ectodermal dysplasia and congenital defects of the heart. We present here a case of a 16-year-old short-limbed dwarf with skeletal deformities and bilateral postaxial polydactyly, dysplastic nails and teeth, also having left-sided facial hemiatrophy. The diagnosis of EVC syndrome was made on the basis of clinical and radiological features. To the best of our knowledge, this is the first report of EVC syndrome with facial hemiatrophy in the medical literature from India.

Big toe metastases as first clinical sign of occult bronchogenic carcinoma

Metastasis to bone is a common manifestation of malignant tumours. However, metastasis to the bones of the foot is exceedingly rare. It usually arise from genitourinary tract and colon, with the tarsal bones accounting for half of all metastases. We report a rare case of pain and destruction of the distal phalanx of great toe, initially suspected as osteomyelitis, which on biopsy proved to be metastases from a clinically silent bronchogenic carcinoma

Clinical presentation and management of adenomatoid odontogenic tumor

To document the clinical presentation and treatment protocols for adenomatoid odontogenic tumor in the oral cavity, this study was carried out at de, Montmorency College of Dentistry I Punjab Dental Hospital, Lahore-Pakistan. The sampling technique was purposive. Six cases of AOT were recorded. The age range was 11-16 years [mean 13.8years] with 4 cases in males [66.6%]. Maxillary involvement was seen in 5 cases [83%]. Only one case presented with mandibular involvement [left side]. AOT is a relatively uncommon lesion seen primarily in the adolescents. It should be managed at an early stage to prevent damage to the adjacent teeth