Impact of viewing conditions on the performance assessment of different computer monitors used for dental diagnostics.

PURPOSE: This study aimed to assess the computer monitors used for analysis and interpretation of digital radiographs within the clinics of the Oral Health Centre of Western Australia. MATERIALS AND METHODS: In total, 135 computer monitors (3 brands, 6 models) were assessed by analysing the same radiographic image of a combined 13-step aluminium step wedge and the Artinis CDDent 1.0® (Artinis Medical Systems B.V.®, Elst, the Netherlands) test object. The number of steps and cylindrical objects observed on each monitor was recorded along with the monitor's make, model, position relative to the researcher's eye level, and proximity to the nearest window. The number of window panels blocked by blinds, the outside weather conditions, and the number of ceiling lights over the surgical suite/cubicle were also recorded. MedCalc® version 19.2.1 (MedCalc Software Ltd®, Ostend, Belgium, https://www.medcalc.org; 2020) was used for statistical analyses (Kruskal-Wallis test and stepwise regression analysis). The level of significance was set at P<0.05. RESULTS: Stepwise regression analysis showed that only the monitor brand and proximity of the monitor to a window had a significant impact on the monitor's performance (P<0.05). The Kruskal-Wallis test showed significant differences (P<0.05) in monitor performance for all variables investigated, except for the weather and the clinic in which the monitors were placed. CONCLUSION: The vast performance variation present between computer monitors implies the need for a review of monitor selection, calibration, and viewing conditions.

Stafne's bone cyst revisited and renamed: the benign mandibular concavity.

OBJECTIVE: Stafne's bone cyst (SBC) is an asymptomatic, round or oval-shaped, well-defined, uniform radiolucent lesion, usually incidentally observed in the posterior aspects of the mandible. Radiographical appearance may be confusing though. This study aimed to review the literature on SBCs and to map the SBC as shown in their respective papers. METHODS: A Pubmed® search (1/9/2018 till 31/5/2019), mentioning SBC, was carried out. Included papers had to contain: patient's age, gender and radiographs. RESULTS: In total, 114 papers were found, but only 64 papers were retained, which contained 109 cases (95 males, 14 females). The patients' ages ranged between 14 and 89 years old (mean age being 52 years). Male patients' ages (N = 95) ranged from 14 to 89 years (mean age 52.3 years), whereas the females (N = 14) ages ranged between 22 and 68 (mean age 50.2 years). 28 combinations of locations of SBC were recorded. Only three lesions were located at the symphysis, six were bilateral, 55 appeared on the left hand side and 45 on the right hand side of the mandible.The literature mentioned that these cavities could contain salivary gland tissue, muscular tissue, lymphoid tissue, blood vessels, fat tissue or connective tissue. DISCUSSION/CONCLUSION: This study illustrates the wide variation of SBC locations across the mandible and leads us to conclude that the differential diagnosis of every asymptomatic, oval or round, well-defined, uniform radiolucent lesion on two-dimensional radiographs of the mandible should include "a benign mandibular concavity", formerly known as SBC.

Assessment of the Location of the Mandibular Lingula in Pediatric Patients Using Cone Beam Computed Tomography Images.

Purpose: The purpose of this study was to determine the position of the mandibular lingula in a sample of cone beam computed tomography (CBCT) images taken on pediatric patients.Methods: A sample of 280 outpatient CBCT (i-CAT) scans (153 males and 127 females) were divided into three age groups: six to nine years (n=103), 10 to 13 years (n=103), and 14 to 18 years (n=74). The position of the lingula was determined relative to the anterior and posterior border of the ramus, mandibular notch, inferior border of the mandible, and mandibular plane. The mandibular angle was also recorded. In Vivo5 software was used to assess the images.Results: The average distance for all positional measurements was significantly greater in 14- to 18-year-old adolescents when compared with six- to nine-year-old children. In the oldest age group, the mandibular angle was significantly more acute. Significant differences in distances were noted bilaterally across all age groups in boys and girls for distance from lingula to mandibular notch, to inferior border mandible and to occlusal plane, while for distance lingula to posterior border of ramus it was only for boys.Conclusions: As children age, the mandible increases in all dimensions, except for the distance from the anterior border to the lingula. Small differences in the position of the mandibular lingula exist between boys and girls. These findings have implications for administering an inferior alveolar nerve block in children.

Evaluation of pharyngeal space and its correlation with mandible and hyoid bone in patients with different skeletal classes and facial types.

INTRODUCTION: The purpose of this article was to evaluate the pharyngeal space volume, and the size and shape of the mandible and the hyoid bone, as well as their relationships, in patients with different facial types and skeletal classes. Furthermore, we estimated the volume of the pharyngeal space with a formula using only linear measurements. METHODS: A total of 161 i-CAT Next Generation (Imaging Sciences International, Hatfield, Pa) cone-beam computed tomography images (80 men, 81 women; ages, 21-58 years; mean age, 27 years) were retrospectively studied. Skeletal class and facial type were determined for each patient from multiplanar reconstructions using the NemoCeph software (Nemotec, Madrid, Spain). Linear and angular measurements were performed using 3D imaging software (version 3.4.3; Carestream Health, Rochester, NY), and volumetric analysis of the pharyngeal space was carried out with ITK-SNAP (version 2.4.0; Cognitica, Philadelphia, Pa) segmentation software. For the statistics, analysis of variance and the Tukey test with a significance level of 0.05, Pearson correlation, and linear regression were used. RESULTS: The pharyngeal space volume, when correlated with mandible and hyoid bone linear and angular measurements, showed significant correlations with skeletal class or facial type. The linear regression performed to estimate the volume of the pharyngeal space showed an R of 0.92 and an adjusted R2 of 0.8362. CONCLUSIONS: There were significant correlations between pharyngeal space volume, and the mandible and hyoid bone measurements, suggesting that the stomatognathic system should be evaluated in an integral and nonindividualized way. Furthermore, it was possible to develop a linear regression model, resulting in a useful formula for estimating the volume of the pharyngeal space.

Dental utilization for Medicaid-enrolled children with cystic fibrosis.

OBJECTIVES: Despite a multitude of risk factors, children with cystic fibrosis (CF) have lower reported dental caries prevalence. A potential explanation is preventive dental care use, but no studies to date have examined dental use for children with CF. METHODOLOGY: Iowa Medicaid data were analyzed for children age 3 to 17 years (N = 156,268). Poisson regression models were used to compare utilization rates for any dental care and also for specific categories of dental care, by CF status. RESULTS: Children with CF were significantly less likely to use any dental care than children without CF (incident rate ratio: 0.819, 95% CI: 0.80 to 0.84, p < .001). There were no significant differences in use across specific categories of dental care. CONCLUSIONS: Medicaid-enrolled children with CF are less likely to use dental care than children without CF. These findings suggest that use of dental care use is an unlikely explanation for lower purported caries rates among children with CF.

Cone-beam computed tomography in pediatric dentistry, a retrospective observational study.

OBJECTIVES: The aim of this study was to find the reasons for referral and their correlation with age, gender, field of view, and resolution for all patients under the age of 18 who underwent a cone-beam computed tomography (CBCT) scan between 1 May 2010 and 1 May 2012 in the dental out-patient clinic of the University Hospital Ghent. MATERIAL AND METHODS: From the local CBCT database, 79 pediatric patients gave their consent. Subsequently age, gender, reason for referral, external or internal referral, field of view (FOV), and resolution data were collected. Descriptive and comparative statistical analysis was performed. RESULTS: There seemed to be a correlation between orthodontic referrals and female patients. The majority of patients referred for trauma follow-up were 12 years and older. Fourteen percent of referrals were for dento-alveolar trauma, 18 % for other dento-alveolar reasons, 4 % for developing dentition-generalized, 36 % for developing dentition-localized, 10 % for endodontics, 1 % for periodontics, 16 % for surgical applications, and 1 % was for the visualization of the TMJ. Eighty percent of the CBCTs were taken at a FOV 50 × 55 mm. Larger FOV was used for surgical planning or follow-up reasons. The majority of the CBCTs was taken at a resolution of 200 µm, while a resolution of 150 µm was used for endodontic issues. From these results, a classification system for referral was developed. CONCLUSIONS: From the present study, it can be concluded that a referral pattern could be detected which was correlated with gender, age group, FOV, and resolution. These results can help practitioners make the decision to refer for CBCT when extra three dimensional imaging is expected to have a benefit in therapeutic value for a pediatric or adolescent patient. CLINICAL RELEVANCE: This study can guide dental professionals referring pediatric and adolescent patients for CBCT.

Flow cytometry-based analysis by Sysmex-UF1000i® is an alternative method in the assessment of periodontal inflammation.

BACKGROUND: Gingivitis is a common inflammatory condition. We explored the value of flow cytometry of saliva in patients with periodontal inflammation. METHODS: A cohort of 249 healthy adults (age range: 18-81 y; 2.5th to 97.5th percentile: 19-66 y) was investigated for caries, dental plaque and gingivitis. Saliva was analyzed using flow cytometry on a Sysmex UF-1000i®. RESULTS: Sysmex UF-1000i® is capable to reproduce reliable measurements of cellular components in saliva. A statistically significant lower number of salivary bacteria was found in patients with gingivitis in comparison with healthy adults (p<0.0001). A significant difference in salivary leukocyte count was found between patients with different gingival index scores (p<0.0005). The gingivitis score was strongly dependent on the number of salivary leukocytes, the age of the patient and the degree of caries and dental plaque (r(2)=0.60, p<0.001). At a cut-off level of 10(3) leukocytes/µl saliva, an area under the curve of 0.82 was obtained with a sensitivity of 76% and a specificity of 78% in patients (>35 y) with a gingivitis score of 3. CONCLUSION: Flow cytometry is an alternative method to evaluate local inflammatory processes in the mouth with a sensitivity of 76% and a specificity of 78%.

Number of accessory or nutrient canals in the human mandible.

OBJECTIVES: The aim of the study was to assess the presence, location and the number of accessory or nutrient canals in the body of the mandible by means of cone beam CT images, obtained with the Planmeca ProMax® 3D Max device. MATERIAL AND METHODS: Seventy-four cone beam images of the mandible from adult patients (37 males and 37 females) who were imaged for dental implantology planning or third molar extraction were used to assess the number and location of accessory or nutrient canals. All images were taken with the same machine (Planmeca® ProMax 3D Max) at 200-, 400- or 600-µm resolution. Distinction was made between canals entering or exiting the mandible superior or inferior of the inferior alveolar canal and between similar canals superior or inferior of the genial tubercula. RESULTS: The number of accessory canals varied between nil to 11. No statistical significant difference between males and females was found with regard to the number or location of accessory canals in the mandible. Only 5.4% of patients had no accessory canals. One to five accessory canals were found in 71.6%, and 23% of patients had more than five accessory canals. The majority (81%) of patients had between two and six accessory canals. CONCLUSION: It seems that subjects showing no accessory canals whatsoever should be considered exceptional as more subjects with than without accessory canals in the body of the mandible were found. CLINICAL RELEVANCE: These results are clinically relevant for mandibular surgery and mandibular local anaesthesia.

Oral implications in children with gastroesophageal reflux disease.

PURPOSE OF REVIEW: To emphasize oral complications in children with gastroesophageal reflux disease. Interest of pediatricians to conduct an orodental examination or to include a dental examination performed by a dentist should be encouraged, as dental erosion, for instance, may be present in these children. RECENT FINDINGS: Dental caries, dental erosion, mucosal lesions and oral bacterial load have been studied extensively in children with gastroesophageal reflux disease, but there is no sound consensus about the impact of gastroesophageal reflux disease on oral health parameters. SUMMARY: Gastroesophageal reflux and oral health deserve to be better understood and recognized by medical staff, pediatricians in particular. Literature on this subject contains many case reports and some cross-sectional studies, resulting in confusing conclusions for clinicians and researchers. Dental caries, dental erosion, mucosal lesions and oral bacterial load are the most frequently studied items in these kinds of study. Dental erosion seems to be an oral finding that should be studied in depth in these children, as conflicting results have been reported in literature, the latter being the result of the use of different indexes to collect clinical data.

[What does saliva represent to the dentist?]. / Que représente la salive pour le dentiste?

Despite the undoubtedly large impact of saliva on the patient's oral health, little is known about its exact properties and role. More research has been put into serum, when compared to saliva, although that is changing. More and more researchers are interested in the role of certain proteins or electrolytes in an oral disease process. Besides the purely laboratory research, practitioners are also interested in the bacterial colonisation of the oral fluids, especially in assessing a patient's caries risk. The use of bacterial chair-side tests illustrates this aspect of progression in oral health care. For the dental professional, saliva is an important ally in preventing dental caries and mucositis. The lubrication properties and antibacterial/antiviral function of saliva play an important role in the protection of the oral cavity. These aspects may be suppressed in some medically compromised patients. In those cases, the dental professional is faced with a challenge to solve the oral health problems.

Review: The physiology of saliva and transfer of drugs into saliva.

Although saliva or oral fluid "lacks the drama of blood, the sincerity of sweat and the emotional appeal of tears", quoting Mandel in 1990 [I.D. Mandel, The diagnostic uses of saliva, J. Oral Pathol. Med. 19 (1990) 119-125], it is now meeting the demand for inexpensive, non-invasive and easy-to-use diagnostic aids for oral and systemic diseases, drug monitoring and detection of illicit use of drugs of abuse, including alcohol. As the salivary secretion is a reflex response controlled by both parasympathetic and sympathetic secretomotor nerves, it can be influenced by several stimuli. Moreover, patients taking medication which influences either the central nervous system or the peripheral nervous system, or medication which mimic the latter as a side effect, will have an altered salivary composition and salivary volume. Patients suffering from certain systemic diseases may present the same salivary alterations. The circadian rhythm determines both the volume of saliva that will and can be secreted and the salivary electrolyte concentrations. Dietary influences and the patient's age also have an impact on composition and volume of saliva. The latter implies a wide variation in composition both inter- and intra-individually. Sampling must therefore be performed under standardized conditions. The greatest advantage, when compared to blood sample collection, is that saliva is readily accessible and collectible. Consequently, it can be used in clinically difficult situations, such as in children, handicapped and anxious patients, where blood sampling could be a difficult act to perform.

[Oral health risks in patients with cystic fibrosis]. / Quel risque pour la santé bucco-dentaire des patients souffrant de mucoviscidose?

Cystic Fibrosis (CF) patients can hypothetically be considered as being high caries risk patients; they frequently consume sugar-rich in-between-meal snacks/drinks and they have a high intake of sugar containing syrups and aerosols (also acidic) and salivary flow reducing medication (beta-2-adrenergica). The aim of this study was to investigate the determining factors of oral health in CF homozygotes, CF heterozygotes and healthy controls. CF homozygotes had significantly the lowest caries experience, while CF heterozygotes had a borderline not significant higher caries experience than healthy controls. CF homozygotes also had significant lower Streptococcus mutans counts than both other groups. CF homozygotes also had significant less gingival bleeding, while no significant differences in plaque and calculus amount were found between the three groups. On behalf of oral hygiene habits, no significant differences were found between the three groups. CF homozygotes appeared to consume more dairy products than the others. The influence of the typical CF medication on oral health did not play a significant role. CF homozygotes had a significant higher total salivary protein concentration than the others, while SDS-PAGE analysis showed a 68 kDa protein being specific in appearance for CF heterozygotes. CF homo- and heterozygotes had significant higher salivary sodium concentrations than controls. CF homozygotes also had a significant higher salivary phosphate concentration than both other groups. The impression that CF patients seem to possess an intrinsic salivary compensatory mechanism should be further investigated.

Salivary electrolyte concentrations are associated with cystic fibrosis transmembrane regulator genotypes.

It is estimated that about one in 24 Belgian Caucasians is a cystic fibrosis (CF) heterozygote. Until now, CF heterozygotes can only be identified by genetic decoding (e.g. Inno-Lipa CF2 test), as they cannot be phenotypically distinguished from the general population. The aim of this study was to evaluate differences in salivary electrolyte concentrations (calcium, bicarbonate, chloride, potassium, sodium and phosphate) and salivary osmolarity between CF homozygotes (n=41), CF heterozygotes (n=56) and healthy controls (n=65). Differences between the three groups were investigated by means of non-parametric tests. Several significant differences between the three study groups and among, as well as between, the different cystic fibrosis transmembrane regulator (CFTR) genotypes were observed. Significant differences in salivary electrolyte concentrations between individuals with delta F508 mutation and those without, and between CF homozygotes and heterozygotes were observed. The concentrations of several salivary electrolytes, and salivary osmolarity were significantly higher in CFTR genotype individuals. Differences in salivary electrolyte concentrations may partly explain differences in caries between the three study groups.

Caries experience and oral cleanliness in cystic fibrosis homozygotes and heterozygotes.

OBJECTIVES AND STUDY DESIGN: In the present study, the caries experience (ie, the number of decayed, missing, and filled teeth) and oral cleanliness (ie, measures of plaque, calculus, and gingival bleeding) of patients homozygous for cystic fibrosis (CF; n = 42), patients heterozygous for CF (n = 48), and healthy control subjects (n = 62) were recorded and statistically analyzed. RESULTS: Those who were homozygous for CF had a significantly lower caries experience than both the control subjects (P <.001) and those who were heterozygous for CF (P =.011). They also had significantly less gingival bleeding sites than the controls (P =.014) and those heterozygous for CF (P =.019). Patients heterozygous for CF showed significantly more extensive restorations than those who were homozygous (P =.015) and significantly more missing teeth than the controls (P =.008), whereas the controls had significantly more missing teeth than those who were homozygous for CF (P <.001). CONCLUSIONS: Although those homozygous for CF are expected to have a high caries risk because of their essential sugar-rich diet, they did not have a significantly higher caries experience in this study. Their better gingival health and lower caries experience may be attributed to medication use (antibiotics) and as-yet unidentified intrinsic salivary mechanisms.

Flow cytometry as a new method to quantify the cellular content of human saliva and its relation to gingivitis.

BACKGROUND: Determining the cellular content of saliva by means of conventional microscopy chamber counting is a very time-consuming and operator-sensitive procedure. This study concentrated on the use of flow cytometry to examine the cellular content of saliva. Erythrocytes, leukocytes, epithelial cells and bacteria were quantified and the results were compared with caries experience and the presence of gingivitis. METHODS: 258 uncentrifuged vortexed paraffin-stimulated saliva samples (112 males and 146 females) were analyzed with the UF-100 flow cytometer. Salivary reference values were established for erythrocyte, leukocyte, epithelial cell and bacterial count. Caries experience (DMF) and the presence of gingivitis were recorded. RESULTS: Caries experience or caries risk could not be assessed with flow cytometry. However, salivary flow cytometry may be useful in determining an individual's risk for gingivitis: a significant increase in salivary leukocytes was observed in individuals with gingivitis. At a cut-off level of 10(3) leukocytes micro l(-1) saliva, a sensitivity of 76% and a specificity of 45% was obtained. Other analytes were not significantly different between individuals with and without gingivitis. CONCLUSION: Flow cytometry of paraffin-stimulated human saliva seems a promising diagnostic or predictive tool and further investigations of diseases of the oro-pharyngeal loge, such as tonsillitis and periodontitis, should be carried out in the future.