Salivary Scca1, Scca2 and Trop2 in Oral Cancer Patients-A Cross-Sectional Pilot Study.

Oral squamous cell carcinoma (OSCC) is frequently diagnosed in the advanced stages. The purpose of this paper is to determine the salivary values of SCCA1, SCCA2 and TROP2 in patients with T1N0M0 OSCC and to compare them with the values obtained from healthy individuals. Unstimulated (UWS) and stimulated (SWS) saliva was sampled from 29 patients with T1N0M0 OSCC and 29 sex- and age-matched healthy individuals. Statistical difference was observed in SCCA1 and SCCA2 levels both in UWS and SWS samples. TROP2 was not measurable in most of the salivary samples. Both SCCA1 and SCCA2 could represent potential biomarkers for the early-stage OSCC. Research on a larger sample and biomarker validation is needed to assess the clinical potential of SCCA1 and SCCA2 in the OSCC early diagnostics.

Atypical Peripheral Ossifying Fibroma of the Mandible.

Peripheral ossifying fibroma (POF) is a benign localized lesion originating from gingival and alveolar oral mucosa. Its origin can be cells of periodontal ligament. The lesions usually develop in women in their twenties. POF is a complex clinical and histological diagnosis due to its shared characteristics with many other conditions. In this paper, we presented a case of an atypical peripheral ossifying fibroma (POF) in the left lateral part of the mandible in a 70-year-old male patient who had two semicircular bridges supported on four implants in the upper and lower jaws. A review of CBCT and orthopedic imaging showed no visible intraosseous changes. Histological analysis revealed the diagnosis of POF. The case in question is interesting, as elaborated on in the discussion section of this paper because POF is usually found in female patients aged between 20 and 30 years.

Anatomical Variations of the Bifid Mandibular Canal on Panoramic Radiographs in Citizens from Zagreb, Croatia.

BACKGROUND: The bifid mandibular canal (BMC) is an anatomical variation with reported prevalence ranging from 0.08 to 65%. Identifying anatomical variations of mandibular canal is very important in order to prevent possible complications during oral surgical and other dental procedures. OBJECTIVES: The aim of this study was to determine the prevalence and to classify the morphology of BMCs using digital panoramic radiographs. MATERIAL AND METHODS: A retrospective study was conducted that included 1008 digital panoramic radiographs (412 female and 596 male) used to identify the type of BMC. Panoramic radiographs were analyzed by three oral surgeons and one dentist, and BMCs were classified into six different types, 4 types according to Langlais et al. (types 1-4), and two new types (types 5 and 6) described by authors. RESULTS: The prevalence of BMC was 4.66% (n=47), with no significant differences in gender between BMC types (P=0.947; χ2=0.74). The prevalence of type 1 BMC was 0.79% (n=8), type 2 2.08% (n=21), type 3 0.30% (n=3), type 4 0% (n=0), type 5 0.89% (n=9) and type 6 0.60% (n=6). CONCLUSION: This study revealed a relatively high prevalence of BMCs among Zagreb citizens. Furthermore, two new types of BMCs were described. These results stress the importance of a careful and thorough radiographic analysis prior to each invasive procedure in the mandible.

Salivary melatonin in oral squamous cell carcinoma patients.

Melatonin's role in circadian rhythm is well documented, as are its' anti-oxidant, oncostatic and anti-inflammatory properties. Poor sleep quality has been associated as a potential risk factor for several malignancies, including head and neck cancers. The purpose of this study is to determine salivary melatonin (MLT) levels in oral squamous cell carcinoma (OSCC) patients, compare the salivary MLT levels with those in healthy individuals and compare the salivary and serum levels in OSCC patients. Furthermore, the aim is to investigate the potential relationship between sleep quality and salivary MLT levels in OSCC patients. Unstimulated (UWS) and stimulated (SWS) whole saliva was sampled from patients with T1N0M0 and T2N0M0 OSCC (N = 34) and 33 sex and age matched healthy subjects. Serum samples were taken from 11 OSCC patients. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) questionnaire. Melatonin levels in UWS and SWS were significantly higher in the OSCC group. Sleep quality was significantly lower in patients with OSCC (P = 0.0001). ROC analysis was found to be significant (P < 0.001) in evaluating MLT concentration limit in diagnosing OSCC. The expected relationship between sleep quality and salivary MLT levels in OSCC patients was not observed. Our results suggest salivary MLT as a potential biomarker that might facilitate non-invasive detection of early stage OSCC.

Differences in self-reported symptoms in patients with chronic odontogenic and non-odontogenic rhinosinusitis.

PURPOSE: To evaluate the possible differences in self-reported symptoms between patients with chronic odontogenic rhinosinusitis (CORS) and patients with chronic non-odontogenic rhinosinusitis (CnORS). MATERIALS AND METHODS: The study included 64 patients diagnosed with chronic rhinosinusitis according to EPOS guidelines. 32 patients had CORS, and the control group were 32 patients with CnORS. Patients were matched according to gender and age. All the patients underwent a CT scan evaluated by a radiologist, and were evaluated by an oral surgeon and otorhinolaryngologist before being assigned to one of the groups. The severity of the symptoms was assessed through questioners SNOT-22 (sino-nasal outcome test) and VAS (visual analogue scale) symptom score. Kolmogorov-Smirnov's, Fisher's and Mann-Whitney U test were used in the statistical analysis of the data. RESULTS: People with CORS show similar symptomatology on SNOT-22 score to patients with CnORS, with no significant statistical difference between any of the SNOT-22 symptoms. VAS symptom score showed that odontogenic group had a significantly higher score for fever (p = .004) and halitosis (p = .003). CONCLUSION: Halitosis and fever might be the most important symptoms in differentiating between CORS and CnORS symptomatology. Better diagnostic tools, such as VAS symptom score might help medical professionals to be quicker at recognizing CORS specific symptomatology, and help them treat the disease as early and adequately as possible.

A Large Cheek Hematoma as a Complication of Local Anesthesia: Case Report.

Hematoma is among less frequent complications which occur following local anesthesia. The posterior superior alveolar nerve block and inferior alveolar nerve block are known to be accompanied with a higher incidence of positive aspiration compared to all infiltration and block anesthesia techniques in oral surgery. We present the case of an otherwise healthy 8-year-old boy who experienced a large cheek hematoma after a routine infiltration anesthesia in the maxilla. Firstly, he was mistakenly treated under the diagnosis of type1 allergic reaction. Subsequently, the topical therapy for an evident, large hematoma was unsuccessful. Ultimately, incision of the infected hematoma and antibiotic therapy were crucial for its resolution. Early recognition of clinical signs of hematoma is of utmost importance for the surgeon in order to treat the patient adequately.

Bronchogenic adenocarcinoma metastatic tumor mimicking a dentoalveolar abscess in the maxilla.

Intraosseous metastatic tumors (IOM) in maxilla are less frequent than the soft tissue metastatic tumors. Lung and bronchogenic metastatic tumors are uncommon in the maxilla. We present a maxillary bronchogenic metastasis with a rare clinical appearance. IOM was misdiagnosed as a dentoalveolar abscess and treated with antibiotics for 3 weeks. After not responding to antibiotics, the patient's general dental practitioner forwarded the patient to the Department of Oral and Maxillofacial Surgery. The associated tooth was extracted and the patient was recalled 1 week later. No signs of improvement were observed, and cytology, biopsy, and radiology diagnostics were performed. Cytologic results and biopsy could not differentiate a metastatic tumor from a salivary duct carcinoma. Ultimately, negative androgen receptors immunohistochemistry supported the diagnosis of bronchogenic metastatic adenocarcinoma. This case report stresses the importance of taking a thorough medical history. To our knowledge, this is the third bronchogenic IOM to the maxilla reported, mimicking a dentoalveolar abscess. General dental practitioners are among the first in contact with oral metastatic tumors and it is therefore important to report unusual clinical cases, as they present a diagnostic challenge for both the clinician and the pathologist.

Ambulatory oral surgery: 1-year experience with 11680 patients from Zagreb district, Croatia.

AIM: To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. METHODS: Sociodemographic and clinical data on 11680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. RESULTS: The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P<0.001) and intraoral incisions (P<0.001) were performed among male patients, whereas significantly more alveolectomies and apicoectomies were performed among female patients (P<0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. CONCLUSION: The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients' awareness of the importance of oral health.

Tonsillolithiasis and orofacial pain.

Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils. Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths. Clinically, there was no sign of inflammation, and the patient's past history revealed an approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of this report was to indicate the importance of tonsilloliths as a cause of orofacial pain.

The effect of tobacco use on oral health and dental readiness in the Croatian Army.

This study examined tobacco use as a risk factor in the development of periodontal disease as dental emergency and dental readiness among soldiers. A total of 884 soldiers were followed: 650 recruits and 234 professional active veterans. They were categorized into dental readiness classes, and questionnaires were completed about tobacco use. Overall, 62.7% of soldiers reported current smoking, with a higher prevalence of smokers among recruits. The results showed a significant difference in smokers vs. non-smokers in dental readiness, supragingival/subgingival calculus, gingivitis, and Class 3 dental fitness. More recruits (63.8%) smoked than veterans (59.4%), but greater prevalence of daily cigarette smoking and duration of smoking habits was found among veterans. In both groups, soldiers who smoked were characterized by a higher percentage of periodontal health problems and decreased combat readiness compared to soldiers who did not smoke. This indicates a need for oral health prevention program, and cigarette smoking and cessation programs.

Large erupting complex odontoma in a dentigerous cyst removed by a piecemeal resection.

Odontomas (ODs) are the most frequent odontogenic tumors in Western societies, they are often asymptomatic and discovered during routine radiography The purpose of this report was to describe the case of a 10-year-old child with an odontoma within a dentigerous cyst (DC). The patient presented with a 1-week history of painful swelling involving the right mandible and cheek. An intraoral examination revealed a defect of the oral mucosa behind the permanent mandibular first molar, which resembled an exposed alveolar bone or tooth remnants. Clinical and radiographic evaluation revealed a large erupting OD associated with a dentigerous cyst. The OD was separated into pieces and enucleated together with the dentigerous cyst to preserve the mandible's integrity and because of the patient's age. This is the first report of an erupting OD associated with a DC in a child. Surgical removal might be a challenge when large ODs are encountered.

Mucoepidermoid carcinoma misdiagnosed as palatal odontogenic infection: an overview on the differential diagnosis of palatal lesions.

Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authors' knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MEC's differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list.

Influence of different etching times on dentin surface morphology.

The aim of this study is to investigate the influence of different etching times on demineralized dentin surface morphology using scanning electron microscopy and qualitative line microanalysis of chemical structure. Two sample groups, consisting of 30 first premolar teeth in each group, were established. Teeth were cut at the half-distance between the enamel-dentin junction and the pulp. The first group of specimens was etched for 10 seconds and the second group for 30 seconds. 37% ortophosphoric acid was used. SEM (scanning electron microscopy) was utilized to observe the following parameters: number and diameter of dentinal tubules, dentinal and intertubular dentinal surface percentage, appearance of the dentin surface porous zone containing smear layer and demineralized residual collagen particles with dentin demineralization products in acid globules, and dissolved peritubular dentin cuff. After calculating measurements of central tendency (X,C, Mo, SD), Kolmogorov-Smirnov and Student t-test were performed to confirm the quantitative results, and the chi2-test was run to produce qualitative data. In contrast to the 10-second etching time, the increased etching time of 30 seconds resulted in the following findings: (1) an increased number of dentinal tubules (p < 0.05), (2) an increase in dentinal tubule diameter (p < 0.05), (3) an increase in dentinal tubule surface percentage (p < 0.001), (4) a decrease in intertubular dentinal surface percentage (p < 0.001), (5) appearance of dentin surface porous zone containing smear layer and demineralized residual collagen particles with dentin demineralization products in acid globules (p < 0.001), and (6) completely dissolved peritubular dentin cuff (p <0.001). Therefore, different etching times using the same phosphoric acid concentration result in different morphological changes in demineralized dentin surface. Moreover, based on a comparison with current studies, prolonged etching time causes morphological changes to dentin surface. Such changes, have, in turn, negative effects on the dentin hybridization process.

Biological bases of dentin hybridization.

The aims of this study were threefold: (1) to characterize and quantify the number, diameter and surface area of exposed dentinal tubules on the cross section of the human coronal dentin; (2) to determine if any such differences in these properties arise in relation to the distance from the dentinoenamel junction; and (3) to evaluate whether such differences can influence dentin hybridization. To accomplish these aims, scanning electron microscopy comparative observation was carried out on 60 prepared human premolars, which were divided into three groups of 20 samples each. The three sample groups were cut as follows: (1) in the central fissure region, one millimeter from the enamel-dentine junction; (2) halfway between the enamel-dentine junction and the pulp; and (3) one millimeter from the roof of the pulp chamber. Using one-way analysis of variance (one-way ANOVA) and a regression linear model, the data enumerated below were obtained. First, the mean number of the tubule openings was 19600/mm2 on the first level, 32400/mm2 on the second and 42300/mm2 on the third. The mean tubule diameter on the first level was 0.67 microm, 1.52 microm on the second and 2.58 microm on the third. Finally, exposed tubules on the first level occupied 2.79% of of total dentinal surface area, 23.90% on the second, and 87.78% on the third level. Therefore, significant statistical differences (p < 0.01) between all three groups of the specimens for all three properties were observed, as well as positive correlation between the dentin depth and each of these properties. This indicates that the dentin structural variety, which ultimately determines adhesion to dentine, involves a complex interaction between biological material (dentin) and the particular adhesion system applied.

Influence of oral hygiene on oral health of recruits and professionals in the Croatian Army.

OBJECTIVES: Good oral health of soldiers would decrease the number of urgent dental interventions and absences from training and the battlefield and would improve the security of the whole formation. This study shows the habits for maintaining oral health and the oral status of the examined population in the Croatian Army. METHODS: The data were obtained from examinations and questionnaires of 912 Croatian soldiers, 650 of whom were recruits and 262 professional soldiers of the Croatian Army land forces. RESULTS: The results showed that the oral health of the examined population was mostly bad, as a consequence of inadequate prevention of illnesses of the oral cavity associated with insufficient oral hygiene. The most common disease was dental caries (5.84 carious teeth per recruit and 2.71 per professional). Only 14 (1.53%) of 912 examinees had completely healthy teeth. Only one-third of the examinees had no bleeding when tested with a periodontal probe. Acute pain of odontogenic origin was present for 23.5% of examinees. Such oral health makes most of the soldiers unreliable for peace operations that would last >6 months, because it lowers their combat readiness. CONCLUSION: Oral hygiene and oral health are poor. Consequently, combat readiness is low because of the need for frequent dental interventions, which could further lead to absence from the field and appointed tasks. The results emphasize the need for obligatory regular check-ups to improve oral health in the Croatian Army.

[Impact of dental emergencies on combat readiness in Croatian Army]. / Utjecaj hitnih stomatoloskih stanja na borbenu spremnost pripadnika Hrvatske vojske.

AIM: The potential of dental emergencies to reduce combat readiness is a major concern of military planners. Dental fitness classification is the primary measure of a soldier's dental readiness. METHODS: The teeth and mouth of 400 soldiers, 200 of them recruits and 200 active duty military personnel, were prospectively examined. According to oral status, the subjects were divided into three classes: class 1, requiring no dental treatment or reevaluation within 12 months; class 2, oral condition not expected to result in dental emergency within 12 months, if not treated or followed up; and class 3, subjects requiring dental treatment to correct both their dental and oral health condition, which is likely to cause dental emergency during a 12-month period. RESULTS: The survey designated 18% of study subjects to class 1, 15.5% to class 2, and 66.% to class 3. Group 3 subjects had a considerably reduced combat readiness, because they may have needed treatment for some dental emergencies at any moment. CONCLUSION: It is concluded that recruits generally have inappropriate dental status when they present for military service. Although they have free dental care (except for prosthetics and orthodontics), professional soldiers also have rather poor dental status, which can reduce the possibility of providing due care for dental emergencies, thus adversely affecting their combat readiness.

[Antibiotic prophylaxis of infective endocarditis in stomatology--a survey of cardiologists]. / Antibiotska profilaksa infekcijskog endokarditisa u stomatologiji--kardioloska praksa.

According to epidemiological reports; 14-20% of infectious endocarditis (IE) are associated with previous stomatological procedures (oral surgery, procedures during periodontal and conservative endodontic therapy and intra-ligament anesthesia) which cause transitory bacteriemia for 10-15 minutes. In patients at risk, such short lasting bacteriemia is sufficient for the development of infectious endocarditis. In everyday practice we encounter patients at risk for IE referred to oral surgery (most often tooth extraction) at the Oral Surgery Division, Department of Facial, Maxillary and Oral Surgery, Dubrava University Hospital. Majority of these patients are given IE prophylaxis according to the latest AHA recommendations. For some patients we first consult a cardiologist due to the underlying disease, and as a rule these patients return with cardiologist's advice on IE prophylaxis. We noticed that these recommendations differ between cardiologists. Some cardiologists have for years been recommending the same "prophylaxis" which is not in accord with AHA guidelines. From the available cardiac records we analyzed antibiotic IE prophylaxis before oral surgery in cardiac patients at risk recommended by cardiologists in four Zagreb hospitals in 2003. We collected in total 17 recommendations prescribed by 12 cardiologists. Regretfully, none was in accord with valid AHA guidelines from 1997. Only 6 out of 17 recommendations are in agreement with the outdated guidelines from 1994, which also raises concern. Therefore, we thought it was worthwhile to present these cases, hoping this will stimulate discussion on common guidelines for the benefit of patients at risk for IE.