Multiple idiopathic cervical root resorption: systematic review and report of four cases.

OBJECTIVES: The objectives of this study were to report four cases of multiple idiopathic cervical root resorption and to systematically review the literature on this condition. METHODS: The clinical and radiographic findings and the medical/dental histories of four patients who presented with multiple idiopathic cervical root resorption were recorded. Additionally, 10 references from the literature that reported on 14 patients were reviewed. RESULTS: Multiple idiopathic cervical root resorption was an incidental finding on routine clinical and radiographic examination. There appeared to be no correlation between this type of resorption and any medical/dental finding. Radiographically, multiple idiopathic cervical root resorption was found to begin at the cemento-enamel junction and then either progress to involve the entire cervical region or, at some point, spontaneously arrest. Those cases that progressed to involve the entire cervical region required extraction. The number of teeth that demonstrated this condition ranged from 5 to 24 per patient. More teeth became involved as the condition was followed in time. There was no detectable frequency of occurrence for any particular dental region or tooth among the involved teeth. Of a total of 18 patients, 13 were females whose ages ranged from 7 years to 68 years. Ten of the 18 patients were Caucasian. CONCLUSIONS: Multiple idiopathic cervical root resorption was found most frequently associated with younger females. This condition appeared to be of unknown aetiology and uncertain natural history.

Radiographic manifestation of clear cell odontogenic tumor.

Clear cell odontogenic tumors are uncommon, only 20 cases having been reported in the literature. We report a case that presented with unique radiographic manifestations over a period of 12 years; no similar case has been reported to date. Documentation of the malignant nature of the condition and of the range of clinical and radiographic manifestations with which this neoplasm can present provides useful insight into its pathogenesis and progression. Early and timely recognition of the lesion, histopathologic examination, and aggressive interventional procedures are in order to successfully treat this condition and prevent a potentially fatal outcome.

Gingival telangiectases: an underappreciated physical sign of juvenile dermatomyositis.

BACKGROUND: MEDLINE searches (1966-June 1969) failed to identify references that give detailed descriptions of the oral manifestations of dermatomyositis (DM). However, several reports predating MEDLINE provided more complete descriptions of oral lesions associated with DM. OBSERVATIONS: We describe 5 cases of juvenile DM with oral manifestations, primarily in the form of gingival telangiectases. These findings are compared with those descriptions found in earlier reports. CONCLUSIONS: Oral lesions in juvenile DM have rarely been reported. Mucous membrane involvement associated with DM may include telangiectases, edema, erosions, ulcers, and leukoplakia-like areas. In cases of DM, gingival telangiectases likely represent an underappreciated diagnostic finding analogous to nail-fold telangiectases.

Laser Doppler flowmetry: a clinical test of pulpal vitality.

PROBLEM: A rapid, accurate, noninvasive method of determining pulpal blood flow would be helpful in determining pulpal vitality. OBJECTIVE: The purpose of this study was to determine if laser Doppler flowmetry can measure induced changes in pulpal blood flow. STUDY DESIGN: Two percent lidocaine with epinephrine 1:100,000 was infiltrated into the labial vestibule to anesthetize five anterior teeth in healthy human volunteers. Stents were placed on the teeth to stabilize the laser Doppler probes. Measurements of pulpal blood flow were made along with electrocardiograms to record the cardiac cycle. RESULTS: Laser Doppler flowmetry demonstrated pulpal blood flow and pulse amplitude decreases under test conditions. These decreases were most significant at 10 minutes after the injection of anesthetic with vasoconstrictor. CONCLUSIONS: Laser Doppler flowmetry was able to measure pulpal blood flow and record changes in blood flow that occurred when epinephrine was used with infiltration anesthesia. The pulse width and the mean flow were dramatically affected as was synchronization with the cardiac cycle.

Comparison of two laser Doppler systems on the measurement of blood flow of premolar teeth under different pulpal conditions.

An in vivo investigation was conducted to assess the ability of two laser Doppler flowmeters (DRT4, Moor Instruments Ltd; Laserflo BPM2, Vasamedics) to differentiate between vital pulp, ischaemically necrosed pulp, and an empty pulp chamber in premolar teeth in children. Sixteen intact, vital teeth in need of extraction for orthodontic purposes were identified. Laser Doppler blood flow readings were taken prior to (T1) and after the administration of adrenaline-free local anaesthetic (T2), after extraction and replantation of the teeth (T3), and after broaching the pulp tissue and replanting the teeth (T4). The data collected (flux values) for both instruments were analysed using a repeated measures ANOVA. Significant differences were found for vital pulp (T1, T2) versus ischaemically necrosed pulp (T3), and for vital pulp (T1, T2) versus an empty pulp chamber (T4), with the Moor DRT4 instrument. This instrument also detected a significant difference in pulpal blood flow to the vital pulp, before and after the administration of local anaesthetic. No other significant differences were found.

Meeting the educational needs of patients with oral lichen planus.

Lichen planus is a chronic oral disorder that is often painful and annoying. The patients have been described as usually over 50 years old, with a high educational level, anxious and high-strung. In previous research studies, these patients have reported unusual and highly stressful life events. Because dentists are in a position to advise their patients about chronic illness, this study was designed to (1) determine what information was given to lichen planus patients by their dentists; (2) determine what questions the patients asked their dentists; and (3) assess what educational materials would be helpful for this group of patients. A survey was sent to 151 biopsy-confirmed lichen planus patients, with a response rate of 55 percent. The results indicated that the patients were concerned about the possibility of malignancy and of contagion, and that they were frustrated by the lack of available patient education.

Pulpal response to cavity preparation with the Er:YAG and Mark III free electron lasers.

OBJECTIVE: The purpose of this investigation was to evaluate the pulp response to class V cavity preparation with the use of the Er:YAG laser and free electron laser. STUDY DESIGN: Class V cavities were prepared in 133 teeth of four beagle dogs by one of three methods: (1) Er:YAG laser, (2) free electron laser, (3) high-speed handpiece. Treatment occurred at 1 hour, 1 day, 7 days, and 28 days. The teeth were removed and the pulp evaluated. Histologically, the data were evaluated with Mantel-Haenszel analysis. RESULTS: The Er:YAG laser, free electron laser, and handpiece treatment groups resulted in specimens with normal or mild pulp reactions in 36, 46, and 42 teeth, respectively; moderate or severe reactions were observed in 7, 1, and 1 teeth, respectively. No statistically significant difference in the pulp response to the three treatment modalities was observed. CONCLUSION: The pulp response to Er:YAG laser and free electron laser application would appear to be similar to the response from high-speed handpiece application.

Assessing the characteristics of patients with oral lichen planus.

The authors assessed the medical history, lifestyles and health habits of 146 patients with oral lichen planus as confirmed by biopsy. The results support a relationship between stress and the development of oral lichen planus. Fifty-one percent of the subjects reported that they had experienced stressful events at the time of the lichen planus onset. Practitioners may want to consider the benefits of stress management and bereavement counseling in managing patients with oral lichen planus.

Peripheral ameloblastoma.

Peripheral ameloblastomas are rare odontogenic tumors presenting as tumoral masses, erythematous plaques, or papillary lesions on the attached gingiva. This study reviews the demographic, clinical, and microscopic features of 8 previously unreported cases. One patient had two separate peripheral ameloblastomas, one 7 years after the first in the opposite side and arch. The cases match those described previously with respect to age, gender, location, and radiographic and microscopic features. Because recurrence has been reported and second primary sites may be found, periodic follow-up is recommended after conservative surgical removal.

Botryoid odontogenic cyst: analysis of 33 cases.

The botryoid odontogenic cyst is considered to be a multiloculated variant of the lateral periodontal cyst. Fewer than 40 of these lesions have been described, many of which have recurred. This paper describes the demographic, clinical, microscopic, and radiographic features of 33 unreported cases from the files of the Oral Pathology Biopsy Service at the University of North Carolina School of Dentistry. Our findings are in agreement with previously published cases for an average age of 57 years and the most common site for occurrence in the lower premolar area. Follow-up information on 12 patients determined that 2 had recurrences.

Blood-flow mapping of oral tissues by laser Doppler flowmetry.

The purpose of this study was to develop a rapid protocol for noninvasive quantification of blood flow at intraoral sites by laser Doppler flowmetry. For each flow measurement, the lowest flow observed over a 30-s period was recorded. Three flow readings at each site were averaged and recorded. Forehead and dorsal right-hand blood flows measured agreed with previous laser Doppler flow measurements. Flows measured with a hand-held probe were not different from flows measured with a stent-stabilized probe on the attached gingiva and an adhesive-stabilized probe on the dorsal hand. High flows were found in the tongue, buccal mucosa, and buccal vestibule. Medium flows were found in the attached gingivae. The lowest flows were found in the teeth. These results indicate that flow in intraoral tissues varies by site and can be noninvasively quantified with the laser Doppler flowmeter when a rigorous measurement protocol is used.

Wet versus dry enamel ablation by Er:YAG laser.

The purpose of this study was to observe tooth structure and pulpal temperature changes in extracted human teeth subjected to a pulsed Er:YAG (2.94 microns) laser. Two teeth were irradiated while dry and three teeth while moistened by a fine water mist. When the dry teeth were irradiated, there was minimal enamel ablation. SEM of the resulting surface showed rounded fragments of enamel rods, enamel melting, cracks, and smooth-edged voids. Intrapulpal temperature measured by thermal sensor rose more than 27 degrees C. When the laser application on the teeth was pulsed with a constant fine water mist, enamel and dentin were efficiently ablated. SEM of the resulting surfaces showed fissures and conical craters with sharp enamel projections remaining. Intrapulpal temperatures rose an average of 4 degrees C. These results indicate that pulsed Er:YAG (2.94 microns) used with a water mist removes enamel and dentin without producing significant pulpal temperature changes.

Nifedipine-induced gingival hyperplasia.

Gingial hyperplasia is a complication which may be seen in a significant number of patients taking nifedipine (Procardia, Pfizer) a commonly used medication for cardiac vessel dilitation. This is a report of gingival changes in a 43-year-old hypertensive male who began using the calcium channel blocking agent during his active dental treatment. Gingival hyperplasia developed which was severe enough to alter the course of his dental treatment and prompt his changing to other medications to control his blood pressure. The recognition that the drug was responsible for the hyperplasia led to prompt and effective methods to resolve this problem.

Dental lesions in tumoral calcinosis.

Tumoral calcinosis (TC) is a rare inherited autosomal dominant metabolic disease manifested by elevated serum phosphorus and 1,25 dihydroxyvitamin D levels and periarticular cystic and solid tumorous calcifications. The dental findings in a large family have been critical in determining the genetic transmission of the condition. Radiographically the teeth have short bulbous roots, pulp stones and partial obliteration of the pulp cavity. Histologically, coronal dentin and a variable amount of radicular dentin appears to be deposited regularly. At nonspecific points the developing radicular dentin appears to encounter a mass of calcified material and proceed to grow around it. This mass has a unique histologic pattern with ovoid spaces surrounded by amorphous calcification. At levels of further root development the radicular dentin has an irregular bending tubule arrangement. The dental lesion of TC appears to be different from that of radicular dentin dysplasia in histologic structure and in the method of initiation of the dentin defect. These data suggest that the specific dental lesion is a new phenotypic marker for TC.

Skin graft vestibuloplasty exostosis. A report of two cases.

Two cases of exostosis developing after mandibular vestibuloplasty and floor-to-mouth lowering with split thickness skin graft are presented, one with multiple recurrences. The lesion is clinically and microscopically described. Hypotheses with respect to the development of this phenomenon are proposed.

Erbium:YAG (2.94 mum) laser effects on dental tissues.

Past trials with soft and calcified tissues have demonstrated that long pulse train (2.5 mus) Er:YAG (2.94 mum) laser may be used to ablate tooth structure of human teeth. Determination of physical and thermal damage to surrounding tissue during removal of enamel and dentin is a primary objective of this study. Extracted human teeth with thermal probes imbedded in the pulp chambers were submitted to cavity preparation using an Erbium YAG laser with water mist. Wavelength selection as well as use of a water mist during the procedure resulted in efficient tissue removal without significant surrounding damage. Ground sections and SEM sections of teeth showed little or no melting or ash formation in adjacent dentin and enamel and no visible change in the pulp chamber. The surfaces produced by laser ablation were rough and irregular with craters and grooves. Average temperature change in the pulp chamber monitored during tooth preparation was 2.2 degrees Centigrade. These findings suggest that constantly available water aids vaporization and microexplosions, increasing the efficiency of tooth structure removal, and aids in cooling of the tooth structures. The long pulse Er:YAG (2.94 mum) laser may be an effective method for tooth reduction applications when used with a water mist.

Temporary silastic implantation following discectomy in the primate temporomandibular joint.

Silastic (Dow Corning, Midland, MI) has been used in the surgical treatment of a variety of temporomandibular joint (TMJ) disorders as either a permanent or temporary implant. In this study four Macaca fascicularis monkeys underwent bilateral TMJ discectomies and high condylar shaves. The experimental side was treated with a Silastic sheet implant which was removed at 3 months postdiscectomy. The contralateral side was left without an implant and served as a control. Animals were killed at 3, 4, 5, and 6 months postoperatively. A fibrous connective tissue capsule was found around the Silastic implant at all time intervals. This capsule formed a single joint space between the inferior surface of the glenoid fossa and articulating surface of the condyle. Three months following implant removal, the capsule was still present and there was no significant inflammatory cell infiltrate. The severity of the degenerative changes was decreased on the implant side.

A peripheral giant-cell granuloma manifestation of primary hyperparathyroidism: report of case.

Profuse granulomatous masses of the gingiva frequently occur in patients with gingival and periodontal disease. A 33-year-old female was seen for followup of a previously treated peripheral giant-cell granuloma. Two years earlier, a mass had been removed from the gingiva between the maxillary right central and lateral incisors. Current laboratory test results indicated hyperparathyroidism, and led to the discovery of a parathyroid adenoma. After the gingival lesion, adjacent teeth, and parathyroid adenoma were removed, the patient had no further recurrence of the lesion or signs of hyperparathyroidism.

Isolated extramedullary relapse of acute myelogenous leukemia in a tooth.

We report a case of isolated extramedullary relapse of acute myelogenous leukemia in a tooth following bone marrow transplantation. The patient was a 4-yr-old child who developed gingival swelling and bleeding while in bone marrow remission. Crush artifact prevented definitive diagnosis of leukemic relapse in a biopsy of the gingival soft tissue, but decalcification of the tooth showed an unequivocal leukemic infiltrate in the dental pulp. Decalcification and sectioning of extracted teeth are recommended when equivocal findings are present in the gingival soft tissue or when there is a history of lymphoreticular malignancy.