Clinical Versus Radiographic Caries Diagnosis in Primary Tooth Approximal Surfaces.

Purpose: The purpose of this study was to compare approximal carious lesions in dentin diagnosed by clinical examination with those diagnosed radiographically in high caries-risk children. Methods: Eighty-four Amish two- to 11-year-olds were evaluated clinically by calibrated examiners using standard epidemiological criteria and radiographically using standard criteria as part of baseline examinations for a two-year pilot clinical trial. Approximal carious surfaces diagnosed by clinical examination were compared to those diagnosed radiographically to determine the number of lesions misdiagnosed by clinical examination alone. Comparisons between the number of lesions detected by clinical exam and radiographic exam were made using McNemar's test. Results: Among 124 anterior approximal tooth surfaces, clinical examination alone identified 61 lesions (49.2 percent), while radiograph examination identified 72 lesions (58.1 percent); thus, nine percent of lesions were misdiagnosed by clinical examination alone. For the 412 posterior approximal tooth surfaces included in the study, 101 lesions (24.5 percent) were identified by clinical examination, whereas 229 lesions (55.6 percent) were identified via radiographic examination. Thus, 128 (31.1 percent) were misdiagnosed by clinical examination alone. Conclusions: Clinical examinations without radiographs significantly underestimate caries prevalence. Therefore, the use of radiographs should be encouraged in epidemiological studies and clinical trials.

COVID-19 and dental emergencies: reflections on teledentistry / COVID-19 e emergências odontológicas: reflexões em teleodontologia

Early in 2020, the COVID-19 virus spread throughout the world. On March 11, 2020 the World Health Organization declared COVID-19 a pandemic due to the level of spread and the severity of the disease. In efforts to control the spread of COVID-19 and reduce the number of new infections and deaths, people around the world took steps that had not been taken in modern history. As countries and locales issued "shelter in place edicts" the economic and social impact on businesses and professions was dramatic. The field of dentistry was similarly affected as edicts were made by governmental officials that elective dental procedures be stopped. In the state of Iowa, Governor Kim Reynolds issued a proclamation mandating that effective March 27, 2020 all dentists and their staff refrain from performing "elective dental procedures and nonessential or elective surgeries". With this turn of events, dental practices across the state were effectively shut down, only being allowed to treat emergency patients. Prior to the COVID-19 pandemic, the Iowa Dental Board, Delta Dental of Iowa, and the University of Iowa College of Dentistry shared an interest in exploring telehealth as a means of improving access to dental care for vulnerable populations. While steady progress was being made prior to the Pandemic, once the practice of dentistry in Iowa was restricted, the interest in telehealth, or "Teledentistry" soared. At the University Of Iowa College Of Dentistry, procedures were put in place to allow all emergency patients to be triaged through Teledentistry prior to being appointed in the Clinic. Using synchronous Teledentistry systems, "e-visits" prior to emergency care became the "new normal". Patients calling in for an emergency appointment were offered a menu of options for these e-visits including: 1) phone call; 2) phone call and sharing of images; or 3) a ZOOM meeting. All e-visits were provided by Dental faculty members at the University of Iowa with experience overseeing patient care in the Dental Emergency Clinic ranging from three to ten years. Final decisions on appointing patients were made by the provider based on existing records (when available), subjective symptoms (pain), objective findings (visible swelling), patients distress level, expectations and availability. During the initial 8-weeks following closure of our dental clinics (March 16-May 15), a total of 491 patients were seen in our dental emergency clinics, all of whom had been triaged by phone calls or e-visits. Most Patients reported overall satisfaction about the procedure. Based on our experience, Teledentistry (e-visits) are a useful tool to help in prioritizing dental emergencies. (AU)

No início de 2020, o vírus da COVID-19 se espalhou pelo mundo. Em 11 de março de 2020, a Organização Mundial da Saúde declarou a COVID-19 uma pandemia devido ao nível de disseminação e à gravidade da doença. Em esforços para controlar a propagação do COVID-19 e reduzir o número de novas infecções e mortes, pessoas em todo o mundo tomaram medidas que nunca haviam sido tomadas na história moderna. Como países e localidades emitiram ordens para ficar em casa, o impacto econômico e social nas empresas e profissões foi dramático. O campo da Odontologia foi afetado da mesma forma, com decretos que interromperam os procedimentos odontológicos eletivos. No estado de Iowa, a governadora emitiu uma proclamação exigindo que, em 27 de março de 2020, todos os dentistas e sua equipe se abstivessem de realizar "procedimentos odontológicos eletivos e cirurgias não essenciais ou eletivas". Com essa decisão, as práticas odontológicas em todo o estado foram efetivamente encerradas, sendo permitidas apenas o tratamento de pacientes emergenciais. Antes da pandemia do COVID-19, o Conselho de Odontologia de Iowa, e a companhia de seguro Delta Dental de Iowa e a Faculdade de Odontologia da Universidade de Iowa compartilhavam o interesse de explorar a telessaúde como um meio de melhorar o acesso à assistência odontológica para populações vulneráveis. Enquanto um progresso constante estava sendo feito antes da pandemia, a partir do momento que a prática da Odontologia em Iowa se tornou restrita, o interesse pela telessaúde, ou "teleodontologia", aumentou. Na Faculdade de Odontologia da Universidade de Iowa, foram implementados procedimentos para permitir que todos os pacientes de emergência fossem submetidos a uma triagem utilizando Teleodontologia antes de serem marcadas consultas na Clínica. Utilizando sistemas síncronicos de Teleodontologia, as "visitas eletrônicas" antes do atendimento de emergência tornaram-se o "novo normal". Os pacientes que ligavam para uma consulta de emergência receberam um menu de opções para essas visitas eletrônicas, incluindo: 1) telefonema; 2) telefonema e compartilhamento de imagens; ou 3) uma reunião pelo ZOOM. Todas as visitas eletrônicas foram realizadas por professores da Faculdade de Odontologia da Universidade de Iowa, com experiência de três a dez anos em supervisionar o atendimento a pacientes na Clínica de Emergência Odontológica. As decisões finais sobre a marcação de consultas para os pacientes foram tomadas pelo professores com base em prontuários (quando disponíveis), sintomas subjetivos (dor), achados objetivos (inchaço visível), nível de sofrimento dos pacientes, expectativas e disponibilidade do paciente e profissional. Durante as oito semanas iniciais após o fechamento de nossas clínicas odontológicas (16 de março a 15 de maio), um total de 491 pacientes foram atendidos em nossas clínicas de emergência odontológica, todos eles submetidos a triagem por telefonemas ou visitas eletrônicas. A maioria dos pacientes relatou satisfação geral com o procedimento. Com base em nossa experiência, a Teledentistry (visitas eletrônicas) é uma ferramenta útil para ajudar na priorização de emergências odontológicas (AU)

Expression of beta-catenin in human tooth germ.

OBJECTIVE: To evaluate beta-catenin expression in human tooth germ development. STUDY DESIGN: Specimens of 7 human fetuses aged between the ninth and sixteenth week were examined for beta-catenin expression by immunohistochemistry. RESULTS: In the bud stage, we observed catenin membranous positivity for all primitive dental lamina and dental ridge cells, cytoplasmic positivity for tooth bud and intense nuclear positivity for early-condensed dental mesenchyme. The cap stage was marked by intense cytoplasmic and nuclear positivity in the outer and inner enamel epithelium and the dental papilla and by moderate cytoplasmic positivity in the enamel knot. In the early bell stage, we noted strong cytoplasmic and nuclear staining in the inner and outer enamel epithelium, only moderate membranous and cytoplasmic staining in the stellate reticulum, a high percentage of intense nuclear positivity in the dental papilla and strong focal nuclear and cytoplasmic positivity in the dental sac. CONCLUSION: All areas with close contact between epithelial structures and ectomesenchymal cells showed increased expression of delocalized cytoplasmic and nuclear beta-catenin. Nuclear localization, tissue expression pattern and timing suggest a pivotal role for beta-catenin in the transcriptional activation of genes probably involved in the mesenchyme-epithelial interactions on which human tooth development is based.

Cytokeratin changes in cell culture systems of epithelial cells isolated from oral mucosa: a short review.

In the past three decades, many studies have analyzed ultrastructural and molecular markers of differentiation in squamous stratified epithelial tissues. In these tissues, epithelial cells migrating from the basal layer to the upper layers undergo drastic changes, which involve membrane-associated proteins, DNA synthesis, phenotypic aspects, lipid composition, and cytoskeletal components. Cytoskeletal components include a large and heterogeneous group, including intermediate filaments, components of the cornified envelope, and of the stratum corneum. When grown in mono- and multilayer cell cultures, epithelial cells isolated from the oral mucosa may reproduce many of the biochemical and morphological aspects of epithelial tissue in vivo. In the present paper, we examine phenotypic changes, development of suprabasal layer, and Involucrin expression occurring in differentiating oral epithelial cells, based on literature review and original data.

Intercellular junctions in oral epithelial cells: ultrastructural and immunological aspects.

The activation of the molecular cascade leading to Ca++ -induced differentiation in cultured epithelial cells might be provided by the establishment of intercellular junctions between cells. In the present paper, we tested the hypothesis that Ca++ concentration would determine morphological and biochemical changes in intercellular junctions of cultured human gingival cells. Triplicate samples of monolayer cultures of human oral gingival cells were grown with two different Ca++ concentrations (0.3 and 1.8 mM), and examined by transmission (TEM) and scanning (SEM) electron microscopy at different time periods. To determine the role of the E-cadherin/beta-catenin complex in intercellular junction formation, oral epithelial cell cultures were grown in 0.3 mM Ca++ in presence of a blocking antibody anti human E-cadherin, stained with antibodies anti human beta-catenin, and examined by confocal laser scanning microscopy (CLSM). By TEM and SEM, cells grown at physiologic Ca++ concentrations (i.e., 1.8 mM) showed a subjective increase of the size of microvilli and of the number of intercellular junctions, which was more evident after 3 days in culture. Desmosome-like junctions were observed in cells grown in 1.8 mM Ca++, not in cells grown in 0.3 mM. By CLSM, development of intercellular adhesion was marked by membranous localization of E-cadherin and beta-catenin within the first hours in both culture types. When cell-cell adhesion was prevented, cells showed round shape and no membranous localization of beta-catenin. Restoring cell adhesion brought about polygonal cell shape and membranous localization of beta-catenin. We can conclude that increased Ca++ concentration may determine biochemical and morphological changes at membranous level in human oral epithelial cells. These changes may facilitate the development of intercellular junctions.

Immunological and ultrastructural characterization of plasma cells of human periapical chronic inflammatory lesions (granulomas).

Despite many studies on the topic, plasma cells found in human periapical chronic inflammatory lesions (granulomas) continue to present unresolved issues. In this study, we tried to assess quantitatively and qualitatively the nature of plasma cells of 4 human periapical granulomas. Samples were analyzed for relative amounts of IgG-, IgM-, IgA-, and IgE-positive plasma cells by immunohistochemistry, and for morphological changes by transmission electron microscopy (TEM). By immunohistochemistry, many plasma cells stained positively with anti-IgG and anti-IgM antibodies; fewer cells reacted with anti-IgE and anti-IgA. Russell Bodies, controversial aspects of plasma cell maturation, showed positive reactivity of the superficial layer only to antibodies against IgG and IgM. By TEM analysis, phenotypes of normal and dysfunctional plasma cells (Mott cells) were evident. Russell Bodies appeared as intra- or extracellular round vesicles, with an homogeneous internal core, and an external membrane, resembling rough endoplasmatic reticulum (RER). We can conclude that mucosal immune response is not the predominant type in the periapical lesions examined. Positive immunoreaction for IgG and IgM of Russell Bodies may be due to the residual RER membrane, whereas components of yet unidentified nature may occupy the internal core.

Influence of amalgam fillings on Hg levels and total antioxidant activity in plasma of healthy donors.

In order to evaluate the influence of specific factors on mercury (P-Hg) levels and antioxidant power (P-FRAP) in human plasma, 26 healthy donors were examined by a dentist, their plasma analyzed for Hg by atomic absorption spectrometry and for total antioxidant activity by FRAP method. Hg plasma concentration was found to be correlated with the number of amalgam fillings, suggesting that Hg released from fillings is a source of Hg in non-occupational exposed subjects. P-FRAP correlated negatively with P-Hg suggesting a pro-oxidant role of the Hg released from amalgam fillings. Though age by itself was not significantly correlated with P-FRAP, when considered together with P-Hg in multivariate analysis, it was found to be a major related cofactor. Multivariate analysis showed no influence of fish consumption or cigarette smoking on P-FRAP.

Subcellular localization of beta-catenin in malignant cell lines and squamous cell carcinomas of the oral cavity.

BACKGROUND: Beta-catenin, an E-cadherin-associated protein involved in cell-cell adhesion and signaling, has been hypothesized to translocate to the nucleus and activate transcription in several human cancers, including oral squamous cell carcinomas (OSCC). METHODS: In the present study, we analyzed the subcellular localization of beta-catenin in cultures of human oral normal and malignant (cell lines SCC15 and SCC25) keratinocytes and in 24 frozen samples of oral squamous cell carcinomas by a double-staining technique for nucleic acids and beta-catenin. Growth potential, as assessed by cell count at different time periods, was established for normal, SCC15 and SCC25 cell lines; oral squamous cell carcinomas were classified according to the histopathological and malignancy indexes. RESULTS: Beta-catenin localized at the plasma membrane in the normal and SCC15 cells, not in the SCC25 cells, where it localized mostly in the perinuclear and nuclear areas. In the growth assays, SCC25 cell lines proliferated faster than in normal and SCC15 cells over a period of 6 days (cell numbers were significantly different, P < 0.0001). Carcinoma sections showed a combination of membranous, cytoplasmic and, in few invading epithelial islands of two tumors, nuclear localization of beta-catenin. CONCLUSIONS: In oral squamous cell carcinomas, nuclear beta-catenin staining was observed only within invading islands of two carcinomas deep in the underlying connective tissue. On the basis of this study, we conclude that intranuclear beta-catenin does not appear to be a common finding in oral squamous cell carcinomas and that a clear association between intranuclear beta-catenin and histopathological and malignancy indexes in vivo could not be established.