The UTHSCSA Dental School in the new millennium.

The UTHSCSA Dental School, just short of 30 years in existence, has made great strides to be a leader in dental education. Although increased use of computers has the greatest potential for revolutionizing dental education, there are other components that must constantly be evaluated and improved. A major curriculum review is in progress. The process is a grass roots effort to allow input from faculty, students, alumni and outside consultants. The school's competencies are being reevaluated to assure they are contemporary and the methods to assess them are valid and reliable. The way we evaluate applicants is an ongoing evolution. Our appropriate role in the community (local, national, and international) continues to be a challenge. Success will be measured by how well we continuously evaluate our mission and goals, identify problems and find and implement solutions.

Common errors in panoramic radiography of edentulous patients.

PURPOSE: Instructions for patient positioning during panoramic radiography usually describe positioning dentate patients, and errors in patient positioning are commonly identified by distortion of the dentition. The purposes of this study were to identify common errors in panoramic radiography of edentulous patients, describe the image distortions that can be expected with positioning errors in edentulous patients, and review quality assurance methods that improve the diagnostic value of panoramic films. MATERIALS AND METHODS: Panoramic films were randomly selected from the inactive files of 75 edentulous patients seen at the dental school for complete denture construction. The radiographs were numbered and reviewed by a board-certified oral and maxillofacial radiologist trained to identify errors in panoramic radiography. RESULTS: Of the 75 panoramic radiographs examined, only 6 films (8.0%) were free of errors, and 67 films (89.3%) had one or more errors in patient positioning and 33 films (44.0%) had one or more technical errors. The most common positioning errors were positioning the chin too high (32 films, 41.3%) and positioning the patient too far forward (26 films, 34.7%). CONCLUSIONS: Without modification, manufacturer's instructions for positioning dentate patients during panoramic radiography may result in positioning errors on the panoramic radiographs of edentulous patients. Proper training and appropriate attention to detail while exposing and developing panoramic films are required to ensure maximum diagnostic benefits for edentulous patients.

Infection control in dental radiology. Current and future.

Multiple opportunities for cross-contamination exist in an oral radiographic procedure, especially when the office is busy. Enforcement of a detailed, written routine included in the operations manual can assure effective infection control to protect both patients and office personnel. Today is the time to evaluate your own office procedures.

Variations in adult cortical bone mass as measured by a panoramic mandibular index.

This study defines a new radiomorphometric index of mandibular cortical bone mass, the panoramic mandibular index (PMI). Differences in the index in a population of 353 adult subjects, equally divided by sex, age (30 through 79 years), and racial group (black, Hispanic, white), were evaluated. The data were analyzed with respect to side, racial group, sex, age, and combinations of these variables. Blacks were found to have a greater mean PMI than Hispanics or whites, who were statistically similar. Age-related changes comparing younger and older age groups within each sex and racial group indicated a significant decrease in mean PMI with increasing age in black and Hispanic women. The mean PMI in white men increased with advancing age.

Drug-induced xerostomia as a cause of glossodynia.

Severe xerostomia may be a primary cause of glossodynia. If radiation therapy and systemic disease are ruled out as causes of xerostomia, the wide variety of pharmacologic agents found in prescription medications, over-the-counter medications, common dietary components, and recreational drugs must be considered. The xerostomic side effect of a medication may be unavoidable; however, it may be minimized by alterations in diet, environment, or elimination of optional concurrent medications. When evaluating the patient with glossodynia, the practitioner must be aware of the many types of offending agents that contribute to a decrease in salivary flow. A clinical referral to a dentist to manage the oral complications of xerostomia is appropriate, although the patient's physician is the one who may make any changes in prescribed medications.

Comparison of image layer location among panoramic machines of the same manufacturer.

The central plane of the image layer was located in several panoramic machines of the same manufacturer by making radiographs of a spherical test object placed in different positions. A round image indicated that the test object was at the central plane. The inconsistency of the location of the central plane in machines tested indicates the need for establishing a quality assurance test to verify image-layer location before patient exposure.

A new technique for imaging the temporomandibular joint with a panoramic x-ray machine. Part II. Positioning with the use of patient data.

In the first article of this series, a new panoramic technique for visualization of the temporomandibular joint was described. In this article, it is shown that the patient positioning required for the implementation of this technique can be inferred from the gender, ethnicity, and bizygomatic width of the patient. Tables for estimating positioning in the Panoral panoramic machine have been derived from the analysis of data from 196 patients. Use of this approach eliminates the requirement for an additional submentovertex radiograph and the associated radiation dose to the patient.

Intercondylar dimension as a positioning factor for panoramic images of the temporomandibular region.

The effect of rotating the patient's head for optimum imaging of the temporomandibular region with the use of a panoramic radiographic machine with a continuous center of rotation (Panex-E) was studied. The result showed that the intercondylar distance influenced the amount of rotation necessary for that optimum image.

Intercondylar dimension as a positioning factor for panoramic images of the temporomandibular region / Dimensão intercondilar como fator de posicionamento para imagens panorâmicas da região temporomandibular

The effect of rotating the patient's head for optimum imaging of the temporomandibular region with the use of a panoramic radiographic machine with a continuous center of rotation (Panex-E) was studied. The result showed that the intercondylar distance influenced the amount of rotation necessary for that optimum image

Red, blistering, and erosive lesions of the oral mucosa.

Clinical diagnosis among the vesiculobullous diseases is difficult. Benign mucous membrane pemphigoid is a chronic condition, whereas bullous pemphigoid and erythema multiforme are self-limiting. Oral lesions can be the initial appearing feature of the disease. Therefore, routine histological examination with immunofluorescent studies and a good medical history will aid in differentiating among them. The case report described here shows a benign mucous membrane (cicatricial) pemphigoid in a 52-year-old female whose initial symptoms involved the oral mucosa with subsequent skin lesions. There is no other apparent mucosal involvement at this time. The symptoms are palliated with use of topical fluocinonide, but continued follow-up care is indicated.

Treatment of common orofacial conditions.

The conditions discussed in this article are those most likely to cause a patient to seek emergency care, primarily for pain. All the characteristics given for the conditions to aid in the diagnosis do not necessarily need to be present and other characteristics not mentioned may in fact be present. A complete differential diagnosis, especially of more obscure lesions, was also not attempted. An attempt was made to provide the practitioner with enough information to develop a working diagnosis from which to alleviate the patient's discomfort. A definitive diagnosis may not be available in an emergency setting. However, it must be emphasized that the final responsibility of the dentist is to make a definitive diagnosis at a later time if one cannot be made when emergency treatment is sought. Alleviating pain without dealing with the underlying cause may be more detrimental to the patient's health in the long run, as palliative therapy may mask a more severe condition.

Melanin pigmentation in a mucoepidermoid tumor of a minor salivary gland.

A low-grade mucoepidermoid tumor rich in melanin has been reported. According to the collective personal experience of the authors and a literature review, such lesions are thought to be rare. It is not anticipated that melanocytic participation will alter the prognosis; however, only long-term followup and reports of any similar lesions of salivary gland will assist in clarifying the nature and significance of this lesion.

The central plane of the image layer determined experimentally in various rotational panoramic x-ray machines.

The location of the image layer with respect to how a patient is positioned in a rotational panoramic machine is very critical. At present, no simple method exists for routine testing of panoramic machines to verify that the image layer is where the manufacturer intended it to be. The purpose of this experiment was to locate the central plane of the image layer with respect to a reference point on various machines currently on the market. The data obtained from this study can be used for further evaluations of the consistency in the location of the image layer, first with the existing device and later with a test device that would be adaptable to these machines and serve as a quality-control device in assuring that the machines are functioning properly.

Bifid mandibular canals in panoramic radiographs.

The purpose of this study was to identify and classify specific anatomic variations of the mandibular canal for which we have suggested the term "bifid mandibular canals." A total of 6,000 panoramic radiographs were studied, and those that contained these canals were identified. A classification of bifid mandibular canals was developed from this material. In addition, as the different variations of these bifid mandibular canals may present a number of problems in clinical practice, some solutions to these problems are presented. In our sample, there were 57 bifid mandibular canals, an incidence of 0.95%. These results suggest that the presence of bifid mandibular canals is not a rare finding. If panoramic equipment is not available, the lateral jaw view may be taken to study the mandible for the anesthetic, surgical, and prosthetic problems.