Herpes zoster infection presenting as an acute pulpitis.

A major reason for referral to an endodontic practice is management of pain. Most cases are diagnosed as being of pulpal or periapical origin. However, some turn out quite differently than their initial appearance. This case report presents a patient referred to the endodontic clinic because of symptoms mimicking an irreversible pulpitis. On examination no obvious cause of the symptoms could be found. The patient was treated conservatively after which a herpes zoster viral infection was diagnosed. This case stresses the importance of a thorough investigation of all signs and symptoms and the delay of definitive treatment until a diagnosis is made.

Two natal maxillary molars. Report of a case.

A 20-day-old black male infant with two rare posterior natal teeth was referred for examination and care. Oral radiographs suggested that the teeth were the right and left maxillary primary molars. The hypermobile teeth and associated suspicious soft tissue masses were removed. Histologic examination revealed irregular tooth structures and infiltrate consistent with inflamed dental follicles.

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.

Autogenous auricular cartilage implantation following discectomy in the primate temporomandibular joint.

The purpose of this study was to evaluate the histologic changes in primate temporomandibular joints (TMJ) treated with autogenous auricular cartilage grafts following total discectomy. Four Macaca fascicularis monkeys underwent bilateral TMJ disc removal and high condylar shaves. One TMJ in each monkey was treated by grafting autogenous auricular cartilage to the glenoid fossa; the contralateral joint served as a control. Monkeys were killed at 6, 12, 16, and 24 weeks postoperatively. Viable auricular cartilage was found in all grafted joints. There was a variable amount of fibrous connective tissue surrounding the cartilage grafts, with some grafts being directly fused to the glenoid fossa. One joint showed significant fibrous connective tissue adhesions between the condylar surface and the inferior portion of the graft. Degenerative changes in the grafted joint appeared grossly to be less severe than in the control joints. The cartilaginous tissues appeared to be a suitable autogenous tissue graft, maintaining its viability and functioning as an interpositioning material between the condyle and fossa.

Central odontogenic fibroma, granular cell variant. A case report with S-100 immunohistochemistry and a review of the literature.

We have identified 14 cases that over the last 40 years have been reported under a series of names, most commonly granular cell ameloblastic fibroma. An additional case in the mandibular premolar region of a 45-year-old woman is described. The tumor was conservatively removed and 4 years later shows no evidence of recurrence. On the basis of our examination of the clinical and histologic features of this lesion and a comparison with the previous cases, we agree with the recent suggestion that the tumor should be designated as a central odontogenic fibroma, granular cell variant. By means of S-100 protein immunostaining techniques, the granular cells in this lesion were compared with the granular cell population in a granular cell tumor (myoblastoma) and the mesenchymal component of an ameloblastic fibroma. The results reveal a lack of S-100 protein reactivity in the granular cells of the central odontogenic fibroma and suggest an origin of those cells different from the origin of cells in a granular cell tumor.

Autogenous dermal grafts for repair of temporomandibular joint disc perforations.

In five Macaca fascicularis monkeys bilateral 5-mm perforations of the intra-articular disc were followed by unilateral repair with autogenous dermal grafts. The monkeys were killed at three, six, 12, 24, and 36 weeks after surgery. The temporomandibular joints (TMJs) were removed en bloc, decalcified, and sectioned in the sagittal plane for histologic examination. All of the control untreated disc perforations, with the exception of one, failed to heal. With all of the grafted disc perforations, viable dermis and fibrous connective tissue proliferation were seen in the area of the repaired perforation. Therefore, autogenous dermal grafting appears to be an acceptable technique for repair of the damaged disc in degenerative joint disease of the TMJ.

Oral amyloidosis: a late complication of multiple myeloma.

Amyloidosis as a complication of multiple myeloma carries with it grave prognostic implications, and the median survival of myeloma patients following a diagnosis of amyloidosis is only 4 months. This article describes a patient who survived 6 years with kappa light chain myeloma, but only 4 months after the development of oral amyloid deposits. Oral amyloidosis may be clinically difficult to distinguish from fibrous, neurogenous, or salivary gland pathosis; however, histologic specimens stained with Congo red have a characteristic "apple green" appearance when examined microscopically with polarized light.

Clinical applications of ultrasonic instrumentation in the surgical removal of bone.

The clinical use of ultrasonic inserts in the surgical removal of alveolar bone has been evaluated. Surgical applications included the removal of 19 teeth and the osseous management of periodontal disease in 50 cases. Histologic material was provided by resected bone fragments attached by periodontal tissues in anatomic relation to removed teeth. Microscopic observations of sections revealed that planed surfaces of bone were smooth, while incised edges were irregular. Evidence for residual debris was absent. No alterations in adjacent lacunar osteocytes, vascular channels, and underlying periodontal tissues were noted in clinical use, the ultrasonic inserts were found to remove bone with ease and preciseness. Hemorrhage from surgical sites was minimal or absent. Healing of tissues was uneventful with no postoperative complications encountered. Patients reported minimal discomfort during and following the surgical application of this instrumentation.

Necrotizing sialometaplasia.

An example of palatal necrotizing sialometaplasia is presented, and the clinical and microscopic features suggestive of squamous-cell carcinoma and mucoepidermal carcinoma are noted. The patient's health status, as shown by a rather thorough work-up, was unremarkable during the period which would seem to preclude a systemic etiology of this disease. The resolution of the lesion with minimal therapy is documented.