Intraoral lesion · history of cirrhosis and smoking · Dx?

A 56-year-old white man presented at our dental clinic for routine care. The intraoral examination revealed an asymptomatic red lesion with white vesicle-like areas on the right side of the soft palate. The extraoral examination was normal, and regional lymph nodes were nonpalpable. The patient's medical history included liver cirrhosis and pancreatitis. He also had a 30-year history of alcohol misuse (1-5 drinks per day) and a 30-pack-year smoking history. (The patient had stopped drinking at the time of presentation, and had quit smoking 2 years earlier.) We instructed him to gargle with warm salt water at home and return in 2 weeks. At follow-up, the lesion was unresolved, so a biopsy was performed.

Dental Faculty Accuracy When Using Diagnostic Codes: A Pilot Study.

The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes.

Perceptions of orthodontic case complexity among orthodontists, general practitioners, orthodontic residents, and dental students.

INTRODUCTION: Our aims were to assess the perceptions of orthodontic case complexity among orthodontists, general dentists, orthodontic residents, and dental students and to compare their perceptions with the American Board of Orthodontics Discrepancy Index (DI). METHODS: Orthodontists, general dentists, orthodontic residents, and dental students (n = 343) participated in a Web-based survey. Pretreatment orthodontic records of 29 cases with varying DI scores were obtained. Respondents were asked to evaluate case complexity on a 100-point visual analog scale. Additional information was collected on participants' orthodontic education and orthodontic treatment preferences. Pearson correlation coefficients were used to assess the relationship between the average complexity score and the DI score. Repeated measures analysis with linear mixed models was used to assess the association between the average complexity score and the DI score and whether the association between the 2 scores varied by level of difficulty or panel group. The level of significance for all analyses was set at P <0.05. RESULTS: The results showed that 71.6% of general dentists provided some orthodontic services, with 21.0% providing full fixed appliances and 38.3% providing clear aligners. DI score was significantly associated with complexity perceptions (P = 0.0168). Associations between average complexity and DI score varied significantly by provider group (P = 0.0033), with orthodontists and residents showing the strongest associations. When the DI score was greater than 15, orthodontists and residents perceived cases as more complex than did the other provider groups. CONCLUSIONS: Orthodontists and orthodontic residents had better judgments for evaluating orthodontic case complexity. The high correlation between orthodontic professionals' perceptions and DI scores suggested that additional orthodontic education and training have an influence on the ability to recognize case complexity.

Mouthguard usage by middle and high school student-athletes in Houston, Texas.

This survey recorded utilization levels of stock and custom mouthguards among middle and high school athletes in a US metropolitan area and gathered data on the prevalence of traumatic injuries that have occurred as a consequence of school-based athletic competition. The data also included reasons for the athletes' noncompliance. A 23-question, online survey form was developed. A geographically diverse list of public and private schools in the Houston metropolitan area was identified and included 30 public middle schools, 32 public high schools, 8 private middle schools, and 10 private high schools. The sports surveyed were baseball, basketball, field hockey, football, lacrosse, soccer, softball, volleyball, and wrestling. Only 1 private middle school participated. Only 5 of 32 public high schools and 1 private high school participated, representing response rates of 16% and 10%, respectively. Overall, there were 503 responses, and 56% of the respondents did not have a mouthguard. Among athletes who owned a mouthguard, most (70%) had stock versions purchased in a retail store, while 11% had a custom mouthguard fabricated by a dentist, and 19% had both types. The most frequent reasons cited for not wearing a mouthguard were forgetting to use it and a lack of comfort. The injury rates reported by respondents in the stock and custom mouthguard groups were 26% and 9%, respectively. A consistent, concerted effort by local dental societies should be aimed at school administrators and coaches to encourage enforcement or reinforcement of mouthguard usage policies among high school athletes, but, ultimately, parents need to step up to protect their children.

A peripheral giant cell granuloma with extensive osseous metaplasia or a hybrid peripheral giant cell granuloma-peripheral ossifying fibroma: a case report.

INTRODUCTION: Peripheral giant cell granuloma and peripheral ossifying fibroma are clinicopathologically distinct gingival lesions. Both are included in clinical differential diagnoses of common benign and reactive gingival epulides in humans. It is often impossible to make a clinical distinction between the two entities, thereby making definitive diagnosis dependent on histopathologic features. While our search of the English literature revealed several reports of peripheral giant cell granuloma with 'bone formation', we were unable to identify any reports of hybrid peripheral ossifying fibroma-peripheral giant cell granulomas. CASE PRESENTATION: We report a case of a 44-year-old Caucasian man presenting with a three-month history of swelling of his right posterior mandible, related to an area of previous dental implant restoration. A clinical examination revealed modest extraoral facial swelling of his right posterior mandible, while an intraoral examination showed a 45 × 25 × 15 mm sessile, lobular soft tissue mass of the right posterior mandibular gingiva. The mucosal covering of the lesion exhibited focal surface ulceration. A panoramic radiograph showed two implants at the vicinity of the lesion with no other significant findings. An excisional biopsy of the lesion followed by histopathologic examination of the biopsy specimen revealed salient and distinctive features of peripheral giant cell granuloma and of peripheral ossifying fibroma, estimated at near equal proportions. This raises the possibility of a hybrid odontogenic lesion. CONCLUSION: The presentation of this lesion, with areas of peripheral giant cell granuloma along with a distinct area of extensive osseous formation and stroma reminiscent of a peripheral ossifying fibroma, justifies consideration of this as a possible hybrid lesion. Although the biologic behavior of a combined lesion is not anticipated to deviate significantly from that of either of the single entities, this case resurrects an enduring debate as to whether peripheral giant cell granuloma and peripheral ossifying fibroma are simply parts of a disease spectrum, or whether some of these lesions represent true hybrid lesions. It is therefore recommended that more cases with histopathologic features similar to the lesion in our case be reported in the literature to further elucidate the histogenesis of these lesions.

An unusual case of tooth loss, abrasion, and erosion associated with a culturally accepted habit.

Tooth structure loss is a normal part of the aging process, with generalized predictable patterns. However, when a dentist is faced with an atypical pattern of extensive structural damage, identifying the etiology responsible for the catastrophic collapse of a patient's anterior incisal guidance can be a diagnostic challenge. Clinicians who are presented with plausible medical histories juxtaposed with socially and culturally accepted eating behaviors may clarify an otherwise nebulous clinical presentation. This article presents an unusual case report involving both synergistic and synchronous habitual and culturally adopted eating practices and pica, which resulted in severe tooth abrasion, abfraction, and erosion.

Rapid onset of Parkinsonian-like symptoms in a geriatric dental patient: a case report.

This article reviews the clinical issues regarding adverse drug reactions in geriatric dental patients. Accurate clinical observations and diagnosis are complicated in geriatric patients because they are predisposed to chronic illnesses, various prescribing physicians, and a decreased ability to metabolize and detoxify multiple medications. The authors have further reviewed neurological motor reactions with a detailed review of the physical presentations of Parkinson's disease. As such, the dental professional has a unique opportunity to provide observational feedback to other healthcare providers concerning the health status of their geriatric patients. In this case report, the changes in the patient's physical status and mental well-being were not a result or associated with a catastrophic event (eg, stroke, cardiovascular event, or head injury). The patient's rapid degeneration was anecdotally associated with a recently prescribed group of medications, which shows the need for healthcare professionals to be aware of changes in medications when assessing patients' health.

An uncommon dental presentation during pregnancy resulting from multiple eating disorders: pica and bulimia: case report.

Pica is a compulsive eating disorder involving non-nutritive substances. The etiology of this eating disorder is unknown but it often is associated with subclinical mineral deficiencies. This article focuses on the simultaneous occurrence of two types of eating disorders, the co-existence of depression during four pregnancies, and the resulting dental clinical implications. The literature is substantial enough to support a possible etiological association between these eating disorders and depression during pregnancy. Associations between eating psychopathology, depression, and anxiety have been described consistently. The diagnosis of pica and the dental treatment related to it are not a common part of most dental practices; knowing the clinical features and detecting the condition depend on careful questioning and diligence. At present, no one has described the physiologic or psychological basis for pica. This article reviews the published literature pertaining to pica, specifically pagophagia.