Necrotic ulcerative stomatitis in a patient with long-standing celiac disease: a case report.

Celiac disease is the most common chronic gastroenterological disease. One of the extraintestinal manifestations of this multifaceted disease are changes in the oral mucosa. However, ulceration leading to the destruction of the soft and hard tissues of the orofacial region has not been reported so far. We report on the development of necrotizing ulcerative stomatitis in a 41-year-old woman with celiac disease. The initial ulcerative lesion was located in the lower lip mucosa. Necrosis of all layers of the left side of the lip and oral commissure progressed very quickly. The resulting defect required plastic reconstructive surgery. We successfully compensated for the defect by applying a combination of two flaps from the remaining tissue of the lower lip. Oral competence was established immediately after the operation, and a very good esthetic appearance two months later.

Dentists' Opinions in Providing Oral Healthcare to Elderly People: A Questionnaire-Based Online Cross-Sectional Survey.

This cross-sectional study aimed to assess the factors in dentists' opinions related to oral health and the treatment management of the elderly. An online questionnaire-based survey was conducted among the dentist population (n = 463). Respondents were divided depending on whether they attended the geriatric dentistry course during their education, and 15 questions on the Likert scale demonstrated the difference in their attitudes. The majority of respondents (61.9%) agree that dental studies should pay more attention to acquiring sufficient knowledge and skills in the treatment of the elderly, and 56.2% would like to attend a course on that subject. Compared to those who participated in the geriatric dentistry course, those who did not consider providing oral healthcare to older people find it more difficult because of its complexity and practical obstacles (37.3% vs. 54%, p ≤ 0.001). From the results of this study, it can be concluded that there are differences in opinion about the provision of oral healthcare to the elderly between dentists who have and who have not attended a geriatric dentist course during their education. During the dentist's education, geriatric dentistry courses should have a significant role in providing knowledge for working with the elderly population.

DESCENDING NECROTIZING MEDIASTINITIS SECONDARY TO RETROPHARYNGEAL ABSCESS.

Descending necrotizing mediastinitis secondary to a nontraumatic retropharyngeal abscess is very rare. This form of mediastinitis in the era of potent antibiotics often ends up with lethal outcome. It usually occurs in immunocompromised patients and requires intensive multidisciplinary treatment approach. We report a case of nontraumatic retropharyngeal abscess complicated by descending necrotizing mediastinitis in a 70-year-old man with insulin dependent diabetes mellitus. The patient was admitted to our hospital after clinical and radiological diagnosis of retropharyngeal abscess. During treatment for retropharyngeal abscess with antibiotic therapy and transoral incision, the patient showed mild clinical improvement but his condition suddenly aggravated on day 4 of hospital stay. He had high fever, chest pain with tachypnea, tachycardia, hypotension, and showed signs of occasional disorientation. Emergency computed tomography (CT) scan of the neck and thorax showed inflammation in the retropharyngeal space, as well as thickening of the upper posterior mediastinum fascia with the presence of air. Emergency surgery including cervicotomy and drainage of the retropharyngeal space and posterior mediastinum was performed. The patient promptly recovered with improvement of the clinical status and laboratory findings. After 16 days of treatment he was discharged from the hospital in good condition. Descending necrotizing mediastinitis can be a serious and life threatening complication of deep neck infection if the diagnosis is not quickly established. Besides inevitable application of antimicrobial drugs, good drainage of the mediastinum is necessary. We believe that transcervical approach can achieve high-quality drainage of the upper mediastinum, especially if it is done timely as in this case. Its efficacy can be verified by intensive monitoring of the patient clinical condition, by CT scan of the thorax, and by laboratory tests. In the case of inefficacy of this type of drainage, subsequently some other, more aggressive transthoracic methods of drainage can be done.

[Descendending necrotizing mediastinitis single center experience]. / Descendentni nekroticni medijastinitis iskustvo jednog centra.

The descending necrotizing mediastinitis is a rare but life-threatening inflammation, and occurs as a complication of deep inflammation of the neck. The mortality rate is still high by 40% despite the use of a variety of potent antimicrobial drugs. We describe 7 patients with the descending necrotizing mediastinitis treated in our hospital during the last 12 years. The primary site of infection in 5 patients were tonsils and pharynx, and in the other two patients odontogenic inflammation of the lower molars. Most of the patients belonged to the risk groups (diabetes mellitus, alcoholism), the average age of 60.4 years. After the diagnosis with computed tomography (CT), we surgically intervened in all patients. Deep neck infections are treated with aggressive surgical cervicotomy and high quality mediastinal drainage was performed with transcervical approach in all patients. Perioperative tracheotomy (n=3) was performed for the upper airway edema and postoperative tracheostomy for extended intubation (n = 1).Only in one case, we subsequently conducted a secondary surgical procedure, lateral thoracotomy because of pleural decortication. All patients were successfully cured with an average length of hospitalization was 24.6 days. For successful treatment of the descending necrotizing mediastinitis diagnosis must be set as early as possible and with the use of computed tomography scanning. Treatment requires the simultaneous application of potent antimicrobial drugs, aggressive surgical debridement of the neck and high-quality drainage of the mediastinum, which can be achieved through the transcervical approach.

Conservative orthodontic treatment of mandibular bilateral condyle fracture.

Maxillofacial trauma is rare in children younger than the age of 5 years (range 0.6%-1.2%), and they can require different clinical treatment strategies compared with fractures in the adult population because of concerns regarding mandibular growth and development of dentition. A 5-year-old girl with a history of falling from a bicycle 7 hours earlier was referred to the department of oral and maxillofacial surgery. Multislice computed tomographic examination demonstrated a bilateral fracture of the mandibular condyle neck associated with minimal fracture of the alveolar ridge of the maxilla. The multislice computed tomographic scan also demonstrated dislocation on the right condyle neck and, on the left side, a medial inclination of approximately 45 degrees associated with greenstick fracture of the right parasymphysis region. In this particular case, orthodontic rubber elastics in combination with fixed orthodontic brackets provided good results in the treatment of bilateral condyle neck fractures associated with greenstick fracture of parasymphysis.

Genotoxicity in gingival cells of patients undergoing tooth restoration with two different dental composite materials.

OBJECTIVES: Dental composite materials come into direct contact with oral tissue, especially gingival cells. This study was performed to evaluate possible DNA damage to gingival cells exposed to resin composite dental materials. MATERIALS AND METHODS: Class V restorations were placed in 30 adult patients using two different composite resins. The epithelial cells of the gingival area along the composite restoration were sampled prior to and after 7, 30, and 180 days following the restoration of the tooth. DNA damage was analysed by comet and micronucleus assays in gingival exfoliated epithelial cells. RESULTS: The results showed significantly higher comet assay parameters (tail length and % DNA in the tail) within periods of 30 and 180 days. The micronucleus test for the same exposure time demonstrated a higher number of cells with micronuclei, karyolysis, and nuclear buds. Results did not reveal any difference between the two composite materials for the same duration of exposure. CONCLUSION: Based on the results, we can conclude that the use of composite resins causes cellular damage. As dental composite resins remain in intimate contact with oral tissue over a long period of time, further research on their possible genotoxicity is advisable. CLINICAL RELEVANCE: Long-term exposure of gingival cells to two different composite materials demonstrated certain DNA damage. However, considering the significant decline in micronuclei frequency after 180 days and efficiency in the repair of primary DNA damage, the observed effects could not be indicated as biologically relevant.

Composite-induced toxicity in human gingival and pulp fibroblast cells.

OBJECTIVE: The most important requirement for a material to be used in medical applications is its biocompatibility. Dental composite materials come into direct contact with oral tissues, especially gingival and pulpal cells. This study was performed to evaluate possible DNA damage in cells of human origin exposed to dental composites in vitro using a cytogenetic assay. MATERIALS AND METHODS: Two composite resins (Vertise Flow, Kalore) were tested on human gingival and pulp fibroblasts using the acridine orange/ethidium bromide viability staining and alkaline comet assay. Cultures were treated with polymerized composites in two different concentrations (20 mg/ml, 40 mg/ml) for 14 days. Chi-square and Kruskall-Wallis non-parametric test were used for the statistical analysis (p < 0.05). RESULTS: Significant cytotoxicity was observed for 40 mg/ml of Vertise Flow in both cultures, while Kalore (40 mg/ml) showed cytotoxic effect only on human pulp fibroblasts. A significant level of DNA damage was detected for both materials and concentrations, in both cell cultures. CONCLUSION: If the two cell cultures are compared, the pulp cells were more sensitive to the cyto/genotoxic effects of dental composites. Based on the results, one can conclude that the use of tested materials may cause cellular damage in gingival and pulp fibroblasts in vitro.

[Necrotizing fasciitis of the neck]. / Nekroticni fascitis vrata.

Necrotizing fasciitis is a rare and rapidly progressive infection characterized by necrosis of the superficial fascia and spread on the surrounding skin or muscles, which can be fatal. It usually occurs in the limbs, abdominal wall and perineum. In this retrospective review, the authors present 15 patients with cervical necrotizing fasciitis. The patient mean age was 54.7 years and they had one or more comorbid health problems. Five of them had descending necrotizing mediastinitis and three had progressive sepsis with toxic shock syndrome. Broad-spectrum intravenous antibiotic therapy was administered to all patients immediately, and in three of them we used five-day intravenous immunoglobulin therapy for the signs of toxic shock syndrome. After positive computed tomography imaging for necrotizing fasciitis, we used surgical exploration and debridement of necrotic tissue. In five patients, the initial surgery also included mediastinal transcervical drainage. Preoperative tracheotomy was performed in six patients and delayed tracheotomy in one patient. Histopathologically, all cases showed extensive necrosis of debrided fascia and vascular thrombosis of the neck soft tissue. The mortality rate was 6.7% (1/15). The authors point to the importance of early diagnosis and timely surgical management, broad-spectrum antibiotics and intravenous immunoglobulin therapy when patients are too unstable to undergo surgery.

Mucositis grades and yeast species.

Surgically treated patients with oral, head and neck cancer commonly develop mucositis during additional irradiation therapy. Oral mucosa inflammation other than irradiation is mostly caused by Candida albicans, yeast of Candida genus. This study evaluated possible connection between grades of oral mucositis and oral yeast profile in irradiated patients before, during and after irradiation. In 25 examined patients mucosits grades "0" to "2" before irradiation with 20% positive smears and only two different species of yeasts (C. krusei 4%, C. albicans 16%) during the irradiation changed into "0" to "4" and 36% positive smears with five different species of oral yeasts (C. albicans 12%, C. glabrata 12%, C. parapsilosis 4%, C. guilliermondii 4% and Saccharomyces cerevisiae 4%). Three weeks after irradiation was finished mucositis decreased into "1" to "3" with 20% positive smears and again only two species of yeasts (C. albicans 16%, C. guilliermondii 4%). Mucositis grades was increased significantly (p = 0.0037) with changes in fungi profile.

Craniofacial morphology of Croatian patients with obstructive sleep apnea.

Currently, there is no information available regarding craniofacial morphology of Croatian patients with obstructive sleep apnea (OSA). The aim of the study was to determine the craniofacial characteristics of patients with OSA and to assess the association of cephalometric and anthropometric variables related to craniofacial morphology with the apnea hypopnea index (AHI). Anthropometric measurements and upright lateral cephalometric radiographs were obtained from 20 male patients with OSA and 20 male controls. The 20 OSA patients were classified into two groups on the basis of body mass index (BMI) as obese and non-obese. Twenty three variables were identified and calculated for each cephalometric radiograph. OSA was defined as AHI > or = 5/hour. The OSA patients showed greater body mass index (BMI), neck circumference (NC) and cranial index (CI) and lower facial index (FI) compared to the controls (p < 0.01). The patients with OSA showed significant cephalometric features as opposed to the controls: smaller linear distance between gonion and menton and anterior cranial base, greater linear distance from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate. Furthermore, they showed reduced upper airway width at two levels: the nasopharynx, and the region of posterior airway space, smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx and greater upper airway length. They also displayed significantly increased craniocervical angulation, larger angle between supramentale, menton and hyoid bone and larger angle between posterior nasal spine, supramentale and hyoid bone. The obese OSA patients showed greater neck circumference (NC) compared with the non-obese OSA. The obese OSA patients showed significant cephalometric features compared with the non-obese OSA patients: larger craniocervical angles larger angle between the third cervical vertebra, the centre of sella turcica and the posterior nasal spine, furthermore, greater linear distance between the hyoid bone and the third cervical vertebra and smaller linear distance from the hyoid bone to the posterior wall of the nasopharynx. In our study, AHI was significantly correlated with cephalometric measurements S-Go, S-H, H-C3 and S-PNS-C3.

Association of cephalometric changes after 5 years of complete dentures wearing and oral health-related quality-of-life.

OBJECTIVE: The aim was to investigate cephalometric changes after 5 years of wearing complete dentures (CDs) and to asses a possible relationship between changes in cephalometric parameters and patients' oral health-related quality-of-life (OHRQoL). MATERIALS AND METHODS: New complete maxillary and mandibular dentures were fabricated for 30 participants. Two lateral radiographs were obtained from each participant with their CDs in the position of maximal intercuspidation (centric relation): the first radiograph was obtained at the CDs delivery and the second one after 5 years of CDs wearing. A questionnaire (OHIP 14) was given to all participants at the 5-year appointment. RESULTS: Significant differences in most linear and angular cephalometric measurements were found after 5 years of CDs wearing, due to the reduction of the height of the lower third of the face and the forward shifting of the mandible. A significant correlation between the OHIP summary scores and five cephalometric variables was found (ANS-Xi/Xi-Pm angle, FH/N-Pog angle, SN/Go-Gn angle, Go-Gn/ANS-PNS angle and occlusal plane/FH), indicating that more severe cephalometric changes were related with the increase of OHIP scores. CONCLUSION: Changes of cephalometric angles due to lowering of the face and forward shifting of the mandible were related to the decreased OHRQoL (increased OHIP scores).

Changes of the dental service delivered to patients with intellectual disability under general anaesthesia in Dental Polyclinic Split, Croatia, during the years 1985-2009.

People with intellectual disability (ID) usually have a poor quality of oral health, which include poor oral hygiene, untreated caries and high proportion of missing teeth. Due to their fear and repulsive attitude towards medical staff general anesthesia is often a useful method for dental treatment. One thousand and fifty four intellectual disability patients for the period of 1985-2009 who received dental treatment under general anesthesia in Dental Polyclinic Split, were included in the study. Patients were divided into five groups based upon the period when a specific dental treatment had been received. Each period was analyzed for the number of ID patients treated and the type of dental treatment. The results showed that the most services provided were 4006 fillings, followed by 3225 extracted teeth and finally 274 endodontic treatments. Significantly the lowest number of fillings and endodontic treatments were found among patients in group II (1990-1994), with significantly the highest number of extracted teeth. In Conclusion, the types of dental treatment have changed during twenty five years. Number of extracted teeth decreased while the number of fillings and endodontic treatment increased. However, dental status of people with intellectual disability should be improved with more restorative treatments and with better oral health prevention program.

Residual ridge atrophy in complete denture wearers and relationship with densitometric values of a cervical spine: a hierarchical regression analysis.

BACKGROUND: The rate of residual ridge atrophy (RRR) and its association with mineral density of other bones have not yet been fully explained. OBJECTIVE: To measure RRR over a 5-year period in complete denture wearers and relate it to the density of a cervical spine (CSBD). MATERIALS AND METHODS: Sixty-two patients (different gender, age, body mass index, duration of edentulousness (DE) and different denture-wearing habits) participated. A copper stepwedge was attached to the cassette, and 50 lateral radiograms met the criteria to be included. RESULTS: A significant decrease in vertical height was observed in all measured sites. The amount of RRR was highest in frontal areas of both jaws and decreased gradually towards lateral regions. Hierarchical regression analysis revealed that the amount of RRR in the maxillary frontal area could be explained up to 48.4% by the variable DE and only up to 6.1% by the CSBD, while gender had almost no influence (1%). Similar results were obtained for the lateral maxillary RRR (33.9%; 7%; 2%), frontal mandibular RRR (40; 8.4; 0.4%) and lateral mandibular RRR (31.5%; 3.4%; 7.7%). CONCLUSION: Skeletal bone density, reflecting systemic and hereditary factors, is weakly related to RRR (3.4-8.4%).

Preliminary clinical report of satisfaction with prosthodontic rehabilitation of intellectually disabled young adults provided by parents or caregivers.

The aim of this research was to analyze satisfaction with prosthodontic rehabilitation of intellectually disabled (ID) patients provided by their parents/caregivers. A total of 12 ID patients received fixed dentures (FDs) and 10 patients received removable dentures (RDs). Parents/caregivers answered a questionnaire related to prosthodontic rehabilitation (1 = unsatisfactory, 5 = excellent). Parents/caregivers were mostly satisfied with their childrens' oral rehabilitation (results were skewed toward the highest scores). There was a significant improvement in masticatory function and a reduction of avoiding certain foods after both FD and RD therapy. RD therapy significantly improved ID patients' social lives. However, FD therapy increased problems with oral hygiene maintenance. Prosthodontic rehabilitation improves oral function of ID patients. Int J Prosthodont 2011;24:303-305.

Decreasing of residual alveolar ridge height in complete denture wearers. A five year follow up study.

The resorption of the residual alveolar ridges is a chronic and continuous process of bone remodeling. The aim of this study was to analyse the rate of residual ridge resorption at different sites in the both jaws in complete denture wearers, through a five-year period of denture wearing. Residual ridge changes were measured on successive lateral cephalograms at 5 measurement points of the maxilla and the mandible. The first lateral radiograph was obtained at the delivery of complete dentures. The second lateral cephalogram was obtained after five years of denture wearing. Measurements were performed using a calibrated grid. The results of this study showed the existence of a significant alveolar ridge resorption at all five measurement points of the maxilla and the mandible. The observed variables, such as body mass index and the night time denture wearing had no significant influence on the rate of residual alveolar ridge resorption (p > 0.05). The duration of edentulousness had a significant influence on the rate of residual ridge resorption with significantly higher amounts of alveolar bone height decrease in those patients who had lost the last remaining teeth more recently.

[Tolosa-Hunt syndrome: a case report]. / Tolosa-Huntov sindrom: prikaz bolesnika.

Tolosa-Hunt syndrome is a nonspecific granulomatous inflammation of the cavernous sinus, superior orbital fissure and apex of the orbit. It involves episodes of unilateral orbital pain which may last several weeks, lesions of cranial nerve III, IV or VI, and rarely II, V, VII and VIII. It is characterized by remissions and exacerbations, and can cause permanent neurological disorder of the affected nerves. We present the course of the disease in a patient whose initial symptom was gradual visual loss in the right eye, followed by neuralgic pain in the right orbit and face. The diagnosis was confirmed by biopsy and corticosteroid therapy was administered. Exacerbation of the disease required repeated surgery, excision of the fibrous tissue of the cavernous sinus, as well as prolonged corticosteroid therapy.

A study of the surface topography and roughness of glazed and unglazed feldspathic ceramics.

The aim of this study was to obtain the 3-D qualitative and quantitative nanoscale data of the surface topography and surface roughness of glazed and unglazed feldspathic ceramics. Twelve samples composed of Ni-Cr alloy (Wiron 99, Bego Germany) and feldspathic ceramics (IPS Classic, Ivoclar-Vivadent, Schaan, Liechtenstein) were prepared, and divided into two groups, dependent of the surface final finishing; 6 unglazed and 6 glazed samples. The surface of the samples was recorded and analysed by atomic force microscopy (AFM, Veeco Instruments, Santa Barbara, CA, U.S.A.). According to the results of this study, unglazed ceramic surface is significantly rougher than the glazed one, showing significantly higher root mean square (RMS), mean roughness (Ra) and maximum height (Z range values) (p < 0.01), higher crystallites with sharper peaks and deeper pores. The roughness parameters of the unglazed samples were almost twice or even more higher than of the glazed samples. Exposed unglazed ceramic surfaces can therefore promote antagonistic tooth wear.

Linear vertical jaw resorption potential in elderly complete denture wearers: a five-year follow-up study.

Human bones decrease in quality and increase in porosity beginning at about the third decade of life. The aim of this study was to establish an equation to predict the maxillary and mandibular linear vertical resorption potential for elderly edentulous patients on the basis of the analysis of the cervical vertebrae in a single cephalometric radiograph. The morphology of the bodies of the third and fourth cervical vertebrae and measurements of linear vertical resorption in the frontal region of the jaws were analyzed in two consecutive cephalometric observations of 26 elderly edentulous patients over the five-year period of wearing complete dentures. An equation was determined to obtain maxillary and mandibular linear vertical resorption on the basis of measurements in the third and fourth cervical vertebral bodies and the average errors between the predicted and the actual values were 0.14 mm. The cervical vertebrae exhibited significant decrease in the height and width, and residual alveolar ridges exhibited significant decrease in the height over the 5-year period of wearing dentures (p < 0.01). These results suggest that using cervical vertebral measurements might allow predicting the maxillary and mandibular resorption for edentulous elderly patients wearing complete dentures.

Relations between anterior permanent teeth, dental arches and hard palate.

The width and length of the anterior teeth, the dimensions of the frontal dental arches and the dimensions of the hard palate were measured (24 men and 56 women, age range of 18-30 years). The results showed gender-related dimorphism only for the cervical width of the maxillary canine, which were wider in men, p < 0.05. The width-to-length ratios of the maxillary frontal teeth varied from 0.82 to 0.91. The tooth-to-tooth width ratios among different maxillary frontal teeth varied from 0.78 to 0.91. The sum of all anterior maxillary teeth widths was equal to the hamular width and to the distal maxillary arch width (p > 0.05), meaning that the sum of the frontal artificial teeth width may be selected upon the measurement of the hamular width on the hard palate. The ratios between the maxillary and the mandibular frontal dental arch dimensions are representative values for the skeletal class I.

Influence of body mass index and the time of edentulousness on the residual alveolar ridge resorption in complete denture wearers.

Alveolar bone loss (RRR) is a continuous process following tooth extraction, more pronounced during the first few months after the tooth extraction than later. The RRR in the mandible is twice that of the maxilla during a 1-year period and the mandibular: maxillary resorption ratio increases further to 4:1. So far, the etiology of RRR has not been elucidated. It has been speculated that both systemic and local factors contribute. The aim of this study was to analyse the rate of RRR in five different regions of both jaws on lateral cephalograms of 100 complete denture wearers during a one-year period and to compare the rate of RRR between patients being edentulous over a different period of time and between patients with different body mass index. The height of residual ridges was measured on 5 different sites at the delivery of the dentures and a year later using a calibrated grid. The results revealed significant RRR in a one year period. Body mass index had no significant influence on the rate of RRR on any of the five examined sites of the maxilla or the mandible (p > 0.05), while the period of edentulousness had a significantly higher rate of resorption in first 3 sites of measurement (anteriorly) in patients being edentulous less than 1 year than in patients being edentulous for 1-10 years or for over 10 years (ANOVA, p < 0.05).