Unusual combination of presenting features in multiple myeloma.

Initial oral signs of multiple myeloma may involve pain, paraesthesia, swelling, tooth mobility and radiolucency. A 62-year-old female patient presented with the chief complaint of numbness in the right lower jaw. Intraoral examination revealed no abnormalities and her history was non-contributory. A panoramic radiograph revealed an irregular, small radiopacity in the premolar region and small, multiple and diffuse osteolytic alterations in the mandible. Computed tomography revealed maxillary and mandibular cortical destruction. An incisional biopsy was performed. The histopathological diagnosis was plasma cell myeloma and further investigations lead to the diagnosis of multiple myeloma. Dysfunction of a nerve coursing through diseased bone is an ominous sign and may be an indication that a malignant process is present.

Attributes and practices of oral and maxillofacial radiology departments in US and Canadian dental schools.

OBJECTIVE: To assess the actual state of oral and maxillofacial radiology departments in US and Canadian dental schools against the ideal characteristics defined by the American Academy of Oral and Maxillofacial Radiology (AAOMR) 1997 position paper. STUDY DESIGN: Cross-sectional survey of all 65 US and Canadian dental schools. RESULTS: Sixty-four surveys were returned (98%). At most schools, oral and maxillofacial radiology (OMR) was an identifiable division of a department, established policies, and had operational authority for radiographic practices in the primary radiology clinic. The majority of full-time faculty (72%) had formal training in OMR; the majority of part-time faculty (86%) did not. Full-time faculty spent approximately 60% of their time teaching, with the remainder of their time divided among research and scholarship, faculty practice, and service. Routine x-ray equipment was universally available; advanced imaging technologies were not. OMR faculty involvement in the interpretation of radiographs varied across diseases and conditions. Most published scholarship (85%+) was produced by full-time faculty. Average output was 1 paper per person per year, but a relatively small cadre of OMR faculty generated most papers. CONCLUSIONS: In some attributes, the status of OMR closely approximated the ideal characteristics established in the AAOMR report. Among the remaining attributes, bridging the difference between the actual and the ideal will be the challenge for the next 5 years.

Growth of an ameloblastoma during pregnancy: opportunity lost?

A 19-year-old pregnant woman presented with an enlarging lesion in the right mandible. She was examined by a general dental practice resident in the hospital outpatient clinic and subsequently managed by the resident as an inpatient. Both moral and ethical questions arose because of the discovery of the lesion early in the patient's pregnancy. Delay on the part of the patient while she contemplated termination of the pregnancy, compounded by loss of contact with her, eliminated the possibility of removal of the lesion during the second trimester. The patient elected to continue the pregnancy, and an en bloc procedure was used to remove the ameloblastoma.

Dentin dysplasia type I. Radiologic and genetic perspectives in a six-generation family.

This is a report of a kindred of at least 181 members, of whom 35 exhibit or are reported to have dentin dysplasia type I. Six others are suspected of having the condition. Radiographic evidence that included obliterated or semilunar pulp chambers and short or undeveloped roots confirmed the diagnosis in 18 persons. The autosomal dominant mode of inheritance has been confirmed. One hundred percent penetrance has been demonstrated. There were insufficient data to determine the degree of expressivity.

Focal osteoporotic bone marrow defect in the anterior maxilla.

An unusual presentation of a focal osteoporotic bone marrow defect is documented. A definitive diagnosis could not be established on the basis of the location, history, clinical, and radiographic appearance. A biopsy provided the identity of the lesion.

Metastatic carcinoma to the mandible. Report of two cases.

Two cases of rare metastases from malignant neoplasms to the posterior mandible in young adults are reported. Multiple imaging modalities were necessary to identify the many metastases and, in one case, the suspected primary site. Many of the radiographic images are presented for that case.

Carcinoma arising in a dentinogenic ghost cell tumor.

A 13-year-old black girl was referred for evaluation of a nonhealing extraction site of 2 years' duration. Radiographs revealed a large, irregularly shaped, mixed radiolucent/radiopaque lesion that occupied almost the entire left area of the maxilla and crossed the midline. Microscopic examination revealed irregular dentinoid material with odontogenic epithelium that exhibited ghost cell keratinization and anaplastic changes. The patient underwent a hemimaxillectomy, and 7 years after surgery she appears to be free of disease.

Idiopathic bone cavity (traumatic bone cyst) with the radiographic appearance of a fibro-osseous lesion.

This article presents an unusual case of idiopathic bone cavity that originally was either not observed or diagnosed as a fibro-osseous condition. When a differential diagnosis was established, it included fibro-osseous conditions, odontogenic cysts and neoplasms, and central giant cell granuloma but not the definitive diagnosis. The patient's demographic data, history, symptoms, and clinical and radiographic appearance all conspired to obscure the true nature of the condition, which was not revealed until a biopsy was attempted. A more thorough initial radiographic examination might have led to an earlier diagnosis.

Dentin dysplasia: review of the literature and a proposed subclassification based on radiographic findings.

The literature is reviewed to determine the radiographic appearance of the reported cases of dentin dysplasia. The sometimes confusing nomenclature is rationalized. Four distinct forms of dentin dysplasia type I and one form of dentin dysplasia type II are identified. There seems to be no need to identify more than two distinct types of this relatively rare inherited defect of human dentin, but a proposed subclassification of type I dentin dysplasia could make identification of the two types easier.

Type I dentin dysplasia: report of two cases.

Dentin dysplasia is a rare developmental disturbance of dentin affecting approximately 1:100,000 people. It has been classified as an autosomal dominant disease. Two distinct forms of dentin dysplasia have been described. As more cases of dentin dysplasia were reported these categories seemed inadequate; subclassification of type I dentin dysplasia were proposed based on root length and the presence or not of a pulpal remnant. This paper presents two cases demonstrating the classic features of type I dentin dysplasia in the mixed and permanent dentitions and discusses the suggested subclassifications. The authors suggest that while differences in root length may be useful in determining treatment options, thinking of these variables as separate types of dentin dysplasia is not warranted at this time. Justification of a subcategory of type I dentin dysplasia should be based on a different disease process, different histology, significantly different symptoms, or different etiologies, and until researchers can clearly prove from a genetic or chromosomal standpoint that the subcategories are separate entities, we should accept, as we do for many other genetic disorders, that some patients are more severely affected than others.

Calcification in the stylohyoid ligament.

This article describes the incidence of calcification in the stylohyoid ligament in a sample of the patient population of the University of Mississippi School of Dentistry. The records of 479 patients were reviewed, with particular attention given to the panoramic radiograph. The patients ranged in age from 4 to 78 years, with a mean age of 29. There was a sharp increase in incidence of calcification during the first three decades of age from 45.3% in the first decade to 86.2% in the third, with a gradual increase from the fourth to the seventh decade (87.3% to 92%). The eighth decade, represented by nine patients, showed an incidence of 100%. There appears to be no race predilection for calcification, a slight sex predilection for females, and an age incidence that seems to support both the developmental and degenerative theories of etiology of calcification in the stylohyoid ligament.