Effects of ozone nano-bubble water on mucositis induced by cancer chemotherapy.

No effective, reliable treatment for stomatitis associated with cancer therapy has been established. This study focused on the its effectiveness of ozone nano-bubble water (ONBW) for the treatment of chemotherapy-induced stomatitis. Oral mucositis was induced in 14-week-old male Sprague-Dawley rats (N = 21). The animals were randomly divided into 3 groups: 7 without treatment (control); 7 treated with physiological salt solution (saline); and 7 treated with ONBW. Animals were weighed on Days 7, 9, 11, and 16. Stomatitis grade evaluation and bacterial count measurements were performed before rinsing in all animals 3, 5, and 10 days after acetic acid irritation (Days 9, 11, and 17 respectively). Weight loss after stomatitis creation was observed in all groups, with significant differences between the control and ONBW groups and between the saline and ONBW groups on Day 16. The stomatitis grade did not worsen during the experimental period in any group, with the lowest grades in the ONBW group on Days 11 and 16. Significant differences were identified between the control and ONBW groups and between the saline and ONBW groups on Days 11 and 16. Oral bacterial counts tended to decrease over time in all three groups, with the greatest decrease in the ONBW group, followed by the saline group. The decrease in the bacterial count was steepest in the ONBW group. Rinsing out the oral cavity with ONBW decreased bacterial counts and encouraged the healing of oral chemotherapy-induced stomatitis. ONBW may be an effective treatment for chemotherapy-induced stomatitis.

Evaluating the mandibular condyles of patients with osteoarthritis for bone marrow abnormalities using magnetic resonance T2 mapping.

OBJECTIVES: This study investigated whether erosion and osteophyte correlates with condyle bone marrow abnormalities (BMA), as detected with quantitative T2 mapping. METHODS: Fifty-six joints (in 44 patients) that demonstrated evidence of bony erosion (ER) or osteophytes (OS) related to disc displacement without reduction were studied with MR images. A control group of 50 joints (in 50 patients) was included. The subjects were divided into five groups; noAR (control), noBMA-ER, BMA-ER, noBMA-OS, and BMA-OS. T2 mapping was performed and the regions of interest were placed over the bone marrow at the top of the condyle. The mean T2 values of the bone marrow of the mandibular condyle were calculated for all mapping images. After assessing age-related changes in T2 values of noAR group using Pearson's product-moment, differences in median T2 values of five groups were analyzed using Kruskal-Wallis test, and Steel-Dwass test (p < 0.05). RESULTS: There was no significant correlation between age and T2 value in noAR group. The median T2 values of noBMA-ER and BMA-ER groups were significantly higher than those of noAR, noBMA-OS and BMA-OS groups. Those of noBMA-OS and BMA-OS groups were significantly lower than those of noAR, noBMA-ER and BMA-ER groups. There was no significant difference between noBMA and BMA groups. CONCLUSIONS: It is suggested that erosion and osteophyte of the condyle may correlate with bone marrow abnormalities. T2 mapping could be show slight marrow changes of the arthritic condyle.

Carcinoma of Maxillary Gingiva with Non-specific Cervical Lymph Node Swelling.

Swelling of the cervical lymph nodes may indicate lymphadenitis, malignant lymphoma, or metastasis. Lymph nodes larger than 10 mm on computed tomography (CT) are strongly indicative of postoperative metastasis from carcinoma. Here, we report a case of large, inflamed lymph nodes mimicking metastasis. The patient was a 76-year-old woman who experienced discomfort in the left-side maxillary gingiva commencing in August 2011. By September, the area had become painful, causing her to visit the Tokyo Dental College Chiba Hospital, at which time a 75×50-mm swollen ulcer was observed in the maxillary gingiva on the left side. A CT image revealed a neoplastic lesion between the alveolar bone on the left side of the maxilla and the base of the maxillary sinus, together with evidence of osteoclastic activity. The bilateral cervical lymph nodes were Level II and had a uniform interior of approximately 5 mm. The lesion was subsequently excised under general anesthesia. At 34 days postoperatively, CT imaging revealed bilateral 40-mm internal heterogeneous lymphadenopathy at Level II. No inflammation of the maxillary gingiva was observed, however, and blood tests revealed no inflammatory findings. Bilateral cervical lymph node metastasis was diagnosed based on CT and oral cavity observation. Radical neck dissection of left cervical region was performed under general anesthesia. Histopathological examination of the lymph nodes revealed no metastasis at Levels I-V, however. The reason for this increase in lymph node size is discussed.

Case of Suspected Sialodochitis Fibrinosa (Kussmaul's Disease).

Here we report a case of Kussmaul's disease, or sialodochitis fibrinosa. This rare disease is characterized by recurrent swelling of the salivary glands, which then discharge clots of fibrin into the oral cavity. An 80-year-old man with a history of allergic rhinitis visited our department with the chief complaint of pain in the bilateral parotid gland area on eating. An initial examination revealed mild swelling and tenderness in this region, and indurations could be felt around the bilateral parotid papillae. Pressure on the parotid glands induced discharge of gelatinous plugs from the parotid papillae. No pus was discharged, and there were no palpable hard objects. Panoramic X-ray showed no obvious focus of dental infection, and there was no calcification in the parotid gland region. Magnetic resonance imaging revealed segmental dilatation of the main ducts of both parotid ducts, with no signs of displacement due to sialoliths or tumors, or of abnormal saliva leakage. Two courses of antibiotic therapy resulted in no improvement. During treatment, gelatinous plugs (fibrin clots) obstructing the left parotid duct were dislodged by massage, which prevented further blockage by encouraging salivary outflow. The obstruction persisted in the right parotid duct, however. Therefore, the distal portion of the right parotid duct was partially resected and the opening into the mouth enlarged, which, in combination with massage, prevented further obstruction. The pain and swelling of the parotid gland and discharge of gelatinous plugs improved, with no further recurrence at 12 months postoperatively. This case is presented along with a review of the relevant literature.

Analysis of Needlestick and Similar Injuries over 10 Years from April 2004 at Tokyo Dental College Chiba Hospital.

Here we investigated needlestick and similar injuries reported over a 10-year period between April 2004 and March 2014. The purpose of this study was to prevent recurrence and reduce the incidence of such injuries at Tokyo Dental College Chiba Hospital. The Division of Medical Risk Management at Chiba Hospital anonymized the data to protect personal information prior to analysis. A total of 213 injuries occurred over the 10-year period investigated, but the number of cases decreased yearly. Many cases involved dental undergraduate students and dentists, followed by trainee dentists, students at the school of dental hygiene, nurses, dental hygienists, and cleaners. Suture needles, followed by injection needles, were the top two most common injury-causing instruments, contributing to approximately 50% of the total number of such cases. Many injection needle injuries occurred during tidying up, while those caused by suture needles occurred during dental treatment. Taken together, these findings suggest the importance of strict adherence to guidelines provided in safety manuals on error-free procedures and handling of instruments. Improvement in the ability to sense potential risk is essential if such injuries are to be avoided.

Narrow-band imaging system with magnifying endoscopy for early oral cancer.

It is often difficult to detect early oral cancer due to the specificity of the oral mucosa structure. The aim of this study was to investigate the potential of narrow band imaging (NBI) as an effective and non-invasive diagnostic tool in early oral cancer and other oral diseases. A magnifying endoscopy system manufactured by Olympus Corporation was used. A total of 121 subjects were included in the study. Subepithelial capillary loops were identified and categorized according to the classification of Inoue, with healthy mucosa graded as Type I or II, and that showing evidence of cancer-induced morphological change as Type III or IV. Sensitivity and specificity for the identification of oral cancer were estimated at 92.3% and 88.2%, respectively. Examination under a microscope with H&E staining and immunostaining for CD34 revealed dilation and extension of the capillaries in epithelial dysplasia, in addition to thickening of the epithelial layer. The present results indicate that use of NBI in conjunction with conventional magnifying endoscopy has great potential as an effective and non-invasive diagnostic tool in the early detection of oral cancer.

Multidisciplinary treatment of peripheral osteoma arising from mandibular condyle in patient presenting with facial asymmetry.

While osteomas often occur in the orofacial area, it is relatively rare for one to occur in the temporomandibular joint area. Here, we report a patient who underwent multidisciplinary treatment including high condylectomy for peripheral osteoma arising in the left mandibular condyle. The patient was a 46-year-old woman with the chief complaint of facial asymmetry. Cephalometric analysis revealed skeletal anterior crossbite due to anterior deviation of the mandible, with chin deviation of 10 mm to the right. A computed tomography scan revealed bone hyperplasia in the mesiodistal and inner areas of the left mandibular condyle, which exhibited outward anterior displacement. Bone scintigraphy showed a circular area of strong radioisotope accumulation with indistinct boundaries, consistent with the lesion in the left mandibular condyle. The above findings led to a diagnosis of skeletal mandibular prognathism with facial asymmetry due to peripheral osteoma originating in the left mandibular condyle. After orthodontic treatment and surgical resection of the tumor and mandibular condyle, preservation and prosthetic treatment were undertaken. A well-balanced facial appearance and good occlusion were achieved.

Accidental ingestion or aspiration of foreign objects at Tokyo Dental College Chiba Hospital over last 4 years.

The aim of this study was to investigate cases of accidental ingestion or aspiration occurring at Tokyo Dental College Chiba Hospital over the last 4 years in order to determine how the incidence of such events could be reduced. Forty cases of accidents occurring at our hospital over a 4-year period commencing in 2008 (representing 27% of the total number of accidents) included accidental ingestion in 39 patients and aspiration in one. Most of these accidents occurred during the removal or placement of restorations or prosthetics, and the ingested objects were mostly crowns and inlays. Accidental ingestion or aspiration occurred more frequently in the right molar region and when procedures were conducted by practitioners with less than 1 to 7 years of experience, and especially 1 to 3 years only. A higher rate of such accidents was observed in male patients in their 50s to 70s. The conventional safety procedures developed by the Medical Risk Management Team should be adhered to wherever possible. Furthermore, we propose the following measures based on the present results: accident prevention training for students and clinical trainees; improvement of the in-hospital manual; personal coaching for those breaching the guidelines of the safety manual; and raising awareness of the need for greater care in preventing incidents of accidental ingestion or aspiration at the Tokyo Dental College Chiba Hospital.

Intraosseous schwannoma originating in inferior alveolar nerve: a case report.

Schwannomas (neurilemmomas) are benign neoplasms derived from Schwann cells of the neurilemma and appear most frequently on the auditory nerve or peripheral nerves of the skin. They arise in the oral and maxillofacial region infrequently, and very rarely in the center of the jaw. We herein present a case of a rare mandibular intraosseous schwannoma derived from the main trunk of the inferior alveolar nerve in a 33-year-old man. Fusiform expansion in the mandibular canal was observed and a mass showing the target sign in the mandibular canal was confirmed on T2-weighted and Gd contrastenhanced T1-weighted MRI. Based on these findings, an inferior alveolar nerve-derived schwannoma or other benign nervous system neoplasm was diagnosed. A buccal side cortical bone flap in the mandibular molar region was removed to expose the mass, which was then peeled away from the nerve fibers and completely removed. Some inferior alveolar nerve fibers that were connected to the mass were removed at the same time, but the remaining nerve fiber bundle was preserved. Histopathology confirmed the diagnosis of a schwannoma with Antoni type A and Antoni type B regions. Although the patient experienced extremely mild paresthesia in the skin over the mental region and mental foramen at immediately after surgery, this had almost entirely disappeared at 7 years and 4 months later, and there has been no tumor recurrence.

Three cases of distomolars.

The Frequency with which impacted supernumerary teeth are encountered in a clinical setting is relatively high, with the majority of such cases occurrig in the median maxillary region, and very few in the molar region. In the molar region, mandibular distomolars (fourth molars) are very rare. Although a small number of case reports have described impacted supernumerary distomolars, very few have compared third molars and distomolars. Herein, the authors report two cases involving mandibular distomolars and one case a maxillary distomolar. In each of these cases, the third molar and distomolar were extracted and a macroscopic morphological analysis conducted. The results were then compared with those of the latest available literature.

A case of calcifying odontogenic cyst with numerous calcifications: immunohistochemical analysis.

The purpose of this study was to investigate a case of calcifying odontogenic cyst (COC) in which numerous calcifications were observed not only in the lining epithelium, but also in the cyst wall, using cytokeratins 13 (CK13), 19 (CK19), and core binding factor a-1 (cbfa-1) as primary antibodies. Cells of Malassez's epithelial rest were stained as controls. Cells of the epithelial nests in the cyst wall were reactive for CK13, but their CK19 staining was similar to that observed in the lining epithelial cells. Calcifying nodules were reactive only for CK13. Cells of Malassez's epithelial rest were reactive for CK19 but not for CK13. Cbfa-1 positive reactivity was observed only in nuclei of spindle cells in the periodontal ligament. CK13 was positive superficial to the prickle cells. CK19 was positive in the basal cells of the oral mucosa. In the lining epithelium of the cyst, the expressions of CK13 and CK19 were similar to their immunoreactions in the oral mucosa. These results suggest that the odontogenic epithelium differentiated into squamous epithelial cells, which began as ghost cells in the COC, and that this process depended on the dystrophic calcification of differentiated odontogenic epithelial cells, not of osteogenic cells.