An unerupted tooth?--who nose?

UNLABELLED: Foreign bodies may present to the general dental practitioner, either as a cause of complaint or, more commonly, as an incidental finding during routine examination. This article describes an unusual case where a rhinolith perforated the hard palate to appear in the mouth as an erupting tooth. CLINICAL RELEVANCE: It is useful for the general dental practitioner to be aware of the existence of foreign bodies, their sequelae and management.

Diagnostic ultrasound in the head and neck region.

UNLABELLED: Improvements in ultrasound (US) resolution have led to the application of this non-ionizing imaging modality in the diagnosis of soft tissue disorders affecting the head and neck region. Although operator experience is paramount in image interpretation, US has the advantage of being inexpensive, safe and widely available. Ultrasound is the first line imaging modality for suspected salivary gland tumours and is useful in evaluating superficial neck swellings, such as lymph node disease, soft tissue cysts and vascular malformations. Ultrasound also improves the success rate when used for guidance during fine-needle aspiration cytology (FNAC). CLINICAL RELEVANCE: This paper aims to provide the general practitioner with an overview of the basic principles of image formation, the advantages and disadvantages of US, and an outline of its indications for conditions that might present to the dental practitioner.

Assessing the quality of radiographic processing in general dental practice.

OBJECTIVES: To determine if a commercial device (Vischeck) for monitoring film processing quality was a practical option in general dental practice, and to assess processing quality among a group of GDPs in the West Midlands with this device. DESIGN: Clinical evaluation. SETTING: General dental practice, UK, 2004. METHOD: Ten GDP volunteers from a practice based research group processed Vischeck strips (a) when chemicals were changed, (b) one week later, and (c) immediately before the next change of chemicals. These were compared with strips processed under ideal conditions. Additionally, a series of duplicate radiographs were produced and processed together with Vischeck strips in progressively more dilute developer solutions to compare the change in radiograph quality assessed clinically with that derived from the Vischeck. RESULTS: The Vischeck strips suggested that at the time chosen for change of processing chemicals, eight dentists had been processing films well beyond the point indicated for replacement. Solutions were changed after a wide range of time periods and number of films processed. The calibration of the Vischeck strip correlated closely to a clinical assessment of acceptable film quality. CONCLUSIONS: Vischeck strips are a useful aid to monitoring processing quality in automatic developers in general dental practice. Most of this group of GDPs were using chemicals beyond the point at which diagnostic yield would be affected.

Rectangular collimation and radiographic efficacy in eight general dental practices in the West Midlands.

INTRODUCTION: Rectangular collimation is recommended in order to reduce radiation doses to patients. However, anecdotal reports suggest that it may result in more retakes, with a possible net increase in patient dosage. METHOD: To test this hypothesis, eight general dental practitioners were recruited to participate in a project. Each took 25 pairs of bitewing radiographs of patients before and 25 after fitting rectangular collimators to their x-ray machines. Double-pack films were used so that duplicates could be examined. These were assessed by a consultant oral radiologist according to the National Radiographic Protection Board (NRPB) grading system for positioning and general film quality. RESULTS: Initially, positioning quality was above the target level for six of the eight dentists; however, for all but one, this dropped after using rectangular collimation. General film quality was of a lower overall standard initially. Using rectangular collimation had an effect on general film quality but the direction and size of this varied among the dentists. CONCLUSION: It was concluded that amongst the participating dentists, although numbers of retakes increased by 7%, there would be a net reduction in dosage to patients following rectangular collimation.

An investigation of the effect on 27-gauge needle tips following a single local anaesthetic injection.

One hundred and forty one, 27-gauge local anaesthetic needles were collected, each following a single injection of local anaesthetic using four commonly performed local anaesthetic injection techniques. The needles were examined for needle tip damage under the scanning electron microscope. Ten unused needles were used as controls. Bone was contacted in 75 (59%) instances and, of these, 73 (97.3%) showed needle tip deformity. Of the four techniques used, bone contact was commonest with the inferior alveolar nerve block, occurring in 88% of instances.

Rhinoliths presenting during routine radiography: two cases.

Rhinoliths are calcified masses found within the nasal cavity. They are an uncommon finding and usually present to ENT surgeons. This article presents two cases where rhinoliths have been recognized in the dental setting, and discusses their management and treatment.

An ossifying fibroma presenting as Stafne's idiopathic bone cavity.

The purpose of this paper is to present a case of a fibro-osseous lesion which was diagnosed as an ossifying fibroma rather than a cemento-ossifying fibroma because of its location away from the tooth bearing parts of the jaw and the absence of cemental tissue in the excised specimen. Its location and features on a panoramic radiographic made Stafne's idiopathic bone cavity a possible diagnosis.

Surgical emphysema following dental treatment: two cases.

Surgical emphysema is an uncommon complication of dental treatment despite the frequent use of air-driven handpieces and high-speed water-cooled equipment in dental practice. As a consequence it may either go unrecognized or be misdiagnosed. Although most cases resolve spontaneously, some patients require emergency intervention. This article outlines the condition and its management and describes two cases that arose during routine dental treatment.

Orofacial radiological manifestations of systemic sclerosis.

OBJECTIVE: To ascertain the orofacial radiological manifestations of systemic sclerosis. METHODS: Twenty-one patients with known systemic sclerosis underwent panoramic, and where appropriate periapical, radiography parotid sialography and a labial gland biopsy. RESULTS: The prevalence of periodontal ligament space widening was 33%, bone resorption 9.5% and abnormal parotid gland sialographic findings 43%. Root resorption affected 4 (33%) of the 12 dentate patients. CONCLUSIONS: Orofacial radiological manifestations occur commonly in systemic sclerosis. Root resorption has not previously been reported.

A comparison of manual and automatic processing in general dental practice.

Although automatic processing is becoming more widely available in general dental practice, there is little objective information regarding the quality of this type of processing. Thus a postal study was undertaken to compare manual and automatic processing using a questionnaire together with a standardised, pre-exposed test radiograph for routine processing. Analysis of variance showed significant differences between the manually processed, automatically processed and control test films, in respect of D Min (P < 0.001), test strip (P < 0.001), and step density values (P < 0.01) but not for D Max (P > 0.1). The manually processed test films generally had significantly less density than the automatically processed test films or control test films.

An adverse reaction following sialography.

Reactions following the administration of iodine are well documented in general radiography, but are unusual following sialography. A patient who experienced an adverse reaction following sialography with an iodine-based, low osmolar, contrast medium, Hexabrix 320, is presented. The reaction consisted of severe shoulder and back pain 24 h after the procedure. A skin rash was identified involving the right axilla, groin and elbow, with swelling visible around the right elbow joint. It was not possible to distinguish, on the basis of the available evidence, between an anaphylactoid and idiosyncratic allergic reaction.

Gingival Kaposi's Sarcoma: the first indication of HIV infection.

This article presents a case of gingival Kaposi's sarcoma that initially mimicked an acute periodontal infection, but was the first clinical sign of HIV infection in a 38-year-old male homosexual patient. The clinical features and treatment of oral Kaposi's sarcoma are discussed and the variable histopathology of the lesion is demonstrated.

Concentration of cefuroxime in mandibular alveolar bone following a single preoperative dose.

A pilot study was undertaken on 12 patients undergoing the bilateral removal of impacted mandibular wisdom teeth to determine the level of cefuroxime sodium within the alveolar bone adjacent to the third molar teeth following a single preoperative intravenous administration. The results indicated that a single 1.5 g intravenous bolus injection provided satisfactory alveolar bone concentrations for routine antibiotic prophylaxis at the time of wisdom tooth removal.

A new oral surgery teaching model.

An anatomical model for teaching the practical aspects of routine oral surgery in a clinical or laboratory environment, is described. Replaceable sections allow the model to be rapidly re-used so that successive students may practise procedures such as incisions, flap reflection, bone removal, tooth removal, apicectomy and suturing. Keeping the cost per procedure to a minimum was considered to be of fundamental importance and this has been achieved through the use of 'factory produced' replacement parts.

Human tissue response to porous hydroxyapatite implants. A case report.

Histological examination of 2 porous hydroxyapatite implants removed from a patient showed a pattern of ossification similar to that reported in a previous animal study. New bone was laid down on the surface of the hydroxyapatite but did not progress to occupy all the pores. Although porous hydroxyapatite blocks are biocompatible and well tolerated by the tissues, they are not recommended for augmentation of the resorbed alveolar ridge where the overlying mucosa is thin and atrophic, because of the risk of mucosal dehiscence and implant exposure. They are suitable in situations where they are deeply buried in the tissues and not subjected to direct trauma.

A comparison of ibuprofen and dihydrocodeine in relieving pain following wisdom teeth removal.

Although dihydrocodeine (DF118) is widely prescribed by general dental practitioners, there is little evidence that it is successful in controlling post-operative dental pain. Ibuprofen is known to be effective in this situation. A single dose, double-blind study was carried out in 148 patients to compare 400 mg ibuprofen with 30 mg dihydrocodeine and placebo for treating moderate to severe pain following the removal of unilateral, impacted mandibular third molar teeth under local anaesthesia. An additional dose of either ibuprofen or dihydrocodeine was available after 2 hours. The post-operative ibuprofen reduced pain and produced more pain relief than dihydrocodeine or placebo. Furthermore, fewer patients receiving ibuprofen took additional analgesic at 2 hours. Patients who received ibuprofen as supplementary medication also experienced less pain and had greater pain relief than those receiving dihydrocodeine as supplementary medication, even when their post-operative treatment had been placebo. More patients reported the medication as having been effective if they took ibuprofen either post-operatively or as supplementary analgesia. Ibuprofen is an appropriate analgesic for treating post-operative dental pain.