The relationship between idiopathic bone cavity and orthodontic tooth movement: analysis of 44 cases.

OBJECTIVES: Idiopathic bone cavity (IBC), also named simple or traumatic bone cyst, is a common lesion of unknown cause. The mandible is a very common location, although it may occur in any bone of the body. The authors performed a retrospective analysis of 44 cases in order to assess the causation of this entity. METHODS: Each case was analysed by two of the authors (IV and SM) for medical and dental history, history of mandibular/maxillary trauma, clinical presentation, radiographic appearance, surgical findings and histopathology. RESULTS: This retrospective study suggested a possible relationship between IBCs and orthodontic treatment. This association was noted in 10/44 cases (22.73%). All of these cases were located in the mandible and were well-circumscribed radiolucencies. Evaluation of these cases disclosed that 6/44 (13.64%) demonstrated scalloping, and 3/44 (6.82%) revealed bony expansion. The age range of the patients evaluated was 9-74 years. None of these cases had a history of trauma or extractions in the area. CONCLUSIONS: The findings of this retrospective study suggest an association between orthodontic treatment and the development of this IBC. This occurrence may be multifactorial; further research in the dental science is required.

Viral and fungal infections of the oral cavity in immunocompetent patients.

Oral lesions are easily visualized and often are signs of systemic diseases. Clinical diagnosis of viral and fungal infections can sometimes be confusing because many lesions will have similar clinical presentations. This article reviews the more common viral- and fungal-associated lesions found in the oral cavity in immunocompetent individuals. Differential diagnoses for the oral lesions are discussed and treatment options are proposed.

Strategies for management of commonly encountered oral mucosal disorders.

Oral mucosal disorders are frequently encountered by the practicing dentist. These lesions may represent oral manifestations of dermatologic or systemic disease, reactive lesions, or occult neoplasms. The diagnosis of these conditions is usually based on case-specific historical findings, clinical appearance, and the results of diagnostic procedures. This article will discuss the diagnosis and management of commonly occurring oral mucosal conditions such as candidosis, recurrent aphthous ulceration, herpes virus infection, and lichen planus. This manuscript represents a synthesis of the literature and the management approach utilized by the author in the treatment of his patients. This article is not intended as a comprehensive review of all the subjects discussed.

Syphilis and gonorrhea.

Syphilis and gonorrhea are prevalent in the United States; thus it is likely that the practicing dentist will encounter these sexually transmitted diseases. Oral-genital contact can result in oral and oropharyngeal lesions of both syphilis and gonorrhea. In most states, the law mandates reporting of these sexually transmitted diseases to local health departments. Dentists must wear gloves, masks, and protective eyewear for all procedures resulting in physical contact between the patient and practitioner. Universal infection control procedures must be carefully followed to ensure against disease transmission from the symptomatic as well as the asymptomatic disease carrier.

Oral presentation and management of vesiculobullous disorders.

Vesiculobullous diseases are frequently encountered by the practicing dermatologist. However, these disorders are often difficult to diagnose and manage. The oral cavity may be overlooked as a source of diagnostic information. Oral manifestations of vesiculobullous diseases may occur independently or precede cutaneous involvement by a year or more. Maintenance of oral hygiene, discomfort that results in poor hydration and nourishment, and secondary infection must be addressed to assure disease control and patient comfort. The three vesiculobullous disorders that occur most commonly in the oral cavity are pemphigus vulgaris, cicatricial pemphigoid, and erythema multiforme. This article will discuss their oral presentation, diagnosis, and management.

Direct immunofluorescence of detached gingival epithelium for diagnosis of cicatricial pemphigoid. Report of five cases.

The diagnosis of mucosal cicatricial pemphigoid is often problematic because of frequent false negative or equivocal biopsy results. We describe an immunofluorescent technique that uses detached gingival epithelium for diagnostic purposes when oral manifestations of cicatricial pemphigoid are suspected. Erythematous mucosa that is gently rubbed produces detached epithelium that is then submitted for direct immunofluorescence studies along with tissue acquired via conventional techniques. In the five cases reported, the detached gingival epithelium stained intensely for immunoglobulins and complement on the basilar pole of the basal epithelial cells. The donor sites healed without a resultant periodontal defect. This adjunctive biopsy technique offers the advantage of easily procuring gingival tissue with deposition of immunoreactants that are quite specific for the diagnosis of cicatricial pemphigoid.

Computer applications in oral diagnosis.

Eventually, computer technology may be used in the home or practice to satisfy continuing education requirements. Additionally, this technology may be used by state licensing agencies as a component of their testing procedure. At the present time, a Patient Simulation Consortium and Electronic Curriculum Consortium have been established within the American Association of Dental Schools.7, 15 These groups, and others, will continue to develop and test new technologies for use in dentistry.

A clinical approach to the diagnosis of facial pain.

Following completion of the patient history, physical evaluation, and cranial nerve assessment, the next step should be a thorough dental evaluation with appropriate radiographs to evaluate caries, periodontal disease, and any other hard- or soft-tissue pathology. If indicated, a thorough evaluation of the craniomandibular complex also should be performed. At this point, the clinician should have a general idea as to the cause of the patient's facial pain and the appropriate course of treatment can then be instituted. If the problem is not solely dental in etiology, the diagnosis and management must be coordinated between the dentist and the appropriate medical specialties.

Intraoral biopsy technique for direct immunofluorescence studies.

A wedge biopsy technique is described for use when oral manifestations of vesiculoerosive disease are suspected. The resultant soft tissue specimens are submitted for both light microscopic and direct immunofluorescence studies. This technique offers the advantage of obtaining highly diagnostic, mirror-image soft tissue specimens from a single perilesional site while minimizing postsurgical morbidity to the patient.

Effect of an antimicrobial mouthrinse on recurrent aphthous ulcerations.

Recurrent aphthous ulceration (RAU) remains a clinical problem for many patients. Efforts in prevention and/or treatment with prescription and nonprescription formulations have to date resulted in minimal success at best. A 6-month double-blind clinical study of 96 adults compared a commercially available antimicrobial mouthrinse (Listerine Antiseptic [LA], Warner-Lambert Co., Morris Plains, N.J.) and a hydroalcoholic control to evaluate the effects of vigorous twice-daily rinsing on the incidence, duration, and severity of RAU in persons prone to this disorder. LA rinse and the hydroalcoholic rinse resulted in a statistically significant reduction in the incidence of RAU occurrences from baseline. The duration of lesions and the severity of pain in subjects with ulcers during the treatment period were also significantly reduced in the LA rinse group of patients when compared with baseline. The hydroalcoholic rinse did not show a significant effect versus baseline for either severity or duration of the lesions. Rinsing therefore can be of clinical value in reducing the occurrence of RAU in susceptible patients, and LA rinse can be of significant additional value in decreasing the duration and severity of RAU.

Diagnosing and treating common oral pathologies.

When the physician is confronted with an oral pathologic condition in a child, the adage "common things happen commonly" should be applied. Congenital lesions such as palatal and alveolar cysts occur in almost 50% of newborns. Developmental conditions such as Fordyce granules and retrocuspid papillae are found in most children. Localized soft-tissue enlargements commonly seen in young children include the parulis, mucocele, papilloma, and inflammatory gingival tumors. In addition, soft-tissue pathologies and discomfort associated with herpesvirus infections or recurrent aphthous ulcerations often present as a chief complaint. The physician's knowledge and treatment recommendations for common oral pathologies should be an integral component to the overall medical management of infants, children, and adolescents.

Medication can induce severe ulcerations.

Nonsteroidal antiinflammatory drugs can cause oral ulcers. In this case, discontinuing piroxicam, a nonsteroidal anti-inflammatory drug, and starting a palliative treatment plan helped resolve a patient's ulcers.

Plasma cell gingivitis of unusual origin. A case report.

Plasma cell gingivitis is a rare benign condition of the gingiva. It is marked by a dense infiltrate of normal plasma cells separated into aggregates by strands of collagen. It is a hypersensitivity reaction to some antigen, often flavorings or spices. The importance of this lesion is that it may cause severe gingival inflammation, discomfort, and bleeding and may mimic more serious conditions. Plaque control and conventional periodontal therapy alone will not cure this disease. The etiologic agent must be identified and the substance eliminated from use. This report outlines a case of plasma cell gingivitis which may have been brought on by the use of red peppers in cooking.

Clinical management of common oral lesions.

Soft tissue lesions are among the most commonly occurring pathologic conditions in the oral cavity. The causes of these lesions can vary from immunologic and viral reactions to underlying systemic disease, dermatologic lesions, or neoplasms. The diagnosis of these conditions is usually based on the history, clinical appearance, and results of diagnostic procedures such as smears, culture, or examination of biopsy specimens when indicated. This paper will discuss the diagnosis and management of some of the most commonly occurring oral lesions, such as recurrent aphthous ulcers, herpetic ulcers, and candidiasis.