Lipopolysaccharide-induced pulpitis up-regulates TRPV1 in trigeminal ganglia.

Tooth pain often accompanies pulpitis. Accumulation of lipopolysaccharides (LPS), a product of Gram-negative bacteria, is associated with painful clinical symptoms. However, the mechanisms underlying LPS-induced tooth pain are not clearly understood. TRPV1 is a capsaicin- and heat-gated nociceptive ion channel implicated in thermosensation and hyperalgesia under inflammation or injury. Although TRPV1 is expressed in pulpal afferents, it is not known whether the application of LPS to teeth modulates TRPV1 in trigeminal nociceptors. By assessing the levels of protein and transcript of TRPV1 in mouse trigeminal ganglia, we demonstrate that dentinal application of LPS increases the expression of TRPV1. Our results suggest that the up-regulation of TRPV1 in trigeminal nociceptors following bacterial infection could contribute to hyperalgesia under pulpitis conditions.

Successful conservative treatment of osteoradionecrosis of the mandible associated with pathological fracture.

RESULTS: Treatment of patients with osteoradionecrosis (ORN) of the mandible associated with pathologic fractures usually consists of a continuity resection of the mandible, leading to severe impairment of the patient's health and quality of life. Conservative treatment may be alternatively attempted; however, it is not usually employed. Here, we report a successful conservative treatment of ORN associated with pathologic fracture. A 48-year-old black man who had undergone radiotherapy for a squamous cell carcinoma in the tongue 6 years previously sought care complaining of facial swelling and draining episodes. Since the patient was fiercely resistant to any kind of hospital-based therapy, a conservative approach was proposed. Daily irrigations with 2% potassium iodate, followed by 3% oxygenated water, were performed by the patient at his house. In addition, local cleaning and debridement were weekly performed at our dental clinic. Systemic antibiotics were also administered. Throughout the therapy course, bone fragments were spontaneously exfoliated. Resolution of the ulcer and fracture was observed after 6 weeks of treatment. This report shows that ORN may be conservatively managed in specific situations, with good cosmetic and functional

Extensive central ossifying fibroma of the maxilla: a case report with description of an alternative surgical technique.

Central ossifying fibroma (COF) is a fibrous-osseous lesion containing fibrous tissue and varying amounts of calcified tissue. Although the lesion is preferentially located in the jaws, it may be found elsewhere. It usually affects patients during their third and fourth decades of life, with a female predilection. The mandibular premolar-molar area is the most common site. Radiographically, COF may present a radiolucent, radiopaque or a mixed appearance. This article reports a case of an extensive COF in the maxilla of a 62-year-old patient. Intraoral examination revealed a swelling with undefined limits in the right side of the upper alveolar ridge, extending towards the palate. The lesion had invaded the maxillary sinus, nasal cavity and orbit. An incision including mucosa, periosteum, and a thin layer of the bone, was performed. The lesion was excised using a flap, and interrupted suture was utilized. The bone which was preserved in the flap was used as graft so that faster and more effective bone formation could occur. The patient has been followed-up for 5 years with no clinical or radiographic signs of recurrence. This article demonstrates that COF has a considerable growth potential. In addition, the surgical technique here in described shows very good cosmetic and functional results, especially when managing very large lesions.