Adult-onset Still's disease initially thought to be an odontogenic infection: A case report.

OBJECTIVE: To present a case of Adult-onset Still's disease (AOSD) initially suspected to be odontogenic inflammation. BACKGROUND: Adult-onset Still's disease is a rare, complex autoinflammatory disease and a known cause of fever of unknown origin. MATERIALS AND METHODS: The patient had both a fever and dental pain. Following meticulous examination, the patient was diagnosed with AOSD. CONCLUSION: Clinicians should keep in mind that a patient such as AOSD may visit their clinics.

Fracture after radiation therapy for femoral metastasis: incidence, timing and clinical features.

We analyzed 428 femoral metastases initially treated with radiotherapy between 2002 and 2011 to clarify the clinical details of post-irradiation fractures of femoral metastasis. Patients included 161 men and 167 women, with a mean age of 62 years. Fracture incidence, fracture site, fracture risk based on X-ray images before radiotherapy, and interval from completion of radiotherapy to fracture occurrence were assessed. In addition, 24 pathological specimens obtained during 27 surgeries for these fractures were examined. Fractures occurred in 7.7% of 428 femoral metastases (total 33: 28 actual fractures and five virtual fractures with progressive pain and bone destruction). The fracture rate was 7.8% in the proximal femur and 1.5% in the shaft (P = 0.001). Fractures occurred a median of 4.4 months after radiotherapy, with 39.4% occurring within 3 months and 63.6% within 6 months. Among femurs with high fracture risk according to Harrington's criteria or Mirels' score, the fracture rate was 13.9% and 11.8%, respectively. Viable tumor cells were detected in all five patients with painful virtual fracture, in 85.7% of femurs with actual fractures that occurred within 3 months, and in only 25.0% of actual fractures occurring after 3 months. Post-irradiation fractures of femoral metastasis most frequently occurred within 3 months after radiotherapy, and were more common in the peritrochanteric area than in the shaft. Radiological evidence of impending fracture did not correlate with a high fracture rate. Actual fractures occurring after more than 3 months were likely caused by post-irradiation fragility of the femur, without viable tumor cells.

Acute exacerbation of chronic disseminated intravascular coagulation associated with thoracoabdominal aortic aneurysm after tooth extraction.

OBJECTIVE: To present a rare case of persistent bleeding from the tooth extraction socket in a patient with chronic disseminated intravascular coagulation (DIC). BACKGROUND: Acute exacerbation of chronic DIC occurs by various trigger factors. CLINICAL REPORT: The patient's chronic DIC in association with thoracoabdominal aortic aneurysm was activated by tooth extraction, resulting in persistent bleeding from the socket. CONCLUSION: Patients with chronic DIC may have persistent bleeding following tooth extraction.

Oral lacerations during motocross: A case report.

Motocross is a high-risk sport that can cause serious injuries including oral injuries. However, mouthguard use is not mandatory in motocross. This report describes a case of an oral laceration with exposure of bilateral inferior alveolar nerves as a result of a motocross accident in which the patient was not wearing a mouthguard.

Huntington's disease with severe neck infection.

OBJECTIVE: To present a case of Huntington's disease (HD) with severe neck infection. BACKGROUND: Huntington's disease (HD) is a progressive neurodegenerative genetic disorder and is often accompanied by dysphagia. MATERIALS AND METHODS: The patient was a 64-year-old man with HD. The severe neck infection was considered as one of the symptoms of HD. CONCLUSION: Clinicians should remember that patients with HD are apt to delay dental consultation, resulting in serious oral infections.

Asymmetrical vertebral collapse from spinal metastasis in lower thoracic and lumbar spine.

OBJECTIVE: The purpose of this study was to investigate the differences between spinal metastasis and osteoporotic compression fractures on plain X-ray images, focusing on asymmetrical vertebral collapse and fracture level. MATERIALS AND METHODS: This study included 180 patients with pathological collapse from spinal metastasis (188 vertebrae) who were treated at our institution and 70 patients (92 vertebrae) with osteoporotic compression fractures. Anteroposterior X-ray images of the lower thoracic and lumbar spine were evaluated for asymmetrical collapse deformity. RESULTS: Asymmetrical collapse was found in 134 vertebrae (71.3%) with metastasis, and in 20 osteoporotic vertebrae (21.7%); this difference was significant (p < 0.0001). The asymmetrical collapse angle in spinal metastasis patients ranged from 0 to 18°, with a mean of 7.0 and a standard deviation (SD) of 4.5. In contrast, the asymmetrical collapse angle in patients with osteoporotic fractures ranged from 0 to 13°, with a mean of 3.1 and a SD of 2.8. The difference in collapse angle between the two groups was statistically significant (p < 0.001). The cutoff value to suspect spinal metastasis was determined to be 5° or more (sensitivity 0.67, specificity 0.74). Fracture at Th10 or below L3 was found in 20.2% of spinal metastasis patients; only 3% of osteoporotic fractures occurred at these levels. CONCLUSION: Asymmetrical collapse with an angle of 5° or more and fractures at atypical levels on plain radiographs can be useful clues to spinal metastasis.

Continuous intra-sinus bone regeneration after nongrafted sinus lift with a PLLA mesh plate device and dental implant placement in an atrophic posterior maxilla: a case report.

BACKGROUND: Sinus lift is a bone augmentation procedure that improves the alveolar crest height in an atrophic posterior maxilla. However, the regenerated bone volume can vary and generally has a tendency to decrease after sinus operation. This article describes nongrafted maxillary sinus lift using a bioresorbable unsintered hydroxyapatite combined with poly L-lactide (HA/PLLA) mesh plate device and dental implant placement in an atrophic posterior maxilla, after which continuous bone gain was observed around the implant apex during a postoperative follow-up period of 3 years. CASE PRESENTATION: A 60-year-old healthy female was referred to our department for dental implant therapy in the right posterior maxilla. Clinical examination revealed that the maxilla was edentulous from the right first premolar to the second molar region. Radiographically, atrophy of the maxillary alveolar ridge in the same tooth site was observed. Sinus membrane elevation and simultaneous implant placement were performed through the lateral approach. HA/PLLA mesh was utilized to maintain space under the elevated sinus membrane and as a fixation device to replace the bone window. Six months later, new bone was generated in the secluded space maintained under the elevated sinus membrane. When observed 42 months after the implant insertion, bone volume around the implant apex had increased in vertical direction under the HA/PLLA mesh plate device, and there was continuous bone formation in the sinus over time. CONCLUSION: This nongrafted sinus lift procedure using an HA/PLLA mesh device attained predictable bone formation. Stable membrane elevation by an HA/PLLA device might induce long-term, continuous bone formation in the sinus.

Temporomandibular joint dislocation in a post-stroke patient with dysphagia caused by gastroesophageal reflux-related vomiting.

Temporomandibular joint dislocation (TMJ) is sometimes found in post-stroke patients, and most cases occurs involuntarily. This report describes a rare case of repeated, voluntary, TMJ in a 73-year-old woman with dysphagia and dysarthria. The cause of dislocation was suspected to be voluntary excessive mouth opening associated with gastroesophageal reflux-related vomiting and the desire to eject oral deposits resulting from hypoglossal and facial nerve paralyses. After an oral hygiene intervention, the frequency of TMJ dislocation decreased and finally disappeared. Thorough oral hygiene seemed to contribute to protection against TMJ dislocation. (J Oral Sci 58, 133-136, 2016).

Quest for Cells Responsible for Age-related Increase of Salivary Glycine and Proline.

We have previously reported that salivary glycine and proline levels are increased to nearly butanoate level in elderly people. In order to identify the source of glycine and proline, we performed high-performance liquid chromatography analysis of amino acid production to a total of seven oral cells before and after stimulation with inflammation inducers. We found that production of amino acids (per a given number of cells) by normal oral mesenchymal cells (gingival fibroblast, pulp cell, periodontal ligament fibroblast) was approximately three-fold that of oral squamous cell carcinoma cell lines (HSC-2, HSC-3, HSC-4, Ca9-22), and that production of glycine and especially proline by all these seven cells was much lower than that of glutamine and glutamic acid. Treatment of three oral mesenchymal cells with interleukin (IL)-1ß or lipopoly-saccharide (LPS) reproducibly increased the production of glutamic acid and glutamine, but not that of glycine and proline. Glycine and proline only marginally stimulated the IL-8 production by IL-1ß-stimulated gingival fibroblast, whereas glycine dose-dependently inhibited the nitric oxide production by lipopolysaccharide-stimulated mouse macrophage-like RAW264.7 cells. These data demonstrated that normal oral mesenchymal cells are not the major source of glycine and proline that accumulates in the saliva of aged people, suggesting the involvement of the deregulation of collagen metabolism during aging.

Replantation of avulsed teeth using the 180-degree rotation method and a vacuum-formed splint in mixed dentition: a case report.

It is often very difficult to replant avulsed teeth in the deciduous and mixed dentition when the cortical bone is fractured and there are no adjacent teeth for anchorage. In this article, we describe the management of avulsed maxillary incisors in a 7-year-old boy. The avulsed teeth could be successfully repositioned by intra-alveolar transplantation using the 180° rotation (buccolingual reverse) method, which was originally applied to preserve teeth with relatively deep subgingival crown-root fracture, and a vacuum-formed splint was used for fixation. The avulsed teeth were followed up for 42 months. The post-operative course was uneventful with an aesthetic and functionally stable outcome.

Anti-inflammatory potential of Rikkosan based on IL-1ß network through macrophages to oral tissue cells.

Rikkosan is a traditional Kampo medicine using the control of oral pain caused by dental caries, pulpitis, periodontitis and stomatitis. In order to provide evidence for its clinical effects, we herein investigated whether Rikkosan inhibits the production of pro-inflammatory substances in human and mouse models of inflammation. Rikkosan alone did not induce prostaglandin E2 (PGE2) production, but inhibited interleukin-1ß (IL-1ß) (5 ng/ml)-stimulated PGE2 production in human gingival fibroblasts and human periodontal ligament fibroblasts, with a selectivity index higher than 4.0 and 4.3, respectively. Rikkosan alone dose-dependently stimulated tumor necrosis factor-α (TNF-α) production, reaching a peak level slightly lower than that attained by lipopolysaccharide (LPS) at 0.4 mg/ml in mouse macrophage-like RAW264.7 cells. At a higher concentration of Rikkosan (4 mg/ml), TNF-α production, however, declined significantly regardless of the presence or absence of LPS. Rikkosan dose-dependently inhibited IL-1ß production by LPS-stimulated RAW264.7 cells, with a selective index of 7.6. Five constituent extracts of Rikkosan, either alone or in combination, showed similar effects on TNF-α and IL-1ß productions in activated RAW264.7 cells, but to lower extents than that of Rikkosan. These results demonstrated that Rikkosan inhibited both IL-1ß production by LPS-activated macrophages and PGE2 production by IL-1ß-stimulated human gingival fibroblasts and human periodontal ligament fibroblasts, suggesting that anti-inflammatory effects of Rikkosan may partially be generated by the inhibition of these pro-inflammatory substances via the IL-1ß network through macrophages to oral tissue cells.

Anti-UV activity of Kampo medicines and constituent plant extracts: re-evaluation with skin keratinocyte system.

AIM: In order to search for new biological activity of Kampo medicines and their constituent plant extracts, we investigated their ability to protect the cells from UV irradiation (referred to as 'anti-UV activity') using the human immortalised skin keratinocyte cell line HaCaT. MATERIALS AND METHODS: Anti-UV activity was represented by the selectivity index (SI), defined as the ratio of the concentration that reduced the viable cell number by 50% to the concentration that increased the viability of UV-irradiated cells to 50%. RESULTS: HaCaT cells were highly resistant to UV irradiation, approximately 20% of cells survived even when the exposure time was prolonged to 480 min. Sodium ascorbate, a popular antioxidant, used as positive control, had excellent anti-UV activity (SI=200). Among 10 Kampo medicines, Shosaikoto (SI=34) had the highest anti-UV activity, followed by Hangesyashinto (SI>28), Unseiin (SI>23) and Ninjinyoeito (SI=23), Saireito (SI>19), whereas another four Kampo medicines were much less active (SI<9.6). Among 25 constituent plant extracts, Scutellaria root had the highest anti-UV activity (SI=38), followed by Polyporus sclerotium (SI>26), Gardenia fruit (SI>23), Japanese Gentian (SI>20) and Saposhnikovia root (SI>20). Glycyrrhizin also had potent anti-UV activity (SI=36). The SI values determined with the present HaCaT system were generally one order higher than those obtained with previously reported HSC-2 human oral squamous cell carcinoma system, although there was good correlation between these two systems (R(2)=0.9118). Conclusion. The present study highlights the improved sensitivity of anti-UV activity detection with the HaCaT system, and suggests the possible application of Kampo medicines as a component of sunscreening cosmetics.

Cortical bone remodeling in parosteal osteosarcoma mimicking medullary involvement: a case with the difficulty in pre-surgical staging.

Parosteal osteosarcoma (POS) is a low-grade well-differentiated variant of osteosarcoma that affects the metaphyseal surface of a long bone. Although Grade-1 POS sometimes involve the medullary canal, such patients are not at a greater risk of local recurrence or metastases. In this report, we describe a rare case of POS in the right distal femur with an intramedullary sclerotic lesion mimicking medullary involvement caused by secondary remodeling of the underlying cortex of the tumor. A 34-year-old woman complained of having a painful hard mass in her right knee for six months. Imaging studies revealed a broad-based sclerotic mass attached to the cortex of the distal and lateral aspect of the femur, along with an intramedullary lesion. Histopathological examination of a biopsy specimen revealed Grade-1 POS. We diagnosed a medullary involvement and we performed a wide resection, including the intramedullary lesion. Histopathological examination of the resected specimen revealed that the intramedullary lesion only exhibited remodeling of the underlying tumor cortex without tumor cell invasion. To the best of our knowledge, this is the first report of such imaging features and pathological findings in a patient with POS. Our experience with the present patient indicates that good local control and overall prognosis of patients with medullary involvement in Grade-1 POS may be due to the remodeling of the underlying cortex mimicking "medullary involvement." This feature will add to the range of diagnostic difficulty experienced during the preoperative staging of POS.

Oral opportunistic infections in institutionalized patients with motor and intellectual disabilities.

To establish a basic strategy for prevention of aspiration pneumonia in patients with motor and intellectual disabilities, we investigated oral opportunistic pathogen (OOP) infections in 31 such patients who were resident at a welfare home. Patients received special oral care from a dental hygienist once a week. OOP samples were collected by scraping the dorsal surface of the tongue, and then cultured. For each patient, the basic reasons for admission and the degree of intellectual disability and mobility were recorded. OOPs were found in 61.3% of the patients, of which methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly detected (38.7%). A significantly high proportion of male patients were OOP-positive, and a significantly high proportion of patients with mental retardation were Candida sp.-positive. However, multivariate logistic regression revealed that disability was not associated with OOP positivity. No correlation was found between OOP positivity and disability. Nevertheless, special oral care may be beneficial for maintenance of oral health in patients with disabilities.

A novel open-tray impression technique for fabrication of a provisional prosthesis on immediate load implants in a completely edentulous arch.

PURPOSE: To evaluate the clinical outcome of a novel open-tray impression technique for fabrication of a provisional prosthesis supported by immediately loaded implants in a completely edentulous arch. MATERIALS AND METHODS: An open-tray impression technique was evaluated in this retrospective study that included patients treated between March 2006 and October 2009. Preoperatively, a diagnostic prosthesis was delivered, and a novel open tray was fabricated based on this prosthesis. After implant placement, the impression and interocclusal record were taken simultaneously using the novel open tray. Laboratory-fabricated, screw-retained, all-acrylic resin provisional restorations were delivered on the same day of surgery. The prosthesis was assessed from the day of surgery until replacement with a definitive prosthesis. RESULTS: The study included 21 patients (mean age, 64.5 years) and a total of 125 implants. Of these, 104 implants were immediately loaded. In all patients, well-fitting provisional restorations supported by a minimum of four implants were delivered. Fracture of the first molar cusp was observed in one case after 30 days. However, there was no extensive fracture in the framework or functional disorder of the prosthesis. No implant failed during the follow-up after implant surgery. CONCLUSION: This protocol enabled fabrication of a well-fitting acrylic resin provisional prosthesis supported by immediately loaded implants because the impression was taken while in centric occlusion and an occlusion identical to the diagnostic prosthesis could be reconstructed.

Molar luxations caused by holding water taps. Report of five cases.

Luxation of a primary molar occurs rarely. Here, we describe five cases of primary molar luxation caused by holding a water tap pipe in the mouth during bathing. The patients were aged 16 to 19 months and the mandibular first primary molar was affected in all five cases. The second primary molar had not erupted. It is assumed that the flange of the pipe got stuck in the interdental space between the mandibular primary canine and first primary molar and the affected first molar was pushed out by force with the flange acting as a lever.

Anti-UV/HIV activity of Kampo medicines and constituent plant extracts.

AIM: In order to search for new biological activities of Kampo medicines and their constituent plant extracts, we investigated whether they protect the cells from the cytotoxicity induced by UV irradiation and human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: Anti-UV/HIV activity (SI value) was evaluated as the ratio of the CC(50) (concentration that reduced the viable cell number by 50%) to the EC(50) (the concentration that increased the viability of UV-irradiated or HIV-infected cells to 50%): SI=CC(50)/EC(50). The content of glycyrrhizin in each sample was determined by high performance liquid chromatography (HPLC). Caspase-3/-7 activity was assayed by cleavage of poly ADP ribose polymerase using western blot analysis. RESULTS: Among 25 plant extracts, Gardenia fruit had the highest anti-UV activity (SI≥8.0), followed by Glycyrrhiza (SI=4.3), Coptis rhizoma (SI=1.5), Cimicifuga rhizoma (SI>1.4), Saposhnikovia root (SI>1.3) and Japanese Gentian (SI>1.1). Among ten Kampo medicines, Unseiin and Hangesyashinto (SI>4.9) had the highest anti-UV activity, followed by Shosaikoto (SI>4.3), Saireito (SI>3.4), Rikkosan (SI>1.2) and Kikyoto (SI=1.1). Glycyrrhiza inhibited UV-induced caspase-3/-7 activation. Only Polyporus sclerotium (SI>4.4), Gardenia fruit (SI>2.7), Atractylodes lancea rhizoma (SI>1.9), Cnidium rhizoma (SI>1.5) and Japanese Angelica root (SI>1.1) exhibited some anti-HIV activity. There was no apparent correlation of their anti-UV/HIV activity and content of glycyrrhizin, a major component of Glycyrrhiza, which exhibited much higher anti-UV activity (SI=20.6) and some anti-HIV activity (SI>2.0). CONCLUSION: The present study suggests the involvement of substances other than glycyrrhizin in the anti-UV/HIV activity of Kampo medicines and their constituent plant extracts.

New bone formation in nongrafted sinus lifting with space-maintaining management: a novel technique using a titanium bone fixation device.

PURPOSE: Sinus lifting without graft materials allows new bone formation in the sinus, but the amount of bone formation varies. This study aimed to investigate whether nongrafted sinus lifting using a titanium bone fixation device can promote bone formation in the sinus. MATERIALS AND METHODS: Patients with atrophic posterior maxillae jeopardizing implant stability were included. After nongrafted sinus lifting in combination with implant placement, repositioning of the bone window and additional space-maintaining management were performed by use of the bone fixation device. The primary variables recorded retrospectively included implant survival and preoperative and postoperative alveolar crest height with and without Schneiderian membrane perforation. Independent variables included patient demographics, position and dimension of the implants, complications, and follow-up period. The t test was used for comparing differences in bone levels. The implant survival rate was estimated by uses of Kaplan-Meier statistics. RESULTS: The study included 11 patients (4 men and 7 women) and a total of 21 implants. Radiographically, new bone formation around the implant was generally observed in accordance with the implant apex. Postoperative alveolar crest height (mean, 10.9 ± 2.2 mm) was significantly higher compared with residual alveolar crest height (mean, 4.7 ± 1.4 mm), and no significant difference in bone formation was seen according to membrane perforation. The cumulative survival rate was 95.2%. CONCLUSIONS: This nongrafted sinus-lifting procedure using a bone fixation device could attain predictable bone formation. Additional space-maintaining management using a bone fixation device in a nongrafted sinus lift offers a useful technique for promoting bone formation in the sinus.

Development and growth of adenomatoid odontogenic tumor related to formation and eruption of teeth.

The number of published cases of adenomatoid odontogenic tumor (AOT) has steadily increased, and about half were reported in Asian populations. Although the clinicopathologic profile of AOT has been extensively reported, factual knowledge of its pathogenesis is rudimentary at best, and there is controversy as to precisely which odontogenic epithelium it arises from. AOT is a successional tooth-associated lesion which develops during the mixed dentition. The permanent successor differs from its deciduous predecessor in that it has an eruptive pathway from the dental follicle to the gingiva, the gubernaculum dentis. With this background in mind, the present review focuses mainly on the early development of AOT. We successfully demonstrated a close spatial relationship between AOT and the gubernaculum dentis in a typical case. From further observations of the same AOT in which an enclosed permanent canine showed enamel hypoplasia, it is possible to pinpoint areas around the crown of a developing successional tooth in continuity with the gubernaculum dentis as starting points. In addition, we discuss the unifying histogenetic concept of three clinical variants, namely, pericoronal (follicular), extracoronal (extrafollicular), (see Article note) and peripheral.