Pior qualidade de sono está associada à disfunção temporomandibular e hábitos parafuncionais entre estudantes e profissionais de Odontologia / La peor calidad del sueño se asocia con disfunción temporomandibular y hábitos parafuncionales en estudiantes y profesionales de Odontología / Worse sleep quality is associated with temporomandibular disorders and parafunctional habits among dental students and professionals

Este estudo teve como objetivo avaliar a associação entre a qualidade do sono e a presença de disfunção temporomandibular (DTM) e hábitos parafuncionais em estudantes e profissionais de Odontologia durante a pandemia de COVID-19. Cirurgiões-dentistas, docentes e estudantes brasileiros de graduação e pós-graduação em Odontologia responderam a um questionário virtual composto pelos seguintes instrumentos: Índice de Qualidade do Sono de Pittsburgh, Lista de Verificação de Comportamentos Orais, Índice Anamnésico de Fonseca e questões socioeconômicas e demográficas. Os questionários foram disponibilizados online de agosto a novembro de 2020. A associação entre as variáveis preditoras e cada desfecho foi avaliada por meio da regressão de Poisson. A amostra foi composta por 449 participantes, sendo que 259 (59,5%) relataramdistúrbios do sono, 352 (78,4%) apresentavam DTM e 311 (69,3%) realizavam hábitos orais parafuncionais. Os distúrbios do sono foram associados à maior prevalência de hábitos orais parafuncionais (RP 1,61; IC 95% 1,36-1,91) e DTM (RP 1,16; IC 95% 1,04-1,29). Além disso, as mulheres apresentaram maior prevalência de DTM em relação aos homens, assim como indivíduos cuja renda era menor. Desta forma, os distúrbios do sono foram associados a hábitos orais parafuncionais e DTM em estudantes e profissionais de Odontologia durante a quarentena da COVID-19 (AU).

Este estudio tuvo como objetivo evaluar la asociación entre la calidad del sueño y la presencia de disfunción temporomandibular (DTM) y hábitos parafuncionales en estudiantes y profesionales de Odontología durante la pandemia de COVID-19. Odontólogos, profesores y estudiantes brasileños de pregrado y posgrado en Odontología respondieron un cuestionario virtual compuesto por los siguientes instrumentos: Índice de Calidad de Sueño de Pittsburgh, Lista de Verificación de Comportamiento Oral, Índice Anamnésico de Fonseca y preguntas socioeconómicas y demográficas. Los cuestionarios estuvieron disponibles virtualmente de agosto a noviembre de 2020. La asociación entre las variables predictoras y cada resultado se evaluó mediante regresión de Poisson. La muestra estuvo compuesta por 449 participantes, de los cuales 259 (59,5%) refirieron trastornos del sueño, 352 (78,4%) DTM y 311 (69,3%) hábitos orales parafuncionales. Los trastornos del sueño se asociaron con una mayor prevalencia de hábitos bucales parafuncionales (RP 1,61; IC 95% 1,36-1,91) y DTM (RP 1,16; IC 95% 1,04-1,29). Además, las mujeres tenían una mayor prevalencia de DTM que los hombres, así como las personas con ingresos más bajos. Así, los trastornos del sueño se asociaron con hábitos orales parafuncionales y DTM en estudiantes y profesionales de odontología durante la cuarentena por COVID-19 (AU).

This study aimed to assess the association between sleep quality and the presence of temporomandibular disorders (TMD) and parafunctional habits in dental students and professionals during the COVID-19 quarantine. Brazilian dentists, professors, and dental undergraduate and graduate students answered a virtual questionnaire composed of the following instruments: Pittsburgh Sleep Quality Index. Oral Behaviors Checklist, Fonseca Anamnestic Index, and socioeconomic and demographic questions. Questionnaires were available on-line from August to November 2020. The association between the predictor variables and each outcome were assessed using Poisson regression. The sample consisted of 449 participants, 259 (59.5%) of whom had sleep disorders, 352 (78.4%) had TMD, and 311 (69.3%) had parafunctional oral habits. Sleep disorders were associated with higher prevalence of parafunctional oral habits (PR 1.61; 95%CI 1.36-1.91) and TMD (PR 1.16; 95%CI 1.04-1.29). Furthermore, women showed a higher prevalence of TMD in comparison to men, as well as individuals with lower income. Sleep disorders were associated with parafunctional oral habits and TMD in dental students and professionals during COVID-19 quarantine (AU).

Survival of conventional dental implants in the edentulous atrophic maxilla in combination with zygomatic implants: a 20-year retrospective study.

PURPOSE: Implant-supported prosthetic rehabilitation in the resorbed maxilla is a great challenge. The aim of this study was to determine the survival rate of conventional anterior implants placed in combination with zygomatic implants according to the Brånemark technique, and to identify risk factors for implant failure. METHODS: We collected data retrospectively from 72 consecutive patients who received treatment from 1998 to 2018 at our center, according to Brånemark's original technique. Kaplan-Meier analysis was conducted to assess survival rate, and a survival regression model was used with the patient as the random factor, applying the Weibull distribution. RESULTS: A total of 236 maxillary anterior implants were included, with a mean follow-up of 12.1 years. Kaplan-Meier analysis showed overall cumulative survival rates of 95.3% at 1 year, 94.8% at 2 years, 93.0% at 5 years, 90.5% at 10 years, 81.6% at 15 years, and 67.7% at 20 years. Survival regression showed an association between bruxism and implant failure as well as implants bearing an overdenture. Implants with length ≤ 10 mm had a significantly lower survival time. No significant association was found between the number of anterior implants and survival rate. CONCLUSIONS: We found acceptable long-term anterior conventional implant survival. Significant risk factors for failure were bruxism, overdentures, and implants shorter than 10 mm.

Oral, dental, and craniofacial features in chronic acid sphingomyelinase deficiency.

The aim of this study was to evaluate the oral, dental, and craniofacial features of individuals affected by the chronic forms of acid sphingomyelinase deficiency (ASMD). This study comprised a sample of adult and pediatric patients (n = 8) with chronic ASMD. The individuals underwent oral examinations to evaluate the occurrence of caries, as well as full-mouth periodontal examinations, to assess the occurrence and severity of periodontal diseases. Panoramic and profile radiographs were obtained to analyze dental conditions and craniofacial parameters. Participants also answered questionnaires to identify systemic impairment, parafunctional habits, and bruxism. Dental anomalies of size, shape, and number were found, with agenesis and microdontia being the predominant findings. The average of caries experience was 11.75 (±8.1). Only one patient had periodontal health and all adult individuals had periodontitis at different stages and degrees. Bruxism was found in 87.5% of the sample. The convex profile and maxillary and mandibular retrusion were the most relevant findings in the cephalometric analysis. It is concluded that individuals with chronic ASMD, in addition to several systemic manifestations, present significant modifications in their oral health, from a greater occurrence of dental anomalies, caries, periodontal disease, in addition to skeletal changes.

Cerebral palsy and bruxism: Effects of botulinum toxin injections-A randomized controlled trial.

Objective: Cerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX-A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX-A injections in subjects with CP and bruxism. Methods: A prospective, parallel, randomized, placebo-controlled, and double-blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX-A or corresponding placebo injections. Matched, healthy references were also evaluated. Results: The reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX-A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX-A was requested by the majority of the patients. Conclusion: The evidence is unable to support the use of BTX-A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials.

Risk Factors for Temporomandibular Disorders among Amphetamine Users in Indonesia

Abstract Objective: To determine the possible risk factors for temporomandibular disorders (TMD) among amphetamine users in Indonesia. Material and Methods: This cross-sectional study involved 152 male amphetamine users, aged 18-45 years, who were undergoing rehabilitation. Data were obtained from medical records, questionnaires, and clinical examinations. Data obtained from medical records included age, gender, duration of amphetamine use, duration of rehabilitation, and psychiatric status. Collected data were analyzed using the Chi-square and logistic regression tests to identify correlations between TMD and bruxism, oral habits, tooth wear, duration of amphetamine abused, and duration of rehabilitation Results: TMD was found in 84.2% of amphetamine users, with clicking being the most frequently reported sign (72.4%). Tooth wear (72.4%), oral habits (60.5%), and bruxism (56.6%) were also frequently found. Statistically, a significant association was found between TMD and bruxism (p<0.001), tooth wear (p<0.001), and oral habits (p<0.001). However, there was no association observed between TMD and duration of amphetamine abused (p=0.526), and duration of rehabilitation (p=0.679). Odds ratios produced by logistic regression for tooth wear, oral habits, and bruxism were 6.657, 6.2, and 1.659, respectively Conclusion: Tooth wear, oral habits, and bruxism were identified as risk factors for TMD among amphetamine users in Indonesia.

Mandibular condylar morphology for bruxers with different grinding patterns.

OBJECTIVES: The purpose of this study was to investigate the mandibular condylar morphology for bruxers with different grinding patterns. METHOD: Condylar sectional morphology and condylar position of 30 subjects were determined by two viewers using cone beam computed tomography (CBCT) image data sets. The grinding patterns during sleep bruxism (SB) were determined objectively using a Brux-checker device.Chi-square tests were used for statistical analysis for the condylar morphology type between different tooth grinding patterns. Spearman's rank correlation coefficient was used for correlation analysis between condylar position and the canine guidance area during SB. RESULTS: Theincidence of condylarmorphologicaldivergence from idealwas35%.There isa significant difference in distribution of condylar morphology type between the group grinding (GG) and GG combined with mediotrusive side grinding (MG) (p < 0.05). There was no significant correlation between condylar position and canine guidance area during bruxism. DISCUSSION: MG during SB is associated with condylar morphology that is considered not to be ideal.

Histological features of peri-implant bone subjected to overload.

PURPOSE: The aim of this review has been to investigate the histological findings of bone structure surrounding implants subjected to excessive load. MATERIALS AND METHODS: Clinical and pre-clinical histological studies that observed overloaded intraoral implants were included. RESULTS: All included studies (n=15) were conducted on animals. Most of them failed to find pathological alteration in the microstructure of bone surrounding overloaded implants. Overload and infection alone may induce bone loss, but related lesions have different and peculiar features. CONCLUSIONS: The different histological features observed around implants subjected to overload or to ligature-induced peri-implantitis may indicate a specific pathogenetic mechanism for overload or infection-induced loss of osseointegration. The clinical significance of these findings should be confirmed in human studies.

Enamel craze lines.

Enamel craze lines are a common clinical finding, especially in older patients and in patients who brux. These craze lines frequently are discolored and may present as clear in color, grey, or brown. The clinical question is, when do enamel craze lines need restoration and when should we leave them untreated? This review will look at enamel structure and the effects of occlusion, bruxing, temperature, and restorations on enamel structure. Recommendations will be made on how and when to deal with these cosmetic defects of enamel.

Factors related to the formation of buccal mucosa ridging in university students.

OBJECTIVE: Buccal mucosa ridging (BMR) is known as a clinical sign of clenching, which is one of the major manifestations of bruxism. However, there are few reports about the formation of BMR and no data regarding the association between BMR and factors such as malocclusion. The purpose of the current study was to investigate the relationship between BMR and factors such as the number of teeth present, gender, body mass index (BMI), occlusion and clenching habit in university students. MATERIALS AND METHODS: A total of 2101 students (1164 males, 937 females), aged 18-29 years old, were included in the study. BMR and the number of teeth present were recorded and malocclusion was defined using a modified version of the Index of Orthodontic Treatment Need. Additional information regarding gender, clenching habit and BMI was collected via a questionnaire. RESULTS: Forty-six per cent of the subjects had BMR and the prevalence of BMR in females was significantly higher than that of males (chi square test, p < 0.001). According to logistic regression analysis, the probability of BMR was significantly associated with female gender (OR = 1.501, 95% CI = 1.259-1.790, p < 0.001), crowding (OR = 2.102, 95% CI = 1.706-2.590, p < 0.001) and overjet (OR = 0.585, 95% CI = 0.418-0.818, p = 0.002). On the other hand, BMR was not associated with awareness of clenching habit and BMI. CONCLUSIONS: Gender, crowding and overjet were related to the formation of BMR in university students. When evaluating BMR as a clinical sign of clenching, one might have to take factors such as gender and crowding into consideration.

A relationship between bruxism and orofacial-dystonia? A trigeminal electrophysiological approach in a case report of pineal cavernoma.

BACKGROUND: In some clinical cases, bruxism may be correlated to central nervous system hyperexcitability, suggesting that bruxism may represent a subclinical form of dystonia. To examine this hypothesis, we performed an electrophysiological evaluation of the excitability of the trigeminal nervous system in a patient affected by pineal cavernoma with pain symptoms in the orofacial region and pronounced bruxism. METHODS: Electrophysiological studies included bilateral electrical transcranial stimulation of the trigeminal roots, analysis of the jaw jerk reflex, recovery cycle of masseter inhibitory reflex, and a magnetic resonance imaging study of the brain. RESULTS: The neuromuscular responses of the left- and right-side bilateral trigeminal motor potentials showed a high degree of symmetry in latency (1.92 ms and 1.96 ms, respectively) and amplitude (11 mV and 11.4 mV, respectively), whereas the jaw jerk reflex amplitude of the right and left masseters was 5.1 mV and 8.9 mV, respectively. The test stimulus for the recovery cycle of masseter inhibitory reflex evoked both silent periods at an interstimulus interval of 150 ms. The duration of the second silent period evoked by the test stimulus was 61 ms and 54 ms on the right and left masseters, respectively, which was greater than that evoked by the conditioning stimulus (39 ms and 35 ms, respectively). CONCLUSIONS: We found evidence of activation and peripheral sensitization of the nociceptive fibers, the primary and secondary nociceptive neurons in the central nervous system, and the endogenous pain control systems (including both the inhibitory and facilitatory processes), in the tested subject. These data suggest that bruxism and central orofacial pain can coexist, but are two independent symptoms, which may explain why numerous experimental and clinical studies fail to reach unequivocal conclusions.

Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions.

A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. The alteration in texture within his mouth created an uncomfortable sensation and, at times, the lesions spontaneously peeled away requiring him to spit repeatedly. The patient denied any history of trauma, cheek biting, or use of tobacco products. On initial examination, the patient was asymptomatic and the oral mucosa had no abnormal findings, but on repeat examination when symptoms were present, the patient had shaggy white plaques on the bilateral buccal mucosa limited to the line of dental occlusion (Figure 1). The plaques could be easily peeled away from the underlying skin with a cotton swab without any pain, leaving behind normal underlying mucosa. A review of the prior biopsy of the affected mucosa revealed an irregularly hyperplastic epithelium with foci of ballooned epithelial cells within the upper layer, parakeratosis, and bacterial overgrowth (Figure 2). Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Results from periodic acid-Schiffstain revealed no fungal elements. The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. The patient found that rinsing with hydrogen peroxide solution was most helpful in reducing the lesions. A bite guard was recommended by an oral and maxillofacial surgeon, but the patient has yet to use it.

Maternal breastfeeding, parafunctional oral habits and malocclusion in adolescents: a multivariate analysis.

OBJECTIVE: Malocclusion may result in esthetic impairment and functional disorders such as bad chewing, speech and swallowing, with a negative impact on quality of life. There is uncertainty regarding the effects of breastfeeding on dentofacial malocclusions. The purpose of the study was to evaluate the relationship between maternal breastfeeding and dental malocclusions and facial characteristics in adolescents with permanent dentition. METHODS: Probabilistic sampling of 2060 12- to 15-year-old students in a cross-sectional study was used. Malocclusion, as defined by Angle, and facial characteristics were the dependent variables. The duration of breastfeeding was the main independent variable. Other covariates were tested as effect modifiers or confounders. The associations were estimated using the odds ratio (OR) in multinomial logistic regression analysis (α=5%). RESULTS: There was an association between a short duration of breastfeeding (less than 6 months) and Angle class II (OR=3.14; 95% CI: 1.28-7.66) and class III (OR=2.78; 95% CI: 1.21-6.36) malocclusion only in students with a prolonged history of bruxism. A higher occurrence of severe convex profile (OR=3.4; 95% CI: 0.63-18.26) and a lower occurrence of cancave profile (OR=0.43; 95% CI: 0.21-0.88) were also observed only among adolescents who had been breastfed for a short period and exposed to a long periods of mouth breathing. CONCLUSIONS: These findings support the hypothesis that breastfeeding alone seems not to be directly associated with malocclusions, but it may have a synergetic effect with parafunctional oral habits on the development of occlusofacial problems. It is recommended that deleterious oral habits be avoided, especially by children who were breast-fed for less than 6 months.

The two main theories on dental bruxism.

Bruxism is characterized by non-functional contact of mandibular and maxillary teeth resulting in clenching or grating of teeth. Theories on factors causing bruxism are a matter of controversy in current literature. The dental profession has predominantly viewed peripheral local morphological disorders, such as malocclusion, as the cause of clenching and gnashing. This etiological model is based on the theory that occlusal maladjustment results in reduced masticatory muscle tone. In the absence of occlusal equilibration, motor neuron activity of masticatory muscles is triggered by periodontal receptors. The second theory assumes that central disturbances in the area of the basal ganglia are the main cause of bruxism. An imbalance in the circuit processing of the basal ganglia is supposed to be responsible for muscle hyperactivity during nocturnal dyskinesia such as bruxism. Some authors assume that bruxism constitutes sleep-related parafunctional activity (parasomnia). A recent model, which may explain the potential imbalance of the basal ganglia, is neuroplasticity. Neural plasticity is based on the ability of synapses to change the way they work. Activation of neural plasticity can change the relationship between inhibitory and excitatory neurons. It seems obvious that bruxism is not a symptom specific to just one disease. Many forms (and causes) of bruxism may exist simultaneously, as, for example, peripheral or central forms.

Abfracciones: lesiones cervicales no cariosas en cuña, su relación con el estrés / Abfractions: non-carious cervical in wedge, its relationship with stress

La abfracción es una lesión por pérdida del tejido duro en la unión amelo cementaría del diente en vestibular o lingual, acompañada generalmente de sensibilidad. El estrés emocional, la acción de fuerzas excéntricas generadas por interferencias oclusales, el bruxismo, pueden ser considerados factores predisponentes; por ello se planteó un estudio observacional descriptivo con componente analítico, el objetivo fue determinar la prevalencia de abfracciones, para luego asociarlas con el estrés emocional en 110 pacientes de 15 a 59 años en edad en la Facultad de Odontología de la Universidad Nacional de Asunción y una clínica privada en el año 2008. Para determinar el nivel de estrés emocional se utilizó un cuestionario, Maslach Burnout Inventory, valorado en una escala de alto/moderado, leve y bajo, se utilizó la inspección clínica y el sondeo para diagnosticar la abfracción. Se encontró una prevalencia de abfracción de 44%, de los cuales el 49% correspondió al sexo masculino. El diente más afectado fue el primer premolar inferior izquierdo (9,9%). El 100% de los pacientes presentaban estrés y hubo asociación estadísticamente significativa entre la abfracción y el bruxismo 0,004 p<0,005(F), también con el estado civil de los pacientes 0,001 p<0,005(F) entre los que prevalecían los casados 59%. Un alto porcentaje de pacientes presentaban abfracciones y estrés, pero no hubo asociación estadísticamente significativa p=0,3(F).

Abfraction is a lesion due to hard tissue loss at the cementoenamel junction either on buccal or lingual surface of a tooth, generally accompanied by sensitivity. Emotional estrés, eccentric forces generated by occlusal interferences, bruxism can be considered as predisposing factors, therefore an observational descriptive study with an analytic component was set out in order to determine the prevalence of abfractions and to relate them to emotional estrés in 110 patients ages 15 - 59 at the Facultad de Odontología de la Universidad Nacional de Asunción as well as at a private clinic in 2008. In order to determine emotional estrés, a questionnaire by Maslach Burnout Inventory was used, ranging from high, moderate, mild and low. Clinical checkup and probing were the means to diagnose abfraction. A prevalence of 44% was found, 49% of which were males. The most affected tooth was lower left first premolar (9.9%). 100% presented estrés and there was statistically significant relationship between abfraction and bruxism 0,004 p<0,005(F), also regarding marital status, there was more prevalence among married patients (59%). A high percentage of patients presented both abfraction and estrés, but there was no statistically significant association p=0,3(F).

Relationship between buccal mucosa ridging and viscoelastic behaviour of oral mucosa.

The aim of this study was to clarify the relationship between the buccal mucosa ridging (BMR), which has been mentioned to be a clinical sign of clenching, and the viscoelastic behaviour of oral mucosa. Twenty-three people with BMR and 21 people without BMR participated as volunteers in this study. Measurements of viscoelastic behaviour were performed using a suction viscoelastic meter on central part of lower labial mucosa. A suction pressure of 300 hPa was applied for 2 s and then released for 2 s, and the time-dependent changes in the deformation of the mucosa over this 4 s were recorded as a deformation curve. Distensibility, remaining deformation and elastic recovery, which describe viscoelastic behaviour, were calculated by the deformation curve. These parameters were compared between groups with and without BMR. No significant difference was found in distensibility between the two groups (P=0·349). There were significant differences for the remaining deformation (P=0·012) and the elastic recovery (P=0·032), and the group with BMR showed higher remaining deformation and lower elastic recovery than the group without BMR. Based on these results, it clarified that the BMR is related to the mucosal viscoelastic behaviour, in particular remaining deformation and elastic recovery.

3 mm can save your case: Making beauty function.

Understanding esthetic design is not enough if restorations are to withstand the forces of function. Dentists also must understand the relationships of incisal tables, the interincisal angle, disclusion forces, and the implications of changing those parameters when restoring the anterior dentition. While canine-protected occlusion is often a goal, it may not always be appropriate or attainable. This article describes the details of creating a functional anterior design that will not only be beautiful but will have the best chance of withstanding parafunctional activity and abnormal force.

The prevalence of cervical tooth wear in patients with bruxism and other causes of wear.

PURPOSE: The aim of this study was to investigate the prevalence of cervical wear lesions in three groups of patients: bruxists, combined tooth wear, and controls. The hypothesis was that those subjects presenting with bruxism were more likely to develop cervical wear lesions. MATERIALS AND METHODS: Of 119 subjects, 31 were bruxists with a mean age 48.7 years [standard deviation (SD): 11.6]; 22 had combined wear, aged 43.5 years (14.2); and 66 controls aged 44.9 years (17.0). The clinical appearance of the tooth wear was used to recruit subjects to the bruxist and combined tooth wear groups. Control subjects were randomly selected from those attending for routine dental examination at two general dental practices. A tooth wear index (TWI) was used by two trained examiners to record the severity of wear in each group. RESULTS: There was a statistically significant difference between the controls and both the bruxist and combined tooth wear groups for wear on all surfaces (p < or = 0.001). There was no significant difference between the bruxist and the combined tooth wear group for wear on any surface. There was a statistically significant difference between the control group and both the bruxist and the combined tooth wear group for the severity of cervical wear (p < or = 0.005), but no difference between the bruxist and combined tooth wear groups. There was also no statistical difference in the number of cervical lesions between the groups. CONCLUSIONS: In this study, the likely cause of cervical tooth wear was multifactorial.

An analysis of human skeletal remains with cerebral palsy: associated skeletal age delay and dental pathologies.

In 2002 the authors were asked to examine the skeletal remains of an individual with a known history of severe cerebral palsy (CP) who was 21-23 years old at death. Skeletal age estimates of 11-15 years and dental age estimates of c. 16 years are younger than the known age of the decedent. Skeletal analysis also identified dental pathologies such as chronic tooth grinding and substantial calculus deposits. Scarce literature exists on forensic human remains cases with CP, and this study contrasts the age discrepancy and other features of this case with typical clinical characteristics of CP. A review of the CP literature suggests that delayed skeletal maturation and dental pathologies such as those observed in this case are indicative of complications related to CP. This article may alert future investigators to some of the osteological signs of CP and the probability that age indicators may be misleading.