A Female Patient Recently Diagnosed with Sjogren Syndrome Presents to the Dental Office Seeking Upper and Lower Complete Dentures.

Sjogren syndrome (SS) is a common autoimmune disease associated with the immune-mediated destruction of exocrine glands, primarily the salivary and lacrimal glands. As a result, patients have xerophthalmia and xerostomia (Sicca syndrome). The diagnosis of SS can be difficult due to its multifactorial nature and often insidious symptoms, and there is no one test for its diagnosis. The many oral manifestations in SS stemming from the xerostomia present challenges to the treating dentist. Dentists should be knowledgeable about SS and its palliative care to help improve their patients' quality of life.

A Patient with a History of Multiple Myeloma Presents for the Evaluation of Oral Lesion and Burning Sensation of the Mouth.

Multiple myeloma (MM) is a hematologic malignancy belonging to a class of disorders known as plasma cell dyscrasias. Common oral manifestations of MM include osteolytic lesions in the mandible and maxilla that can present as painful bony swellings, epulis formation, or sudden teeth movement. MM treatment is coordinated by a multidisciplinary team and is dependent upon the age and physical fitness of the patient, as well as the staging of the disease. A large proportion will be treated with intravenous bisphosphonates, such as pamidronate and zoledronic acid, which places the patients at high risk for developing medication-related osteonecrosis of the jaw (MRONJ).

A Patient Presenting for Dental Extraction After Completion of Chemotherapy.

Acute myeloid leukemia (AML) presents several oral manifestations, including gingival hyperplasia, pale mucosa, poor wound healing, petechiae, ecchymoses, candidiasis, recurrent herpes infection, and ulcerations in the oral mucosa. Chemotherapy is the first-line treatment of AML. Common dental complications of chemotherapy include mucositis, infections secondary to profound bone marrow aplasia, and gingival bleeding. When treating patients with AML, preparing a comprehensive treatment plan is essential to help minimize their risks for developing these oral complications.

A Patient Presents for Dental Extraction and Goes into Sickle Cell Crisis in the Dental Chair.

Sickle Cell Disease is an inherited autosomal recessive hemoglobinopathy associated with multiorgan damage. This single gene disorder involves one DNA base pair alteration, producing HbS. The sickle-shaped cells form when deoxygenated in the capillaries. The resulting RBC stasis leads to ischemia and pain, and acute and chronic organ damage. Patients with SCD presenting to a dental office need careful examination to rule out any current infections, neurologic deficits, or other organ involvement before formulating a dental treatment plan to avoid prolonged and complicated procedures. Early intervention and dental anxiety management are key to the dental treatment of patients with SCD.

A Patient with Herpes Zoster of the Maxillary Division of Trigeminal Nerve Presents for Oral Evaluation and Toothache.

Herpes zoster (HZ) is an acute and painful neurocutaneous infection caused by the reactivation of a latent varicella-zoster virus in the dorsal root or cranial nerve ganglia. It is characterized by 3 stages: prodromal, acute, and chronic. During the prodromal stage, reactivation in the maxillary branch of the trigeminal nerve closely mimics odontalgia, and HZ should be in the differential diagnosis. Patients with HZ develop painful lesions following the affected dermatome. Laboratory testing confirms the diagnosis; treatment is with antiviral agents. Early detection and treatment shorten the course of the infection and lessen the severity of the associated postherpetic neuralgia.

A Patient Diagnosed with Bulimia Reports to the Dental Office Seeking Cosmetic Dental Work.

Bulimia nervosa (BN) is a serious psychiatric illness that typically occurs in adolescents and young adults. It is characterized by recurring episodes of consuming large amounts of food with an inappropriate compensatory behavior of purging to prevent weight gain. The purging behavior results in oral manifestations such as dental erosion, dental caries, sialadenosis, and oral mucosal trauma. Medical complications include electrolyte imbalances, esophageal rupture, and renal and cardiovascular failure. Treatment of BN involves psychosocial and psychopharmacologic approaches. Dentists are in a unique position to recognize patients with BN and help patients with BN and other eating disorders.

Fundamentals of Radiographic Interpretation for the Dentist.

Radiographic imaging is an integral part of the diagnostic process in clinical dentistry. This article provides the fundamentals of radiographic interpretation beginning with evidence-based guidelines on dental radiographic selection criteria and cone beam computed tomography use. The goal is to present to the reader with a systematic approach to radiographic interpretation such that no significant features are overlooked and an optimal differential diagnosis can be achieved. In addition, medicolegal considerations of radiographic acquisition, interpretation, and storage are discussed.

Physiologic and Pathologic Calcifications of Head and Neck Significant to the Dentist.

This article aims to help the practitioner identify structures found in routine three-dimensional imaging studies of the head and neck region and understand their significance and possible need for intervention. The prevalence of advanced imaging in dental practice, especially cone beam computed tomography, highlights the need to recognize and identify various high-density structures that are, in fact, soft tissue calcifications or alterations of normal bony anatomy. The wide range of these findings includes both benign and malignant pathologic entities as well as age-related calcifications and remodeling of normal anatomic structures and dystrophic calcifications.

Review of cone beam computed tomography guidelines in North America.

OBJECTIVE: The aim of this article is to investigate, study, and summarize cone beam computed tomography (CBCT)-related guidelines offered by relevant organizations and associations within North America to provide the dental practitioner a clearer direction on the practice of CBCT-related procedures in North America. DATA SOURCES: Scientific databases including PubMed, Science Direct, Scopus, MedLine, and Web of Science were used for the search of relevant literature on the CBCT guidelines developed in North America. In addition, the World Wide Web was searched for comparative CBCT guidelines nationally or internationally using the same search strategies. CONCLUSION: In 1999, the American Dental Association (ADA) recognized Oral and Maxillofacial Radiology as the ninth dental specialty in the United States. The American Academy of Oral and Maxillofacial Radiology (AAOMR) issued their first statement on the use of CBCT in 2008. There have since been several statements issued, independently or jointly with other specialty organizations, related to the use and interpretation of the CBCT volumes. The guidelines identified Oral and Maxillofacial Radiologists (OMR) as providers of interpretative services, portrayed as key players in the dissemination of information related to CBCT, implementation of CBCT-related services and radiation protection, as well as interpretation assistance for CBCT volumes, especially medium to large volumes covering anatomical areas of head and neck, considered beyond the scope of a general dentist. Regulations concerning radiation-producing devices are promulgated through state health codes and practice acts. Selection criteria and interpretation of imaging studies are left to the clinician's choice and abilities.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement.

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement.

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Dental radiographic guidelines: a review.

The 2004 American Dental Association (ADA)/US Food and Drug Administration (FDA) radiographic selection criteria and guidelines were reviewed and compared with the prior radiographic selection criteria and guidelines. The authors reviewed the publications from the US FDA, US Department of Health and Human Services, and National Council on Radiation Protection and Measurements. The positions outlined by the Canadian Dental Association and the European Commission were also reviewed and compared to US guidelines. The FDA guidelines were first published in 1987, and several changes have been made to them over the years. Recent literature reveals that the general compliance of these guidelines is very low, especially within dental schools in the United States and Canada. Little is known about the compliance outside of the dental school environment; however, it is expected to be low for various reasons. In 2007, the International Commission on Radiological Protection (ICRP) revised its estimates of tissue radiosensitivity, which resulted in effective doses of dental radiographs 32% to 422% higher than the 1990 ICRP guidelines. Flow charts summarizing the latest guidelines were developed to facilitate general compliance among practitioners. Based on the literature reviewed and the recent ICRP findings, it would be prudent for dental health care professionals to follow dental radiographic guidelines.

Calcified carotid artery atheroma and stroke: a systematic review.

BACKGROUND: Calcified carotid artery atheroma (CCAA) and its identification on panoramic radiographs have been advocated as a predictor of a cerebrovascular accident (CVA). TYPES OF STUDIES REVIEWED: The authors conducted an electronic search using 11 databases to evaluate the evidence from the literature that links CCAA detection on panoramic radiographs and the precipitation of CVAs among those people. They used the Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK) checklist to perform this systematic review. RESULTS: One study of the 54 studies the authors identified satisfied the REMARK criteria in which CCAA was associated with a negligible increased risk of stroke (95 percent confidence interval, 0 to 0.04 percent) in the population studied. CLINICAL IMPLICATIONS: This systematic review suggests the data supporting the hypothesis that radiographically detectable CCAA is associated with an increased risk of stroke are incomplete and inconclusive. Further research is needed, as clinical guidelines for risk prediction using panoramic radiographs cannot be established on the basis of the current evidence.