Dental management of patients with renal diseases or undergoing renal transplant.

BACKGROUND: The kidneys carry out many essential processes. A reduced glomerular filtration rate is the primary cause of renal failure. Patients with chronic kidney disease are significantly increasing all around the world. Patients with varying degrees of renal disease will be seen on the dental chair, and the dentist must be aware of dental considerations when treating such patient. Dental clinicians should carefully evaluate the oral findings and general condition of the renal disease patient. OBJECTIVE: To increase the awareness of dentists in the dental management of patients with renal diseases or undergoing renal transplant. METHODS: This study reviews 56 articles searched on two databases PubMed and Google Scholar with English language. CONCLUSION: Every dentist should be well-informed regarding dental considerations and oral manifestations when treating a patient with any renal disease. Simple treatment plan modification can prevent the evolution of mild to critical medical or dental complications in renal disease patients.

Comparing Artificial Intelligence and Senior Residents in Oral Lesion Diagnosis: A Comparative Study.

INTRODUCTION: Artificial intelligence (AI) is a field of computer science that seeks to build intelligent machines that can carry out tasks that usually necessitate human intelligence. AI may help dentists with a variety of dental tasks, including clinical diagnosis and treatment planning. This study aims to compare the performance of AI and oral medicine residents in diagnosing different cases, providing treatment, and determining if it is reliable to assist them in their field of work. METHODS: The study conducted a comparative analysis of the responses from third- and fourth-year residents trained in Oral Medicine and Pathology at King Saud University, College of Dentistry. The residents were given a closed multiple-choice test consisting of 19 questions with four response options labeled A-D and one question with five response options labeled A-E. The test was administered via Google Forms, and each resident's response was stored electronically in an Excel sheet (Microsoft® Corp., Redmond, WA). The residents' answers were then compared to the responses generated by three major language models: OpenAI, Stablediffusion, and PopAI. The questions were inputted into the language models in the same format as the original test, and prior to each question, an artificial intelligence chat session was created to eliminate memory retention bias. The input was done on November 19, 2023, the same day the official multiple-choice test was administered. The study had a sample size of 20 residents trained in Oral Medicine and Pathology at King Saud University, College of Dentistry, consisting of both third-year and fourth-year residents. RESULT: The responses of three large language models (LLM), including OpenAI, Stablediffusion, and PopAI, as well as the responses of 20 senior residents for 20 clinical cases about oral lesion diagnosis. There were no significant variations observed for the remaining questions in the responses to only two questions (10%). For the remaining questions, there were no significant differences. The median (IQR) score of LLMs was 50.0 (45.0 to 60.0), with a minimum of 40 (for stable diffusion) and a maximum of 70 (for OpenAI). The median (IQR) score of senior residents was 65.0 (55.0-75.0). The highest and lowest scores of residents were 40 and 90, respectively. There was no significant difference in the percent scores of residents and LLMs (p = 0.211). The agreement level was measured using the Kappa value. The agreement among senior dental residents was observed to be weak, with a Kappa value of 0.396. In contrast, the agreement among LLMs demonstrated a moderate level, with a Kappa value of 0.622, suggesting a more cohesive alignment in responses among the artificial intelligence models. When comparing residents' responses with those generated by different OpenAI models, including OpenAI, Stablediffusion, and PopAI, the agreement levels were consistently categorized as weak, with Kappa values of 0.402, 0.381, and 0.392, respectively. CONCLUSION: What the current study reveals is that when comparing the response score, there is no significant difference, in contrast to the agreement analysis among the residents, which was low compared to the LLMs, in which it was high. Dentists should consider that AI is very beneficial in providing diagnosis and treatment and use it to assist them.

Radiolucent lesions that may resemble inflammatory periapical lesions: A review article.

Non-endodontic lesions (NEL) closely resemble lesions of endodontic origin. Its etiology can be odontogenic, non-odontogenic, neoplastic, or anatomic variations that can resemble inflammatory periapical lesions in the periapical area. Inflammatory periapical lesions are caused by pulpal pathoses and require endodontic treatment. Since numerous NEL may resemble inflammatory periapical lesions, they can lead to misdiagnosis and inappropriate management. Thus, a detailed review of the patients' medical and dental histories with clinical examination, including radiographic findings, is essential for the proper assessment of periapical lesions. Numerous cases of misdiagnoses of NEL have been reported in literature. Thus, this review aimed to strengthen the awareness of clinicians on periapical radiolucency, which may resemble inflammatory periapical lesions.

Oral Squamous Cell Carcinoma Mimicking Lichenoid Reaction After Implant Placement: A Case Report.

The early detection of oral squamous cell carcinoma (OSCC) poses significant challenges, especially if it mimics a benign condition. This report presents a case of a 79-year-old nonsmoker Saudi male patient with an alveolar lesion that initially resembled an implant-induced reaction but upon biopsy revealed dysplastic squamous epithelium indicative of squamous cell carcinoma (SCC). This case highlights that lesion mimicry, the absence of pain, and low cancer awareness can cause diagnostic delays. Treatment options for OSCC include surgery, chemotherapy, and radiotherapy, with surgery being the primary treatment modality. This case emphasizes the need for heightened vigilance among healthcare providers, regular follow-ups, and enhanced cancer awareness to promote early detection and intervention. Recognizing the diverse clinical presentations of OSCC remains essential for effective management and improved patient outcomes, despite the complexities of its etiology and diagnostic challenges.

Oral Pemphigus Vulgaris: A Case Report With Review of Literature.

Pemphigus vulgaris (PV) is a chronic autoimmune bullous disease that is characterized by mucocutaneous blister formation resulting in painful erosions. The autoantibody immunoglobulin (Ig) G directed toward glycoproteins desmoglein (Dsg) 3 and desmoglein 1 is the main underlying mechanism behind PV leading to intraepithelial clefting and bulla formation. Patients usually present with oral ulcers causing severe pain and dysphagia that can be misdiagnosed as erythema multiforme (EM) or viral infections. The diagnostic process requires the correlation between clinical, histopathological, and immunopathological findings. Systemic and/or local corticosteroids are considered the cornerstone therapy of PV cases. This article describes a case of a 42-year-old male patient who presented in the Department of Oral Medicine and Radiology with chronic oral ulcers that were diagnosed with PV and treated using systemic corticosteroids.

Morphea Involving the Lips and Gingiva: A Rare Case Report.

Morphea is a subtype of scleroderma that does not involve Raynaud's phenomenon or internal organ involvement. It is a connective tissue disease that features the excessive deposition of collagen in the dermis and subcutaneous tissue, leading to a thickening of the dermis and subcutaneous tissue, eventually forming a scar-like lesion. We represent a 19-year-old male Saudi patient displaying a white patch on the marginal gingiva of tooth #21 and multiple yellowish papules on the outer surface of the lip. Both teeth #21 and #22 have experienced recession and bone loss. The patient's clinical history and histopathology revealed characteristic features of localized scleroderma. A treatment was proposed involving immunosuppressants, methotrexate, and pimecrolimus cream along with topical corticosteroids and excimer laser therapy (308 nm). The patient followed the treatment plan for a full month and the white patch quickly improved for the patient. Afterward, the patient has been taking only methotrexate with a significant but gradual improvement. In this paper, we discuss the differential diagnosis to be considered and present an unusual occurrence of localized scleroderma in the oral cavity.

The analysis of periodontal diseases and squamous cell esophageal cancer: A retrospective study.

Aim: The potential links between periodontal disease and various cancers have drawn more and more attention in recent years. The objective of the current study was to investigate any potential associations between parameters of periodontal disease, the number of teeth lost, and the risk of developing squamous cell esophageal cancer in a representative adult sample. Materials and Methods: The study sample included 178 healthy individuals with matched age and socioeconomic status as controls and 60 patients with the primary histological type of esophageal cancer, Squamous Cell Esophageal Cancer. Data were collected from cases and controls on epidemiological factors like age, gender, smoking status, alcohol intake, socio-economic status, level of education, and prior medical/dental history. The clinical data on periodontal health status was obtained through a clinical examination. This data concerned Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), the number of teeth lost, and the common risk factors for Squamous Cell Esophageal Carcinoma. Additionally, univariate, and logistic regression models that were modified for potential confounders were used to estimate unadjacent and adjacent odds ratios (ORs) and 95% confidence intervals (CIs). Results: Lower socioeconomic status (p = 0.048) (OR = 1.882, 95% CI = 0.987-3.591), smoking (p = 0.052) (OR = 1.768, 95% CI = 0.931-3.359), moderate and heavy alcohol abuse (p = 0.035) (OR = 1.880, 95% CI = 0.987 3.579), and irregular tooth brushing frequency (p = 0.001) (OR = 0.326, 95% CI = 0.171-0.619) were indeed discovered to be significantly linked. Conclusion: Individuals with lower socio-economic status, smoking, moderate and heavy alcohol consumption, and irregular tooth brushing frequency were significantly associated with Periodontal diseases and Squamous Cell Esophageal Cancer.

Proliferative verrucous/multifocal leukoplakia: Updates and literature review "case report".

RATIONALE: Proliferative verrucous leukoplakia (PVL) is a multifocal, slowly evolving lesion that resists all types of treatment and has a high propensity for malignant transformation into oral squamous cell carcinoma. Lack of awareness and acquaintance with white lesions of the oral cavity makes it difficult to diagnose. Besides being rare, PVL significantly aggressive, so clinicians need to be aware of it carefully. Therefore, it is recommended to have the earliest possible diagnosis and total excision of this lesion. We report this case to present typical clinical and histologic features of PVL so a For the purpose of sensitizing clinician. PATIENT CONCERN: A 61-year-old female came to the clinic concerning of recurring painless, white patch on the tongue 2 months ago, associated with oropharyngeal dryness. DIAGNOSES: This case satisfies these major and minor criteria to diagnosed PVL. INTERVENTION: An excisional biopsy of the lesion was done to check for the presence of dysplasia, as lesions were persisting. Hemostasis was achieved with single interrupted sutures. OUTCOME: no recurrence has been observed since excisional 1 year follow-up. LESSON: The key feature is early detection, precisely in cases of PVL it is critical for better treatment outcomes, lifesaving, quality-of-life enhancement. To detect and treat any potential pathologies, clinicians should meticulously examine the oral cavity and patients have to be aware and informed of the importance of regular screenings. This lesion is resistant to the presently available treatment modalities; therefore, total excision with free surgical margins is critical combined with a lifelong follow-up.

Occlusal splints-types and effectiveness in temporomandibular disorder management.

Background: Occlusal splints are routinely used in dental offices to diagnose and treat abnormalities of the masticatory system. There are different occlusal splints, each of which can address various conditions. They may treat individuals with temporomandibular disorders (TMDs) and bruxism or be used for occlusal stabilization and dentition wear reduction. Methods: The literature in the National Library of Medicine's Medline Database was reviewed using the Mesh terms 'occlusal splints' AND 'Temporomandibular Disorders. Conclusion: Occlusal splints can treat a wide variety of TMDs. They can treat bruxism, headaches, postural imbalances related to TMDs, and decreased vertical dimension of occlusion (VDO). However, there is no clear evidence that occlusal splints are superior to physiotherapy in treating TMDs. In the long-term follow-up, they were equally effective as other therapies.

Knowledge and awareness assessment of cross-contamination of dental floss containers in King Saud University dental hospital clinics.

Introduction: Infection control procedures are implemented in dental clinics to reduce the risk of cross-contamination; saliva, blood, or airborne droplets containing infective agents are example of direct contamination, while indirect exposure via contact with contaminated surfaces and dental equipments such as dental chair, tray, faucet, air syringe, suction tip, gutta percha, paper points, retraction cords, and dental floss containers. Dental floss is known to be an integral part of most dental procedures. Objectives: The objective of this study was to assess the knowledge and awareness regarding cross-contamination of dental floss containers among a selected population of dental assistants in dental clinics at King Saud University (KSU). Material and Methods: A swab was taken from 60 dental floss containers selected by simple random sampling among 60 different dental clinics at KSU and culture test was done using a charcoal transport swab to identify the type of bacteria that might be present on the dental floss containers. Also a Google forms questionnaire which consisted of 20 multiple choice questions, including demographic questions on gender, nationality, and professional experience, followed by questions to evaluate different infection control concepts and practices. Results: This study included 70 dental assistants, most of whom were female (94.3 %). A significant number (41.4 %) of the dental assistants have never heard of OSHA course, and most of them (77.1 %) have never taken an OSHA course. Some participants who attended > 2 infection control courses (37.8 %) did not disagree that it is a waste of material to use new gloves to clean each clinic. Regarding the laboratory results for the collected samples, the highest frequency was noted for Staphylococcus hominis (27.8 %). Conclusion: The present study concluded that there is still further need for implementation of infection control programs and raising more awareness regarding this subject.

Habitual khat chewing and oral melanoacanthoma: A case report.

BACKGROUND: Habitual khat (Catha edulis) chewing has been proven to cause numerous oral tissue changes. However, oral melanoacanthoma triggered by chronic khat chewing is rare. Oral melanoacanthoma is an uncommon, sudden, asymptomatic, benign pigmentation of the oral cavity. Under the microscope, the epithelial layer of the oral mucosa showed dendritic melanocyte proliferation and acanthosis. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma. CASE SUMMARY: In the current study, we report a case of a 26-year-old male patient with a rare presentation of oral melanoacanthoma triggered by regular khat chewing. Many intrinsic and extrinsic factors can cause oral pigmentation. Chewing khat is an extrinsic factor that can cause several diseases, including oral pigmentation. In this case, the definitive diagnosis was oral melanoacanthoma. This diagnosis was made based on the patient's history, clinical lesion presentation, and microscopic biopsy results. CONCLUSION: Habitual khat (Catha edulis) chewing causes many oral tissue changes including oral melanoacanthoma. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.

The objective of this article is to review the role of the dentist in the early diagnosis of pediatric obstructive sleep apnea (OSA) and to provide an in-depth review of the best evidence-based practices available to treat and/or to refer these patients for intervention. MATERIAL AND METHODS: A narrative review was performed using indexed data bases (PubMed, Medline, EMBASE, OVID, Scopus and Cochrane) up to year 2020, and approximately 1000 articles were reviewed. The articles included were those with the best information provided. RESULTS: Detailed review of the literature suggests that the role of the dentist has been redefined owing to their expertise in the orofacial region. Every patient consulting a dental practice is not merely a dental patient; he/she also requires a comprehensive medical review. The role of the dentist is pivotal in pediatric patients once diagnosed with OSA; as the patients grow, growth modification can be achieved, and future management will be easier. Initiating dental treatments during growth can benefit patients two-fold, saving them from malocclusion, and intervening in orofacial structural growth can help to avoid cumbersome treatments, such as CPAP and various surgeries. Proper diagnosis and management of systemic illnesses can prevent compromised quality of life, delays in treatment, morbidity and, in some cases, mortality.

Large peripheral ossifying fibroma interfering with the normal functions of the oral cavity: A rare case report presentation and discussion.

INTRODUCTION: Peripheral ossifying fibroma (POF) is a common localized, reactive benign gingival growth. POF usually measuring <2 cm in diameter. CASE PRESENTATION: We present a case of a 25-year-old, female with a large-sized peripheral ossifying fibroma in the oral cavity. The patient presented with an asymptomatic, slowly growing gingival mass in the lower left anterior area of the oral cavity which had been gradually increased in size for more than five years. CLINICAL DISCUSSION: This case report shows that POF can grow and reach unusual dimensions that may, also, contribute to occlusal problems and lip incompetence. CONCLUSION: POF should be excised completely to decrease the chance of lesion recurrence.

Oral and perioral herpes simplex virus infection type I in a five-month-old infant: A case report.

BACKGROUND: Herpes simplex virus (HSV) is a highly infectious pathogen that is easily transmitted via the bodily fluids of an infected individual. This virus usually affects individuals older than six months of age, and rarely causes lesions or symptoms in younger patients. CASE SUMMARY: We present the case of a five-month-old healthy girl who presented with painful herpetic gingivostomatitis and perioral vesicles. We discuss the pathophysiology of primary HSV infection and the effect of maternal antibodies on the infant's immune system. In addition, we explain the diagnosis, management, and prognosis of HSV infection in young infants. CONCLUSION: This case highlights the importance of early diagnosis and management of HSV infections to decrease the risk of developing severe complications and death.

Efficacy of lidocaine versus mepivacaine in the management of myofascial pain.

OBJECTIVES: There are many treatment modalities for myofascial pain, and recent findings reported in the literature highlight the superiority of using local anesthetics as the treatment of choice. The objective of the present study was to compare the effectiveness of two of the most used local anesthetic agents-lidocaine and mepivacaine-in the management of myofascial pain. MATERIALS AND METHODS: Thirty patients (20 females, 10 males) were randomly assigned to one of two groups: 50% received lidocaine and 50% received mepivacaine. Trigger point injections in the orofacial region were administered 4 times, 10 days between each injection, with 4 weeks of follow-up after the end of the treatment course. Pain levels were recorded using a visual analog scale (VAS) at the time of follow-up and 30 min after injection. RESULTS: All patients exhibited statistically significant improvement when comparing pre- and post-treatment mean values. Both local anesthetics (i.e., lidocaine and mepivacaine) were similarly effective for the management of myofascial pain (p = 0.875). The mepivacaine-treated group exhibited significantly lower post-injection tenderness than the lidocaine group (p = 0.038). There was no relationship between sex and treatment response. Female and male patients both reported similar responses in terms of VAS scores (p = 0.818). CONCLUSION: No drug was superior in the long term; thus, the clinician's choice can be based on drug availability and patient medical history.

Intramuscular hemangioma in the zygomaticus muscle: A rare case report presentation and diagnosis.

INTRODUCTION: intramuscular hemangioma (IMH) is a relatively rare benign vascular tumor of the skeletal muscles. It shows less than 1% of all soft tissue hemangiomas. In the head and neck area, it occurs usually in the masseter muscle followed by temporalis and sternocleidomastoid muscles. PRESENTATION OF CASE: we present a case of 25-year-old male patient with a chief complaint of slowly growing facial swelling in the left zygomatic area. Clinical, imaging and histopathological evaluation lead to the diagnosis of intramuscular hemangioma in the zygomaticus major muscle. DISCUSSION: IMH in the zygomaticus muscle is very rare; hence, the clinical diagnosis of IMH is challenging. Different diagnostic procedures can be used such as CT and MRI. In addition, the ideal therapy for esthetic disfiguring IMH in the head are is the complete surgical excision of the lesion. Through the review of literature and to our knowledge this case is the first report of intramuscular hemangioma in the zygomaticus muscle. CONCLUSION: IMHs are rare in the head and neck area and must be considered in differential diagnosis of isolated muscle mass in this region.

Case Report: Bilateral mandibular buccal bifurcation cysts.

Buccal bifurcation cyst (BBC) is a rare inflammatory odontogenic cyst, which commonly affects children in the first decade of life. We report a case of a seven-year-old healthy boy with bilateral BBC, which involved unerupted incomplete permanent mandibular first molars. A review of the literature in English language revealed few similar cases. We reviewed 16 manuscripts of bilateral mandibular BBC, reporting a total of 20 cases since 1970. The clinical features of bilateral mandibular BBC summarized here could assist specialists with an accurate diagnosis and provide patients with optimal management.

Case Report: A rare presentation and diagnosis of gingival melanoacanthoma caused by teeth whitening strips: A Case Report.

Background: Oral melanoacanthoma is not common. It occurs mostly on the buccal mucosa. Since it happens suddenly and progresses rapidly, it clinically resembles melanoma. Melanoacanthoma occurs in regions susceptible to trauma. The clinical presentation of the lesion is not enough to diagnose it; therefore, tissue biopsy is necessary to exclude malignancy. Case report: We report a case of oral melanoacanthoma in a rare mucosal location in a 21-year old female patient in whom generalized gingival melanoacanthoma was related to the use of the teeth whitening strips. This irritating factor increased melanocyte activity in the gingival tissues and labial mucosa. Discussion: Oral melanoacanthoma is a rarely encountered pigmented lesion in the oral cavity and is especially uncommon in the gingiva. It is a reactive lesion affecting the mucous membranes with no risk of malignant transformation. This case report shows that teeth whitening strips may trigger oral melanoacanthoma in susceptible individuals. Long-term irritation of the oral tissues may increase the number of dendritic melanocytes throughout the epithelium and accordingly increase the brown pigmentation of the oral cavity.  Eliminating all possible local sources of irritation and ruling out other causative factors are the standard first step in the treatment of oral melanoacanthoma. Conclusions: This case shows the importance of including oral melanoacanthoma in the differential diagnosis of diffuse gingival pigmented lesions.

Self-perception, knowledge, and awareness of halitosis among female university students.

BACKGROUND: Halitosis or oral malodor is defined as an unpleasant breath odor. It can become a serious problem affecting individuals' social communication and self-confidence. Furthermore, it is a discomforting issue for the people around the person affected, because they consider it embarrassing to inform the person of the problem. AIM: This study was designed to measure self-perception, knowledge, and awareness of halitosis among female university students in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional survey was implemented with 392 volunteer participants who responded to a questionnaire on their self-perception, knowledge, and awareness of halitosis. RESULTS: The response rate was 89.1% (392/440). Self-perception of halitosis was low (21.4%), whereas a larger percentage (78.1%) indicated noticing people with bad breath. Most participants (80.4%) thought that the gastrointestinal tract is the primary source of halitosis. Seventy-seven percent preferred using personal methods such as mouthwash and chewing gum to treat oral malodor. According to 82.1% of respondents, a dentist is the most appropriate professional to treat halitosis. CONCLUSION: The investigation revealed low self-perception and limited knowledge regarding halitosis. Therefore, the role of dentists in informing and educating their patients concerning oral malodor should be enhanced. Public education about the causes of and possible ways of managing bad breath should be increased.