Cranial arteritis: a medical emergency with orofacial manifestations.

BACKGROUND: Cranial arteritis, or CA, a vascular disease affecting primarily elderly people, may result in permanent blindness if untreated. Since it frequently mimics temporomandibular joint, myofascial or odontogenic pain, dentists must be familiar with this condition. CASE DESCRIPTION: The authors present reports of two patients who had signs and symptoms of CA, some of which were suggestive of other head and neck pain disorders. In both cases, the diagnosis of CA was confirmed by temporal artery biopsy, and treatment with systemic steroids resulted in rapid resolution of symptoms. CLINICAL IMPLICATIONS: Prompt diagnosis and treatment of CA not only results in resolution of symptoms, but also may prevent blindness, the most serious sequela of the condition.

[Head- and neck pain of non-dental origin]. / Nem fogeredetú fej- és nyakfájdalom.

Although temporomandibular joint and masticatory myofascial pain (TMD) are a common cause of chronic head and neck pain, there are a number of other conditions which may cause chronic head and neck pain with similar symptoms. Differentiation between the various causes of chronic head and neck pain must be based primarily on historical information because there are few objective physical, laboratory or imagery findings that establish a definitive diagnosis of a specific chronic head and neck pain disorder.

Irritant contact stomatitis: a review of the condition.

Several different types of interactions are possible between a chemical, a mixture of chemicals, and associated extrinsic factors (i.e., mechanical irritation) in the oral mucosa. These interactions can be broadly classified as irritative or allergenic in nature. In each case, the pathology usually includes mucosal inflammation. The information compiled and reviewed in this article suggests that, given the broad definition of surface lesions/mucosal abnormalities, there may be a continuum of irritation that can be termed "irritant contact stomatitis." This may be due to the fact that the mouth is lined with highly vascular mucosa that turns over rapidly compared to the skin, and may or may not be covered by keratin. Some regions in the mouth are uniquely sensitive to irritants because they can penetrate through the tissue easily. Key factors involved in the potential development of irritation are: inherent irritation potential of the agent, amount of exposure (concentration, duration, and frequency), ability to penetrate the tissue, and inherent reactivity of the subject as well as other extrinsic factors. Irritation leading to oral mucosal alterations is a common occurrence caused by a wide variety of exposures and insults to the oral cavity. Various irritants such as foods, chemicals, friction, thermal/mechanical injury, metals, spices, and oral care products have been documented to cause irritant reactions in susceptible individuals, particularly if used under exaggerated exposure conditions. It is important to note that most irritation in the oral cavity tends to reverse quickly when the causative agent is removed. Oral irritation is a commonly occurring phenomenon. Thus, it is important that the clinician be aware of the clinical manifestations and etiology of the condition.

Clinical, historic, and therapeutic features of cicatricial pemphigoid. A literature review and open therapeutic trial with corticosteroids.

Cicatricial pemphigoid is at present an incurable, autoimmune disease that involves mucosa and skin. We have documented the clinical, microscopic, and therapeutic features of 23 patients with cicatricial pemphigoid and added these to reports of past literature. The mean age at the time of diagnosis was 63 years, and women were involved twice as often as men. Eighty-three percent of patients had oral mucosal involvement, 70% had conjunctival involvement, and 22% had skin involved. Direct immunologic evaluation revealed IgG at the basement membrane in 57% of cases and C3 in 66%. We have been able to manage the disease adequately in most patients with topical or systemic corticosteroids. The most commonly encountered side effect was oral candidiasis.

Recurrent enlargement of the left maxillary alveolus.

Presented is a case report of osteosarcoma of the maxilla in a patient with Paget's disease. This case is unusual because of recurrent benign soft tissue enlargements at the site of eventual malignant disease.

Clinical, historic, and therapeutic features of aphthous stomatitis. Literature review and open clinical trial employing steroids.

The clinical and historic features of 50 patients with diagnosed aphthous stomatitis and treated with topical triamcinolone acetonide, 0.1% or 0.2% aqueous suspension; alone or in combination with initial burst therapy of 40 to 60 mg of prednisone, are reviewed. The mean age of our patients was 36.6 years (range 6 to 80 years). The duration of the chief complaint, usually oral pain, or more specifically, recurrent oral ulcers, was 11.1 years (range 4 weeks to 40 years). All patients showed a wide range of ulcer sizes when examined initially or at follow-up. Forty were followed up for an average of 22.9 months. Thirty-four reported prompt healing of ulcers identified at the time of initial evaluation, and no or markedly fewer ulcers subsequently if maintenance therapy of prophylactic topical triamcinolone, 0.1% or 0.2% aqueous rinse, was used. Five patients reported partial relief. No systemic side effects were noted even after long-term topical therapy. Local candidosis was a complication encountered in five patients.

A computer management system for patient simulations.

A series of interactive videodisc patient simulations is being used to teach clinical problem-solving skills, including diagnosis and management, to dental students. This series is called Oral Disease Simulations for Diagnosis and Management (ODSDM). A computer management system has been developed in response to the following needs. First, the sequence in which students perform simulations is critical. Second, maintaining records of completed simulations and student performance on each simulation is a time-consuming task for faculty. Third, the simulations require ongoing evaluation to ensure high quality instruction. The primary objective of the management system is to ensure that each student masters diagnosis. Mastery must be obtained at a specific level before advancing to the next level. The management system does this by individualizing the sequence of the simulations to adapt to the needs of each student. The management system generates reports which provide information about students or the simulations. Student reports contain demographic and performance information. System reports include information about individual patient simulations and act as a quality control mechanism for the simulations.

Dental diagnosis and treatment (DDx & Tx): interactive videodisc patient simulations for dental education.

Judgement skills and critical thinking in dentistry are developed through: (1) a systematic approach to gathering and processing information, and (2) an essential amount of practical experience. A new system of interactive videodisc patient simulations titled 'Dental Diagnosis and Treatment' or 'DDx & Tx' has been developed to provide students or practicing dentists an opportunity to develop and practice their critical thinking skills. The DDx & Tx system consists of patient simulation software, a laser-reflective videodisc with its accompanying database, a patient simulation management system, and documentation. An authoring tool is under development. Faculty-authored simulations require students to gather information, formulate diagnoses, order appropriate treatments and properly sequence those treatments. The students' performance is automatically scored and a critique is provided as a review.

Osteolysis of the mandible associated with progressive systemic sclerosis.

A case of progressive systemic sclerosis presenting with extensive osteolysis of both coronoid processes of the mandible together with the right angle is presented. MRI demonstrated that the adjacent muscles were unchanged in size.

Incidence and characterization of temporomandibular joint sounds in adults.

The findings from this study indicate that some signs and symptoms associated with TM dysfunction are relatively common clinical observations in adults, and that they might or might not be associated with pain, decreased joint mobility, and most importantly, might not be progressive. The rationale for instituting therapy in patients with TM noises who are asymptomatic and have freedom of mandibular movements needs to be evaluated in relation to these findings.

Treatment of trigeminal neuralgia: use of baclofen in combination with carbamazepine.

A patient with trigeminal neuralgia who became refractory to carbamazepine but responded well to the addition of baclofen to his regimen is described, and the drug and surgical treatment of trigeminal neuralgia are discussed. A 57-year-old white man sought medical help following a six-week history of paroxysmal pain in the right jaw. Rubbing the skin in the right third division of the trigeminal nerve produced a paroxysm of pain. Trigeminal neuralgia was diagnosed, and carbamazepine therapy was initiated with good results. Pain recurred upon discontinuation of the therapy, and carbamazepine was restarted. However, debilitating pain persisted despite continuous treatment that produced moderate postdose ataxia. Baclofen was added to the patient's regimen and increased to 60 mg daily with subsequent reductions in the carbamazepine dosages. The patient remained pain-free during the following 10 months. Carbamazepine is considered the drug of choice and is initially very effective in treating trigeminal neuralgia. However, many patients are forced to discontinue drug therapy because of intolerance or ineffectiveness and are faced with surgery as their only option. Baclofen does not appear to be as effective as carbamazepine when used as a single agent. However, its apparent synergism with carbamazepine and phenytoin combined with its low incidence of serious side effects make baclofen a valuable adjunct in the treatment of refractory trigeminal neuralgia.

Mucosal cysts of the maxillary sinus: a clinical and radiographic study.

Of 4,546 patients examined, 73 had mucosal cysts in one or both maxillary sinuses. Distribution between sinuses was approximately equal. Most cysts appeared to arise from the floor of the sinus. Almost half of those with cysts reported an allergy of some type. No significant relationship to other medical problems was found. About one half of the patients had identifiable periodontal disease, and a trend toward larger cysts with increasingly severe periodontal disease was noted. Thirty-four patients were re-examined after 2 to 38 months, and 21 still had cysts unchanged in size. A trend toward higher occurrence of cysts during certain times of the year was also noted.