Assessment of caries diagnostic thresholds of DMFT, ICDAS II and CAST in the estimation of caries prevalence rate in first permanent molars in early permanent dentition-a cross-sectional study.

BACKGROUND: The actual burden of dental caries prevalence varies with the caries assessment tool used. Therefore, the present study evaluated the caries diagnostic potentials of Decayed, Missing and Filled Teeth (DMFT); International Caries Detection and Assessment System (ICDAS) II and Caries Assessment Spectrum and Treatment (CAST) indices in estimating the caries prevalence rate of first permanent molar (FPM) in Saudi male children aged 7-9 years. METHODS: This descriptive, cross-sectional study included 390 children by multistage stratified cluster sampling method in Al-Jouf Province, Saudi Arabia. The prevalence rates of FPM caries were determined by DMFT, ICDAS II and CAST indices at various diagnostic cut-off points. Intra- and inter-examiner reliability was determined. RESULTS: The prevalence rates of FPM caries determined by DMFT (decayed), ICDAS II (codes 1-6) and CAST (codes 3-7) were 64.4% (61.6-67.2), 71.5% (69.2-73.2) and 71.0% (68.7-73.3), respectively. The prevalence rates of FPM caries determined by ICDAS II at various diagnostic cut-offs were as follows: 'sound' (code '0'), 28.5% (26.3-30.8); 'enamel caries' (codes 1-3), 57.2% (54.7-59.7) and 'dentinal caries' (codes 4-6), 14.3% (12.6-16.1). Similarly, the prevalence rates estimated by CAST at different diagnostic cut-off points were: 'healthy' (scores 0-2), 28.1% (25.9-30.4); 'premorbid' (score 3, enamel carious), 56.5% (54.0-59.0); 'morbid' (scores 4-5, cavitated carious dentin), 7.9% (6.6-9.3); 'severe morbidity' (scores 6-7, pulp exposure/fistula/abscess), 6.6% (5.4-8.1) and 'mortality' (score 8, lost), 0.8% (0.4-1.4). CONCLUSION: Enamel caries lesions were found in more than half of the FPMs investigated in the current study. CAST index is preferable because it detects the complete spectrum of caries. ICDAS II at codes 1-6 and CAST at codes 3-7 projected similar caries prevalence rates in FPMs.

TMJ pain as a presentation of metastatic breast cancer to the right mandibular condyle.

Cancer metastasis to the oral and maxillofacial region is uncommon, and metastasis to the mandibular condyle is considered rare. We present a case of a 56-year-old woman with a history of invasive ductal cell carcinoma of the right breast, 10 years in remission, presenting with a 6-month history of symptoms typical of temporomandibular joint (TMJ) dysfunction. Imaging revealed an osteolytic lesion of her right TMJ and subsequent open biopsy confirmed the diagnosis of metastatic breast cancer. Despite the rarity of metastatic cancer to the head and neck region, it is still important for clinicians from both medical and dental backgrounds to consider this differential diagnosis, particularly in patients with a history of hormonal positive subtype of breast cancer. Given that bony metastasis can manifest even 10 years after initial diagnosis, surveillance which includes examination of the head and neck region is important, and may include routine plain-film imaging surveillance with an orthopantomogram (OPG).

Evaluating the effectiveness of nonsteroidal anti-inflammatory drug(s) for relief of pain associated with temporomandibular joint disorders: A systematic review.

AIM: The aim of this systematic review was to compile the latest evidence to assess the effectiveness of nonsteroidal anti-inflammatory drug(s) (NSAID) in patients with temporomandibular joint disorders (TMDs) in relieving pain. TMDs are a group of musculoskeletal disorders that affect the temporomandibular joint and/or masticatory muscles. METHODS: After a literature review, a comprehensive search was conducted via Pubmed, Scopus, Google Scholar, and Cochrane databases with a systematic search strategy. The inclusion criteria were randomised controlled trials in humans, published in the last 50 years evaluating the effect of NSAIDs on TMDs. Although this duration chosen would potentially identify studies that have utilised outdated treatments, research methodology, and TMDs diagnostic criteria, and this has been considered before making clinical recommendation, it was used to advise future methodological changes necessary. The included studies were subjected to full-text review. RESULTS: Out of 646 studies initially identified through searches, 12 were selected for full-text review of which 11 were included in the data synthesis. All 11 studies were randomised controlled trials. In total, 424 patients were included in this review. The earliest study included was 1996. Diagnostic criteria varied among all studies, and some did not specify enough signs and symptoms to construct a diagnosis. Intervention varied among all studies, as did the control. Nonspecific diagnosis, variable control groups, and heterogenous intervention protocols affected the outcome of this review. Despite the reduction of pain in the joint and/or masticatory muscles as well as improved range of motion, conclusive clinical recommendation could not be made. CONCLUSION: Heterogeneity did not allow for definitive conclusion; however, there was some evidence to support the use of NSAIDs in patients with TMDs for relief of pain. Further studies with strict, consistent diagnostic criteria and treatment are required.