Early life stress is associated with earlier emergence of permanent molars.

Exposure to adversity can accelerate biological aging. However, existing biomarkers of early aging are either costly and difficult to collect, like epigenetic signatures, or cannot be detected until late childhood, like pubertal onset. We evaluated the hypothesis that early adversity is associated with earlier molar eruption, an easily assessed measure that has been used to track the length of childhood across primates. In a preregistered analysis (n = 117, ages 4 to 7 y), we demonstrate that lower family income and exposure to adverse childhood experiences (ACEs) are significantly associated with earlier eruption of the first permanent molars, as rated in T2-weighted magnetic resonance images (MRI). We replicate relationships between income and molar eruption in a population-representative dataset (National Health and Nutrition Examination Survey; n = 1,973). These findings suggest that the impact of stress on the pace of biological development is evident in early childhood, and detectable in the timing of molar eruption.

Temporomandibular joint osteoarthritis: diagnosis and long-term conservative management: a topic review.

Degenerative joint disease (DJD), a common osteoarthritic problem encountered in clinical practice presents as a chronic debilitating disease resulting in altered joint structure due to degradation and loss of articular cartilage, along with changes in the subchondral bone and other soft tissues. DJD is a frequent finding in the Temporomandibular joints (TMJs). Consequently, a good understanding of the use of a diagnostic algorithm will lead to a better control of DJD in the TMJ. The etiopathogenesis of osteoarthritis is complex, and it is associated with multiple risk factors. The condition progresses slowly through different phases with periods of remission and activity finally reaching the burnout phase. Conservative management forms the cornerstone for the treatment of most of these cases. This review attempts to acquaint the dentist with the diagnosis, pathogenesis and general characteristics of the disease while highlighting and updating them with the current conservative treatment algorithms in order to assist in the formulation of a treatment plan for these patients.

Leveraging Pretrained Transformers for Efficient Segmentation and Lesion Detection in Cone-Beam Computed Tomography Scans.

INTRODUCTION: Cone-beam computed tomography (CBCT) is widely used to detect jaw lesions, although CBCT interpretation is time-consuming and challenging. Artificial intelligence for CBCT segmentation may improve lesion detection accuracy. However, consistent automated lesion detection remains difficult, especially with limited training data. This study aimed to assess the applicability of pretrained transformer-based architectures for semantic segmentation of CBCT volumes when applied to periapical lesion detection. METHODS: CBCT volumes (n = 138) were collected and annotated by expert clinicians using 5 labels - "lesion," "restorative material," "bone," "tooth structure," and "background." U-Net (convolutional neural network-based) and Swin-UNETR (transformer-based) models, pretrained (Swin-UNETR-PRETRAIN), and from scratch (Swin-UNETR-SCRATCH), were trained with subsets of the annotated CBCTs. These models were then evaluated for semantic segmentation performance using the Sørensen-Dice coefficient (DICE), lesion detection performance using sensitivity and specificity, and training sample size requirements by comparing models trained with 20, 40, 60, or 103 samples. RESULTS: Trained with 103 samples, Swin-UNETR-PRETRAIN achieved a DICE of 0.8512 for "lesion," 0.8282 for "restorative materials," 0.9178 for "bone," 0.9029 for "tooth structure," and 0.9901 for "background." "Lesion" DICE was statistically similar between Swin-UNETR-PRETRAIN trained with 103 and 60 images (P > .05), with the latter achieving 1.00 sensitivity and 0.94 specificity in lesion detection. With small training sets, Swin-UNETR-PRETRAIN outperformed Swin-UNETR-SCRATCH in DICE over all labels (P < .001 [n = 20], P < .001 [n = 40]), and U-Net in lesion detection specificity (P = .006 [n = 20], P = .031 [n = 40]). CONCLUSIONS: Transformer-based Swin-UNETR architectures allowed for excellent semantic segmentation and periapical lesion detection. Pretrained, it may provide an alternative with smaller training datasets compared to classic U-Net architectures.

Uncertainty-based Active Learning by Bayesian U-Net for Multi-label Cone-beam CT Segmentation.

INTRODUCTION: Training of Artificial Intelligence (AI) for biomedical image analysis depends on large annotated datasets. This study assessed the efficacy of Active Learning (AL) strategies training AI models for accurate multilabel segmentation and detection of periapical lesions in cone-beam CTs (CBCTs) using a limited dataset. METHODS: Limited field-of-view CBCT volumes (n = 20) were segmented by clinicians (clinician segmentation [CS]) and Bayesian U-Net-based AL strategies. Two AL functions, Bayesian Active Learning by Disagreement [BALD] and Max_Entropy [ME], were used for multilabel segmentation ("Lesion"-"Tooth Structure"-"Bone"-"Restorative Materials"-"Background"), and compared to a non-AL benchmark Bayesian U-Net function. The training-to-testing set ratio was 4:1. Comparisons between the AL and Bayesian U-Net functions versus CS were made by evaluating the segmentation accuracy with the Dice indices and lesion detection accuracy. The Kruskal-Wallis test was used to assess statistically significant differences. RESULTS: The final training set contained 26 images. After 8 AL iterations, lesion detection sensitivity was 84.0% for BALD, 76.0% for ME, and 32.0% for Bayesian U-Net, which was significantly different (P < .0001; H = 16.989). The mean Dice index for all labels was 0.680 ± 0.155 for Bayesian U-Net and 0.703 ± 0.166 for ME after eight AL iterations, compared to 0.601 ± 0.267 for Bayesian U-Net over the mean of all iterations. The Dice index for "Lesion" was 0.504 for BALD and 0.501 for ME after 8 AL iterations, and at a maximum 0.288 for Bayesian U-Net. CONCLUSIONS: Both AL strategies based on uncertainty quantification from Bayesian U-Net BALD, and ME, provided improved segmentation and lesion detection accuracy for CBCTs. AL may contribute to reducing extensive labeling needs for training AI algorithms for biomedical image analysis in dentistry.

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.

Correlation between TMJ Space Alteration and Disc Displacement: A Retrospective CBCT and MRI Study.

This study aims to determine if a large anterior and reduced posterior/superior joint space is highly predictable for disc displacement. From patients with temporomandibular disorders symptoms, fifty-two experimental joints and fourteen control joints were included. The cone beam computed tomography (CBCT) images were used to calculate posterior-to-anterior (P-A) and superior-to-anterior (S-A) joint space ratios, while disc position was determined using magnetic resonance imaging (MRI). One-way analysis of covariance test and receiver operating characteristics analysis were carried out. The results showed that among the 52 experimental joints, 45 were diagnosed as disc displacement and 7 as normal disc positions (N). All 14 control joints showed normal disc positions. The P-A ratio was 1.46 ± 0.21, 0.99 ± 0.23, and 0.86 ± 0.30 in the control, N, and DD groups, respectively (p < 0.001). The S-A ratio was 1.80 ± 0.27, 1.44 ± 0.33, and 1.08 ± 0.35 in the control, N, and DD groups, respectively (p < 0.001). When an altered P-A ratio and/or S-A ratio are observed on the CBCT, the diagnosis of disc displacement is quite predictable with high sensitivity and specificity.

Developmental Correlates of Accelerated Molar Eruption in Early Childhood.

Background: Adversity has been linked to accelerated maturation. Molar eruption is a simple and scalable way to identify early maturation, but its developmental correlates remain unexplored. Thus, we examined whether accelerated maturation as indexed by molar eruption is associated with children's mental health or cognitive skills. Methods: Molar eruption was evaluated from T2-weighted magnetic resonance imaging in 117 children (63 female; ages 4-7 years). Parents reported on child mental health with the Child Behavior Checklist. Children completed standardized assessments of fluid reasoning, working memory, processing speed, crystallized knowledge, and math performance. Relationships between molar eruption and developmental outcomes were examined using linear models, with age, gender, and stress risk as covariates. Results: Earlier molar eruption was positively associated with children's externalizing symptoms (false discovery rate-corrected p [pFDR] = .027) but not internalizing symptoms, and the relationship with externalizing symptoms did not hold when controlling for stress risk. Earlier molar eruption was negatively associated with fluid reasoning (pFDR < .001), working memory (pFDR = .033), and crystallized knowledge (pFDR = .001). The association between molar eruption and both reasoning and crystallized knowledge held when controlling for stress risk. Molar eruption also partially mediated associations between stress risk and both reasoning (proportion mediated = 0.273, p = .004) and crystallized knowledge (proportion mediated = 0.126, p = .016). Conclusions: Accelerated maturation, as reflected in early molar eruption, may have consequences for cognitive development, perhaps because it constrains brain plasticity. Knowing the pace of a child's maturation may provide insight into the impact of a child's stress history on their cognitive development.

Guidelines for oral and maxillofacial imaging: COVID-19 considerations.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the current coronavirus disease 2019 (COVID-19) pandemic, is not only highly infectious but can induce serious outcomes in vulnerable individuals including dental patients and dental health care personnel (DHCPs). Responses to COVID-19 have been published by the Centers for Disease Control and Prevention and the American Dental Association, but a more specific response is required for the safe practice of oral and maxillofacial radiology. We aim to review the current knowledge of how the disease threatens patients and DHCPs and how to determine which patients are likely to be SARS-CoV-2 infected; consider how the use of personal protective equipment and infection control measures based on current best practices and science can reduce the risk of disease transmission during radiologic procedures; and examine how intraoral radiography, with its potentially greater risk of spreading the disease, might be replaced by extraoral radiographic techniques for certain diagnostic tasks. This is complemented by a flowchart that can be displayed in all dental offices.

Voice over Internet protocol for the orthodontic practice: a sensible switch from plain old telephone service.

Voice over Internet protocol (VoIP) is a revolutionary new technology that is causing a stir in the telecommunications industry and threatening the existence of traditional telephone service providers. Based on a simple method of converting analog audio signals into digital data before being transmitted over the Internet, VoIP has gained immense popularity among consumers. The technology is now regarded as an alternative to traditional telephone service for the orthodontic office. When the economics are considered, it is cost-effective, especially for a busy orthodontic practice where the call volumes both in and out are always high. VoIP has the potential to reduce costs, break the barriers between local vs long-distance calling, and make life easier for the office staff. However, deploying VoIP requires a cautious and thought-out process. Users should fully understand the risks and benefits before switching from the public switched telephone network. VoIP customers and service providers are vulnerable to many of the same impersonation-based attacks by those who attempt toll fraud, and identity and information theft. In this article, VoIP is introduced to orthodontic practitioners, who might be unfamiliar with this technology. Internet protocol based private branch exchange systems that are currently marketed as open-source technologies are also reviewed. Additionally, VoIP is compared with the traditional public switched telephone network technology and evaluated for its potential applications in an orthodontic office for both increased efficiency and cost savings.

Implementation of a Digital Radiographic Image Acquisition and Retrieval System (DRIARS) using a wireless network in an orthodontic department.

AIM: The objective of this report is to describe the implementation and pilot-test of an integrated wireless local area network (WLAN) system that incorporated the Planmeca Promax CCD based digital panoramic/cephalometric x-ray system, Dolphin(R) software, and multiple remote user units to increase the efficiency of data management by the residents in the Department of Orthodontics. BACKGROUND: The Department of Orthodontics of the New Jersey Dental School (NJDS) acquired the Dolphin cephalometric analysis software and the Planmeca Promax digital panoramic/cephalometric x-ray units on separate occasions. Dolphin has been in use for many years at this institution, the current version being 10, and the Promax was acquired in the Fall of 2002. The digital panoramic and cephalometric radiographs were acquired and stored separately in the Planmeca's Dimaxis database. REPORT: During the incorporation of the WLAN, there was an opportunity to research and install the best available security system for the WLAN so it could be a network model for the other departments within the dental school and perhaps other dental schools around the nation. SUMMARY: Digital radiographs, once obtained, can be stored locally or transmitted securely to remote locations via a local area network. This article describes the selection criteria and methodology that would optimize the transmission and retrieval of such images instantaneously on demand at chair side locations. This will not only save significant clinical time but will enhance the productivity of the clinic in the long run.

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.

Remote access of electronic patient data with cellular wireless broadband technology.

Wireless cellular broadband technology currently transmits data at speeds that only wired broadband connections were capable of until now. By using high-speed data access protocols such as evolution data optimized (EV-DO) or enhanced data rate for global system for mobile communications evolution (EDGE), gaining access to patient data in an orthodontic office remotely has become a relatively simple task. Affordable and convenient cellular broadband networks allow the orthodontist to remotely access schedules, and update, review, add, or modify data virtually from anywhere. Newer generation wireless broadband technologies have made the virtual office a reality. This article discusses the various broadband technologies that are available for the orthodontist as a techno-savvy consumer and the availability of wide area networks that include third-generation cellular technologies that can be used for remote access of patient data. The new enterprise-level gadgets that use third-generation technologies are also introduced.

Bluetooth: The invisible connector. Short-range wireless technology for the contemporary orthodontic practice.

Although it sounds like a nonvital tooth, Bluetooth is actually one of technology's hottest trends. It is an industrial specification for wireless personal area networks, but for a busy orthodontic practice, it translates to freedom from cables and cords. Despite its enigmatic name, Bluetooth-based devices and the wireless technology that these gadgets work with are here to stay. They promise to make life easier for the electronic-device users of all stripes, and orthodontists are no exception. The purpose of this article is to orient orthodontists, office staff, and auxiliary personnel to this universal wireless technology that is slowly becoming an integral part of every office.

Unusually large complex odontoma in maxillary sinus associated with unerupted tooth. Report of case and review of literature.

An unusual case of a large complex odontoma with an associated impacted tooth is presented. Odontomas are hamartomatous growths of enamel, dentin, cementum and pulp tissue. Although they are usually tooth-sized or smaller, occasionally, the complex variant can exhibit considerable growth, as was seen in the case presented here. It occupied most of the maxillary sinus and displaced the floor of the orbit and the medial and posterior walls of the left maxillary sinus. Panoramic radiographs, as well as axial and coronal CT studies, showed the extent of the lesion in various dimensions. A differential diagnosis of various calcifying tumors was formulated on the basis of these findings. The lesion was surgically excised, and histologic analysis confirmed the radiographic impression. Although odontomas of this magnitude are rare, this case demonstrates the value of imaging, radiographic histopathologic diagnosis and surgical treatment planning prior to any definitive treatment.

A review of dens invaginatus (dens in dente) in permanent and primary teeth: report of a case in a microdontic maxillary lateral incisor.

An unusual presentation of dens invaginatus affecting a microdontic permanent lateral incisor in a 19-year-old female patient is reported and pertinent literature reviewed. The patient was referred to the oral and maxillofacial radiology clinic of the authors' institution for radiographic examination of her maxillary teeth. Dens invaginatus was identified on the maxillary right lateral incisor in the anterior periapical radiographs. The tooth was microdontic and clinically simulated a primary tooth. Dens invaginatus occurs rarely in primary dentition although it is fairly common in permanent teeth. Only 4 instances of dens invaginatus affecting the primary dentition have been reported in the literature. The etiology, pathophysiology, association with other dental anomalies, as well as management aspects of this common anomaly, are discussed.

Hereditary cranium bifidum persisting as enlarged parietal foramina (Catlin marks) on cephalometric radiographs.

Cranium bifidum occultum is a rare skull ossification disorder referred to as the Catlin mark characterized by ossification defects in the parietal bones. Evidence suggests that this condition has a strong genetic heterogenicity. It is believed that, as calvarial growth continues, ossification in parietal bones fills these defects, and they can remain as parietal foramina on either side of the sagittal suture. During the conversion phase of cranium bifidum to the persistent parietal foramen, there will be periods when the brain is unprotected because of the delay in the ossification of the parietal bones. This report describes cranium bifidum occultum diagnosed as an incidental finding in a 14-year-old boy who initially had large bilateral unossified parietal bones and many congenital abnormalities. The patient underwent various surgical procedures over 6 years for the correction of cleft lip and palate. With craniofacial corrections and orthodontic treatment, the patient now has stable dentition and a firm palate with most of the parietal bones ossified. Cranioplasty was not recommended by his family physician after consultation with a neurosurgeon. Orthodontists should be familiar with this genetic abnormality because it causes delay in parietal bone ossification, and they should be able to distinguish between anatomic parietal foramina and enlarged parietal foramina (persistent unossified areas of cranium bifidum occultum), especially when craniofacial abnormalities are noticed.

Trichodental dysplasia: a rare syndrome with distinct dental findings.

The association of fine, dry, short hair and the developmental absence of several teeth has been associated with a rare autosomal dominant variant of ectodermal dysplasia known as trichodental syndrome or trichodental dysplasia. The purpose of this study was to present the case of a 4-year-old boy with trichodental syndrome. Clinical, radiographic, and genetic manifestations are described, along with a pertinent review of the literature.

Contemporary, emerging, and ratified wireless security standards: an update for the networked dental office.

Wireless networking is not new to contemporary dental offices around the country. Wireless routers and network cards have made access to patient records within the office handy and, thereby, saving valuable chair side time and increasing productivity. As is the case with any rapidly developing technology, wireless technology also changes with the same rate. Unless, the users of the wireless networking understand the implications of these changes and keep themselves updated periodically, the office network will become obsolete very quickly. This update of the emerging security protocols and pertaining to ratified wireless 802.11 standards will be timely for the contemporary dentist whose office is wirelessly networked. This article brings the practicing dentist up-to-date on the newer versions and standards in wireless networking that are changing at a fast pace. The introduction of newer 802.11 standards like super G, Super AG, Multiple Input Multiple Output (MIMO), and pre-n are changing the pace of adaptation of this technology. Like any other rapidly transforming technology, information pertaining to wireless networking should be a priority for the contemporary dentist, an eventual end-user in order to be a well-informed and techno-savvy consumer.