What every dentist needs to know about chocolate.

Chocolate is one of the most popular treats in the world. Debate over the potential benefits of its consumption has made chocolate a widely researched health topic. This article reviews the general health benefits of chocolate consumption, focusing on its involvement with the oral microbiota, caries development, and biofilm control, and discusses the potential negative consequences of excess chocolate consumption.

Severe radiographic artifact created by a large fenestration of the skin and labial mucosa following placement of a plate piercing: a case report.

The presence of facial jewelry and medical devices within a radiographic field of view may promote the formation of artifacts that challenge diagnostic interpretation. The objective of this article is to describe a previously unreported radiographic anomaly produced by an oral piercing site below the lower lip. This unusual artifact masqueraded as a severe resorptive defect, dental caries, or cervical abfraction and occurred following removal of an extremely large labret below the lower lip and subsequent acquisition of a radiographic image. The radiolucency was ultimately attributed to an extensive aperture below the lower lip created by a series of sequentially larger soft tissue expanders. Clinicians should seek correlation of atypical radiographic presentations with soft tissue defects secondary to injury or intentional oral piercing.

Responsible artificial intelligence for addressing equity in oral healthcare.

Oral diseases pose a significant burden on global healthcare. While many oral conditions are preventable and manageable through regular dental office visits, a substantial portion of the population faces obstacles in accessing essential and affordable quality oral healthcare. In this mini review, we describe the issue of inequity and bias in oral healthcare and discuss various strategies to address these challenges, with an emphasis on the application of artificial intelligence (AI). Recent advances in AI technologies have led to significant performance improvements in oral healthcare. AI also holds tremendous potential for advancing equity in oral healthcare, yet its application must be approached with caution to prevent the exacerbation of inequities. The "black box" approaches of some advanced AI models raise uncertainty about their operations and decision-making processes. To this end, we discuss the use of interpretable and explainable AI techniques in enhancing transparency and trustworthiness. Those techniques, aimed at augmenting rather than replacing oral health practitioners' judgment and skills, have the potential to achieve personalized dental and oral care that is unbiased, equitable, and transparent. Overall, achieving equity in oral healthcare through the responsible use of AI requires collective efforts from all stakeholders involved in the design, implementation, regulation, and utilization of AI systems. We use the United States as an example due to its uniquely diverse population, making it an excellent model for our discussion. However, the general and responsible AI strategies suggested in this article can be applied to address equity in oral healthcare on a global level.

Successful completion of orthodontic therapy in a patient with osteopetrosis: Case Report.

INTRODUCTION: Orthodontic therapy in patients with osteopetrosis (OP) of the jaws has typically been contraindicated owing to the presence of poorly perfused and extremely compact bone, and the potential risk for infection and osteomyelitis. As such, completed orthodontic cases in association with OP have rarely been published. PATIENT CONCERNS: A patient aged 14 years 6 months, with no known diagnosis of OP, sought orthodontic assessment for anterior crowding. CLINICAL FINDINGS: The patient exhibited a straight facial profile and increased mandibular facial height, competent lips, shallow mentolabial sulcus with mild mentalis strain, flat/reverse smile arc and wide buccal corridors on smiling. PRIMARY DIAGNOSIS: The patient had a Class I incisor relationship on Class I skeletal bases with bilateral Class I molars and Class II canine relationships. This was complicated by a crossbite involving the lateral incisors and a Bolton discrepancy due to small maxillary lateral incisors. A radiologic assessment revealed polyostotic OP of the oromaxillofacial complex. INTERVENTIONS: Treatment consisted of maxillary and mandibular fixed orthodontic therapy, bite turbos and elastics to level and align the dentition. Extractions of permanent teeth were not needed. OUTCOMES: At the conclusion of treatment, there was a slight left Class II malocclusion, with incomplete intercuspation on the left side due to tooth size discrepancy, possibly attributed to inadequate elastics compliance and the presence of osteopetrotic bone. The treatment was completed in 3 years, 1 year longer than anticipated. CONCLUSION: This report represents the second published account of a patient with OP successfully managed with comprehensive orthodontic care and without osseous complications. Obtaining cephalometric measurements on OP-affected patients may be imprecise owing to the presence of extremely dense bone and difficulty to identify bony landmarks. To reduce osteopetrotic sequelae, attending clinicians should consider reduced exertional orthodontic forces and closely monitor patients for adverse alveolar events.

Florid follicular lymphoid hyperplasia of the palate: review of the literature and report of an illustrative case.

OBJECTIVE: The aim of this report was to review oral follicular lymphoid hyperplasia, with emphasis on palatal lesions. METHOD AND MATERIALS: A comprehensive search was performed on PubMed for case reports and case series of palatal follicular lymphoid hyperplasia published in the English language literature. Relevant data from collated articles was sought, including patient demographics, clinical manifestations, imaging modalities and findings, comorbidities, etiopathogenesis, lesional management, and lesional outcome. A new palatal case has also been provided to illustrate several features of this lesion. RESULTS: In total, 32 cases were assembled to establish clinicopathologic correlations, representing the largest aggregation of published cases. Most of the affected patients were at least 60 years old and with a decisive female predilection. The majority of lesions were ≤ 3 cm, appearing as normal color, purple-red or red, and varied from soft to firm. Notably, 32% of palatal follicular lymphoid hyperplasias were associated with denture wear, and lesional recurrence was recorded in 16% of cases. To date, none of the reported cases of palatal follicular lymphoid hyperplasia has undergone malignant transformation. CONCLUSIONS: Palatal follicular lymphoid hyperplasias often arise as a reactive process. Critical histopathologic and histochemical assessments are necessary to establish benignity. Postoperatively, clinicians should follow patients for at least 5 years for recurrence and remain vigilant for neoplastic change as several published accounts of non-oral follicular lymphoid hyperplasias have undergone malignant transformation, usually to lymphoma.

Diffuse idiopathic skeletal hyperostosis (DISH): Detection on dental radiologic examinations in two older adults and overview of the literature.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is a potentially serious osteopathic disorder associated with coalescing ossifications of the anterior vertebrae and may be concomitant with a constellation of symptomatology and systemic comorbidities. There is limited dental literature describing this finding on panoramic radiographs and cone beam computed tomography (CBCT) scans. CASE PRESENTATIONS: Two case reports of DISH are provided. One patient manifested extensive ossifications along the cervical vertebrae and consequent episodes of dysphagia and hoarseness. The other affected patient's cervical ossification was found at an earlier stage of formation and without symptomatology. Panoramic radiography, cervical spine radiography, and CBCT examinations have been provided. CONCLUSION: Attending dental healthcare practitioners should carefully evaluate all areas of interest and surrounding fields of view when taking panoramic radiographs and CBCT scans for manifestations of DISH and other potential disorders of the cervical vertebrae. A suspected radiologic finding of DISH should prompt timely referral for comprehensive medical assessment to mitigate neurologic deficits and other comorbidities.

Performance of AI chatbots on controversial topics in oral medicine, pathology, and radiology.

OBJECTIVES: In this study, we assessed 6 different artificial intelligence (AI) chatbots (Bing, GPT-3.5, GPT-4, Google Bard, Claude, Sage) responses to controversial and difficult questions in oral pathology, oral medicine, and oral radiology. STUDY DESIGN: The chatbots' answers were evaluated by board-certified specialists using a modified version of the global quality score on a 5-point Likert scale. The quality and validity of chatbot citations were evaluated. RESULTS: Claude had the highest mean score of 4.341 ± 0.582 for oral pathology and medicine. Bing had the lowest scores of 3.447 ± 0.566. In oral radiology, GPT-4 had the highest mean score of 3.621 ± 1.009 and Bing the lowest score of 2.379 ± 0.978. GPT-4 achieved the highest mean score of 4.066 ± 0.825 for performance across all disciplines. 82 out of 349 (23.50%) of generated citations from chatbots were fake. CONCLUSIONS: The most superior chatbot in providing high-quality information for controversial topics in various dental disciplines was GPT-4. Although the majority of chatbots performed well, it is suggested that developers of AI medical chatbots incorporate scientific citation authenticators to validate the outputted citations given the relatively high number of fabricated citations.

Surveying the landscape of diagnostic imaging in dentistry's future: Four emerging technologies with promise.

BACKGROUND: Advances in digital radiography for both intraoral and panoramic imaging and cone-beam computed tomography have led the way to an increase in diagnostic capabilities for the dental care profession. In this article, the authors provide information on 4 emerging technologies with promise. TYPES OF STUDIES REVIEWED: The authors feature the following: artificial intelligence in the form of deep learning using convolutional neural networks, dental magnetic resonance imaging, stationary intraoral tomosynthesis, and second-generation cone-beam computed tomography sources based on carbon nanotube technology and multispectral imaging. The authors review and summarize articles featuring these technologies. RESULTS: The history and background of these emerging technologies are previewed along with their development and potential impact on the practice of dental diagnostic imaging. The authors conclude that these emerging technologies have the potential to have a substantial influence on the practice of dentistry as these systems mature. The degree of influence most likely will vary, with artificial intelligence being the most influential of the 4. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The readers are informed about these emerging technologies and the potential effects on their practice going forward, giving them information on which to base decisions on adopting 1 or more of these technologies. The 4 technologies reviewed in this article have the potential to improve imaging diagnostics in dentistry thereby leading to better patient care and heightened professional satisfaction.

Real-Time Three-dimensional Dynamic Navigation for Post Space Preparation in Root Canal-Treated Teeth: An In vitro Study.

INTRODUCTION: The aim of this study was to investigate the feasibility of a real-time three-dimensional dynamic navigation system (3D-DNS) for post space preparation (PSP) in root canal-treated teeth and to compare the accuracy and efficiency of 3D-DNS to freehand (FH) for PSP. METHODS: Fifty-four maxillary molars were divided into two groups: 3D-DNS (n = 27) and FH group (n = 27). Cone beam computed tomography (CBCT) scans were taken preoperatively and postoperatively. The drilling path for the PSP was virtually planned in the preoperative CBCT scan in the X-guide software (X-Nav Technologies, Lansdale, PA). For the 3D-DNS group, the PSP drilling was conducted under dynamic navigation. The 3D deviations and angular deflections were calculated. The residual dentin thickness (RDT) was determined after PSP. The operation time and the total number of mishaps were recorded. Shapiro-Wilk, t-test or Mann-Whitney rank sum, weighted Cohen's kappa, and Fisher exact tests were used (P < .05). RESULTS: The PSP was completed in all samples (54/54). The 3D-DNS was more accurate than the FH, with significantly fewer 3D deviations and angular deflections (all, P < .05). The 3D-DNS required less operating time than the FH (P < .05). For the 3D-DNS, no teeth had RDT < 1 mm, whereas 6/27 in the FH showed RDT < 1 mm after the PSP. There was no difference in the total number of mishaps (P > .05). CONCLUSION: Within the limitations of this in vitro study, the 3D-DNS is feasible for PSP. The 3D-DNS improved the accuracy and efficiency of PSP. The dynamic navigation system can potentially become a safe and reliable technology for PSP.

Dental implant failure possibly attributed to embedded pencil graphite: first clinical report.

Implant failures have been associated with a diversity of etiologic processes, predominately arising from bone loss (peri-implantitis) due to inadequate maintenance of oral hygiene or excess luting agents. The aim of this article is to report a novel case of the apparent failure of a dental implant to undergo osseointegration in the presence of submerged pencil graphite. Practitioners are advised to carefully evaluate the clinical and radiographic site of a proposed implant for occult foreign substances. Embedded pencil graphite in the jawbone may promote a foreign body reaction and should be considered in the list of possible contributing factors to dental implant complications.

Artificial intelligence for classification and detection of oral mucosa lesions on photographs: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to review and synthesize studies using artificial intelligence (AI) for classifying, detecting, or segmenting oral mucosal lesions on photographs. MATERIALS AND METHOD: Inclusion criteria were (1) studies employing AI to (2) classify, detect, or segment oral mucosa lesions, (3) on oral photographs of human subjects. Included studies were assessed for risk of bias using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A PubMed, Scopus, Embase, Web of Science, IEEE, arXiv, medRxiv, and grey literature (Google Scholar) search was conducted until June 2023, without language limitation. RESULTS: After initial searching, 36 eligible studies (from 8734 identified records) were included. Based on QUADAS-2, only 7% of studies were at low risk of bias for all domains. Studies employed different AI models and reported a wide range of outcomes and metrics. The accuracy of AI for detecting oral mucosal lesions ranged from 74 to 100%, while that for clinicians un-aided by AI ranged from 61 to 98%. Pooled diagnostic odds ratio for studies which evaluated AI for diagnosing or discriminating potentially malignant lesions was 155 (95% confidence interval 23-1019), while that for cancerous lesions was 114 (59-221). CONCLUSIONS: AI may assist in oral mucosa lesion screening while the expected accuracy gains or further health benefits remain unclear so far. CLINICAL RELEVANCE: Artificial intelligence assists oral mucosa lesion screening and may foster more targeted testing and referral in the hands of non-specialist providers, for example. So far, it remains unclear if accuracy gains compared with specialized can be realized.

Diminutive compound odontoma in a child: a case report with emphasis on early detection.

The odontoma is regarded as a hamartomatous process of the jaws. Most are discovered as an incidental radiographic finding, averaging 15 mm in size. This report describes a case of a diminutive odontoma that was surgically removed before the onset of eruptive and pathologic consequences. A compilation of documented complications and syndromes associated with odontomas is also presented.

Detection of extracranial and intracranial calcified carotid artery atheromas in cone beam computed tomography using a deep learning convolutional neural network image segmentation approach.

OBJECTIVE: We leveraged an artificial intelligence deep-learning convolutional neural network (DL CNN) to detect calcified carotid artery atheromas (CCAAs) on cone beam computed tomography (CBCT) images. STUDY DESIGN: We obtained 137 full-volume CBCT scans with previously diagnosed CCAAs. The DL model was trained on 170 single axial CBCT slices, 90 with extracranial CCAAs and 80 with intracranial CCAAs. A board-certified oral and maxillofacial radiologist confirmed the presence of each CCAA. Transfer learning through a U-Net-based CNN architecture was utilized. Data allocation was 60% training, 10% validation, and 30% testing. We determined the accuracy of the DL model in detecting CCAA by calculating the mean training and validation accuracy and the area under the receiver operating characteristic curve (AUC). We reserved 5 randomly selected unseen full CBCT volumes for final testing. RESULTS: The mean training and validation accuracy of the model in detecting extracranial CCAAs was 92% and 82%, respectively, and the AUC was 0.84 with 1.0 sensitivity and 0.69 specificity. The mean training and validation accuracy in detecting intracranial CCAAs was 61% and 70%, respectively, and the AUC was 0.5 with 0.93 sensitivity and 0.08 specificity. Testing of full-volume scans yielded an AUC of 0.72 and 0.55 for extracranial and intracranial CCAAs, respectively. CONCLUSION: Our DL model showed excellent discrimination in detecting extracranial CCAAs on axial CBCT images and acceptable discrimination on full-volumes but poor discrimination in detecting intracranial CCAAs, for which further research is required.

Idiopathic bone cavity mimicking a botryoid odontogenic cyst: A rare radiographic presentation in an older adult.

OBJECTIVES: This report describes an unusual case of a multilocular idiopathic bone cavity (IBC) that presented as a botryoid odontogenic cyst situated between the mandibular lateral incisor and canine in an older adult. BACKGROUND: The IBC represents an intraosseous concavity that appears radiographically as a unilocular or multilocular radiolucent lesion found in various skeletal sites, including the jaw. Atypical cases of gnathic IBC have not been appreciated in the gerodontologic literature. MATERIALS AND METHODS: The teeth adjacent to the bony lesion had normal pulpal responses to cold. A full-thickness flap was elevated and provided a direct entry into a bony concavity, which was devoid of an epithelial lining and fluid. RESULTS: The lack of a cystic lining within the empty osseous lesion following surgical entry, concomitant with the vital pulpal status of the proximal teeth, led to a diagnosis of an IBC. The bony walls underwent curettage and copious irrigation prior to primary closure. A 10-month follow-up revealed partial evidence of osseous repair. The patient will continue to be monitored. CONCLUSION: Timely surgical intervention of central lesions of the jaws may improve clinical outcomes. Variants of the IBC should be included in the differential diagnosis of multilocular lesions, particularly in the geriatric population.

Incidental detection of bilateral cochlear implants on panoramic radiography: Case report associated with antecedent traumatic brain injury.

Patients with chronic and severe hearing loss, refractory to nonsurgically-worn devices, may consider use of cochlear implants to regain auditory capability. Cochlear implants consist of surgically emplaced and externally worn components. There are few published examples of the radiographic presentation of these devices appearing in the special needs-based dental literature. This article features a case report and panoramic radiographic examination involving a 67-year-old patient who received bilateral cochlear implants after experiencing a traumatic brain injury and onset loss of hearing. A brief review of strategies for communicating with individuals with severe hearing impairment has also been provided.

Augmented Reality and 3-Dimensional Dynamic Navigation System Integration for Osteotomy and Root-end Resection.

INTRODUCTION: Augmented reality (AR) superimposes high-definition computer-generated virtual content onto the existing environment, providing users with an enhanced perception of reality. This study investigates the feasibility of integrating an AR head-mounted device into a 3-dimensional dynamic navigation system (3D-DNS) for osteotomy and root-end resection (RER). It compares the accuracy and efficiency of AR + 3D-DNS to 3D-DNS for osteotomy and RER. METHODS: Seventy-two tooth roots of 3D-printed surgical jaw models were divided into two groups: AR + 3D-DNS (n = 36) and 3D-DNS (n = 36). Cone-beam computed tomography scans were taken pre and postoperatively. The osteotomy and RER were virtually planned on X-guide software and delivered under 3D-DNS guidance. For the AR + 3D-DNS group, an AR head-mounted device (Microsoft HoloLens 2) was integrated into the 3D-DNS. The 2D- and 3D-deviations were calculated. The osteotomy and RER time and the number of procedural mishaps were recorded. RESULTS: Osteotomy and RER were completed in all samples (72/72). AR + 3D-DNS was more accurate than 3D-DNS, showing lower 2D- and 3D-deviation values (P < .05). The AR + 3D-DNS was more efficient in time than 3D-DNS (P < .05). There was no significant difference in the number of mishaps (P > .05). CONCLUSIONS: Within the limitations of this in vitro study, the integration of an AR head-mounted device to 3D-DNS is feasible for osteotomy and RER. AR improved the accuracy and time efficiency of 3D-DNS in osteotomy and RER. Head-mounted AR has the potential to be safely and reliably integrated into 3D-DNS for endodontic microsurgery.

Rare nonsyndromic recurrent solitary gingival neurofibroma in an older adult.

BACKGROUND: Neurofibromas are benign peripheral nerve sheath tumors usually featured with neurofibromatosis type 1 syndrome. Recurrent gingival neurofibromas have been rarely reported in the periodontal literature, particularly affecting elderly patients. METHODS AND RESULTS: A 70-year-old man with a pale, rubbery, and painless thickening along the facial/buccal gingiva of the mandibular right canine and first premolar. Ten years prior, the patient had undergone excision of a neurofibroma within the same region. The patient denied a history of cutaneous disease or neurofibromatosis. Histopathologic and immunostaining of the excised lesion confirmed the diagnosis as a recurrent gingival neurofibroma. CONCLUSIONS: With cases of suspected recurrent neurofibroma, attending practitioners should consult with an oral pathologist whether the primary lesion had exhibited tumor cells to the surgical specimen margin. Preoperative use of a cone beam computed tomography scan may enhance determination of tumor depth. Clinicians should also carefully weigh the decision for conservative excision of gingival neurofibromas and greater risk of recurrence versus performing a somewhat wider extirpation and possible formation of a mucogingival defect. KEY POINTS: What are important clinical considerations when performing a gingival biopsy? Gingival neurofibromas may be associated with an increased risk for recurrence owing to decisions for tissue-sparing excision and prevention of a mucogingival defect; supplemental use of cone beam computed tomographic scans may provide greater appreciation of tumor depth. What is a reasonable length of time of postoperative assessment for gingival neurofibromas? Patients who have undergone surgical removal of a gingival neurofibroma should undergo yearly surveillance for at least 10 years. What is a key limitation to this case study? Preoperatively, attending clinicians should consult with an oral pathologist to ascertain whether a primary lesion had manifested tumor cells to the surgical margin. Conservative gingival resection of a neurofibroma may promote recurrence.

Diagnosis of vestibular schwannoma following an 11-year interval of head and neck manifestations: case report.

Vestibular schwannoma (VS) is a benign peripheral nerve sheath tumor involving the vestibulocochlear nerve. Affected patients typically experience a gradual emergence of episodic imbalance and unilateral hearing loss, tinnitus, and headache. Less often, VS may be associated with facial pain; ocular, otic, and taste disturbance; paresthesia of the tongue and face; and temporomandibular disorder-like presentations. There is limited information in the dental literature relating the myriad of oral and maxillofacial manifestations of VS. The objective of this article is to underscore the importance for dental clinicians to seek clinicopathologic correlations with VS-related symptomatology, potentially resulting in a timelier diagnosis and improved patient outcomes. To convey this clinical challenge, a detailed narrative of a 45-year-old patient with an 11-year delay in diagnosis has been reported. In addition, the typical radiographic appearance of an implanted cranial device placed following VS resection has been provided.

Recurrent peripheral odontogenic keratocyst: Review of the literature and presentation of a novel case initially masquerading as an atypical infected lateral periodontal cyst.

AIM: To review published cases and case series of the peripheral odontogenic keratocyst (POKC) of the gingiva, report an unusual presentation, and discuss lesional recurrence. MATERIALS AND METHODS: A search of the English language literature for gingival OKCs was conducted. The inclusion of new case yielded a database containing 29 affected patients. Clinical, surgical, radiographic, and histopathologic findings have been summarized. RESULTS: With available patient demographics, 62.5% were female and 37.5% were male, with an overall mean age at diagnosis of 53.8 years. There was near-equal lesional affinity for the jaws, of which 44.0% occurred in the posterior region, 32.0% anteriorly, and 24.0% overlapped these areas. Twenty-five percent of lesions had a normal color, 30.0% appeared yellow, 20.0% were white, and 10.0% were blue. The majority of lesions were < 1 cm and nearly 42% manifested exudation or fluctuance. Lesional pain was infrequent. Pressure resorption was recorded in 45.8% of cases. Most lesions were managed with conservative surgical modalities. Follow-up information was available in 16 primary cases, of which 5 recurred, signifying a 31.3% recurrence rate, including the featured case, which recurred twice. CONCLUSION: To reduce recurrence of a gingival OKC, supraperiosteal dissection is advocated. Further, it is advised to follow POKCs for 5-7 years postoperatively, remaining vigilant for subtle clinical manifestations of recurrence. Timely discovery and excision of a POKC of the gingiva may decrease the incidence of a mucogingival defect.

A Cadaver-based Comparison of Sleeve-guided Implant-drill and Dynamic Navigation Osteotomy and Root-end Resections.

INTRODUCTION: This study compared the accuracy and efficiency of fully guided static and dynamic computer-assisted surgical navigation techniques for osteotomy and root-end resection (RER). METHODS: Fifty roots from cadaver heads were divided into two groups: fully guided static computer-assisted endodontic microsurgery (FG sCAEMS) and dynamic computer-assisted endodontic microsurgery (dCAEMS) (all, n = 25). Cone-beam computed tomography scans were taken pre and postoperatively. The osteotomy and RER were planned virtually in the preoperative cone-beam computed tomography scan and guided using 3D-printed surgical guides in the FG sCAEMS and 3D-dynamic navigation system in the dCAEMS. The 2D and 3D deviations and angular deflection were calculated. The osteotomy volume, resected root length, and resection angle were measured. The osteotomy and RER time and the number of procedural mishaps were recorded. RESULTS: FG sCAEMS was as accurate as dCAEMS, with no difference in the 2D and 3D deviation values or angular deflection (P > .05). The osteotomy and RER time were shortened using FG sCAEMS (P < .05). The FG sCAEMS showed a greater number of incomplete RERs than dCAEMS. Osteotomy volume, RER angle, and root length resected were similar in both groups (P > .05). FG sCAEMS and dCAEMS were feasible for osteotomy and RER. CONCLUSIONS: Within the limitations of this cadaver-based study, FG sCAEMS was as accurate as dCAEMS. Both FG sCAEMS and dCAEMS were time-efficient for osteotomy and RER.