Simultaneous presentation of dual pathologies within the oral cavity: an unusual and diagnostically challenging presentation.

Necrotising sialometaplasia (NS) is a rare condition, with a limited scientific evidence base regarding its aetiology and pathophysiology. Diagnosing NS demands extensive investigatory tests. Their accuracy is vital in order to exclude oral malignancy and prevent unwarranted, invasive management.Within Birmingham Dental Hospital, a 22-year-old, South Asian woman presented with generalised pain from the lower right third molar extending to involve the palate, to which the patient's general medical practitioner previously attributed to a viral upper respiratory infection. Clinical examination revealed bilateral erythematous: non-ulcerated, palatal swellings (10 mm x 5 mm) at the greater palatine foramina. Following extensive investigations, the challenging definitive diagnoses of two distinct pathologies were made: non-ulcerative NS and pericoronitis.This case report describes the successful diagnosis and management of non-ulcerating NS, an 'atypical' presentation of a rare condition, that was confounded by a simultaneous episode of pericoronitis - a presentation not previously documented within scientific literature.

Assessment of pain among a group of Nigerian dental patients.

BACKGROUND: Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients' level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. METHODS: A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. RESULTS: Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. CONCLUSION: It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with patients with multiple diagnoses experiencing more severe pain, and there is a correlation between the VAS and FCT for pain assessment among dental patients.

Effects of low-level laser therapy as an adjunct to standard therapy in acute pericoronitis, and its impact on oral health-related quality of life.

OBJECTIVE: The purpose of this study was to evaluate the effect of low-level laser therapy (LLLT) as an adjunct to standard therapy in acute pericoronitis. METHODS: Eighty acute pericoronitis patients were randomly assigned to one of four LLLT groups: (neodymium:yttrium-aluminum garnet [Nd:YAG] 1064-nm: n=20, 8 J/cm2, 0.25 W, 10 Hz, 10 sec; 808-nm diode: n=20, 8 J/cm2, 0.25 W, continuous mode, 10 sec; 660-nm diode: n=20, 8 J/cm2, 0.04 W, continuous mode, 60 sec; or a placebo laser control group: n=20). After standard treatment, LLLT or a placebo laser were applied to the treatment area at a distance of 1 cm from the buccal site. Interincisal opening, pain perception, and oral health-related quality of life (OHRQoL) were evaluated at baseline, 24 h, and 7 days after laser application. The data were analyzed by the one-way ANOVA test. RESULTS: We found that the trismus and the OHRQoL in the Nd:YAG and the 808-nm diode groups were significantly improved when compared with the 660-nm diode and control groups at 24 h (p<0.05). No statistically significant differences were detected on day 7 among the groups with regard to any of the parameters evaluated. CONCLUSIONS: The results demonstrate that both the 1064-nm Nd:YAG and the 808-nm diode lasers were effective in improving trismus and OHRQoL in acute pericoronitis. Taking into account the limitations of this study, we conclude that the 1064-nm Nd:YAG laser has biostimulatory effects and improves OHRQoL, making it suitable for LLLT.

O que é, e como diagnosticar, a pericoronarite / What is pericoronitis and how is it diagnosed

A pericoronarite é um quadro inflamatório no tecido mole que recobre parcialmente a coroa de um dente semi-irrompido. Os terceiros molares inferiores são, geralmente, os mais acometidos; clinicamente, é observada a presença de tecido eritematoso; e, muitas vezes, pode evoluir para um estado infeccioso, apresentando coleção purulenta, drenando espontaneamente ou não...

[Acute conditions of the oral cavity]. / Akutte tilstande i mundhulen.

Acute conditions are mainly caused by inflammatory and infectious reactions in the dental pulp, periodontal tissues, periapical bone and the tissues around partially impacted teeth. Pain may also be related to traumatic injuries to the teeth and jaws as well as sequelae after oral surgery. Emergency treatment involves incision of abscesses, root canal treatment, irrigation with antiseptics, immobilisation of teeth or fractured bones, and prescription of analgetics. Antibiotics are only indicated in cases in which there is a risk that an infection spreads to adjacent regions or a risk of fever and malaise.

Validation of a dental pain screening questionnaire in a semi-urban hospital setting in South India.

AIMS: To assess the validity of modified DePaQ items in correctly classifying dental pain patients into three groups of common dental conditions when compared against clinically-determined classification; generate a model of classification equations from a sub-population of the sample; and assess the validity of the model in predicting group membership of new dental pain cases. METHODS: Consecutive adult hospital dental patients aged 18 years and older attending with a dental pain complaint were diagnosed by a dentist. Before treatment commenced a self-complete questionnaire was completed. The examining dentist was blinded to the questionnaire responses. The sample was randomly split into two groups (RS1 and RS2). Discriminant analysis was carried out on RS1 to develop a model for classifying new dental pain cases into three groups. This model was used to classify dental pain cases in RS2. RESULTS: Of the 311 questionnaires distributed, 306 (98.4%) were returned. Of the 205 Group 1 cases diagnosed clinically 186 (90.7%) were correctly predicted as belonging to that group by M-DePaQ. For 54 clinically diagnosed Group 2 cases 44 (81.5%) were correctly predicted, and for 32 Group 3 cases, 26 (81.3%) were correctly predicted. The model of classification equations derived from RS1 were capable of correctly classifying 85%, 82% and 79% of clinically-derived classification for Group 1, 2 and 3 respectively. CONCLUSIONS: This study has demonstrated that the M-DePaQ is valid in classifying dental pain patients into three groups of common dental conditions. Classification equations generated from a sub-group of the sample provided a valid statistical model for classifying dental pain cases from the same setting.

Evolución clínica de las pericoronaritis tratadas con OLEOZON® en urgencias estomatológicas / Clinical evolution of pericoronaritis treated with OLEOZÓN® in stomatologic urgencias

La pericoronaritis es una patología bucal que aparece con frecuencia en consultas de urgencias estomatológicas. Se considera un proceso infeccioso agudo caracterizado por inflamación del tejido blando que rodea el diente retenido, lo cual provoca efectos indeseables en el paciente. El tratamiento indicado es la aplicación de sustancias caústicas que pueden ocasionar daños en los tejidos dentarios, por lo cual se decidió utilizar la ozonoterapia para realizar un ensayo clínico fase III, aleatorizado, controlado y abierto, lo cual permitió estudiar la eficacia del OLEOZON® en el tratamiento de la Pericoronaritis, en la Clínica Estomatológica Docente César Escalante, del municipio Matanzas, de enero 2003 a enero de 2008. El universo de estudio fueron los pacientes que en ese período asistieron con Pericoronaritis a la consulta de urgencia, y la muestra abarcó 90 pacientes, conformándose dos grupos: uno experimental, donde se aplicó el OLEOZON®, y otro control, donde se empleó el tratamiento convencional. Se caracterizaron los grupos desde el punto de vista sociodemográfico y clínico, determinándose la eficacia del OLEOZON®, la cual resultó ser alta en los pacientes tratados.

Pericoronaritis is an oral pathology frequently found in stomatologic urgency consultations. It is considered an acute infectious process characterized by inflammation of the soft tissues surrounding the retained tooth, causing unwanted effects in the patient. The indicated treatment is applying caustic substances that may damage dental tissues, so we decided using ozonotherapy to develop a clinical assay Phase III, randomized, controlled and open, allowing us to study the efficacy of OLEOZÓN® in treating Pericoronaritis at the Teaching Stomatologic Clinic Cesar Escalante, municipality of Matanzas, from january 2003 to january 2008. The universe of study were the patients assisting to the urgency consultation with Pericoronaritis in that period of time, and the sample were 90 patients, divided in two groups, an Experimental one where OLEOZÓN® was applied, and a Control one where the conventional treatment was used. Both groups were characterized from the sociodemographic and clinic points of view, stating the efficacy of OLEOZÓN®, high in treated patients.

Estudo retrospectivo de cisto paradentário na cidade do Recife, Pernambuco, Brasil / Retrospective study of paradental cyst in the city of Recife/PE, Brazil

Objetivo: Analisar retrospectivamente a ocorrência do Cisto Paradentário (CP) em uma população brasileira. Método: Foi realizado um estudo retrospectivo, avaliando os aspectos epidemiológicos de 25 casos de pacientes com diagnostico de Cisto Paradentário no período de janeiro de 1992 a abril de 2008 no Laboratório de Patologia Oral da Faculdade de Odontologia de Pernambuco - FOP/UPE. Foram avaliados os indicadores gênero, faixa etária, raça, localização topográfica, tamanho das lesões e presença de sintomatologia dolorosa ao exame clínico. A análise estatística foi realizada através do programa SPSS (v. 13.0), sendo criado um banco de dados para análise dos resultados obtidos. Foi aplicado o teste Qui-quadrado para analisar a significância estatística dos achados (p<0,05). Resultados: Não houve diferença estatisticamente significante da prevalência desta lesão em relação ao gênero (p=0,992). A terceira década de vida mostrou-se a faixa etária de maior prevalência da referida patologia (76%), assim como a ocorrência em indivíduos leucodermas em detrimento a feodermas e melanodermas (72%), a mandíbula mostrou-se como a localização anatômica mais freqüente (96%). Estas lesões apresentaram pequenas dimensões independentemente da região topográfica acometida. Não houve diferença significante quanto a presença ou ausência de sintomatologia. Conclusão: O cisto paradentário foi mais prevalente em pacientes do gênero feminino, leucodermas, representado principalmente por lesões de pequenas dimensões e que se apresentaram em grande parte na mandíbula. A terceira década de vida foi a mais acometi da pelo fato de ser nessa época, em quem observamos mais episódios de pericoronarite.

Objective: To evaluate retrospectively the occurrence of paradental cyst (PC) in a Brazilian population. Method: A retrospective study was performed to investigate the epidemiological aspects of 25 cases of patients with PC diagnosis between January 1992 and April 2008 at the Oral Pathology Laboratory of Pernambuco Dental School - FOP/ UPE. The following indicators were evaluated: gender, age group, ethnical group, topographic localization, lesion size and presence of pain to the clinical exam. The statistical analysis was performed with the SPSS soft ware (v. 13.0) and a database was created to analyze the obtained results. The chi-square test was used to analyze the statistical significance of the findings. A p value less than 0.05 was considered statistically significant. Results: There was no statistically significant difference for the prevalence of this lesion regarding gender (p=0.992). There was higher prevalence of PC in the 3rd decade of life compared to the other age groups (76%) and in whites (72%) compared to blacks and mixed black-white. The mandible was the most frequent anatomic site (96%). These lesions were small sized regardless of the affected topographic region. There was no statistically significant difference as for the presence or absence of painful symptomatology. Conclusion: PC was more prevalent in white female patients and manifested more frequently as small lesions mainly in the mandible. A 3rd decade of life was the most affected because pericoronaritis episodes are more commonly observed in this age group.

Assessment of the associated symptoms, pathologies, positions and angulations of bilateral occurring mandibular third molars: is there any similarity?

OBJECTIVE: The aim of this study was to evaluate and establish any similarity between the associated symptoms, pathologies, positions, and angulation types of bilateral occurring mandibular third molars among a group of young adult patients. STUDY DESIGN: A total of 342 patients (167 females, 175 males), aged between 20 and 25 years (mean: 22.2, SD: 1.8) participated in the study. Clinical and radiographic examinations were performed. Eruption status, mucosal and bony coverage type, presence of pain, pericoronitis, suppuration, ulceration, caries in third molar, distal caries in second molar, bone loss, root resorption, or cyst or tumor formation was investigated in addition to the position and the angulation of each tooth. Patients having at least one completely or partially erupted mandibular third molar were classified as group 1 and patients having bilateral impacted mandibular third molars were classified as group 2. RESULTS: No significant difference was found between the symptoms and pathologies related with the mandibular right third molar (RM) and the left third molar (LM) among both groups and genders (P > .05). In the total sample, no significant difference was found between the RM and the LM in terms of mucosal coverage type, bony coverage type, and position both in group 1 and group 2 (P > .05); but gender had an influence on the bony coverage type and ramus distance of the RM and the LM in group 2 (P < .05). In the total the sample, symmetry was present for horizontal or distoangular and vertical or distoangular angulations in group 1 and group 2, respectively. Gender was found to also have an impact on angulation symmetry. CONCLUSION: In most cases, a similarity was present between the symptoms and pathologies related with the bilateral mandibular third molars; but symmetry in position and angulation differed according to eruption status, angulation type, and gender.

Eficacia de la electroacupuntura en la pericoronaritis del tercer molar inferior / Effectiveness of the electroacupuncture in the pericoronitis of the third lower molar

Se realizó un ensayo clínico controlado multicéntrico en 100 pacientes con pericoronaritis en terceros molares inferiores, que acudieron a las respectivas consultas de Cirugía Maxilofacial de los hospitales provinciales Dr Joaquín Castillo Duany y Saturnino Lora de Santiago de Cuba en el período de enero y diciembre del 2006, para ser tratados con electroacupuntura o medicamentos, según estuviesen asignados al grupo 1 (de estudio) o grupo 2 (de control) con 50 integrantes cada uno, a fin de evaluar la eficacia de la primera de ambas terapéuticas en la eliminación del proceso inflamatorio, mediante la activación eléctrica de los puntos acupunturales IG4 , IG11, E6 y VB2, en sesiones diarias durante 7 días; en el segundo grupo se utilizó tratamiento convencional. La evolución fue favorable en 96,0 y 90,0 por ciento, respectivamente, además de que las manifestaciones clínicas desaparecieron al tercer día en los pacientes del grupo de estudio y en un tiempo mayor en los tomados como control, de donde se concluyó que la terapia con electroacupuntura resultó ser más eficaz para eliminar la mencionada inflamación en esas piezas dentarias.

A clinical controlled multicenter trial in 100 patients with pericoronitis in third inferior molars was carried out. They went to their respective visits of Maxillofacial Surgery at Dr Joaquín Castillo Duany and Saturnino Lora provincial hospitals in Santiago de Cuba from January to December, 2006, to be treated with electroacupuncture or drugs, as they were assigned to group 1 (study) or group 2 (control) with 50 members each one, in order to evaluate the effectiveness of the first therapy in the elimination of the inflammatory process, through the electric activation of the acupunctural points IG4, IG11, E6 and VB2, in daily sessions during 7 days; in the second group conventional treatment was used. The clinical course was favorable in 96,0 and 90,0 percent, respectively. Besides the clinical manifestations disappeared at the third day in the patients of the study group and in more time in those taken as control. The conclusion was that the therapy with electroacupuncture turned out to be more effective to eliminate the aforementioned inflammation in those teeth.

The performance of a screening test for urgent dental treatment need in a prison population.

OBJECTIVE: To compare the performance of a questionnaire-based assessment of dental pain delivered by non-dental prison nursing staff against a clinical examination performed by an experienced prison dentist (gold standard). SETTING: The research fieldwork took place in the healthcare department at HMP Brixton located in South London. METHODS: The cohort were those who had complained of dental/facial pain to the prison authorities and were therefore placed on the waiting list for emergency dental care. Subjects were asked to complete the screening test and were then clinically examined by trained and calibrated dentists. The screening test was in the form of a 12-item questionnaire designed to categorise a population reporting dental pain into one of three groups. The screening test results were compared with the diagnosis of a clinical examination. RESULTS: Ninety-six subjects were recruited during the 16-week study period. Of the 96 prisoners recruited, 27 of those failed to complete the screening test and/or the diagnostic examination even though they had reported pain previously. When sensitivity and specificity values were calculated for the 96 prisoners recruited, the sensitivity was fairly high (81%) and the specificity was poor (33%). However, when these values were calculated for the sub-population, those that completed both the screening test and diagnostic examination (n = 69), the sensitivity did not improve particularly (83%) but the specificity value fell substantially to 13%. CONCLUSIONS: This study highlighted the problems of conducting research in the prison environment, for example increased security preventing researchers from gaining access into the prison and general pressures on prison staff. Additionally, the study demonstrated that screening is not effective in local prisons with a high turnover of prisoners.

Infection frequency of Epstein-Barr virus in subgingival samples from patients with different periodontal status and its correlation with clinical parameters.

OBJECTIVE: To detect the infection frequencies of different genotypes of Epstein-Barr virus (EBV) in subgingival samples from chronic periodontitis (CP) patients, and to discuss the correlation between infection with EBV and clinical parameters. METHODS: Nested-PCR assay was used to detect EBV-1 and EBV-2 in subgingival samples from 65 CP patients, 65 gingivitis patients and 24 periodontally healthy individuals. The amplicons were further identified by restriction fragment length polymorphism analysis (RFLP) with endonucleases Afa I and Stu I. Clinical parameters mainly included bleeding on probing (BOP), probing depth (PD), attachment loss (AL) in six sites of the dentition. RESULTS: In CP patients, gingivitis and periodontally healthy individuals, the infection frequencies were 47.7%, 24.6% and 16.7% for EBV-1, and 15.4%, 7.7% and 0% for EBV-2, respectively. In 2 out of the 65 CP patients co-infection of EBV-1 and EBV-2 was found. The positive rate of EBV-1 in chronic periodontitis patients was higher than that in gingivitis patients (P=0.01) and periodontally healthy individuals (P=0.01). But no significant difference was shown in EBV-1 frequency between gingivitis patients and healthy individuals (P>0.05) or in EBV-2 frequency among the three groups (P>0.05). In CP patients, higher mean BOP value was found in EBV-1 or EBV-2 positive patients than that in EBV negative ones (P<0.01), but with no statistical difference in the mean PD or AL value between EBV positive and negative patients (P>0.05). After initial periodontal treatment, 12 out of the 21 EBV-1 positive CP patients did not show detectable EBV-1 in subgingival samples. CONCLUSION: nPCR plus RFLP analysis is a sensitive, specific and stable method to detect EBV-1 and EBV-2 in subgingival samples. Subgingival infection with EBV-1 is closely associated with chronic periodontitis. Infection of EBV in subgingival samples was correlated with BOP.