Clinical, Imaging, and Laboratory Findings in Sjögren's Syndrome.

Sjögren's syndrome (SS) is a rare condition characterized by structural damage and secretory dysfunction of the lacrimal and salivary glands that leads to dryness, particularly xerophthalmia (eyes) and xerostomia (mouth). No cure is known; however, the effects of the disease are manageable and symptoms may be reduced. Although the salivary damage is irreversible, the dental decay and oral infections may be prevented, which highlights the importance that the clinician plays in the diagnosis and management of SS. The cardinal features of this disease are summarized through the case report of primary SS in a 23-year-old woman who received an early diagnosis based on clinical features, laboratory investigations, lower lip biopsy, and imaging findings.

Ulcerated anterior maxillary swelling showing radiopaque bodies on cone beam computed tomography.

The calcifying epithelial odontogenic tumor (CEOT), also known as Pindborg tumor, is a rare benign tumor of epithelial origin of locally aggressive behavior, which represents less than 1% of all odontogenic tumors affecting the oral cavity. The lesion usually presents as a nonulcerated painless mass of slow growth, commonly affecting the posterior region of the mandible. Depending on the stages of development, CEOTs may present variable radiographic appearances. To date, a few number of cases affecting the anterior maxillary region have been published in the English-language literature. This article describes an interesting and rare case of an anterior ulcerated maxillary swelling diagnosed as a CEOT based on clinical, cone beam computed tomography and pathologic findings. Functional results were obtained with the surgical approach, and no recurrence of the lesion during a 2-year follow-up period was observed.

Computed tomography findings of periostitis ossificans

Periostitis ossificans (PO) is a type of chronic osteomyelitis, an inflammation of cortical and cancellous bone. In the maxillo facial region, the mandible is most frequently affected. The cause of inflammatory subperiosteal bone production in PO is spread of infection from a bacterial focus (e.g.: odontogenic disease, pulpal or periodontal infection, and extraction wounds). This pathology is most commonin younger people (mean age of 13 years). Conventional radiographs are one of the most usefultools for diagnosis, but in some cases computed tomography (CT) has a key role in both diagnosis and identification of the tissues involved. This paper reports two cases of PO in which CT help edestablishing the suspicious etiology: a 12-year-old boy with PO of pulpal origin and a 14-year-old boy with PO of periodontal origin.

The relationship between temporomandibular dysfunction and head and cervical posture

OBJECTIVE: This study aimed to evaluate the possibility of any correlation between disc displacement and parameters used for evaluation of skull positioning in relation to the cervical spine: craniocervical angle, suboccipital space between C0-C1, cervical curvature and position of the hyoid bone in individuals with and without symptoms of temporomandibular dysfunction. MATERIAL AND METHODS: The patients were evaluated following the guidelines set forth by RDC/TMD. Evaluation was performed by magnetic resonance imaging for establishment of disc positioning in the temporomandibular joints (TMJs) of 30 volunteer patients without temporomandibular dysfunction symptoms and 30 patients with symptoms. Evaluation of skull positioning in relation to the cervical spine was performed on lateral cephalograms achieved with the individual in natural head position. Data were submitted to statistical analysis by Fisher's exact test at 5%significance level. To measure the degree of reproducibility/agreements between surveys, the kappa (K) statistics was used. RESULTS: Significant differences were observed between C0-C1 measurement for both symptomatic (p=0.04) and asymptomatic (p=0.02). No statistical differences were observed regarding craniocervical angle, C1-C2 and hyoid bone position in relation to the TMJs with and without disc displacement. Although statistically significant difference was found in the C0-C1 space, no association between these and internal temporomandibular joint disorder can be considered. CONCLUSIONS: Based on the results observed in this study, no direct relationship could be determined between the presence of disc displacement and the variables assessed.

Breast adenocarcinoma mimicking temporomandibular disorders: a case report.

AIM: The aim of this report is to present a case of a metastatic lesion in the mandible originating from a breast adenocarcinoma that was initially diagnosed as temporomandibular disorder (TMD). The role of the dental practitioner in the diagnostic phases is also discussed. BACKGROUND: It is not uncommon to see a patient who complains of what seems to be a TMD but who in reality suffers from a systematic disease, dental infection, or neoplasia. Although metastases to the head and neck are uncommon, it should always be considered among the differential diagnoses of lesions. REPORT: A 42-year-old female presented with pain and swelling in the right temporomandibular joint (TMJ) previously diagnosed as TMD. Further clinical, radiological, and histological examinations coupled with a history of adenocarcinoma of the breast lead to a final diagnosis of a metastatic lesion in the right TMJ region. SUMMARY: In most patients who present with an oral metastasis the distant primary tumor has already been diagnosed and treated. Occasionally the discovery of an oral metastasis leads to the detection of an occult primary malignancy elsewhere in the body. Thus the dentist should be able to perform an adequate diagnosis and play an important role in the diagnostic phase of care that can lead to a useful palliation and an enhanced quality of the patient's life. CLINICAL SIGNIFICANCE: In order to avoid the pitfalls so common in evaluating patients with TMJ pain, the clinician must perform a complete and critical review of the medical history along with a comprehensive examination. The challenge is to know and evaluate the differential diagnosis. Failure to do so can result in a misdiagnosis which may lead to unnecessary care, long-term therapy without clinical resolution, or potentionally death.

Dental maturity as an indicator of chronological age: radiographic assessment of dental age in a brazilian population

OBJECTIVE: The purpose of this investigation was to evaluate the applicability of the methods proposed by Nolla and by Nicodemo and colleagues for assessing dental age and its correlation to chronological age. METHODS: Panoramic radiographs of 360 patients from the city of Fortaleza (CE, Brazil) aged 7-15 years were used to assess the associations between dental and chronological age. Data were submitted to statistical analysis using the BioEstat 2.0 (2000) software. Student-Neuman-Keuls test was performed and Pearson's correlation coefficients were calculated at 5 percent significance level. RESULTS: When the Nolla method was applied, the mean difference between true and estimated age for males and females was underestimated. The use of the method proposed by Nicodemo and colleagues also resulted in underestimation, although it was more evident in male subjects. The correlation coefficients between chronological age and estimated dental age were high, with mean values ranging between 0.87 and 0.91 for males and between 0.84 and 0.93 for females. CONCLUSION: Although both methods proved to be reliable in estimating age, the use of correction factors is recommended.