Prevalence of Dental Caries and Dental Fluorosis among 7-12-Year-Old School Children in an Indian Subpopulation: A Cross-Sectional Study

ABSTRACT Objective: To assess the prevalence of dental caries and fluorosis among 7-12-year-old school children in Muradnagar, India. An additional objective was to determine the relationship between dental caries and fluorosis in the studied population. Material and Methods: A total of 1500 school children aged between 7 to 12 years, and both genders were randomly selected for the present study. The selected participants were divided into three groups based upon age, viz 7-8 year (group I), 9-10 year (group II) and 11-12 year (group III). Sterile mouth mirrors and explorers were used for the detection of caries. The water samples were collected to assess the fluoride concentration. The data collected were tabulated and statistically analysed using Chi-square, ANOVA, Spearman's correlation and t-test wherever applicable. Results: Out of 1500 participants, 54.1% were females and 45.9% were males. The prevalence of dental caries and fluorosis was 89.3% and 93.7%, respectively. The prevalence of caries increased with age (p<0.05) and females showed a higher prevalence in both the dentitions. Most dental fluorosis was 'very mild' (40.1%). Prevalence of dental fluorosis increased with age and males showed more fluorosis than females. A negative relationship was found between dental caries and fluorosis (p<0.05). Conclusion: Dental caries and fluorosis are the public health problems in Muradnagar; therefore, preventive programs should be organized to increase awareness among the general people.

Current herbal medicine as an alternative treatment in dentistry: In vitro, in vivo and clinical studies.

Since the time that human population comprehended the importance of general health maintenance and the burden of disease, there has been a search for healing properties in the natural environment. Herbal medicine is the use of plants with medical properties for prevention and treatment of conditions that can affect general health. Recently, a growing interest has been observed toward the use of traditional herbal medicine alongside synthetic modern drugs. Around 80% of the population, especially in developing countries relies on it for healthcare. Oral healthcare is considered a major part of general health. According to the world health organization (WHO), oral health is considered an important part of general health and quality of life. The utilization of natural medications for the management of pathologic oro-dental conditions can be a logical alternative to pharmaceutical methods due to their availability, low costs, and lower side effects. The current literature review aimed at exploration of the variety and extent of herbal products application in oral health maintenance including different fields of oral healthcare such as dental caries, periodontal maintenance, microbial infections, oral cancers, and inflammatory conditions.

Oral manifestations of Langerhans cell histiocytosis with unusual histomorphologic features.

Langerhans cell histiocytosis (LCH) is a bone marrow-derived immature myeloid dendritic cell proliferative disorder with diverse clinical manifestations commonly involves bone, skin, lymph node and lung. Oral involvement is uncommon. Intraoral lesions can be the first sign of either a localized LCH or clinically undiagnosed systemic LCH, predates systemic manifestations of LCH, or an early indicator of recurrence in known cases. Clinically, it can be mistaken for primary oral and dental inflammatory, infectious and neoplastic lesions. Histologically, diagnostic challenges may arise because of the nature of oral and dental specimens, different tissue reaction patterns and variations in histomorphology of LCH. We performed a retrospective review study over 10 years. We searched for diagnosed cases of LCH. We retrieved and reviewed cases of LCH with oral involvement. We found 54 cases of LCH, four (7.4%) with oral involvement. The age range was between 1 and 27 years with an average age of 13.7 years. They were males. They were clinically confused with abscess, cysts, infection, granulation tissue and other neoplastic lesions. Histologically, they showed different histopathologic features including different patterns of necrosis, granulomas, allergic-like inflammation, superimposed infection, stomatitis, cyst and sinus formation, foreign body giant cell reaction, and foci mimicking lymphomas and metastasis. Certain cytologic features were helpful hints. In doubtful cases, immunohistochemistry helped confirm the diagnosis. Because of the multiple fragmented nature of oral specimens with different tissue reaction patterns, the diagnostic Langerhans cells may be missed or misinterpreted. Oral LCH may be confused with infectious, inflammatory, benign and malignant neoplastic lesions because of its variable clinical presentations and its heterogeneous histomorphologic features. Pathologists have an important role in guiding clinicians to the correct diagnosis and patients' management. They should be familiar with the different histomorphologic patterns to avoid pitfalls. Attention to certain morphologic features and immunohistochemistry should help resolve challenging cases.

Novel molecular cues for dental defects in hypophosphatasia.

Mineralization disorders with a broad range of etiological factors represent a huge challenge in dental diagnosis and therapy. Hypophosphatasia (HPP) belongs to the rare diseases affecting predominantly mineralized tissues, bones and teeth, and occurs due to mutations in the ALPL gene, which encodes tissue-nonspecific alkaline phosphatase (TNAP). Here we analyzed stem cells from bone marrow (BMSCs), dental pulp (DPSCs) and periodontal ligament (PDLSCs) in the absence and presence of efficient TNAP inhibitors. The differentiation capacity, expression of surface markers, and gene expression patterns of donor-matched dental cells were compared during this in vitro study. Differentiation assays showed efficient osteogenic but low adipogenic differentiation (aD) capacity of PDLSCs and DPSCs. TNAP inhibitor treatment completely abolished the mineralization process during osteogenic differentiation (oD). RNA-seq analysis in PDLSCs, comparing oD with and without TNAP inhibitor levamisole, showed clustered regulation of candidate molecular mechanisms that putatively impaired osteogenesis and mineralization, disequilibrated ECM production and turnover, and propagated inflammation. Combined alteration of cementum formation, mineralization, and elastic attachment of teeth to cementum via elastic fibers may explain dental key problems in HPP. Using this in vitro model of TNAP deficiency in DPSCs and PDLSCs, we provide novel putative target areas for research on molecular cues for specific dental problems in HPP.

Assessment of Maximum Bite Force in Oral Submucous Fibrosis Patients: A Preliminary Study

Abstract Objective: To determine the maximum bite force (MBF) in oral submucous fibrosis (OSMF) patients and to compare them with that of healthy subjects. Material and Methods: Twenty patients who were clinically confirmed, as OSMF and 20 healthy controls matched for age, gender, and number of intact functional teeth were included in this study. For each subject, age, gender, weight, height and body mass index (BMI) were recorded. The MBF registration was carried out by the two evaluators, who were previously calibrated. Bite force was measured in the first molar region using a force transducer occlusal force meter for each subject seated at the upright position, with Frankfort's plane nearly parallel to the floor, and no head support. The Student's independent t-test was used to determine the statistical significance in relation to mean height, weight, BMI and the presence of number of intact teeth and MBF between the healthy subjects and OSMF individuals. A comparison of grades of OSMF with all variables was carried out by one-way ANOVA test. Results: No significant difference was found in mean age, mean height, weight, BMI and the presence of the number of intact teeth between healthy individuals and OSMF patients. The mean MBF in healthy subjects was 628.23 ± 24.39 N and 635.47 ± 31.22 N in OSMF patients. Even though the healthy subjects reported a higher MBF than OSMF patients did, the difference was statistically non-significant. With regards to sides, no significant difference was observed in mean MBF in healthy subjects and OSMF patients on the right (p=0.7818) and left side (p=0.6154). Conclusion: The healthy subjects reported higher MBF values than OSMF patients did and the difference was statistically non-significant.

Epidemiological study of intraosseous lesions of the stomatognathic or maxillomandibular complex diagnosed by a Reference Centre in Brazil from 2006-2017.

This epidemiological study was designed to find out the incidence and factors associated with the occurrence of intraosseous lesions diagnosed at a Reference Centre in Brazil. We included all patients diagnosed with intraosseous lesions (cyst, tumour, bone-associated lesion, and periapical disease) during the period 2006-2017, and analysed the association between some sociodemographic and clinical variables and the types of lesion. There was a total of 290 intraosseous lesions, the most common being odontogenic cysts. There was a significant association between age and odontogenic tumours (p=0.001). In relation to the histopathological diagnosis, root cysts were the most common (n=57), followed by dentigerous cysts (n=26). The lesions studied were seen most often in women between the second and fourth decades of life, odontogenic cysts being the most common type found. We know of few publications of similar epidemiological work, either in Brazil or in the rest of the world, so we suggest that more such studies are made.

Estudo epidemiológico de biópsias realizadas em uma clínica odontológica universitária no período entre 2011 e 2018 / Epidemiological survey of biopsies performed in a dental school clinic in the period from 2011 to 2018

A grande quantidade de patologias com características clínicas semelhantes possibilita a coexistência de vários diagnósticos diferenciais frente a uma única lesão na mucosa bucal. Muitas vezes a realização de exames complementares, como a biópsia, torna-se mandatória para confirmação do diagnóstico sugestivo. Realizar levantamento dos laudos histopatológicos provenientes de biópsias executadas em uma clínica-escola odontológica no período entre 2011 e 2018. A partir dos prontuários odontológicos, as informações foram coletadas e tabuladas. Foram determinadas a frequência de cada lesão em relação ao total e ao seu próprio grupo de doenças e as características dos indivíduos. Um total de 106 diagnósticos de 105 pacientes (idade média 47,5 anos), sendo a maioria do sexo feminino (68 indivíduos - 64,8%) e leucoderma (67 indivíduos - 63,8%), foram avaliados. Em relação aos grupos de doenças, o mais representativo foi o das neoplasias benignas epiteliais ou mesenquimais (35 casos - 33%), seguido pelo dos processos proliferativos não neoplásicos (30 casos - 28,3%). Quanto aos diagnósticos, foram observados 25 diferentes, nos quais se destacaram o fibroma (30 casos - 28,3%) e a hiperplasia fibrosa inflamatória (22 casos - 20,8%). Não foi constatada nenhuma patologia maligna. Traçar o perfil epidemiológico de certo grupo de indivíduos pode muitas vezes facilitar os diagnósticos, além de auxiliar na implementação de medidas de prevenção e na orientação dos assuntos a serem abordados nos cursos das instituições de ensino superior(AU)

A large number of pathologies with similar clinical features may allow coexistence of several differential diagnoses in a single lesion on the buccal mucosa. According to the clinical picture, complementary exams such as biopsy are often mandatory to confirm the suggestive diagnosis. To carry out a survey of histopathological diagnoses from biopsies performed in a dental school clinic in the period from 2011 to 2018. Information from dental records was gathered and tabulated. The frequency of each lesion was determined in relation to the total and its own group of diseases as well as the epidemiological characteristics of the individuals. A total of 106 diagnoses from 105 patients (mean age 47.5 years) were evaluated, being the majority of them female (68 individuals - 64.8%) and white (67 individuals - 63.8%). In relation to the groups of diseases, epithelial or mesenchymal benign neoplasms (35 cases - 33%) were the most representative, followed by nonneoplastic proliferative processes (30 cases - 28.3%). Regarding the diagnoses, 25 different ones were observed, in which fibroma (30 cases - 28.3%) and inflammatory fibrous hyperplasia (22 cases - 20.8%) were more prevalent. No malignant pathology was found. To describe the epidemiological profile of a population can often facilitate diagnoses, besides assisting in the implementation of preventive measures and in the definition of graduate and post-graduate courses' scope(AU)

Formation of papillary mucosa folds and enhancement of epithelial barrier in odontogenic sinusitis.

BACKGROUND: Odontogenic sinusitis (OS) presents more satisfactory therapeutic effect after endoscopic surgery compared with chronic rhinosinusitis (CRS) of other origin. The aim of the present study was to investigate the clinical characteristics, morphological features, and epithelial barrier function of sinus mucosa of OS and discuss the possible relationship with good prognosis. METHODS: A total of 25 subjects with OS, 7 CRS without nasal polyps (CRSsNP), 10 CRS with nasal polyps (CRSwNP), and 9 control subjects were recruited. The biopsy specimens were stained with hematoxylin and eosin for general observation of cytomorphologic features. Epithelial tight junctions (TJs) protein claudin-4 expression was determined to evaluate the epithelial barrier integrity by using immunofluorescence and Image-Pro Plus software analysis. The representative cytokine profiles regarding T helper 1 (Th1) (interferon [IFN]-γ), Th2 (interleukin [IL]-5), and Th17 (IL-17) were examined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Extensively small papillary protrusions could be seen in the maxillary sinus mucosa of OS patients under nasal endoscopy, similar to the morphological behavior, which also presented as papillary folds in the surface of the epithelium. The epithelium in OS kept an increased claudin-4 expression compared with that seen in CRSsNP, CRSwNP, and control subjects. The inflammatory pattern analysis demonstrated that OS belonged to the lymphocyte and plasma cell-dominant cellular phenotypes, whereas IL-17 was dominant compared with IFN-γ as well as IL-5. CONCLUSION: The odontogenic infections might induce the formation of papillary mucosa folds and enhance the epithelial TJ barrier function. OS exhibited as lymphocyte and plasma cell-dominant cellular phenotypes and Th17 cytokine profiles.

Skull pathology in 10 cats with patellar fracture and dental anomaly syndrome.

CASE SERIES SUMMARY: The aim of this case series is to describe the clinical and radiological features of mandibular and maxillary abnormalities in cats diagnosed with patellar fractures and dental anomalies, a condition that we have named 'patellar fracture and dental anomaly syndrome' (PADS), also known previously as 'knees and teeth syndrome'. Where available, clinical records, skull and/or intraoral dental radiographs, head CT images, microbiology and histopathology reports were collected, and follow-up was obtained. Ten cats with mandibular or maxillary abnormalities were identified. Common clinical features included multiple persistent deciduous teeth, gingivitis and swellings of the jaw. Skull radiographs were available for 7/10 cats and head CT images were available for one cat. Findings included marked bony and periosteal proliferation, hypodontia, root resorption, root malformation and unerupted permanent teeth. Where available, microbiology and histopathology results were consistent with osteomyelitis. RELEVANCE AND NOVEL INFORMATION: Mandibular and maxillary abnormalities are an additional unreported clinical feature of the rare condition that we have termed PADS. Radiologically, these lesions can have an aggressive appearance, which can mimic neoplasia. Medical management with antibiotic and anti-inflammatory therapy improves clinical signs in the short term; however, surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome. Additional information on long-term outcome is required.

Oral lymphoid lesions: a 47-year clinicopathological study in a Brazilian population.

We performed an epidemiological, clinical and histopathological analysis of oral lymphoid lesions (OLLs) during a 47-year period. Data regarding patient age, sex, duration, location, symptomatology, type of growth, implantation, staining, presence of ulceration and bleeding of all cases were compiled from the clinical data. For the histopathological analyses, all slides stained by H/E were reassessed. During the analyzed period, 14,565 patients with oral and maxillofacial lesions were diagnosed, with 45 cases diagnosed as OLLs. The most prevalent location was the tongue. Females were more affected, and the mean age was 40.8 years. OLLs presented a heterogeneous frequency, with the prevalence of reactive lesions (42.3%) followed by developmental lesions (35.6%). Among the reactive lesions, foreign body granulomas were the most common. Regarding diagnosed neoplasms, malignant represented 13.2% of the cases. The average time of evolution of OLLs in general was of 22.2 months. Regarding the histopathological characteristics, the presence of primary lymphoid follicles was observed in 37.8% of the cases, while inflammatory infiltrates were diffuse in 66.7% and epimyoepithelial islands were observed in 13.3%. Our study concludes that OLLs involves a broad spectrum of lesions that share the presence of the lymphoid component, which can range from indolent to more aggressive behavior.

Controversies in Oral and Maxillofacial Pathology.

Several benign pathologic entities that are commonly encountered by the oral and maxillofacial surgeon remain controversial. From etiology to treatment, no consensus exists in the literature regarding the best treatment of benign lesions, such as the keratocystic odontogenic tumor, giant cell lesion, or ameloblastoma. Given the need for often-morbid treatment to prevent recurrence of these lesions, multiple less-invasive treatments exist in the literature for each entity with little agreement. As the molecular and genomic pathogenesis of these lesions are better understood, directed treatments will hopefully lessen the contention in management.

Anatomy and Disorders of the Oral Cavity of Rat-like and Squirrel-like Rodents.

The order Rodentia comprises more than 2000 species divided into 3 groups based on anatomic and functional differences of the masseter muscle. Myomorph and sciuromorph species have elodont incisors and anelodont cheek teeth, unlike hystrichomorph species which have full anelodont dentition. Diseases of incisors and cheek teeth of rat-like and squirrel-like rodents result in a wide variety of symptoms and clinical signs. Appropriate diagnostic testing and imaging techniques are required to obtain a definitive diagnosis, formulate a prognosis, and develop a treatment plan. A thorough review of elodontoma, odontoma, and pseudo-odontoma is provided, including treatment of pseudo-odontomas in prairie dogs.

Anatomy and Disorders of the Oral Cavity of Miscellaneous Exotic Companion Mammals.

Unusual mammalian species such as the hedgehog, sugar glider, and miniature pig are encountered with increasing frequency in exotic companion medicine. Disease of the oral cavity can occur in any species; although occasionally encountered in exotic mammalian species, it is rarely described in the literature. Anatomy and dentition vary significantly; diagnosis and treatment are often extrapolated from that known in other species. The best-documented disease of the oral cavity in this group of species is oral neoplasia in the hedgehog.

Conservative Nonsurgical Treatment of Class 4 Invasive Cervical Resorption: A Case Series.

External cervical resorption, also called invasive cervical resorption (ICR), is a pathological process difficult to diagnose that causes a progressive replacement of dentin by granulation tissue and results in complete tooth destruction. According to the literature, class 4 ICR can be expected to have success rates of 12.5% if treated. In this case series, we show nonsurgical conservative treatment of 4 patients affected by class 4 ICR. In 4 patients affected by class 4 ICRs, granulomatous tissue was orthograde removed with the help of an operating microscope and cone-beam computed tomographic imaging. The teeth were devitalized, the granulomatous tissue was mechanically removed, and the defects were filled with either mineral trioxide aggregate or Biodentine (Septodont, Saint-Maur-des-Fossés, France). After a follow-up period varying from 18 months for case 1 to 4 months for case 4, neither signs of periradicular bone rarefaction nor recurrence of resorption were observed. The teeth were asymptomatic, and conservative restorations appeared to be in excellent condition. Given the results achieved in this case series, it may be assumed that many class 4 ICRs could be successfully treated with the help of an operating microscope and cone-beam computed tomographic imaging.

A Multicenter Retrospective Cohort Study on Pediatric Oral Lesions.

PURPOSE: The purpose of this study was to evaluate the profile of pediatric oral lesions in northeastern Brazil. METHODS: Biopsy records of oral lesions were retrieved from patients aged zero to 18 years who were treated over 18 years in two university hospitals in northeastern Brazil. Routine pathological sections were re-examined and classified into six groups: (1) odontogenic and nonodontogenic cysts; (2) odontogenic tumors; (3) salivary gland pathology; (4) nonodontogenic tumors and tumor-like lesions; (5) bone pathology; and (6) miscellaneous. RESULTS: From a total of 4,690 oral biopsies, 564 (12 percent) were from children and adolescents. The largest number of cases was salivary gland pathology, followed by nonodontogenic tumors and tumor-like lesions. The most common oral biopsies were mucocele, pericoronal dental follicle, pyogenic granuloma, dentigerous cyst, and odontoma. Only three cases of malignant tumors were observed. Our results were similar to most studies. CONCLUSIONS: Although malignant tumors comprised a small portion of the pediatric oral biopsies, the possibility of their occurrence in children and adolescents should not be overlooked.

Do anti-inflammatory drugs worsen odontogenic cervico-facial cellulitis?

OBJECTIVE: The aim of this prospective study was to determine the influence of anti-inflammatory drugs on the severity of odontogenic cellulitis in patients admitted to our hospital emergency unit. STUDY DESIGN: The study was made from April 30 to October 31 2006. The clinical and pharmacological data was prospectively collected at admission, during hospitalization, and during systematic follow-up. We first studied the whole population and then compared the 2 groups: patients having received anti-inflammatory drugs before admission or not. RESULTS: Two hundred and sixty-seven patients were included. The only severity criterion significantly different between the 2 groups was spreading of cervical lymphangitis (P=0.028). None of the 4 studied parameters was identified as a risk factor for spreading of cervical lymphangitis in multivariate analysis: anti-inflammatory use (OR=5.99, 95%CI [0.71-50.88]), alcohol abuse (OR=4.00, 95%CI [0.66-24.12]), dental hygiene (OR=1.53, 95%CI [0.36-6.56]), and tobacco use (OR=0.27, 95%CI [0.57-1.28]). DISCUSSION: The use of anti-inflammatory drugs during the initial phase of an odontogenic infection was not related to the severity of infection.

OK-432 sclerotherapy of lymphatic malformation in the head and neck: factors related to outcome.

BACKGROUND: No previous study to the best of our knowledge has examined the multiple factors related to the outcome of OK-432 sclerotherapy of lymphatic malformations. OBJECTIVE: This study aimed to assess factors related to the successful outcome of OK-432 sclerotherapy for lymphatic malformations in the head and neck region. MATERIALS AND METHODS: During a 6-year period, OK-432 sclerotherapy was performed in 26 patients with lymphatic malformations. Several factors related to the efficacy of OK-432 sclerotherapy were evaluated, including the type (macrocystic or microcystic), the maximum lesion diameter, amount and hemorrhagic cytology of the aspirate, degree of aspiration, injected dose of OK-432 and post-therapy inflammation-related symptom. In all cases, ultrasound (US) follow-up was performed. RESULTS: Of the 26 cases, 13 (50%) showed successful elimination of the lymphatic malformations in the follow-up US after the initial session, and all successful cases were of the macrocystic type. The type of lymphatic malformation and the success of OK-432 sclerotherapy were significantly related (P = 0.0149). Of the 16 cases of complete aspiration, 11 (68.8%) showed a successful outcome. Further, of the 17 cases with inflammation-related symptom, 13 (76.5%) showed a successful outcome. While the degree of aspiration and presence of inflammation-related symptom showed a significant relationship with the success of OK-432 sclerotherapy (P < 0.05), no other factors showed a significant relationship. CONCLUSION: The study results suggest that the macrocystic type and complete aspiration of cystic contents were important factors for the success of OK-432 sclerotherapy of lymphatic malformations, and that inflammation-related symptom was a predictor of a successful outcome.

Dental anatomy and pathology encountered on routine CT of the head and neck.

OBJECTIVE: Although dental CT is not routinely performed at hospital imaging centers, dental and periodontal disease can be recognized on standard high-resolution CT of the neck and face. These findings can have significant implications with regard to not only dental disease, but also diseases of the sinuses, jaw, and surrounding soft tissues. This article serves to review dental and periodontal anatomy and pathology as well as other regional entities with dental involvement and to discuss the imaging findings. CONCLUSION: Recognition of dental and periodontal disease has the potential to affect management and preclude further complications, thereby preserving the smile, one of the most recognizable and attractive features of the human face and, unfortunately, often disease ridden. Although practicing good oral hygiene and visiting the dentist for regular examinations and cleanings are the most effective ways to prevent disease, some patients do not take these preventative measures. Thus, radiologists play a role in diagnosing dental disease and complications such as chronic periodontitis and abscesses, nonhealing fractures and osteomyelitis, oroantral fistulas, tumoral diseases, osteonecrosis of the jaw, and other conditions.