Unusual cause of tooth mobility.

We describe a case of a 71-year-old otherwise healthy man who presented to the dental clinic with the chief complaint of mobility involving his upper left molar teeth. The patient was a febrile, and clinical oral examination revealed localised grade II mobility and absence of gingival swelling, erythema or sinus tract. Orthopantogram revealed a poorly defined radiolucency involving the upper left second and third molar teeth. Surgical exploration of the involved area was performed and revealed the presence of a 'jelly like' brown tissue that fragments easily. Pathological examination confirmed the diagnosis of diffuse large B cell lymphoma.

Periotestometry and tissue hydration. How are these indicators related?

The mobility of teeth in terms of periotestometry and hydration of periodontal tissues in terms of bioimpedance spectrometry were studied in healthy volunteers without dental and concomitant somatic diseases. It was found that teeth of these subjects have both low and pathological mobility. It was also revealed as increased hydration (edema), indicating the presence of inflammation, and reduced hydration, indicating atrophic processes in periodontal tissues. A comparison of the data of periotestometry and bioimpedance spectrometry showed that the indicators of mobility of the teeth and hydration of the periodontal tissues reflect different characteristics of the functional state of dentoalveolar system, and can be used as complementary in the diagnostic studies.

A rare case report and appraisal of the literature on spontaneous tooth exfoliation associated with trigeminal herpes zoster.

BACKGROUND: Reports of post herpetic maxillofacial complications have been very rarely documented in the literature that includes periapical lesions, calcified and devitalized pulps, resorption of roots, osteonecrosis, and spontaneous exfoliation of teeth. The atypical feature of the case of concern to the dental surgeon is the rare complication of spontaneous tooth exfoliation following herpes zoster. CASE REPORT: This case reports a male patient of age 47 years who reported to the Department of Periodontology with the chief complaint of mobility in the left upper central incisor. Patient history revealed herpes zoster infection that began 11 days earlier along with underlying diabetes mellitus condition. We hereby report a known diabetic patient with history of herpes zoster infection who presented with rare complication of spontaneous tooth exfoliation involving the maxillary division of the trigeminal nerve. DISCUSSION: Limited number of cases has been reported in the literature regarding spontaneous teeth exfoliation secondary to herpes zoster. The exact pathogenesis regarding the spontaneous exfoliation of teeth in herpes zoster patient is still controversial. Thus, an oral health care provider should be aware of this rare complication while managing a case of tooth mobility with the previous history of herpes zoster of trigeminal nerve.

Manejo de dientes natales y neonatales: reporte de dos casos / Management of natal and neonatal teeth: report of two cases

Los dientes natales son órganos dentarios que se presentan al nacimiento, y los neonatales son aquellos que erupcionan durante el primer mes de vida. La etiología exacta es desconocida. El manejo de estos dientes depende de múltiples factores. La extracción está indicada cuando eldiente es un supernumerario o presenta movilidad excesiva debido al riesgo de broncoaspiración. Cuando tienen ligera movilidad, generalmente se estabilizan conforme van erupcionando. El objetivo de este reporte es la presentación de dos casos clínicos de dientes natales yneonatales que se manejaron con abordajes diferentes, el primero demanera conservadora y el segundo con la extracción del órgano dental.

Natal teeth are those present at birth. Those erupting during the fi rst month of life are neonatal teeth. The etiology is not known. Natal teeth management is dependent on multiple factors. If the natal tooth is su-pernumerary, the treatment of choice is extraction; likewise, when the teeth are excessively mobile, extraction is indicated due to the risk of aspiration. When natal teeth are only slightly mobile, they often stabilize soon after eruption. The aim of this report is to present two cases of natal and neonatal teeth that were managed with different approaches; the fi rst with a more conservative treatment and the second one with the extraction of the teeth.

Validity of screening methods for periodontitis using salivary hemoglobin level and self-report questionnaires in people with disabilities.

BACKGROUND: The aim of this study is to evaluate the validity of screening methods in predicting periodontitis in people with disabilities using the objective salivary hemoglobin level, a subjective self-report questionnaire, and a combined model of the two methods with demographic characteristics. METHODS: The participants were 195 patients with disabilities aged >18 years who were examined using the community periodontal index (CPI), salivary hemoglobin level, and answers to 10 self-report questions (n = 192). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to evaluate the validity of the methods and the combined model in predicting the prevalence of ≥CPI 3 (probing depth [PD] ≥4 mm) or CPI 4 (PD ≥6 mm). RESULTS: Overall, 75.9% of the study group (148 of 195) were diagnosed with ≥CPI 3, and 38.5% of the study group (75 of 195) were diagnosed with CPI 4. The areas under the ROC curve (AUCs) of the salivary hemoglobin level were 0.578 (sensitivity of 41% and specificity of 77%) and 0.662 (sensitivity of 53% and specificity of 75%) for predicting the prevalence of ≥CPI 3 and CPI 4, respectively. Multivariable modeling incorporating four different questions for predicting ≥CPI 3 or CPI 4 indicated higher AUCs of 0.710 and 0.732, respectively, yielding higher sensitivity (55% for ≥CPI 3 and 69% for CPI 4) than that of salivary hemoglobin level. The most useful prediction models for ≥CPI 3 or CPI 4 were combined models, which yielded AUCs of 0.773 and 0.807, respectively, with sensitivity values of 70% and specificity values >75%. CONCLUSION: The salivary hemoglobin level, self-report questionnaire, and the combined method demonstrated screening potential that could predict the population prevalence of ≥CPI 3 or CPI 4.

Performance of self-reported measures for periodontitis in rheumatoid arthritis and osteoarthritis.

BACKGROUND: This study evaluates the performance of self-report against the reference standard of clinically defined periodontitis in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after accounting for factors associated with periodontitis. METHODS: Six self-report periodontitis questions were evaluated in patients with RA and OA. Questions were validated against a reference standard of severe and moderate-to-severe periodontitis based on full-mouth examination. Multivariable logistic regression was used to evaluate the performance of: 1) self-report alone; 2) age, sex, education, and smoking status; and 3) a combination of the above. Model performance was assessed using the c-statistic. Convergent validity of self-reported "bone loss/deep pockets" and "loose teeth" was assessed; associations of self-report with RA disease characteristics were explored. RESULTS: Self-report performed similarly in RA and OA, with individual question specificity for periodontitis ≥ 68% and sensitivity from 9.8% to 45%. Question-only models yielded c-statistics of 0.66 to 0.72, whereas risk factor-only models yielded c-statistics of 0.74 to 0.79. The highest-performing models incorporated both self-report questions and periodontitis risk factors, with c-statistics ≥ 0.79. Greater radiographic alveolar bone loss was observed among participants reporting "bone loss/deep pockets" (P < 0.001) and "loose teeth" (P < 0.001). Among patients with RA, "loose teeth," but not other self-report items, was associated with rheumatoid factor positivity (P = 0.047) and higher disease activity (P < 0.001). CONCLUSIONS: Patient self-report, when combined with other risk factors, performs well in identifying periodontitis among patients with RA and OA. Self-report questions related to alveolar bone loss exhibit excellent convergent validity in these patient subsets.

Salivary biomarkers of bacterial burden, inflammatory response, and tissue destruction in periodontitis.

AIM: Chronic periodontitis has an episodic and multifactorial character, with fluctuations in bacterial burden, inflammatory response, and tissue destruction. We investigated the association of selected salivary biomarkers with periodontal parameters and validated the use of a novel salivary diagnostic approach, the cumulative risk score (CRS), in detection of periodontitis in subjects with angiographically verified coronary artery disease diagnosis. MATERIALS AND METHODS: The concentrations of matrix metalloproteinase (MMP)-8, interleukin (IL)-1ß, and Porphyromonas gingivalis were analysed from saliva of 493 subjects. The subjects participated in a detailed clinical and radiographic oral examination. The CRS index, combining the three salivary biomarkers, was calculated for each subject. RESULTS: High salivary concentrations of MMP-8, IL-1ß, and P. gingivalis were associated with deepened periodontal pockets and alveolar bone loss, and MMP-8 and IL-1ß with bleeding on probing. The CRS index had a stronger association with moderate to severe periodontitis (OR 6.13; 95% CI 3.11-12.09) than any of the markers alone. CONCLUSIONS: Salivary concentrations of MMP-8, IL-1ß, and P. gingivalis are associated with various clinical and radiographic measures of periodontitis. The CRS index, combining the three salivary biomarkers, is associated with periodontitis more strongly than any of the markers alone regardless of the coronary artery disease status of the patients.

Solitary myofibroma of the adult mandible: a case report.

A 43-year-old woman presented with a swelling in the anterior mandible appearing radiographically as a well-defined radiolucency causing mobility of the anterior teeth. A clinical diagnosis of a radicular cyst led to removal of the lesion and the associated mobile teeth. Postoperative histopathology led to a diagnosis of intraosseous solitary myofibroma of the mandible. Solitary lesions of myofibroma are exceedingly rare in adult jaws, with only 3 previously documented cases.

Análise imuno-histoquímica de proteínas relacionadas às respostas Th1, Th2 e Th17 na doença periodontal / Immunohistochemical analysis of proteins related to the Th1, Th2 and Th17 cells in periodontal disease

A doença periodontal é uma condição inflamatória de caráter infeccioso, caracterizada pela destruição dos tecidos de proteção e sustentação dentários, face à resposta produzida pelo hospedeiro frente às agressões sofridas pelos microrganismos. Vários fatores estão envolvidos nesse processo, sendo as citocinas as principais moléculas reguladoras dessa resposta imune, desempenhando um papel protetor e/ou destrutivo na progressão da lesão. Diante disso, este experimento investigou a expressão iimmo-histoquímica de IFN-y, GATA-3, IL-17, IL-23, IL-6 e TGF-p em tecidos gengivais de humanos, na tentativa de se obter um maior entendimento da participação das respostas imunes Thl, Th2 e Thl7 no desenvolvimento destes processos patológicos. Para tanto, oitenta e duas amostras de tecidos gengivais foram subdivididas em três grupos: Grupo 1=15 (amostras de tecido gengival saudável-controle), Grupo 2=36 (amostras com gengivite crónica) e Grupo 3=31 (amostras com periodontite crónica). Todos os casos foram submetidos à análise morfológica a partir de cortes corados em hematoxilina e eosina e, posteriormente, submetidas à técnica de coloração pela imuno-histoquímica através do método da Estreptoavidina-Biotina. Os resultados mostraram positividade de marcação para todas as proteínas, sendo observada uma maior tendência de marcação para as citocinas das respostas Thl e Thl7 no grupo 3. Diferença estatisticamente significativa foi verificada entre a expressão de TGF-p e a condição clínica das amostras (p=0,02). Assim, podemos concluir que as respostas Thl e Thl7 podem atuar sinergicamente no processo destrutivo dos tecidos periodontais, sobrepondo-se à resposta Th2 que também se encontrou presente nestes tecidos.

Movilidad dentaria en la periodontitis crónica / Tooth mobility in chronic periodontitis

Evaluar la presencia de factores etiológicos secundarios relacionados a la movilidad dentaria en individuos portadores de periodontitis crónica en los grados de severidad leve, moderada y grave. La muestra por conveniencia fue formada por 155 pacientes de ambos sexos, atendidos en la Clínica de Periodoncia de la Facultad de Odontología de Pernambuco, Brasil, con edad mayor o igual a 35 años. El grado de movilidad dentaria fue comparado a través del método manual de forma bi-digital. Entre los pacientes que presentaban dientes con movilidad, los resultados revelaron que el mayor grado de movilidad (grado 3) estaba presente entre los pacientes del sexo femenino (53,7%) que presentaban de 51 a 70 (69,4%), fumadores (70,6%) y ex-fumadores (83.3%). De toda la muestra, 52,9% presentaban periodontitis grave; el factor de riesgo local más relacionado a la movilidad fue la ausencia dentaria sin recomposición protética (43,9%); el mayor porcentaje de pacientes con movilidad (grado 1, 2 ó 3) era de individuos sin alteraciones sistémicas (61,9%). Los exámenes estadísticos comprobaron relación significativa (p<0,05) entre el mayor grado de movilidad y las variables investigadas (sexo, edad, grado de periodontitis, hábito de fumar, condición sistémica y número de dientes perdidos). Se concluye que el mayor grado de movilidad estuvo asociado a pacientes del sexo masculino, con edad superior a 51 años, fumador o ex-fumador y con alguna alteración sistémica

An osteosarcoma, presenting as a loose maxillary bridge, with pain and swelling.

UNLABELLED: An osteosarcoma (OS) is the second most common primary bone malignancy, yet rarely presents in the jaws. This paper describes the progress of a patient, with osteosarcoma of the jaw (OSJ), from the initial presentation at the dental surgery, through to diagnosis and treatment. CLINICAL RELEVANCE: This paper reminds the dental practitioner to be wary of any unusual presentation or clinical picture. It emphasizes the benefit of a prompt and appropriate referral.

[Eosinophilic granuloma or aggressive periodontitis?]. / Granulome éosinophile ou parodontite agressive ?

INTRODUCTION: Eosinophilic granuloma in the jawbones can be confused with aggressive periodontitis or more rarely with inflammatory lesions of dental origin. We had for objective to analyze the various elements of clinical, radiological, and pathological differential diagnosis for this rare lesion through a clinical observation. CASE REPORT: A 26-year-old male patient consulted for loose teeth and gingivitis. The initial diagnosis was aggressive periodontitis. The ineffective periodontal treatment suggested another diagnosis, eosinophilic granuloma, requiring tooth extraction and curettage. A histological analysis confirmed the diagnosis. Bone scintigraphy revealed a second focus on the left maxilla. Complementary chemotherapy was efficient on the mandibular site but failed to prevent worsening on the maxilla, which was treated surgically. Thirty months after, the patient's condition was stable. DISCUSSION: The diagnosis of eosinophilic granuloma is difficult and relies on histology and immunolabelling with protein S100 and antigen CD1a. Treatment is surgery and conservative in case of isolated lesions.

The relationship between periodontal diagnosis and prognosis and the survival of prosthodontic abutments: a retrospective study.

OBJECTIVE: To examine the relationship between periodontal diagnosis and prognosis and survival of prosthodontic abutments over time. METHOD AND MATERIALS: The study consisted of 70 randomly selected patients with either fixed or removable partial dentures delivered by dental students. Age, gender, ethnicity, pertinent medical history, smoking status, procedure performed, abutment tooth number, year of prosthesis delivery, year of most recent periodontal examination, year of tooth loss, periodontal diagnosis and prognosis, date of prosthesis delivery, and most recent periodontal examination were extracted from dental charts. Statistical analyses included chi-square, Kaplan-Meier, and Cox proportional hazards models. RESULTS: A total of 16 of 226 abutment teeth (7.1%) were lost. A total of 88.6% of subjects lost no abutment teeth during the study, while 15.7% lost at least 1 tooth. Analysis showed a cumulative 13.8-year survival rate of 66.0% (SE = +/- 0.10). Tooth-specific periodontal prognosis was a significant predictor of tooth loss. The data showed a 3.05-fold increased risk for tooth loss with removable partial denture abutments compared to fixed partial denture abutments. Abutment teeth with an initial specific prognosis of "good" had a 9.3-fold lower risk of loss than teeth with any other specific prognosis. CONCLUSIONS: Teeth with a periodontal prognosis other than good and those used as removable partial denture abutments had an increased risk of tooth loss. Periodontal diagnosis, overall prognosis (prognosis for the entire dentition), gender, ethnicity, smoking status, and diabetes were not significantly associated with abutment tooth loss over time.

An unusual case of a glandular odontogenic cyst.

UNLABELLED: A case of an adult Nigerian female patient, who was found to have an unusual lesion, namely a glandular odontogenic cyst of the anterior mandible, is described. This lesion was found to be an extensive intra-bony lesion with alveolar expansion and was initially associated with infection and mobile teeth. Treatment for this ranges from curettage to block excision. There is a significant recurrence rate for these lesions and long-term follow-up is advised. CLINICAL RELEVANCE: This case highlights that a high index of suspicion is needed for unusual pathology.

A comparison of diagnostic screening data derived from general dental practitioners and periodontists used for initial treatment planning in periodontitis patients.

As the quality of clinical information contained in referral letters for specialist care may determine the initial decisions as to appropriate treatment for patients, it is important that this information is objective and accurate. The use of a standardised questionnaire for this purpose improves the quality of information received, but it is not known how accurate this information is if used in the decision-making process for treatment planning. The aim of this study was to compare the clinical assessment data derived from a standardised questionnaire used by referring patients to a specialist periodontal unit. Equivalent data recorded by dentists and periodontists were compared to establish whether the data were consistently reproducible, and therefore usable for deciding on the appropriate initial phase of treatment for patients. Data from 50 patients referred for periodontal treatment planning and specialist care in which the questionnaires from the general dental practitioner and the subsequent periodontal assessment were available were compared. All of the patients were medically healthy and were not taking any long-term medication. The patients were selected based on the retrospective availability of equivalent clinical data from the questionnaires and consultation in the periodontal department at the Eastman Dental Hospital, London. The equivalence or disparity in the identification of different cofactors, and the community periodontal index of treatment need (CPITN) (basic periodontal examination, BPE) scores recorded by referring dentists (GDP), and periodontists (EDH, Eastman Dental Hospital) were annotated and compared. A level of equivalence of over 50% of assessments was demonstrated between referring dentists and periodontists in the variables of oral hygiene, smoking, bleeding on probing and restorative factors, as well as in the recorded scores of the CPITN (BPE) screening system. It can be concluded that the use of questionnaires for referral for specialist services is useful to not only improve and standardise the quality and extent of the relevant clinical information received, but may also be a valuable resource that may be used in the initial decision-making process for screening patients to the appropriate level of periodontal care. However, the limitations of this observational study preclude drawing any definitive conclusions in the absence of a more carefully controlled study designed specifically to overcome these limitations.

Lesão apical do implante. Caso clínico com etiologia e tratamento alternativo / Apical injury of the implant. Clinical case etilology and alternative treatment

A Odontologia teve um grande impulso com a descoberta da osseointegração há 40 anos tornando a terapia com implantes dentais bastante segura. Algumas complicações vêm sendo relatadas por alguns autores, dentre elas a lesão apical do implante. Esse caso clínico demonstrao tratamento por curetagem de toda a lesão, limpeza das espiras do implante e colocação de enxerto. Não houve remoção de parte do implante, nem aplicação de ácidos ou outras drogas. Utilizou-se enxerto de osso autógeno nas espiras e a adição de biomaterial para regularização do defeito.

The effect of periodontal surgery on bite force, occlusal contact area and bite pressure.

BACKGROUND: Tooth mobility resulting from the loss of periodontal support or trauma induced by periodontal surgery may change the amount of bite force (BF) and bite pressure (BP) and number of occlusal contact areas (OCAs). The aim of the authors' study was to compare BF, BP and OCA of teeth with periodontal disease before and after periodontal surgery with similar values of healthy teeth. METHODS: The authors performed quantitative analysis of BF, BP and OCA using a pressure measurement film. Ten patients with periodontitis who needed periodontal surgery served as the test group. The authors took measurements of BF, BP, OCA and mobility (using Miller's Mobility Index) just before surgery and at one, four and 12 weeks after surgery. They also measured clinical attachment levels (CAL) before surgery and 12 weeks after surgery. Ten subjects without periodontitis served as the control group. RESULTS: Although BF and OCA increased the first week after periodontal surgery, analysis of variance (ANOVA) showed no statistically significant differences at a 95 percent confidence interval. There were statistically significant differences between first-week mobility and that at four and 12 weeks (P = .001). A factorial ANOVA showed significant interaction between BF and mobility (P < .05). CONCLUSIONS: The authors' findings suggest that changes in BF, BP and OCA were not affected by periodontal surgery. However, mean mobility values and BF are correlated. Further investigations of this measurement method involving larger study populations and a longer follow-up period are needed. CLINICAL IMPLICATIONS: It seems to be helpful to follow occlusal changes after periodontal surgery using a pressure measurement film. It also may be suggested that this measurement method could be used to evaluate the treatment prognosis.

Rhabdomyosarcoma of the mandible in a 6-year-old boy.

INTRODUCTION: Rhabdomyosarcoma is an aggressive malignant tumour composed of neoplastic mesenchymal cells that infiltrate surrounding tissue structures, making their precise site of origin unclear. Although rare, this is highly aggressive and the most common soft-tissue neoplasm of the head and neck in children. Regrettably by the time most cases are initially seen, the patients already have large tumours, due to rapid tumour growth and delayed medical consultation. CASE REPORT: This report describes a 6-year-old presenting with just such symptoms of facial swelling and pain but elicitation of further information and findings, including tooth mobility of 3 days duration, led to prompt referral and early treatment of an embryonal rhabdomyosarcoma. CONCLUSION: General dental practitioners are frequently presented with a child with a swollen face and pain. Experience would suggest a dental abscess to be the most likely cause with treatment as appropriate. However, all swellings in children, should be thoroughly investigated and reviewed as particularly in this age group, tumour growth is rapid while early diagnosis allows successful treatment with multimodality therapy.