Sjögren's syndrome and ranula development.

OBJECTIVES: We hypothesized that the extravasation of saliva from damaged ducts with lymphocytic infiltration in patients with Sjögren's syndrome causes ranulas. There are too many uncertainties to support this hypothesis. The aim of this study was to investigate whether there is an association between Sjögren's syndrome and ranulas. MATERIALS AND METHODS: We observed three cases of patients with ranulas who were also diagnosed with Sjögren's syndrome at the same facility. These cases led to the question of whether there are other such cases, and thus, an exhaustive literature search was conducted. RESULTS: Three cases in two case reports of mucocele of the floor of the mouth associated with adult Sjögren's syndrome were noted. Including our cases, until now, there have been six cases of ranula with adult Sjögren's syndrome. CONCLUSIONS: It could be useful to investigate whether patients presenting with a ranula are also affected by Sjögren's syndrome and, conversely, investigate patients with Sjögren's syndrome longitudinally to see whether they develop ranulas.

Chewing ability and desaturation during chewing in patients with COPD.

Chewing ability is essential to maintain nutrition status and can be associated with oral conditions, sarcopenia, and lung function in patients with chronic obstructive pulmonary disease (COPD). Herein, our pilot study investigated the chewing ability and degree of desaturation during chewing in patients with COPD (n = 41) and control subjects (n = 22). Subjects chewed a color-changing chewing gum for 1 minute and chewing ability was assessed by the color of the chewed gum, which was scored from 1 (very poor) to 5 (very good). Arterial oxygen saturation (SpO2) was monitored using a pulse oximeter and the difference in SpO2 was determined by comparison between before and during chewing. The mean color score of the chewed gum was lower in the COPD group than in the control group (3.1±0.7 vs 4.2±0.9, p<0.0001). Muscle mass loss (p<0.05), <20 remaining teeth (p<0.005), and COPD (p<0.001) were risk factors for poor chewing ability. The mean SpO2 decreased by 0.78±1.46% during gum chewing for 1 min. The mean SpO2 during gum chewing (95.1±2.4%) was lower than before gum chewing (95.9±1.7%) (p<0.05). The reduction of SpO2 was greater in COPD patients who had fewer remaining teeth (p<0.05). COPD patients with SpO2 reduction >4% during the 6-minute walk test showed greater reduction during gum chewing (p<0.05). Our results suggest that COPD patients with fewer remaining teeth exhibit poor chewing ability and greater desaturation during chewing.

Prenatal Counseling on Prenatal Diagnosis of Cleft Lip and/or Cleft Palate at Tokyo Dental College Ichikawa General Hospital.

Remarkable technological advances have been made in the field of medicine in recent years, one result of which is that a prenatal diagnosis of cleft lip and/or cleft palate (CL/P) is now possible. In this situation, it is extremely important to provide the parents with mental care from the moment they are informed. Here, we describe cases of CL/P treated at our hospital and how such a diagnosis and prenatal counseling are handled. A survey was carried out on 4 cases seen at our department between April 2013 and March 2014. Patients are referred to our department from local or our own obstetrics clinics on a prenatal diagnosis of CL/P based on findings from ultrasonography. If the case is a referral from outside, the patient will first be seen at our own obstetrics department. Our department may then be subsequently requested to provide the parents with prenatal counseling. Effort is made to reassure the parents that postnatal support will be provided, right from the start. Next, the multidisciplinary nature of the treatment process is explained. However, only the essential outline is given at first so as to avoid inducing unnecessary anxiety. A response is also given to any questions the parents may have. Our experience of giving such care leads us to believe that improvements are required in the way that explanations and assistance are provided. The number of cases in which prenatal counseling is required is expected to increase in future.

Bisphosphonate-related osteonecrosis of jaw (BRONJ) in Japanese population: a case series of 13 patients at our clinic.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) affects quality of life and is an important problem for dentists. A Japanese position paper on BRONJ was published in 2010. The purpose of this study was to review clinical data on the treatment of BRONJ obtained at the Clinic of Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba Hospital to further our understanding of this disease. A total of 13 patients (6 men and 7 women) were included. All the patients included in this study had received Bisphosphonate (BP) therapy and had BRONJ. Five of them (38.5%) had received oral BP therapy for osteoporosis, while the remaining 8 (61.5%) had received parenteral BP therapy for bone metastases from breast or prostate cancer. Osteoporosis patients were treated with risedronate or alendronate. Breast or prostate cancer patients were treated with zoledronate. Two patients with rheumatoid arthritis were treated with corticosteroid. Three patients had diabetes mellitus. Eleven patients were treated with antibiotics, while 5 underwent surgical treatment. Discontinuation of BP was recorded in 7 patients during dental treatment. Sequestration was observed in 6 patients during an 11-month follow-up. Eventually, healing and improvement of the oral mucosa were observed in 3 patients. The current standard treatment for BRONJ does not always provide good results. It is necessary to accumulate further clinical data to establish more effective treatment strategies for BRONJ.

Primary treatment for cleft lip and/or cleft palate in children in Japan.

OBJECTIVE: To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. DESIGN: Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. PARTICIPANTS, PATIENTS: Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. MAIN OUTCOME MEASURE(S): Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. RESULTS: Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. CONCLUSION: This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.

A case of congenital midline fistula of the upper lip.

Congenital fistulas of the lip are commonly found in the lower lip and accompany cleft lip. They are seen as a symptom of Van der Woude syndrome, which is predominantly hereditary. In contrast, congenital fistulas of the upper lip are rare. A number of hypotheses have been proposed to explain the pathogenesis of fistulas of the upper lip, including fusion failure of facial prominences and absence of mesoblasts, suggesting a relationship between this condition and the development of cleft lip. The pathogenesis of this disorder has been attracting attention. We report the case of a 5-year-old girl with congenital fistula of the upper lip.

Changes in expression of imprinted genes following treatment of human cancer cell lines with non-mutagenic or mutagenic carcinogens.

It remains possible that chemicals that act by mutagenic mechanisms as well as chemicals that do not induce gene mutations may affect epigenetic gene expression. To test the possibility, we investigated the ability of both types of chemicals to alter the expression of five imprinted genes, PEG3, SNRPN, NDN, ZAC and H19, using two human colon cancer cell lines and a human breast cancer cell line. The expression of imprinted genes was changed by some non-mutagenic and mutagenic carcinogens independent of their mutagenic activity. The genes most commonly exhibiting the changes in expression were SNRPN and PEG3. Alterations of the expression of NDN and ZAC were also observed in some conditions. Methylation-specific PCR and chromatin immunoprecipitation assays suggest the possibility that changes in the expression of SNRPN may be associated with DNA hypomethylation and histone acetylation of the promoters and euchromatinization of the heterochromatic domains of the promoters. Changes in expression of the imprinted genes, PEG3 and NDN, were also observed in cells immortalized by treatment of normal human fibroblasts with 4-nitroquinoline 1-oxide or aflatoxin B1. We previously demonstrated that expression of the cancer-related gene, INK4a, in these immortal cells was lost via epigenetic mechanisms. The results prove that, in cancer cells, some mutagenic or non-mutagenic carcinogens can epigenetically influence the transcription levels of imprinted genes and also suggest the possibility that some chemical carcinogens may have epigenetic carcinogenic effects in human cells.

Utilizing a low-cost desktop 3D printer to develop a "one-stop 3D printing lab" for oral and maxillofacial surgery and dentistry fields.

BACKGROUND: In the oral and maxillofacial surgery and dentistry fields, the use of three-dimensional (3D) patient-specific organ models is increasing, which has increased the cost of obtaining them. We developed an environment in our facility in which we can design, fabricate, and use 3D models called the "One-stop 3D printing lab". The lab made it possible to quickly and inexpensively produce the 3D models that are indispensable for oral and maxillofacial surgery. We report our 3D model fabrication environment after determining the dimensional accuracy of the models with different laminating pitches (; layer thickness) after fabricating over 300 3D models. Considerations were made for further reducing modeling cost and model print time. MDCT imaging was performed using a dry human mandible, and 3D CAD data were generated from the DICOM image data. 3D models were fabricated with a fused deposition modeling (FDM) 3D printer MF-2000 (MUTOH) with a laminating pitch of 0.2 mm, 0.3 mm, 0.4 mm, or 0.5 mm. Each 3D model was then subjected to reverse scanning to evaluate the modeling conditions and deformation during modeling. For the 3D image processing system, Volume Extractor 3.0 (i-Plants Systems) and POLYGONALmeister V2 (UEL) were used. For the comparative evaluation of CAD data, spGauge 2014.1 (Armonicos) was used. RESULTS: As the laminating pitch increased, the weight of the 3D model, model print time, and material cost decreased, and no significant reduction in geometric accuracy was observed. CONCLUSIONS: The amount of modeling material used and preparation cost were reduced by increasing the laminating pitch. The "One-stop 3D printing lab" made it possible to produce 3D models daily. The use of 3D models in the oral and maxillofacial surgery and dentistry fields will likely increase, and we expect that low-cost FDM 3D printers that can produce low-cost 3D models will play a significant role.

Odontogenic cutaneous fistula mimicking malignancy.

It is important for the dentists to make accurate diagnosis and appropriate treatment of odontogenic cutaneous fistula. Although large facial skin lesions may bring up malignancy on top of the differential list, careful evaluation including physical observation, imaging, and pathology can rule out malignancies.