The peripheral odontogenic keratocyst.

A case with a firm asymptomatic nodule of 1 cm diameter on the gingiva between the left upper cuspid and first bicuspid is presented. Radiographic examination did not reveal any pathology of the bone in that region. Histologic examination revealed a cyst wall lined by squamous stratified epithelium, characteristic to the lining of an odontogenic keratocyst. It is suggested that the term peripheral odontogenic keratocyst be used for the diagnosis of this lesion.

Nifedipine-induced gingival hyperplasia. A comprehensive review and analysis.

A comprehensive review of the literature and analysis of the clinical history, mechanisms, pathogenesis, histology, and management of nifedipine-induced gingival hyperplasia is reported. A correlation to age, gender, drug, dosage, duration of drug therapy, location, and mode of treatment is discussed. The case report presented provides a model for management of nifedipine-induced gingival hyperplasia and other drug-induced gingival hyperplasia.

Dental caries and sugar consumption into the 21st century.

New trends towards the effect and role of sugar consumption in the etiology of dental caries into the 21st century are presented, analyzed and discussed. Many factors such as the amount of sugar consumed, the frequency of sugar intake and the kind of sugars ingested have to be taken into consideration. Over the years, the relative importance of these factors has changed. For a very long time, sugar has been "blamed" as a primary etiological factor in the development of dental caries. However, a number of recent reports have attributed a much less important role to carbohydrates. Sugar consumption only does not affect caries prevalence as much as it used to. It is obvious that the role of sugar in the etiology of caries must be reviewed. Additional factors like overall nutrition, the number of meals and snacks per day, education and motivation, fluoride (in tablets or drops, in mouthwashes, toothpastes, baby foods, formulas, beverages, milk, vitamin supplements and/or fluoridated water ingested), socioeconomic group, ethnicity, oral hygiene status, use of preventive methods and sweeteners other than sucrose are presented.

The right of dentists to take extra precautions when treating patients known to carry the human immunodeficiency virus.

Oral health care providers have taken various positions toward the concept of correct behavior toward and management of patients who are seropositive for human immunodeficiency virus. Several tribunal judgments and articles have discussed and analyzed this subject. This article presents a new detailed report and analysis and decision issued by a dental profession panel (tribunal) in Ontario, Canada. The concepts of universal precautions and antidiscriminatory acts are discussed.

Cosmetic or esthetic dentistry?

This article, through presentation of case studies, defines differences and suggests separate definitions for the terms cosmetic dentistry and esthetic dentistry. Dentistry strives to emulate harmonious form and function for therapy, and modification of appearance is an integral part of dental treatment. Cosmetic dentistry suggests a certain accommodation and is a compromise of current technology. Cosmetic dentistry is commonly selected as an interim procedure that does not necessarily function ideally and does not always emulate the pristine state of a natural dentition. Esthetic dentistry requires less accommodation, incorporates acceptable biologic technology for long-term survival, functions suitably, and mimics the pristine state of the natural dentition. Cosmetic and esthetic dentistry are different in definition, concept, and execution.

Candidal infection of the tongue together with candidal infection of the palate in patients with the human immunodeficiency virus.

The most common oral opportunistic infection affecting persons with acquired immunodeficiency is candidiasis. This article reports on candidal infection of the tongue together with candidal infection of the palate in patients who have the human immunodeficiency virus. A retrospective analysis of 336 patients with acquired immunodeficiency syndrome revealed a prevalence of 8% with candidal infection of both the tongue and palate. Patients in this group were significantly older (39.2 years versus 34.5 years) and had significantly lower CD4-CD8 ratios than did the rest of the cohort.

Pemphigus vulgaris--the potential for error: a case report.

The importance of correlation, referral, and collaboration between dermatology, or any other medical department, and the oral health profession is reported through a case presentation. A case of pemphigus vulgaris diagnosed from a tongue biopsy and confirmed by immunofluorescence is reported. The patient was treated for actinic keratosis of the scalp for 16 months due to inadequate biopsy material. The diagnostic value of proper biopsy material is stressed. The clinical manifestations leading to a misdiagnosis between actinic keratosis and pemphigus vulgaris are discussed.

Oral epidermolysis bullosa in adults.

A rare case of epidermolysis bullosa in an adult is reported and the English-language dental literature of the last 20 years is reviewed. Special dental management is suggested. Early detection because of potential malignant transformation is discussed.

Fourth molars: a clinical study.

Supernumerary teeth may be found in both the primary and permanent dentition, although they are more common in the permanent dentition. Presence of a fourth molar is rare, and such a tooth is almost invariably impacted. Dental practitioners should be aware of the possibility of encountering this rare supernumerary, its diagnosis and treatment. The authors of this article conducted a survey of patients in Montreal, looking specifically at the prevalence, aetiology, diagnosis, pathology and treatment of fourth molars. Their findings are reported here, and compared with data from the literature over the past 15 years.

Oral osteomyelitis: pre-AIDS manifestation or strange coincidence?

A bizarre and unexplained localized osteomyelitis was discovered in the mandible of an otherwise apparently healthy 36-year-old man. This strange oral manifestation was followed 2 years later by a diagnosis of Pneumocystis carinii pneumonia, which indicated full-blown AIDS. Could osteomyelitis of the mandible be an alarming oral manifestation of AIDS before the disease is manifested in other ways?

The retrocuspid papillae in Israeli Jews.

The prevalence of an anatomic variation, called retrocuspid papilla, was determined in Israeli Jews. The distribution of the retrocuspid papillae, according to two age groups, and symmetry within the dental arch and in relation to ethnic origin were examined. Results showed that retrocuspid papillae were observed in 38.5% of the young group and in 11.3% of the adult group. Greater occurrence of bilateral than unilateral retrocuspid papillae was observed in each age group and in both sexes. No significant ethnic trend was found when the prevalence of retrocuspid papillae was examined in relation to the ethnic origin of the study sample.

Implant-supported overdenture rehabilitation and progressive systemic sclerosis.

Progressive systemic sclerosis, or systemic scleroderma, is an autoimmune multisystemic disease associated with vascular abnormalities, connective tissue sclerosis, atrophy, and autoimmune changes. The complex oral problems that may develop in patients with the disease and the difficult oral access necessitate extreme care in preventing dental disease. The oral management of a patient with an edentulous mandible and progressive systemic sclerosis, using an overdenture supported by osseointegrated implants, is presented and discussed.

The law and ethics in relation to dentists treating HIV-positive patients: two recent court cases.

Two recent Canadian judgements regarding the application of human rights legislation to dentistry and HIV-seropositive patients are summarized and discussed. In the Ontario case of Jerome v. DeMarco, the Ontario Human Rights tribunal found that seropositivity constitutes a "handicap" under human rights legislation. However, the tribunal dismissed the claim by a seropositive patient that he had been illegally discriminated against by a dentist who, on learning the patient was seropositive, delayed treating him until the end of the day. This decision served as a precedent in the lengthy Quebec small claims court judgment of Hamel v. Malaxos. In this case, the dentist was held to have violated Quebec human rights legislation by trying to refer an HIV-seropositive patient to a hospital treatment centre rather than performing the appropriate dental treatment himself. Court judgments regarding this problem are reported and discussed.

Migratory stomatitis.

Migratory stomatitis is a unique oral condition with several descriptive names. The diagnosis is based on the clinical appearance and the history of the lesions. The etiology of this entity is still open to debate. A review of the literature and a clinical description of a study group consisting of seven additional cases, in which long-term follow-up was done, are presented. Migratory stomatitis is suggested as the most suitable term to describe accurately the nature and the behavior of this condition.