Oral and Physical Manifestations of Anorexia and Bulimia Nervosa.

Food avoidance and disordered eating behavior are hallmarks of the psychopathologic disorders known as anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by severe restriction of food intake, which leads to weight loss and the medical consequences of starvation. Bulimia nervosa is characterized by attempts to curtail food intake, interspersed with binge eating, followed by self- induced vomiting to rid the body of food. Tooth erosion and heightened sensitivity, caused by tooth contact with gastric acid during vomiting, are among several intraoral signs and symptoms of anorexia nervosa and bulimia nervosa. Self-induced vomiting in bulimic patients may cause trauma to intraoral soft tissues in the form of epithelial ulceration. Dentists and dental hygienists are often the first health care providers to examine patients with anorexia nervosa and bulimia nervosa, and are in a good position to recognize the physical and oral effects of eating disorders. Unfortunately, too few oral health practitioners consistently assess patients for oral manifestations of eating disorders, and equally few patients suffering with eating disorders regard their oral health practitioners as an important source of information about eating disorders. Lack of knowledge about the intra- and extraoral effects of eating disorders creates barriers that prevent patients from speaking frankly with oral health practitioners about their issues. It is incumbent upon oral health practitioners to recognize and diagnose the effects of these disorders and render appropriate treatment.

Rapid Life-Saving Response to Anti-PD-1 in a Solid Organ Transplant Recipient With Metastatic Cutaneous Squamous Cell Carcinoma: A Case Report and Review.

SUMMARY: Anti-programmed cell death protein 1 (PD-1) therapy is considered effective in the treatment of metastatic or locally advanced cutaneous squamous cell carcinoma but the use of these agents in solid organ transplant recipients (SOTRs) is often taken with caution. While anti-tumor effects without graft rejection have been reported, studies have shown high rates of fatal graft rejection with immune checkpoint therapy. In this case report, we present an SOTR patient with life-threatening, acute hypoxic respiratory failure due to rapidly progressive metastatic cutaneous squamous cell carcinoma with lung and pleural involvement. Modification of their immunosuppressive regimen and treatment with front-line anti-PD-1 inhibitor, pembrolizumab, led to rapid clinical response with near complete resolution of metastatic pulmonary disease and no long-term evidence of graft rejection. Our case report shows that front-line treatment with PD-1 inhibitors can be safely administered in SOTR patients with rapid metastatic disease control.

The role of occlusal loading in the pathogenesis of non-carious cervical lesions.

PURPOSE: To evaluate the putative role of occlusal loading in the pathogenesis of non-carious cervical lesions (NCCLs) in subjects who exhibited mixed excursive guidance [i.e., immediate canine guidance on one side and group function (GF) on the other]. METHODS: 20 subjects with Angle Class 1 occlusion and having from 1 to 5 NCCLs on separate teeth were selected. Only subjects who displayed mixed excursive guidance were recruited so that they could serve as their own controls. Non-carious cervical lesions were recorded on casts mounted in semi-adjustable articulators. RESULTS: On the GF sides, 22.5% of all teeth that contacted in working excursions exhibited NCCLs; only 2.1% of the teeth on the canine guided sides exhibited NCCLs, which were found exclusively in canines. Although a case for the multifactorial etiology of NCCLs remains strong, our data, albeit limited, seems to support the dominant role of occlusion in lesion formation.

The occlusal guard: a simplified technique for fabrication and equilibration.

Hard occlusal guards have been used effectively to treat myofacial pain originating from parafunctional activities. Also, they can protect the natural dentition when it opposes porcelain restorations, help to evaluate changes in occlusal vertical dimension during full mouth rehabilitation, minimize further tooth loss in patients with abfraction lesions, and redirect occlusal loads more favorably onto dental implant-supported prostheses. A simplified technique is described to fabricate a properly designed wax model of an occlusal guard that can be processed in acrylic in the same manner used to construct a complete denture.

Abfraction lesions--where do they come from? A review of the literature.

The theory of non-carious cervical lesions (NCCLs) suggests that tooth flexure arising from cyclic, eccentric occlusal forces causes their formation and progression in vulnerable cervical regions of teeth. The etiology is still controversial. Attrition, corrosion, abrasion and stress-corrosion might act alone or in combination to initiate and perpetuate lesions. This review of the literature provides the basis for the diagnosis that can be used in consideration of treatment options.

The acrylic resin transfer coping technique for making accurate interocclusal records.

When the goal of restorative treatment is to maintain the patient's preexisting intercuspation and occlusal vertical dimension (OVD) following tooth preparation for crowns or fixed partial dentures (FPDs), casts must be mounted on an articulator in the same pretreatment tooth-to-tooth relationship. A simple technique is described that uses acrylic transfer copings over prepared teeth to record and preserve this relationship so that working and opposing casts can be mounted accurately. The technique may be used to recapture the lost third leg of the tripod after teeth have been prepared. To further reduce errors when mounting casts onto an articulator, a method is recommended that uses rigid connectors to join and stabilize casts in a manner that minimizes potential movement during placement and setting expansion of gypsum mounting materials.

Tensile bond strength of three dual-cure bonding systems.

OBJECTIVES: The purpose of this study was to test and compare the tensile bond strength of three dual-cure bonding systems on dentinal surfaces. METHODS: Scotchbond MP Plus (3M Dental Products, St. Paul, MN 55144-1000), Allbond 2 (Bisco INC. Itasca, IL 60143) and Prime & Bond 2.1 Dual Cure (DENTSPLY Caulk, Milford, DE 19963-0359) were the three agents tested following manufacturer's instructions on flat dentinal surfaces. A total of 60 teeth were obtained, prepared and stored in distilled, deionized water prior to testing. Twenty teeth were distributed randomly to each bonding agent product. Ten of the 20 were light-cured and the other 10 were activated chemically, thereby creating six experimental groups. "Enforce" (DENTSPLY Caulk) resin cement was placed in a cylinder on the bonding agent interface in all 60 teeth. A pull test was performed using an Instron machine (Instron Corp., Canton, MA 02021) at a speed of 1 mm/min and under continuous load until failure. RESULTS: This study demonstrated that no significant difference existed among the means of the six sample groups involved when they were compared against each other using two-way ANOVA (p < 0.05). Yet, when comparing light-cured samples as a group, versus chemically-cured samples, light-cured samples produced a significantly stronger bond. When comparing adhesive systems, regardless of the cure method, Scotchbond MP Plus resulted in a significantly stronger bond than Allbond 2. When only comparing chemically-cured samples, Scotchbond MP Plus was significantly stronger than Allbond 2. Prime & Bond 2.1 was not significantly different than Scotchbond MP Plus or Allbond 2 regardless of cure type. No difference existed when comparing only light-cured samples. CLINICAL RELEVANCE: The bond strengths of adhesive systems are critical for the dentist in deciding which product to purchase to ensure the restoration will be a long-lasting one.

A resin acrylic and plaster solder index technique for realigning an ill-fitting fixed partial denture framework.

A resin acrylic and plaster solder index technique is a simple, accurate, secure, and cost-effective way to intraorally realign an ill-fitting fixed partial denture framework. Once the fixed partial denture framework is sectioned and segments are found to fit, an intraoral index preserves the correct relationship among segments and holds castings together securely enough to avoid separating until they can be embedded in solder investment and soldered in the dental laboratory. This technique is described here, together with a literature review and a discussion of the technique's advantages relative to other indexing techniques and materials.

Quantifying Flabby Ridge Tissue Displacement During Impression-Making for Patients With Combination Syndrome.

Patients with Combination syndrome present with early bone loss and flabby hyperplastic tissues in the anterior maxilla caused by functional loads exerted by mandibular anterior teeth on maxillary complete dentures. Use of conventional mucocompressive impression techniques captures flabby maxillary anterior ridge tissue in a distorted state, and dentures made from such impressions could displace flabby tissues when loaded and become loose when unloaded. In this study, which examined two patients diagnosed with Combination syndrome, computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to determine the degrees of displacement when six impression materials were used for making final impressions for complete dentures.

Oral manifestations of renal osteodystrophy: case report and review of the literature.

Renal osteodystrophy, characterized by uneven bone growth and demineralization, is described. Oral manifestations of the disorder are described, and the value of dental radiographs in early detection of renal osteodystrophy is noted. A case report of a patient with severe oral complications, which resulted from long-standing end-stage renal disease and secondary hyperparathyroidism, is presented. Giant cell lesions of hyperparathyroidism, referred to as brown tumors (which may be associated with pain and swelling), are the key clinical oral manifestations and are the most dramatic dental radiographic finding in patients with renal osteodystrophy. Bone changes may include loss of lamina dura, giant cell lesions of hyperparathyroidism, and bone demineralization. The dentist's role in detection, assessment, and treatment is stressed.