Early Tooth Loss in Children: A Warning Sign of Childhood Hypophosphatasia.

Premature exfoliation of primary teeth may be the first manifestation of this serious condition and the general dental practitioner plays an important role in recognizing dental anomalies and referring patients at an appropriate time. This is imperative to ensuring early diagnosis and good quality patient care. This article describes the case of a 4-year-old boy affected by childhood hypophosphatasia, who presented with premature exfoliation of his primary teeth as the first manifestation of this condition. An overview of the condition is outlined including a discussion of the likelihood of permanent dentition involvement. Clinical relevance: Oral manifestations of hypophosphatasia may be the first and the only signs of this condition and may be the basis upon which a diagnosis is made.

Quality assurance tests for digital radiography in general dental practice.

UNLABELLED: Quality assurance (QA) is essential in dental radiography. Digital radiography is becoming more common in dentistry, so it is important that appropriate QA tests are carried out on the digital equipment, including the viewing monitor. The aim of this article is to outline the tests that can be carried out in dental practice. CLINICAL RELEVANCE: Quality assurance for digital equipment is important to ensure consistently high quality images are produced.

Incidental findings on cone beam computed tomography in orthodontic patients.

OBJECTIVES: The objective of this study was to find out the incidence of incidental findings seen in cone beam computed tomography scans taken for orthodontic purposes and to see if these findings influence orthodontic treatment. SUBJECTS AND METHOD: Three hundred and twenty-nine consecutive scans carried out for orthodontic purposes using an i-CAT Classic were included in the study. Each scan was evaluated by a single radiologist and any incidental findings recorded. The incidental findings were further classified depending on whether the finding would influence orthodontic management. RESULTS: There were a total of 370 incidental findings in the 329 scans, with at least one incidental finding in 66% of patients. The most common incidental findings were dental (n = 120) and included retained deciduous roots (n = 24) and periapical disease (n = 15). Of the incidental findings 200 required no follow-up. A total of 168 findings required follow-up, but the overall orthodontic treatment plan was not altered. Only two findings were significant in that the orthodontic treatment was amended in light of the incidental finding. CONCLUSIONS: Incidental findings are very common on CBCT. However the majority of these findings do not affect orthodontic treatment planning.

The use of cone beam computed tomography in planning supernumerary cases.

This paper presents a series of four supernumerary cases where the use of further investigation with CBCT facilitated in the treatment planning process. The cases highlight different problems encountered when treatment planning this group of patients.

The role of cone beam computed tomography in the management of unfavourable fractures following sagittal split mandibular osteotomy.

Cone beam computed tomography (CBCT) has been at the forefront of recent technological advances within the maxillofacial region. CBCT is useful in the accurate assessment and planning of patients undergoing orthognathic surgery. We propose that it also has a role in the post-operative evaluation of a subgroup of patients who have suffered complications at the time of surgery. We present two cases where unfavourable splits occurred during a bilateral sagittal split osteotomy (BSSO) of the mandible. Both cases were investigated post-operatively with CBCT with the aim of identifying the potential cause of the unfavourable split and to establish accurate localization of the condyle in the glenoid fossa following intra-operative attempts at proximal segment control. CBCT should be considered for evaluation of the mandible following an unfavourable split where it is deemed that plain radiographs would not provide adequate information.

New developments in: three-dimensional planning for orthognathic surgery.

The limitations of plain film radiographs are well documented and the recent introduction of cone beam computed tomography (CBCT) imaging has been a breakthrough in enabling three-dimensional (3D) visualization of the bony skeleton and dentition. There are many reported applications for CBCT in the field of orthodontics and maxillofacial surgery, including the localization of impacted teeth and implant site assessment. More recently, by augmenting CBCT volumes of the maxilla, mandible and dentition, a virtual 3D patient can be created, which can allow planning of orthognathic surgery entirely in 3D. A commercially available software package for 3D orthognathic planning (Maxilim(R), Medicim NV, Belgium) is independently reviewed, familiarizing the reader with the technique for creating a virtual 3D patient, outlining the advantages and disadvantages of the software and concluding on the feasibility of its routine use in clinical practice.

Radiation protection: protection of patients undergoing cone beam computed tomography examinations.

UNLABELLED: Cone beam computed tomography is becoming a popular imaging modality in dentistry. The effective dose from these examinations is generally higher than conventional plain film radiography. This article outlines the ways of protecting patients from the harmful effects of radiation. CLINICAL RELEVANCE: Cone beam computed tomography is an emerging imaging modality. The effective doses are generally higher than conventional radiography and it is therefore important that anyone requesting or performing these investigations understands how to keep the doses to patients as low as reasonably practicable.

Dental and maxillofacial radiology: confidence, knowledge and skills in the newly graduated dentist.

Introduction The UK General Dental Council says that the new graduate will have the range of skills required to begin working as part of a dental team and be well-prepared for independent practice. This study examines the views of new dental graduates in the area of dental and maxillofacial radiology.Materials and methods A questionnaire survey of newly graduated dentists in Wales and South West England asked about their experience of undergraduate education in dental and maxillofacial radiology, and their confidence in the use and interpretation of imaging techniques in early independent practice.Results Most survey participants were confident in the teaching they had received in dental radiography and radiology, and that they could apply their knowledge and understanding to the more common investigations used in general dental practice. They were less confident in the uncommonly used techniques, such as oblique lateral and lateral cephalometric views.Discussion This study is encouraging in that new dental graduates say that their undergraduate education has given them the knowledge to be able to take, interpret and make clinical diagnoses using the commonest radiological investigations. This tends to validate the undergraduate education received and identifies areas to improve.Conclusion New dental graduates are confident in their knowledge and skills, and apply these to the most commonly used radiological investigations used in general dental practice.

Cone beam computed tomography: a useful tool in orthodontic diagnosis and treatment planning.

The aim of this article is to make clinicians aware of the use of cone beam computed tomography (CBCT) within the field of orthodontics. The paper describes five cases each one illustrating the improved diagnostic yield using CBCT over conventional radiography thus facilitating the appropriate treatment planning of patients.

Chondrosarcoma of the jaws.

UNLABELLED: Chondrosarcomas are rare lesions within the head and neck. They are most common in the 4th to 5th decade of life and usually present as a painless swelling. The purpose of this paper is to present a case and review the literature with regard to the radiographic appearance. Although the radiographic appearance is variable, there are some features that are common to most cases, the most important feature being that of an ill-defined radiolucent lesion with scattered radio-opacities. Although these features are seen in other malignant diseases, these features should alert the clinician to the possibility of a chondrosarcoma. CLINICAL RELEVANCE: Chondrosarcomas of the jaw are rare but important malignant lesions that require prompt diagnosis and treatment for improved outcomes.

Cone Beam Computed Tomography (CBCT) in General Dental Practice.

Cone beam computed tomography (CBCT) can be a useful adjunct to conventional plain film radiography, but its use must be carefully justified as the radiation dose is generally higher. Factors affecting the dose include the field of view (FOV) size, the exposure factors, the angle of rotation and voxel size. Once justified, the exposure should be fully optimised to ensure the dose to the patient is kept as low as possible while ensuring there is no reduction in the diagnostic yield. The European Commission (EC) and the Faculty of General Dental Practice (FGDP)(UK) have published selection criteria on the use of CBCT in dentistry. This article provides an overview of CBCT and summarises the latest guidance on selection criteria relevant to the general dental practitioner.

Cutaneous neck lesion of occult odontogenic origin: search for the tooth.

The differential diagnosis for inflammatory neck swellings is vast. A swelling of dental origin should be considered because, while rare, they mimic more common causes of neck lumps. We report the case involving a recurrent submandibular swelling in a young female patient that was presumed to be an epidermoid cyst by her general medical practitioner. After 6 months of unsuccessful treatment in the community, an odontogenic source was identified and treated successfully following referral to a local Oral and Maxillofacial department.

Inferior alveolar nerve injury related to mandibular third molar surgery: an unusual case presentation.

Perforation of the lower third molar roots by the inferior alveolar nerve is uncommon and can be difficult to determine by conventional radiographic methods. Presented is a case of perforation that was treated by coronectomy, and showed an unusual complication in that the retained root erupted, moving the canal with it. The radiographic assessment of root perforation and the imaging modalities used to assess such cases are discussed.

Adherence to NICE guidelines on recall intervals and the FGDP(UK) Selection Criteria for Dental Radiography.

AIM: The study investigated adherence of GDPs to National Institute for Health and Clinical Excellence (NICE) guidelines on recall intervals and the FGDP (UK)'s Selection Criteria for Dental Radiography. It also explored any factors that might influence GDPs' compliance with the guidelines. METHOD: A previously piloted questionnaire was circulated to all GDPs within the district of the Cardiff and Vale University Health Board (UHB). The questionnaire sought demographic data as well as answers to questions relating to compliance with guidelines. RESULTS: Of 215 questionnaires, 133 (61.9%) were returned. One hundred a nd thirty (97.7%) respondents were familiar with NICE recall guidelines and 112 (84.2%) were familiar with the FGDP(UK) publication Selection Criteria for Dental Radiography. Thirty six (27.7%) 'always' followed the NICE recall guidelines and, overall, 108 (81.8%) 'always or mostly' followed the guidance. Fifty one (38.6%) respondents 'always' carried out a caries risk assessment for adult patients and 57 (43.5%) 'always' carried out a caries risk assessment for child patients. Seventy nine (59.8%) reported that they 'always or mostly' recorded the patient's disease risk category in the notes. Fifty two (39.7%) respondents 'always' took bitewing radiographs that corresponded to disease risk. Overall, however, 119 GDPs (90.8%) 'always or mostly' took bitewing radiographs at appropriate intervals according to disease risk. Bitewing radiographs for new adult patients were prescribed more often for new child patients. The dentist's length of experience, NHS commitment, country of graduation, access to digital radiography or panoramic machines, receipt of any postgraduate qualifications or involvement in dental foundation training were proven not to have any statistically significant association with adherence to NICE or FGDP(UK) guidelines. CONCLUSIONS: Most dentists are familiar with NICE guidelines on recall intervals and the FGDP(UK)'s Selection Criteria for Dental Radiography. The number of dentists who always comply with these sets of guidance is low. None of the variables investigated were shown to have any statistically significant association with adherence to these guidelines.

Accuracy and reliability of cone beam computed tomography of the jaws for comparative forensic identification: a preliminary study.

Conventional computed tomography is an emerging modality in forensic identification but is not sufficiently accurate for use in dental identification primarily because of problems with metallic dental restoration-induced streak artifact. In this study, the accuracy and reliability of recording forensic information from cone beam computed tomography (CBCT) scans of the jaws when compared to conventional panoramic radiographs has been analyzed under experimental conditions. Information could be recorded with near-perfect repeatability and reproducibility. Information could also be recorded accurately, the sensitivity being 96.6% (95% CI, 95.1-98.1) and specificity being 98.4% (95% CI, 96.2-100). The metal dental restoration-induced streak artifact was at a level that permitted, in most cases, accurate observations. This is considered an important step in validating CBCT as a tool in comparative dental identification of bodies. It may have a role in mass fatalities and in chemical, biological, radiological, and nuclear incidents, but further studies are required to assess the feasibility of this.

Incidental findings arising with cone beam computed tomography imaging of the orthodontic patient.

Cone beam computed tomography (CBCT) of orthodontic patients is a diagnostic tool used increasingly in hospital and primary care settings. It offers a high-diagnostic yield, short scanning times, and a lower radiation dose than conventional computed tomography. This article reports on four incidental findings-that appear unrelated to the scan's original purpose-arising in patients for whom CBCT was carried out for orthodontic purposes. It underlines the need for complete reporting of the data set.

Is amelogenesis imperfecta an indication for renal examination?

BACKGROUND: The term 'amelogenesis imperfecta' (AI) describes a diverse group of hereditary conditions primarily affecting the quality and/or quantity of dental enamel. CASE REPORT: This paper describes a case in which hypoplastic AI with delayed/failure of eruption of the permanent teeth was shown to be associated with renal calcification. CONCLUSION: Given the importance of the renal involvement, the authors suggest that paediatric dentists consider referring all children with this dental phenotype for renal ultrasound examination.

A comparison of bone mineral density in the spine, hip and jaws of edentulous subjects.

OBJECTIVES: The aim was to investigate the relationship between bone mineral density (BMD) of the jaws (mandible and maxilla) and other skeletal sites. In addition, the influence of gender, smoking and the number of years without natural teeth were examined. MATERIALS AND METHODS: 18 edentulous patients (9 females, 9 males) with a mean age of 67.1 (sd 12.6) years had DXA scans to assess the BMD of the lumbar spine and hip, together with the ramus, body and symphysis of the mandible and the anterior of the maxilla. RESULTS: BMD values for the ramus were similar to those for the femur but significantly lower than the lumbar spine. The body and anterior mandible had higher values and the anterior maxilla lower values than both the femur and ramus. The ramus BMD showed moderately strong relationships with the standard measures of BMD in the spine and hip, but the BMD of other areas of the jaws showed no relationship with skeletal sites. The BMD for both the hip and the ramus showed an inverse relationship with increasing age. There was no statistically significant relationship between BMD of hip, spine and jaw and either years edentulous or cigarette years. (207) CONCLUSIONS: Although the ramus of the mandible may show correlation of BMD with skeletal sites, the areas of the jaws where implants may be placed do not. Therefore BMD of the skeletal sites could not be used to predict BMD of the jaws. The BMD of the jaws as measured by DXA showed no relationship with either years edentulous or cigarette smoking.

The genu of the submandibular duct--is the angle significant in salivary gland disease?

OBJECTIVES: To investigate whether the angle of the genu of the submandibular duct is a significant contributory factor in the development of salivary calculi or sialoadenitis. METHODS: A preliminary test with a phantom was performed, taking oblique lateral views with different vertical and horizontal beam angulations to assess the effect on the genu angle. The phantom comprised a dried mandible and a piece of wire bent to simulate the submandibular duct. There were no differences in the measured angle of the bend in the wire within the range of beam angulations used in the clinical study. One hundred and two sialographs were analysed from three separate groups of patients, normal controls (n=18), proven salivary calculi (n=61) and those with sialoadenitis (n=23). The oblique lateral radiographs were digitised and imported into the Denoptix digital system, and the angle measured using the VixWin 2000 software. Differences in angle between groups were investigated using analysis of variance. RESULTS: The mean angle of the genu was 103 degrees (range 41 degrees-147 degrees) in the control group, 108 degrees (range 46 degrees-178 degrees) salivary calculi group, and 91 degrees (range 24 degrees-155 degrees) in sialoadenitis patients. There were no statistical differences in the angle between the groups. CONCLUSIONS: There is a wide variation in the angle of the genu of the submandibular duct (24 degrees -178 degrees ). This angle does not appear to be associated with either sialolithiasis or sialoadenitis.