Solitary Large Intraoral Neurilemmoma of the Maxillary Vestibule: A Rare Case with Brief Literature Review.

AIM: This current report aimed at presenting a rare case of a large solitary intraoral neurilemmoma of the buccal vestibule followed by a brief review of literature of neurilemmoma published between 1997 and 2017. BACKGROUND: The diagnosis of slow-growing intraoral lesions requires a thorough patient history and clinical examination. Despite the best efforts of even the most experienced oral medicine expert, a definitive diagnosis may sometimes only be reached through excisional biopsy and histopathological evaluation. CASE DESCRIPTION: To the best of our knowledge, there have been only two cases of neurilemmoma of the buccal vestibule reported in the literature till date and, looking at the size of the lesion, our case is the largest among the ones reported. CONCLUSION: In the present case, a rare presentation of solitary buccal vestibular neurilemmoma establishes the need for the consideration of a wide range of pathologies in the differential diagnosis. CLINICAL SIGNIFICANCE: Clinicians should include neurilemmoma in their differential diagnosis for asymptomatic, slow-growing intraoral growths and ensure complete excision to prevent tumor recurrence. The reader should be able to recognize the clinical features of neurilemmoma and describe the histopathological features and management of the condition.

Comparison of Accuracy and Reliability of Working Length Determination Using Cone Beam Computed Tomography and Electronic Apex Locator: A Systematic Review.

AIM: To compare the accuracy and reliability of cone beam computed tomography (CBCT) and electronic apex locator (EAL) in determining the working length (WL). BACKGROUND: A comprehensive literature search was conducted across several databases and gray literature. A total of 1,358 potentially relevant journal articles were identified with publication dates ranging from 1996 to 2017. After screening and applying the inclusion and exclusion criteria, five studies were identified as eligible for review. Data extraction was completed in two blinded pairs, cross-referenced and subsequently merged. Discrepancies were resolved through collaborator mediation. Meta-analysis was not undertaken due to heterogeneity between included studies. REVIEW RESULTS: In all five studies, no statistically significant difference was found between CBCT and EAL measurements of WL. The reliability of CBCT compared with EAL was not determined. CONCLUSION: Due to significant heterogeneity between the included studies, the accuracy of CBCT compared to EAL couldn't be determined. Based on limited evidence, CBCT appeared to be as accurate as EAL. There was weak evidence suggesting that CBCT was reliable. Also the superiority of one method over the other could not be determined. These results should be interpreted judiciously. Further research is required to conclusively evaluate the accuracy and reliability of CBCT compared with EAL. CLINICAL SIGNIFICANCE: Preexisting CBCT scans may be appropriate for WL determination but acquiring a new CBCT for endodontic treatment is inadvisable due to cost and the as low as reasonably achievable (ALARA) principle.

Recurrent exophytic growth on maxillary posterior edentulous alveolar ridge--a diagnostic challenge.

Accurate diagnosis of recurrent intra-oral exophytic lesions require a thorough history, meticulous clinical examination and the experience of assessing these lesions, because they are not commonplace. Despite this, instituting the correct diagnosis tests the skills of an oral medicine expert. Therefore, the same is all the more challenging for a general practitioner who may encounter these lesions without any significant experience. The importance of diagnosing such lesions cannot be understated, as they may represent a myriad of conditions ranging from seemingly innocuous benign pathologic processes to much more sinister ones, like oral malignancy; occasionally some of these lesions may manifest atypically. Such atypical presentations may cloud the diagnostic process. Here a case uncharacteristic of the condition it represented is reported with the aim of increasing awareness of the diagnosis of such lesions.

Total anodontia in patient with hypohidrotic ectodermal dysplasia. Report of rare case of Christ-Siemens Touraine syndrome.

Ectodermal dysplasias are a complex group of genetically determined disorders clinically characterized by congenital alterations of the structures derived from the ectoderm. Even though ectodermal dysplasia with partial anodontia is common, this condition with total anodontia is not. We describe features of hypohidrotic ectodermal dysplasia with complete anodontia in a 6-year-old boy. In order to improve esthetics, speech and mastication, the child was provided with upper and lower complete dentures.

Comparison of efficacy of sodium hypochlorite with sodium perborate in removal of stains from heat-cured clear acrylic resin.

Acrylic resin bases of removable dentures attract stains and odor-producing organic and inorganic deposits. The use of chemical denture cleanser soaks is the most popular method of denture cleansing. This study was undertaken to compare the efficacy of two different denture cleansers--sodium perborate (Clinsodent) and sodium hypochlorite (VI-Clean)--in removing tea, coffee, turmeric and tobacco (paan) stains from heat-cured clear acrylic resins. Distilled water was used as a control. Both Clinsodent and VI-Clean were found to be the least effective in removing coffee stains and best for removing turmeric stain. It is necessary that the dental professional be aware of these results to ensure that denture wearers know how to select the appropriate denture cleanser.

Cone beam computed tomography in dentistry: practitioner awareness and attitudes. A scoping review.

Familiarity with cone beam computed tomography is a requisite for all dental practitioners involved in its use or referral. This scoping review examines the knowledge, attitudes, competence and confidence of dental practitioners and students towards cone beam computed tomography in the dental setting. A search of Medline, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature was conducted to identify and chart existing evidence. Relevant studies written in English and published after 1998 and up to July 2020 were included. Of 679 papers, 39 studies were included for analysis. Key findings include deficient knowledge despite a widespread recognition of its importance and willingness to increase proficiency in its use, as well as a largely positive and optimistic view of the technology. Future studies on practitioners' knowledge and attitudes towards cone beam computed tomography are suggested to consider the contexts of an Australian setting.

Non-syndromic oligodontia in permanent dentition of monozygotic twins: report of a rare case.

AIM: To report a case of non-syndromic oligodontia involving 26 permanent teeth in monozygotic twin sisters and to discuss the possible genetic etiology, inheritance pattern and associated dental anomalies of this condition. BACKGROUND: Hypodontia constitutes one of the most common developmental anomalies in humans and is defined as developmental absence of one or more teeth with reported prevalence of 1.6 to 9.6% in the permanent dentition. Oligodontia is defined as agenesis of six or more teeth excluding third molars. CASE REPORT: This article describes a case of non-syndromic oligodontia involving 26 permanent teeth in monozygotic twin sisters. The twins had positive family history of hypodontia in their paternal grandmother, parental consanguinity (first cousin) and similarity in pattern of oligodontia. Root formation of permanent maxillary first molars and central incisors was delayed in both the twins. SUMMARY: This article reports a case of non-syndromic oligodontia in permanent dentition of monozygotic twins. Possible genetic etiology, inheritance pattern and associated dental anomalies are discussed. CLINICAL SIGNIFICANCE: Strong genetic link associated with oligodontia help the dentist to know the possibility of its occurrence in other family members and in future generations.

Oral malignancy--an uncommon presentation with sinus tract opening: a case report.

Routine cases of oral carcinomas may present with history of longstanding nonhealing lesion of the ulcero-proliferative type with a rolled or indurated border. They are most often diagnosed accurately based on clinical evidence, radiographs, and histopathology. However, patients can present with confusing clinical features that can pose diagnostic dilemma with other lesions of the orofacial region. This paper presents a case of malignancy with swelling with concurrent sinus openings.

Professionally Delivered Local Antimicrobials in the Treatment of Patients with Periodontitis-A Narrative Review.

This review sheds light on the recent published scientific evidence relating to the use of professionally delivered local antimicrobial agents (LA's). The review also analyses drug delivery systems available to date and provides an update on the latest scientific evidence about the benefits, limitations, and clinical results obtained by use of local drugs in the treatment of periodontal disease. The search strategy revealed randomized controlled trials (RCTs) that compared the efficacy of adjunctive LA's to mechanical therapy alone. Based on the available evidence gathered from this review, we can infer that the use of local antimicrobial agents in conjunction to scaling and root debridement (SRD) delivers significant benefits in periodontal therapy and it is a useful aid, avoiding many of the side effects that systemic antibiotic therapy may involve. Local drug delivery (LDD) is an efficient and effective means of delivering drugs based on the evidence presented in the review. The authors of this review would suggest the use of local antimicrobials in cases of localized periodontitis or individual areas that do not respond to the usual mechanical therapy alone. This review summarizes the current use of local drug delivery in periodontal management ensuring that the general practitioners are able to choose an appropriate local antimicrobial.

Management of Dental Avulsion Injuries: A Survey of Dental Support Staff in Cairns, Australia.

BACKGROUND/AIM: The aim of this study was to assess the knowledge of dental support staff in providing appropriate first-aid advice regarding dental avulsion emergencies. METHODS: This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies. Dental support staff (includes dental assistants, administrative staff and other non-clinical staff) were contacted and data were collected from 50 private dental clinics across the Greater Cairns Area, Queensland, Australia. These data were collected through an online survey throughout 2020. Descriptive statistics and Pearson's Chi-squared test was used to analyze the data and any associations between categorical outcomes. RESULTS: This survey yielded a response rate of 34.1% with a margin of error of 10.3%. More than four-tenths of participants (42%) reported that they had received some form of dental avulsion management training previously. All but five participants (92%) denoted that they would immediately replant an avulsed permanent tooth. More than half of all participants would choose to rinse a soiled avulsed tooth with fresh milk (55%) and transport that tooth in fresh milk (65%) should they not be able to replant the tooth at the site. Almost nine in every ten participants (85%) expressed willingness to further their training in this area. Knowledge in replanting avulsed permanent teeth was found to be significantly impacted by gender, age, years of experience and participation in formal avulsion training. Male participants were found to be significantly more likely (p = 0.025) to replant a permanent avulsed tooth than their female counterparts. Participants who were 40 years of age and above were found to be significantly more likely to choose fresh milk to transport avulsed teeth (p = 0.0478). Older participants (p = 0.0021), alongside those who had greater years of experience (p = 0.0112) and those who had undertaken formal avulsion training (p = 0.0106) were all significantly more likely to express greater confidence in their ability to manage dental avulsion injuries. Participants who had previously received some form of education regarding avulsion injury management were also most likely to warrant further education and training in this area (p < 0.0001). CONCLUSION: This study demonstrated that dental support staff in the Greater Cairns Area seem to have a fair grasp of first-aid knowledge regarding the management of dental avulsion injuries. This result indicates that this knowledge has been picked up through years of experience, rather than a formal education. Despite this, one would expect people who work in the dental industry to be able to provide accurate and appropriate assistance during dental emergencies, hence, further training is warranted to ensure optimum patient outcomes.

Small cell carcinoma of the oral cavity: report of a rare case.

Small cell carcinoma is primarily a lung malignancy occurring rarely in extra pulmonary sites such as the larynx, nasal cavity, paranasal sinuses, and oral cavity. The authors report a rare case of primary small cell carcinoma of the maxillary sinus presenting as a growth of the alveolus extending into the hard palate and the buccal vestibule.

Maxillary sinus findings in the elderly: a panoramic radiographic study.

AIM: The aim of the present study was to investigate the prevalence of maxillary sinus findings in elderly subjects above the age of 50 through the use of panoramic radiography and to test the hypothesis that such findings are more prevalent in dentate subjects. METHODS AND MATERIALS: A total of 105 subjects over the age of 50 years were examined both clinically and radiographically in the Department of Oral Medicine and Radiology of the Manipal College of Dental Sciences in Manipal, India, over a period of three months for various reasons. Eight were excluded due to the lack of diagnostic quality of their radiographs. The manually calculated kappa test was used to determine the statistical significance of intra-examiner reliability. The other data were analyzed using a manually calculated z-test for proportions where z > or = 1.96 or p < 0.05 were considered statistically significant. RESULTS: The prevalence of radiographic maxillary sinus findings in 97 elderly subjects (aged above 50 years) were investigated with the use of panoramic radiography. Fifty subjects had at least one natural tooth radiographically in the upper jaw and 39 subjects were radiographically edentulous in the upper jaw. Mucous cysts or diffused mucosal thickenings were found in 42.26% of the subjects. Of the mucosal thickenings, 74.35% were found in subjects with a dentate upper jaw (p < 0.05). The prevalence of a mucous cyst was 2.06% in subjects with a dentate upper jaw and a finding of no mucous cysts in edentulous subjects suggests an odontogenic cause. CONCLUSION: According to the findings of the present study, the presence of mucosal thickening or mucosal cysts may be due to the presence of irritative stimuli, often an infection of dental origin, as these findings are more prevalent in dentulous subjects. CLINICAL SIGNIFICANCE: The panoramic radiograph is an excellent diagnostic tool for the identification of mucosal thickening and mucosal cysts. The accurate diagnosis of infective foci (chronic apical periodontitis, deep pockets caused by periodontitis) is necessary, because in conditions of decreased host resistance it may lead to acute sinusitis.

Bilateral Bifid mandibular canals - Special relevance for a general dental practitioner. Report of 2 cases.

Dental practitioners may encounter bifid mandibular canals upon radiographic assessment, and may not understand the true extent of this presentation. The presentation of a bifid mandibular canal poses difficulties when carrying out dental procedures, including administration of mandibular block anaesthesia, oral surgical procedures of the lower third molars, orthognathic surgery and implant placement. Therefore it is of paramount importance that general dental practitioners be aware of the radiographic appearance, as incorrect diagnosis of this rare presentation can lead to detrimental consequences. The purpose of the communication is to draw dental practitioner's attention to the variations of bifid mandibular canals and ensure practitioners interpret radiograph correctly to make an informed diagnosis and eliminate the risk of damage and discomfort in the event of surgical treatment being carried out. It is advised that dental practitioners refer for further imaging such as a cone beam scan for greater understanding of the anatomical variation. Key words:Bifid mandibular canal, inferior alveolar nerve, bilateral bifid mandibular canal.

Comparison of cone-beam computed tomography and panoramic imaging in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus: A systematic review.

The objective of the present systematic review was to analyze research articles that compare the accuracy of panoramic imaging to cone-beam computed tomography (CBCT) in assessing the relationship between posterior maxillary tooth roots and the maxillary sinus. A comprehensive literature search was conducted using various databases. Initial searching yielded 64 results, and after exclusion, five full-text articles were eligible. All were cohort studies, and the CBCT and panoramic images were either obtained from a pre-existing database or patients were recruited specifically for the study. Analysis showed that a panoramic image is sufficient for accurately detecting when the roots are at distinct distance from the sinus. However, if the roots are either laterally or medially projecting over the sinus and "just touching" it, panoramic images generally misinterpret this position, and instead make the root appear to be in the sinus. There were mixed results for when the root tip penetrates the sinus. Some studies claimed there was high agreeance between both modalities in this situation, while others had a low level of agreeance. In these situations, ordering a CBCT should be strongly considered to properly assess oral surgery risk with regard to maxillary posterior teeth.

Patients' views on dentists' ability to manage medical crises - results of focus group research.

BACKGROUND: Australia faces an ageing population which is more medically complicated than in years past, and it is important that we meet public expectations of management of medical emergencies in the dental clinic. No research before has examined in depth the public perception of dentists' medical emergency management. AIM: To qualitatively assess the publics' perception of medical emergencies in dentistry and their expectations of medical emergency management by dentists. METHODS: Twelve members of the public associated with a university clinic participated in two focus groups of six persons, where semi-structured discussions were carried out, audio recorded and transcribed, and subsequently underwent comprehensive thematic analysis. RESULTS: Key findings included a high expectation of dentists' general medical knowledge, as well as potential concern regarding a lack of routine medical assessment prior to undertaking dental treatment. CONCLUSIONS: Participants expected dentists to be highly proficient at managing medical crises and support the concept of medical emergency management certification for dentists.

Investigation of radiation-protection knowledge, attitudes, and practices of North Queensland dentists.

AIM: Queensland has current radiation-protection guidelines; however, with the absence of data exploring compliance and implementation, the efficacy is unknown. The aim of the present study was to investigate the knowledge and attitudes on radiation protection among private North Queensland (NQ) dentists. METHODS: A quantitative methodology was employed in an observational and descriptive study using questionnaires for data collection. RESULTS: Of the 154 questionnaires distributed, 63 were completed and returned. The respondents' knowledge concerning the technical details of their equipment was limited, with 31.5% and 47% not knowing the tube voltage and current utilized for their machines, respectively. In total, 23.8% of dentists had limited knowledge about the speed of the conventional film they used, 90.5% of respondents agreed that the role of imaging in dentistry is important, and 75.8% dentists reported the thyroid as the most important organ to protect during dental radiography. Their knowledge regarding position-distance rule was reasonably adequate; 80.3% of the dental practices appeared to follow the Australian Radiation Protection and Nuclear Safety Agency guidelines, 95.2% preferred taking radiographs if it was only urgent, and 69.8% identified a need for spreading awareness regarding radiation protection. CONCLUSIONS: An opportunity and need for further continuing education was identified among NQ dentists to ensure safety of patients.

Prosthetic rehabilitation of a complete bilateral maxillectomy patient using a simple magnetically connected hollow obturator: a case report.

AIM: The purpose of this clinical report is to present a description of the prosthetic rehabilitation of a bilateral complete maxillectomy patient using a two piece magnetically connected prosthesis. BACKGROUND: A complete bilateral maxillectomy defect presents a considerable reconstructive challenge for the prosthodontist. It results in devastating effects on cosmetic, functional, and psychological aspects of the patient. REPORT: A 46-year-old woman reported with a chief complaint of missing teeth in the upper jaw. Her primary concerns were a poor facial appearance, inability to chew food, and regurgitation of the food into the nasal cavity. She was diagnosed with carcinoma of the maxillary sinus, for which a bilateral maxillectomy was done followed by post surgical radiation therapy. The prosthetic treatment objectives were to separate the nasal and oral cavities, restore the mid-facial contour, and improve her masticatory functions by providing a full complement of maxillary teeth using a two-piece connected hollow obturator prosthesis connected by a magnet. SUMMARY: Insertion and removal of a large prostheses used for rehabilitation of midfacial defects requires good neuromotor coordination and an adequate mouth opening. Because these factors were problematic for this patient, the treatment plan was to fabricate a two piece magnetically connected prosthesis. After fabrication and insertion of the prosthesis, the fit between two sections was evaluated and instructions for insertion, removal, and maintenance of the obturator were given. The patient's speech, masticatory efficiency, and swallowing dramatically improved after insertion.

Clinical diagnosis and oral rehabilitation of a patient with amelogenesis imperfecta: a case report.

AIM: This clinical report describes the oral rehabilitation of a young female patient diagnosed with the hypocalcified, autosomal recessive type of Amelogenesis imperfecta (AI). A brief discussion on diagnosis of AI is also included. BACKGROUND: AI has been defined as a group of hereditary enamel defects not associated with evidence of systemic disease. It can be characterized by enamel hypoplasia and/or hypomaturation or hypocalcification of the existing teeth. Restoration for patients with this condition should be oriented toward the functional and esthetic rehabilitation and the protection of these teeth. REPORT: A 31-year-old female patient presented with concerns including extreme sensitivity; dissatisfaction with size, shape, and shade of teeth; and poor masticatory efficiency. She was very conscious about the appearance of her teeth and reported that her primary dentition was affected in the same manner. The specific objectives of this treatment were to eliminate tooth sensitivity, enhance esthetics, and restore masticatory function. Treatment included crown lengthening procedures and placement of anterior and posterior metal-ceramic crowns. A 12-month follow-up with clinical and radiographic examinations revealed no evidence of any untoward effects of the treatment on the restored teeth or their supporting structures. SUMMARY: Management of a patient with AI is a challenge for the clinician. The treatment options vary considerably depending on several factors such as the age of the patient, socio-economic status, periodontal condition, loss of tooth structure, severity of the disorder, and, most importantly, the patient's cooperation. The clinician has to consider the long-term prognosis of the treatment outcome. This clinical report describes the fabrication of metal ceramic and all metal crowns for the restoration of severely worn teeth in a patient with AI which requires meticulous maintenance of oral hygiene and patient co-operation.

Central giant cell granuloma of the anterior maxilla.

Central giant cell granuloma (CGCG) formerly called giant cell reparative granuloma is a non-neoplastic proliferative lesion of unknown etiology. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination but was histopathologically diagnosed as CGCG. We describe a case of central giant cell granuloma arising from the anterior maxilla to highlight to the general dental practitioner the importance of histopathology in the diagnosis of this enigmatic lesion.

The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India.

The purpose of the present study was to evaluate the prevalence of oral mucosal lesions in Manipal, Karnataka State, India. A total of 1190 subjects who visited the department of oral medicine and radiology for diagnosis of various oral complaints over a period of 3 months were interviewed and clinically examined for oral mucosal lesions. The result showed the presence of one or more mucosal lesions in (41.2%) of the population. Fordyce's condition was observed most frequently (6.55%) followed by frictional keratosis (5.79%), fissured tongue (5.71%), leukoedema (3.78%), smoker's palate (2.77%), recurrent aphthae, oral submucous fibrosis (2.01%), oral malignancies (1.76%), leukoplakia (1.59%), median rhomboid glossitis (1.50%), candidiasis (1.3%), lichen planus (1.20%), varices (1.17%), traumatic ulcer and oral hairy leukoplakia (1.008%), denture stomatitis, geographic tongue, betel chewer's mucosa and irritational fibroma (0.84%), herpes labialis, angular cheilitis (0.58%), and mucocele (0.16%). Mucosal lesions like tobacco-related lesions (leukoplakia, smoker's palate, oral submucous fibrosis, and oral malignancies) were more prevalent among men than among women. Denture stomatitis, herpes labialis, and angular cheilitis occurred more frequently in the female population.