Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism.

Hyperparathyroidism (HPT) is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone (PTH), causing disturbances in calcium homeostasis. Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia. Brown tumors are rare, benign, tumor-like bone lesions, occurring in 1.5% to 4.5% of patients with HPT, as a complication of an uncontrolled disease pathway, and are nowadays rarely seen in clinical practice. The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass. Furthermore, it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion. The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium, phosphorus, and PTH. Although when present, brown tumor is quite pathognomonic for HPT, the histologic finding often suggests a giant cell tumor, while clinical presentation might suggest other more frequent pathologies such as metastatic tumors. Treatment of brown tumors frequently focuses on managing the underlying HPT, which can often lead to regression and resolution of the lesion, without the need for surgical intervention. However, in refractory cases or when dealing with large symptomatic lesions, surgical treatment may be necessary.

Analysis of Hospital-Based Dental Procedures Under General Anesthesia in Uncooperative Patients: a Retrospective Study.

Background: General anesthesia is a well-documented therapeutic option for the provision of dental treatment, particularly in patients with special healthcare needs and uncooperative pediatric patients. Objectives: This retrospective study aimed to analyze the characteristics of dental general anesthesia (DGA) procedures for uncooperative patients of all ages in a tertiary healthcare facility, Clinical Hospital Dubrava, in Zagreb, Croatia. Material and methods: The hospital records for the patients treated for various dental reasons under GA were obtained at the Clinical Hospital Dubrava in Zagreb, Croatia. Results: Between 2014 and 2019, a total of 810 DGA procedures were performed including 607 patients. The median age was 18 years. Almost half of the patients referred to undergo DGA procedures were from the City of Zagreb and Zagreb County, 27.8% (N=225) and 21.0% (N=170), respectively. More than 90% of patients undergoing DGA procedures were referred with 1 to 3 medical conditions. 47.9% of patients had 1 to 3 dental conditions, of which caries was the most common condition (95.7%). The mean waiting time (±SD) was 113.06 (±62.62) days. 90 patients (14.8%) were referred for dental procedures under GA more than once, accounting for 203 procedures (25.1%). Conclusions: DGA remains a single dental treatment option for specific individuals. There is an institutional and, also, an organizational need to address the long waiting times and high repeated DGA rates.

Tonsillolithiasis and orofacial pain.

Tonsilloliths are rare calcified structures that usually result from chronic inflammation of the tonsils. Concretions show differences in size, shape and colour. They are usually asymptomatic but can be associated with halitosis, foreign body sensation, dysphagia and odynophagia, otalgia, and neck pain. A patient was referred because panoramic radiography performed by a general dentist revealed radiopaque shadows over the ascending rami of the mandible, located bilaterally: a solitary structure on the higher portion of the right side and two small structures on the left side. Paroxysmal attacks of orofacial pain and symptoms such as dysphagia and swallowing pain on the left side distributed within the tonsillar fossa and pharynx and the angle of the lower jaw were present. The computed tomography images revealed bilateral tonsilloliths. Clinically, there was no sign of inflammation, and the patient's past history revealed an approximately 2-year history of dysphagia, swallowing pain and left-sided neck pain. At the request of the patient, no surgical intervention was carried out. Glossopharyngeal neuralgia is a rare entity, and the aim of this report was to indicate the importance of tonsilloliths as a cause of orofacial pain.

Salivary Scca1, Scca2 and Trop2 in Oral Cancer Patients-A Cross-Sectional Pilot Study.

Oral squamous cell carcinoma (OSCC) is frequently diagnosed in the advanced stages. The purpose of this paper is to determine the salivary values of SCCA1, SCCA2 and TROP2 in patients with T1N0M0 OSCC and to compare them with the values obtained from healthy individuals. Unstimulated (UWS) and stimulated (SWS) saliva was sampled from 29 patients with T1N0M0 OSCC and 29 sex- and age-matched healthy individuals. Statistical difference was observed in SCCA1 and SCCA2 levels both in UWS and SWS samples. TROP2 was not measurable in most of the salivary samples. Both SCCA1 and SCCA2 could represent potential biomarkers for the early-stage OSCC. Research on a larger sample and biomarker validation is needed to assess the clinical potential of SCCA1 and SCCA2 in the OSCC early diagnostics.

Anatomical Variations of the Bifid Mandibular Canal on Panoramic Radiographs in Citizens from Zagreb, Croatia.

BACKGROUND: The bifid mandibular canal (BMC) is an anatomical variation with reported prevalence ranging from 0.08 to 65%. Identifying anatomical variations of mandibular canal is very important in order to prevent possible complications during oral surgical and other dental procedures. OBJECTIVES: The aim of this study was to determine the prevalence and to classify the morphology of BMCs using digital panoramic radiographs. MATERIAL AND METHODS: A retrospective study was conducted that included 1008 digital panoramic radiographs (412 female and 596 male) used to identify the type of BMC. Panoramic radiographs were analyzed by three oral surgeons and one dentist, and BMCs were classified into six different types, 4 types according to Langlais et al. (types 1-4), and two new types (types 5 and 6) described by authors. RESULTS: The prevalence of BMC was 4.66% (n=47), with no significant differences in gender between BMC types (P=0.947; χ2=0.74). The prevalence of type 1 BMC was 0.79% (n=8), type 2 2.08% (n=21), type 3 0.30% (n=3), type 4 0% (n=0), type 5 0.89% (n=9) and type 6 0.60% (n=6). CONCLUSION: This study revealed a relatively high prevalence of BMCs among Zagreb citizens. Furthermore, two new types of BMCs were described. These results stress the importance of a careful and thorough radiographic analysis prior to each invasive procedure in the mandible.

Salivary melatonin in oral squamous cell carcinoma patients.

Melatonin's role in circadian rhythm is well documented, as are its' anti-oxidant, oncostatic and anti-inflammatory properties. Poor sleep quality has been associated as a potential risk factor for several malignancies, including head and neck cancers. The purpose of this study is to determine salivary melatonin (MLT) levels in oral squamous cell carcinoma (OSCC) patients, compare the salivary MLT levels with those in healthy individuals and compare the salivary and serum levels in OSCC patients. Furthermore, the aim is to investigate the potential relationship between sleep quality and salivary MLT levels in OSCC patients. Unstimulated (UWS) and stimulated (SWS) whole saliva was sampled from patients with T1N0M0 and T2N0M0 OSCC (N = 34) and 33 sex and age matched healthy subjects. Serum samples were taken from 11 OSCC patients. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) questionnaire. Melatonin levels in UWS and SWS were significantly higher in the OSCC group. Sleep quality was significantly lower in patients with OSCC (P = 0.0001). ROC analysis was found to be significant (P < 0.001) in evaluating MLT concentration limit in diagnosing OSCC. The expected relationship between sleep quality and salivary MLT levels in OSCC patients was not observed. Our results suggest salivary MLT as a potential biomarker that might facilitate non-invasive detection of early stage OSCC.

Mucoepidermoid carcinoma misdiagnosed as palatal odontogenic infection: an overview on the differential diagnosis of palatal lesions.

Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authors' knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MEC's differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list.

Undergraduate Students' Knowledge on Temporomandibular Disorders in Croatia.

The aim of this study was to evaluate Croatian undergraduate students' knowledge based on what they learned in the recent course, as well as the students' own judgment and opinions about geriatric dentistry education concerning temporomandibular disorders (TMDs) of the elderly. The study was carried out by means of a questionnaire administered in the last study year to students of the School of Dental Medicine, University of Zagreb and students of the Department of Dental Medicine at the School of Medicine, University of Rijeka. Th e questionnaire included questions about relevant specific knowledge on TMD, and statements related to their own opinion about geriatric dentistry education received during the study. Regarding students' knowledge related to TMDs, students from Rijeka gave more positive answers (p=0.012). Students from Rijeka gave more positive answers regarding physical therapy for treatment of TMD (p=0.004) and disc displacement and osteoarthritis as the most common disorders of the temporomandibular joint (p=0.031). Students from Zagreb were more unsatisfi ed with the skills in the field of geriatric dentistry (disagreed 57.45%) than students from Rijeka (45.83% had neutral standpoint and 37.50% agreed) (p=0.005). The level of the participants' knowledge pointed to the need of improving undergraduate dental teaching about the specific geriatric education, including knowledge about TMD.

The effect of tobacco use on oral health and dental readiness in the Croatian Army.

This study examined tobacco use as a risk factor in the development of periodontal disease as dental emergency and dental readiness among soldiers. A total of 884 soldiers were followed: 650 recruits and 234 professional active veterans. They were categorized into dental readiness classes, and questionnaires were completed about tobacco use. Overall, 62.7% of soldiers reported current smoking, with a higher prevalence of smokers among recruits. The results showed a significant difference in smokers vs. non-smokers in dental readiness, supragingival/subgingival calculus, gingivitis, and Class 3 dental fitness. More recruits (63.8%) smoked than veterans (59.4%), but greater prevalence of daily cigarette smoking and duration of smoking habits was found among veterans. In both groups, soldiers who smoked were characterized by a higher percentage of periodontal health problems and decreased combat readiness compared to soldiers who did not smoke. This indicates a need for oral health prevention program, and cigarette smoking and cessation programs.