Proliferative and anti-apoptotic indices of unicystic ameloblastoma, odontogenic keratocyst, dentigerous cyst and radicular cyst.

OBJECTIVE: The aim of this study is to compare the proliferative capacity and antiapoptotic capacity of unicystic ameloblastoma (UA), odontogenic keratocyst (OKC), dentigerous cyst (DC) and radicular cyst (RC) by assessing the Ki-67 labeling index (LI) and Bcl-2 LI, respectively. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue blocks of twenty-three histopathologically diagnosed UAs, 6 OKCs, 8 DCs and 10 RCs were selected from the archival specimens. Five micrometer thick sections of tissue blocks of the lesions were processed for immunohistochemical staining with Ki-67 and Bcl-2. The Ki-67 LI and Bcl-2 LI were determined for the cases with a positive reaction. RESULTS: Ki-67 expression was seen in 6 (26.1%) cases of UA, 4 (66.7%) OKC, 1 (12.5%) DC and 1 (10.0%) RC. There was a statistically significant difference between the mean Ki-67 LI of UA and OKC (P = 0.024). Bcl-2 expression was seen in 16 (69.6%) UA, 5 (83.3%) OKC, 5 (62.5%) DC and 5 (50.0%) RC. The mean Bcl-2 LI of UA was significantly higher than that of DC (P = 0.048). Furthermore, cases of OKC had significantly higher mean Bcl-2 LI compared to DC (P = 0.026) and RC (P = 0.049). CONCLUSION: This study suggests that the Ki-67 LI may help in differentiating OKC from UA. The Bcl-2 LI may be useful in differentiating UA from DCs, and differentiating OKC from DC and RC.

Evaluation of Psychological Factors in Temporomandibular Joint Pain Dysfunction Syndrome: A report of 3 cases and review of the literature

Objective: This study reports the findings from the psychological assessment of temporomandibular pain dysfunction syndrome (TMJPDS) patients and the treatment outcome following a multidisciplinary team management of this condition. Methods: Three patients suffering from TMJPDS were administered the following psychological assessment questionnaires: Eysenck Personality Questionnaire (EPQ), Symptom Distress Checklist ­ 90 (SCL - 90), Spielberger's State-Trait Anxiety Inventory (STAI), Index of self Esteem (ISE) and Chronic Pain Grade (CPG). The completed questionnaires by the patients were analyzed by a Clinical Psychologist. Case Reports: Case 1 was a 32 years old male. Psychological assessment showed that he manifested high peak position to being anxious and high feeling of tension associated with dental treatment. He also showed an increased pain perception and disability caused by TMJPDS. Case 2 was a 61 years old female. Psychological test showed that despite her high level of trait anxiety, the feeling of tension associated with dental treatment was low. She perceived her abnormal pain and disability caused by the disease to be low. Case 3 was a 39 years old female. Psychological assessment revealed that her predisposition to being anxious was high; however, her anxiety related to dental care was low. She also reported a reduced pain perception and disability caused by the disease condition. Conclusion: This study shows that TMJPDS is often associated with psychological problems, such as anxiety, with or without tension related to dental care, abnormal pain perception and psychological disability. A multidisciplinary team approach including dentists and mental health experts in the management of patients suffering from TMJPDS is recommended

Early response to medical treatment of trigeminal neuralgia in a Nigerian population.

BACKGROUND: This study evaluates the clinical profile of patients suffering from trigeminal neuralgia (TN) and correlates the findings with early response of the patients to medical treatment. PATIENTS AND METHODS: A 4-year prospective study in which patients diagnosed of TN were treated medically and followed up weekly for 8 weeks to determine early treatment outcome, in the University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: Of the 287 patients seen during the study period, a total of 14 (4.9%) patients were diagnosed of TN. Thirteen (4.5%) of the cases were selected based on compliance to the 8-week follow-up visits, consisting of 8 (61.5%) males and 5 (38.5%) females, giving a ratio of 1.6:1. The mean age of the patients was 50±1.5 years. The mandibular (n = 6, 46.2%) and maxillary (n = 5, 38.5%) divisions of the trigeminal nerve were mostly affected. The lesion was slightly more common on the right side of the face (n = 7, 53.8%) than the left side (n = 6, 46.2%). Talking (n=4, 30.8%) and chewing (n = 3, 23.1%) were the most frequent trigger factors. The patients mostly described the pain as severe, spontaneous, and sharp (n = 5, 38.2%). Most patients became stable on tablets carbamazepine 200 mg 12 hourly, folic acid 5 mg daily, and phenytoin 100 mg daily. Good response was observed in most patients within 2 weeks (n = 6, 46.2%) of medical treatment, especially in patients at the seventh decade of age (n = 3, 23.1%) and those with lesions involving the mandibular division of the trigeminal nerve (n = 3, 23.1%). CONCLUSION: This study shows early response of TN to medical treatment. We recommend combination therapy of carbamazepine and folic acid in the treatment of patients, especially elderly patients with lesions involving the mandibular division of the trigeminal nerve.

Prevalence of Oro-Facial Lesions in Human Immunodeficiency Virus Infected Women in a Nigerian Teaching Hospital.

BACKGROUND: Orofacial lesions are among the earliest clinical manifestations of HIV infections. OBJECTIVE: This study to investigate the oral lesions seen in HIV positive women with emphasis on the need for diagnosis of oral lesions by all health workers. METHOD: A prospective cross-sectional study of HIV positive women attending the HIV/AIDS clinic (PEPFAR) of the University of Benin Teaching Hospital, Benin-city, Nigeria. The subjects were investigated for the presence of oral lesions, between the period January and March, 2011. The study was approved by the ethics committee of the hospital and a written informed consent was obtained from each subject that participated in the study. Determination of HIV related oral lesions was carried out clinically using the criteria proposed by the ECC/WHO, 1993. P values ≤ 0.05 were considered significant. RESULTS: A total of 107 HIV/AIDS infected women attending the HIV/AIDS Clinic were examined. The age ranged from 18 to 50 years with mean age of 36 ± 9.2 years. The age group of 21 to 30 was the most affected (n = 36, 33.6%). Sixty-one subjects (57.0%) presented with oral lesions. The most common observed oral lesion was pseudomembranous candidiasis (n = 37, 37.8%); followed by melanotic pigmentation (n = 11, 11.2%) and xerostomia (n = 11, 11.2%). Group 1 oral lesions accounted for 64.3%, group 2 accounted for 30.6%, while group 3 accounted for 5.1%. CONCLUSION: Oro-facial lesions are among the earliest clinical manifestations of HIV infection. These were commonly observed in HIV infected Nigerian women. Oral candidiasis the most common oral lesion observed in the series may therefore be used as a clinical indicator of early immunodeficiency associated with HIV.

Alveolar Osteitis: Patients' compliance to post-extraction instructions following extraction of molar teeth.

BACKGROUND: To evaluate the effect of various combination of post-extraction regimen administered to patients who had intra-alveolar molar tooth extraction. PATIENTS AND METHODS: One year prospective study involving 76 consenting patients who came for 1-week post-extraction review. The patients were placed on warm saline mouth rinse with (verbal instruction) or without antibiotic and or analgesic therapy (written prescription), after intra-alveolar molar tooth extraction. Information was obtained from the patients through questionnaire and clinical examination. RESULTS: The patients were placed on warm saline mouth rinse (n = 29, 38.2%) only, warm saline rinse, antibiotics (Amoxicillin and metronidazole) and Paracetamol (n = 31, 40.8%), Paracetamol and warm saline rinse (n = 12, 15.8%) and antibiotics (Amoxicillin and metronidazole) and Paracetamol (n = 4, 5.3%). A total of 63 (82.9%) patients complied with the post-extraction regimen, giving a significant high compliance to the post-extraction instructions (P = 0.001). There were 10 (13.2%) cases of post-extraction localised alveolar osteitis, with predilection for the lower molar teeth (n = 6, 7.9%) and a significant predilection for females (n = 8, 10.5%) [P = 0.005]. Overall, there were five (6.6%) cases each of localised alveolar osteitis in the compliant patients (n = 63, 82.9%) and non-compliant patients (n = 13, 17.1%), giving a ratio of 1:13 and 1:3, respectively. There was significant association of compliance with post-extraction instruction and the reduced incidence of localized alveolar osteitis (P = 0.015). CONCLUSION: This study showed a significant patients' compliance with post-extraction warm saline rinse, prophylactic antibiotics and analgesic and a corresponding significant reduction in the incidence of localised alveolar osteitis following intra-alveolar molar tooth extraction. This study emphasises the need to properly educate patients on the effect of compliance to various combination of post-extraction regimen.

A clinicopathologic correlation in the diagnosis of periradicular lesions of extracted teeth.

PURPOSE: We aimed to determine the contributory percentage of histopathologic diagnoses of routine biopsies and to ascertain the possible indicators for histopathologic examination to confirm the clinical diagnosis of periradicular lesions of extracted teeth. PATIENTS AND METHODS: This was a prospective study carried out over a period of 8 months on patients who had single tooth extraction and routine histopathologic examination of recoverable periradicular tissues from extracted teeth. RESULTS: A total of 136 patients participated in this study. There was a male/female incidence ratio of 3:2 and most of the patients with histopathologically diagnosed lesions were within the first, second, and third decades of life (n = 49, 36.0%). Seventy-five (55.2%) cases had histopathologically diagnosed periradicular lesions, which were mostly periapical abscess (n = 30, 22.8%) and inflammatory (periapical) granuloma (n = 23, 16.9%). Some clinical and radiologic features were associated significantly with histopathologic diagnosis of some periradicular lesions (P < .05). There also was a significant correlation of clinical diagnosis with histopathologic diagnosis of inflammatory (periapical) granuloma, periapical abscess, chronic osteomyelitis, and Burkitt's lymphoma (P < .05). CONCLUSIONS: This study shows a higher contributory percentage of histopathologic diagnoses after routine biopsies, compared to previous reports from selected biopsies of periradicular lesions. We identified clinical indicators for predicting possible histopathologic diagnosis of some periradicular lesions, in particular, those that predict possible histologic diagnosis of neoplastic periradicular lesions.