Assessing current clinical eruption stage of mandibular third molars by dental panoramic radiography.

OBJECTIVE: We examined whether dental panoramic radiography (PAN) can be used to identify the clinical stage of eruption of mandibular third molars at the time of radiological examination. MATERIALS AND METHODS: Cross-sectional data included records from clinical oral examination and PANs of university students. In the retrospective analysis of 345 mandibular third molars in 189 participants (20% men, 80% women; mean age 20.7 years; standard deviation [SD] ± 0.6), clinical stages of eruption were compared with their radiographic depth in bone, inclination, and root development. Statistics included χ2, Mann-Whitney U tests, and logistic regression. RESULTS: Significant (p < 0.001) predictor variables for assessing the clinical stage of eruption were radiographic depth in bone and inclination. All teeth radiologically at a depth of the cementoenamel (CE) junction of the neighbouring second molar or deeper were clinically unerupted. Above the CE junction, 80% of vertical and 97% of distoangular teeth were connected to the oral cavity, and 82% of mesioangular and 69% of horizontal teeth were clinically unerupted. CONCLUSION: All teeth below or at the CE junction are clinically unerupted. Above the CE junction, stage of eruption should be assessed together with the inclination, but horizontally inclined teeth are recommended to be verified clinically.

Deep odontogenic infections - Computed tomography imaging-based spreading routes and risk for airway obstruction.

PURPOSE: This study aimed to evaluate deep odontogenic infection (DOI) spread and features utilizing head and neck computed tomography (CT) imaging. MATERIAL AND METHODS: Patients with acute DOI and preoperative contrast-enhanced CT-imaging were included in the study. Infection spaces, radiological features of these infections, CT imaging-based compromised airway and patients' background factors were evaluated and associations between these and need for postoperative mechanical ventilation (MV) were reported. RESULTS: Altogether 262 hospitalized patients were included in the final analysis. Typically affected spaces were submandibular (74%), mandibular buccal/vestibular (37%), and sublingual (26%). Retropharyngeal (1%), mediastinal (1%) and danger space (1%) involvements were unusual. The infections were quite evenly distributed between multispace abscesses (53%) and other infections (47%). In multivariate analysis, CT-based compromised airway (OR 5.6, CI 95%, 2.9-10.9, P <0.001), midline crossing (OR 3.3, CI 95%, 1.2-8.8, P = 0.018) and extension at the level or below hyoid body (OR 2.4, CI 95% 1.2-5.1, P = 0.016) predicted the need for MV. Other radiological findings and patients' background variables remained statistically non-significant for MV. CONCLUSION: Anterolateral and superior spread to the neck is typical in DOIs, whereas caudal progression is rare. Postoperative need for MV can be well recognized from CT.

Preoperative C-reactive protein to albumin ratio and oral health in oral squamous cell carcinoma patients.

BACKGROUND: The C-reactive protein to albumin (CRP/alb) ratio can predict early survival of a hospitalized patient. We evaluated factors that influence the preoperative CRP/alb ratio in oral squamous cell carcinoma (OSCC) patients and in particular clarified the role of oral health to this ratio. MATERIALS AND METHODS: Data from surgically treated OSCC patients were collected retrospectively. The outcome variables were preoperative CRP/alb ratio, CRP level, and alb level. The studied predictors were total number of teeth, periodontal stability, marginal bone loss, tumour stage, T-class, lymph node status, and site. The statistical significance of age, sex, comorbidity combination of age and disease history (Charlson Comorbidity Index [CCI]), smoking, and alcohol history for outcome variables were evaluated. Patient 3-month mortality and occurrence of postoperative infections were recorded. RESULTS: A total of 159 patients were included in the study. The early mortality was 3.8%. CRP/alb was higher in these patients than in those who survived. The only independent variables for CRP/alb changes were CCI and heavy alcohol use. The CRP/alb ratio was significantly lower in non-heavy alcohol users (odds ratio [OR] 0.114, 95% confidence interval [CI] 0.024-0.541; adjusted p = 0.006) than in other patients. Patients with CCI 0-1 were more likely to have a lower CRP/alb ratio than patients with CCI ≥ 5 (OR 0.033, 95% CI 0.004-0.284; adjusted p = 0.002). In addition, high CRP/alb ratio associated with postoperative infections (p = 0.026). CONCLUSIONS: The CRP/alb ratio was high in OSCC patients with combined comorbities of age and disease history and in patients with heavy alcohol use. Oral health or tumour-related variables did not independently affect the CRP/alb ratio. The CRP/alb ratio appears suitable for prediction of OSCC patient early survival.

Periodontitis in tonsil cancer patients-A comparative study in accordance with tumour p16 status.

OBJECTIVES: We assessed the periodontal situation radiologically according to tumour p16 status. MATERIALS AND METHODS: Patients with a diagnosis of tonsillar cancer and availability of a digital panoramic radiograph (DPR) during a 5-year period were included in this retrospective study. The predictor variables were periodontal stability, marginal bone loss, marginal bone loss without periodontal stability and total number of teeth. Periodontal status was compared with p16 status, age, gender, smoking and alcohol use. RESULTS: Among 115 patients included in the analyses (p16-negative, n = 24; p16-positive, n = 91), smoking (p < .0001), heavy alcohol use (p < .0001) and total number of teeth (p = .0001) were significantly associated with p16 status. Current smoking (OR = 7.3) and heavy alcohol use (OR = 10.1) increased the risk of p16-negative cancer. CONCLUSIONS: Patients with p16-negative tonsillar carcinoma had less teeth than patients with p16-positive tumours. Other periodontal findings were common in both groups without statistical significance. Heavy alcohol use and smoking were the most important risk factors for p16-negative tonsillar carcinoma.

Did malpractice claims for failed dental implants decrease after introduction of CBCT in Finland?

OBJECTIVES: To examine the role of cone beam computed tomography (CBCT) in preventing failures in implant treatment. We hypothesize that the number of malpractice claims related to dental implant treatment would decrease after the first CBCT device came available in 2002 in Finland. MATERIAL AND METHODS: Data concerning malpractice claims related to dental implant treatment during the years 1997-2011 were collected from the Finnish Patient Insurance Centre (N = 330 subjects). We selected the cases that might have benefitted from the use of CBCT examination. These cases (n = 131) led to financial compensation due to permanent inferior alveolar nerve injury, improper implant position, or insufficient amount of bone for the implant. The annual total number of inserted dental implants, CBCT devices, and CBCT examinations in Finland were drawn from the national registers and used to estimate the impact of CBCT in preventing treatment failures. RESULTS: The most common reason for all failures (n = 268 implants) was an improper implant position (46.3%). The most common area of malpractices was upper front teeth (34%). We have noticed a fall in the rate of compensable malpractice cases concerning implant failure, simultaneously with CBCT technology emerging on the market. CONCLUSIONS: There may be an association between the increasing availability of CBCT equipment and the reducing frequency of compensable malpractice claims. CLINICAL RELEVANCE: It is possible that the use of CBCT may result in fewer compensable malpractice claims.

Effectiveness of low-dose doxycycline (LDD) on clinical symptoms of Sjögren's syndrome: a randomized, double-blind, placebo controlled cross-over study.

BACKGROUND: Matrix metalloproteinases (MMPs) are proteolytic enzymes that may contribute to tissue destruction in Sjögren's syndrome (SS). Low-dose doxycycline (LDD) inhibits MMPs. We evaluated the efficacy of LDD for the subjective symptoms in primary SS patients. This was a randomized, double blind, placebo controlled cross-over study. 22 patients were randomly assigned to receive either 20 mg LDD or matching placebo twice a day for 10 weeks. The first medication period was followed by 10-week washout period, after which the patient received either LDD or placebo, depending on the first drug received, followed by the second washout period. Stimulated saliva flow rates and pH were measured before and after one and ten weeks of each medication and after washout periods. VAS scale was used to assess the effect of LDD and placebo on following six subjective symptoms: xerostomia; xerophtalmia; difficulty of swallowing; myalgia; arthralgia; and fatigue. The effect was evaluated for each medication and washout period separately. RESULTS: Overall, the effects of medications on subjective symptoms were minor. Wilcoxon test demonstrated increased fatigue with LDD during medication (p < 0.05). The differences may, however, reflect normal fluctuation of symptoms in SS patients. CONCLUSION: LDD may not be useful in reducing the primary SS symptoms.