Osteosarcoma (osteogenic sarcoma) of the jaws presenting in general dental practice - a series of four cases.

Introduction Osteosarcoma is the most common primary malignant bone tumour, usually arising in the long bones, with occurrence in the head and neck accounting for 8% of all osteosarcomas. Clinical features include swelling, pain, facial dysesthesia and abnormal mobility of teeth. Treatment consists of a combination of surgery, radiotherapy and chemotherapy.Case series Here, we present four cases of osteosarcoma of the jaws - two maxillary and two mandibular. All cases were initially assessed in the dental primary care setting before being referred for specialist opinion.Discussion The purpose of this paper is to present an overview of an uncommon but serious disease which can mimic common life-threatening dento-facial conditions. We discuss the diagnostic features, with an overview of clinical, histopathological and radiographic features.Conclusion These cases are important reminders of the potential clinical and radiographic appearance of a rare cause of facial swelling, and highlight the role of the general dental practitioner in early diagnosis and referral.

Magnetic resonance diffusion weighted imaging using constrained spherical deconvolution-based tractography of the extracranial course of the facial nerve.

OBJECTIVE: To evaluate the accuracy of magnetic resonance diffusion weighted imaging (DWI) featuring constrained spherical deconvolution-based tractography in tracking the extracranial course of the facial nerve to provide a reliable facial nerve map to facilitate well-tolerated and effective tumor resection. STUDY DESIGN: Magnetic resonance DWI was conducted on 2 parotid-healthy cadaveric patients with various protocols to identify the best representation of the extracranial facial nerve tract. This was subsequently correlated to dissection of the facial nerves to ascertain anatomic validation. These protocols were applied to 2 live, parotid-healthy patients to assess feasibility of in vivo facial nerve tract identification. RESULTS: Correlations between imaged tracts and the anatomic course of the extracranial facial nerve were identified to an accuracy of 1 mm. The main trunk and bifurcation tracts were identified on imaging. Fractional anisometry values in cadaveric and live patients were within the range expected for the facial nerve within the parotid gland. CONCLUSIONS: Our results indicated the potential for accurate 3-dimensional visualization of the extracranial course of the facial nerve, which could have diagnostic implications in differentiating benign from malignant tumors and, crucially, neural involvement. Preoperative planning applications of DWI could help in planning surgical approaches and providing focused counseling.

Is Eminectomy Effective in the Management of Chronic Closed Lock?

PURPOSE: This study assesses the effectiveness of eminectomy in the management of chronic closed lock, refractory to conservative medical management in the largest multi-centred study of its kind in the UK, with a cohort of 167 patients. Temporomandibular mandibular joint disorder affects 30% of adults in the UK. Chronic closed lock is a well-documented sub-type. METHOD: A retrospective study of patients with refractory closed lock was carried out, where conservative management had been implemented for a minimum of 6 months. Refractory patients were offered eminectomy at three separate centres over a period from 1995 to 2011. The primary variable was the inter-incisal distance (IID). Other variables included pain, clicking and nerve damage pre- and post-operatively. RESULTS: There were 167 patients across all three centres, 81% of which were female. The mean IID was 23 mm pre-operatively and 37 mm post-operatively. There was a statistically significant association with the primary predictor variable, yielding a p value of < 0.05. Clicking resolved completely post-operatively in 84 patients (58%). Pain subjectively improved in 56% cases. CONCLUSION: Eminectomy is a safe and effective surgical procedure and has a role to play as a second-line surgical option in the management of closed lock after more conservative medical options have failed.

Quantitative Ultrasound of the Mandible as a Novel Screening Approach for Osteoporosis.

This study used an axial transmission quantitative ultrasound (QUS) device to assess mandibular bone strength. The aim of the study was first to establish the precision and repeatability of the axial transmission QUS measurement for a range of mandibular anatomic sites, and second to investigate the ability of the modality to differentiate between osteoporotic subjects and a control group. Three groups of adult Caucasian women were recruited: (1) healthy premenopausal women (n = 26), (2) healthy postmenopausal women (n = 48), and (3) women with osteoporosis (n = 53). Subjects were excluded from groups 1 and 2 if they had any pre-existing bone conditions. Speed of sound (SOS) measurements were taken from the mandible using an OmniSense multisite QUS device. Group 3 had dual-energy X-ray absorptiometry scans of the lumbar spine and femur. The most suitable site on the mandible was determined by repeat SOS measurements in 10 healthy premenopausal subjects, at 5 different sites. The parasymphysis site had the lowest root mean squared coefficient of variation at 0.74%, and was chosen as the most suitable site for mandibular SOS measurements. Group 1 and group 2 had significantly higher mean SOS measurements than the osteoporotic subjects (group 3), with means of 3683 m/s (210), 3514 m/s (221), and 3312 m/s (264), respectively. A 1-way analysis of variance confirmed a statistically significant difference between mean SOS measurements from the 3 groups (p < 0.0001). Axial transmission QUS of the mandible can differentiate between subjects with osteoporosis and a healthy control group, and shows potential for use as a screening tool for osteoporosis.

The non-healing extraction socket: a diagnostic dilemma - case report and discussion.

STATEMENT OF THE PROBLEM: Delayed healing, or failure of the alveolus to heal post exodontia, is not an uncommon finding in both primary care and hospital practice. Local factors dominate and the majority of cases are the result of clot dissolution, secondary infection, foreign bodies, etc. However, potentially life-threatening, malignant lesions complicating healing can be overlooked and underestimated due to their rare occurrence. PURPOSE OF THE REVIEW: This article presents a contemporary review of the normal physiological process that directs healing within the extraction socket and a differential diagnosis for delayed healing or failure of healing following extraction, with guidance on appropriate management. METHOD: A case report of a squamous cell carcinoma presenting in the clinical setting of a non-healing extraction socket, and a discussion of local and systemic factors that may interfere with healing, are presented. CONCLUSION: The aetiologies of delayed healing and failure of the extraction site to heal are diverse, and the process can be affected by local and systemic factors alike.'Given that neoplastic lesions are relatively rare, it is therefore all the more important for GDPs to remain cognisant of the diagnostic red flags that may raise suspicions of a mitotic lesion to ensure that appropriate referral pathways are instituted.

Does access to general dental treatment affect the number and complexity of patients presenting to the acute hospital service with severe dentofacial infections?

AIM: This is a retrospective study to review the treatment and management of patients presenting with odontogenic infections in a large urban teaching hospital over a four-year period, comparing the number and complexity of odontogenic infections presenting to an acute general hospital in two periods, as follows: Group A (January 2008 to March 2010) versus Group B (April 2010 to December 2011). The background to the study is 'An alteration in patient access to primary dental care instituted by the Department of Health in April 2010'. OBJECTIVES: a) to identify any alteration in the pattern and complexity of patients' presentation with odontogenic infections following recent changes in access to treatment via the Dental Treatment Services Scheme (DTSS) and the Dental Treatment Benefit Scheme (DTBS) in April 2010; and, b) to evaluate the management of severe odontogenic infections. METHOD: Data was collated by a combination of a comprehensive chart review and electronic patient record analysis based on the primary discharge diagnosis as recorded in the Hospital In-Patient Enquiry (HIPE) system. RESULTS: Fifty patients were admitted to the National Maxillofacial Unit, St James's Hospital, under the oral and maxillofacial service over a four-year period, with an odontogenic infection as the primary diagnosis. There was an increased number of patients presenting with odontogenic infections during Group B of the study. These patients showed an increased complexity and severity of infection. Although there was an upward trend in the numbers and complexity of infections, this trending did not reach statistical significance. CONCLUSIONS: The primary cause of infection was dental caries in all patients. Dental caries is a preventable and treatable disease. Increased resources should be made available to support access to dental care, and thereby lessen the potential for the morbidity and mortality associated with serious odontogenic infections. The study at present continues as a prospective study.

The occurrence of paraesthesia of the maxillary division of the trigeminal nerve after dental local anaesthetic use: a case report.

Paraesthesia can be a complication of surgical intervention. Its occurrence after dental local anaesthetic use is a rare event in general dental practice. Reported cases have mainly described its presentation for the mandibular division of the trigeminal nerve with very few reports for the maxillary division of this nerve. This report describes a case of paraesthesia in the maxillary region following local anaesthetic use prior to removal of an upper molar tooth.

Smoking cessation and the role of the dental practitioner.

As dentists we are uniquely positioned to influence the rate of tobacco smoking and could contribute to a decrease in the associated mortality and morbidity. The detrimental effects of smoking on oral health are well established; thus, a structured approach to initiate smoking cessation, help to manage the initial phase of withdrawal symptoms, and provide long-term support is an important role for our profession. It has been shown that smoking cessation advice for even a few minutes increases long-term smoking abstinence rates by 5%, which can be increased by 50-70% with the use of adjunctive pharmacotherapy, e.g., nicotine replacement therapy, for withdrawal symptoms. This article aims to give a brief overview of smoking in relation to oral health, review the management of tobacco smoking dependence, and discuss how we as dentists can help our patients to quit smoking.