Can the Position of the Impacted Third Molars Be an Early Risk Indicator of Pathological Conditions? A Retrospective Cone-Beam Computed Tomography Study.

Objectives: The aim of this retrospective study was to evaluate the prevalence of pathologies associated with impacted third molars in relation to tooth position on cone-beam computed tomography images. Material and Methods: In 348 cone-beam computed tomography images, the position of 640 impacted third molars (mesiodistal angulation, buccolingual inclination, impaction depth, and contact point localization) and the presence of pathologies (distal caries, external root resorption, marginal bone loss, and pathological follicular space) were evaluated. The data were analysed statistically with a significance level set at P < 0.05. Results: Distal caries was mostly detected in relation to Class A (20.4%) and contact point at (12.5%) and above (10.5%) the cementoenamel junction (CEJ) (P = 0.000; P < 0.05). External root resorption and marginal bone loss were more common in mesioangular angulation (52.3% and 80.1%, respectively), Class C (53% and 73.8%, respectively), and contact point below the CEJ (53.2% and 73.3%, respectively) (P = 0.000; P < 0.05). Lingual inclination was identified as a new risk factor for associated pathologies (P < 0.05). Pathological follicular space was significantly more likely to occur in those with inverted angulation (100%) and absence of contact (31.5%) (P = 0.000 and P = 0.010, respectively; P < 0.05). Conclusions: Pathologies arising in second molars in relation to impacted third molars are significantly associated with the three-dimensional position of impacted third molars, and watchful monitoring or prophylactic removal of impacted third molars should be considered, taking into account the relevant risk parameters for the related pathologies.

Radiological assessment of alveolar bone loss associated with overhanging restorations: A retrospective cone beam computed tomography study.

Background/purpose: Studies suggested that presence and size of overhanging restoration margins play role in alveolar bone loss. The aim of this study was to determine the prevalence and distribution of overhanging approximal restorations, to evaluate the effect of presence and size of overhang on bone loss using cone beam computed tomography (CBCT) reformatted panoramic images, and to encourage the use of CBCT in retrospective studies on restorative dentistry. Materials and methods: CBCT images of 382 patients with approximal restorations were included in the study. On CBCT images, alveolar bone loss adjacent to each restored surface was determined and compared to the control tooth. The overhang size was measured and categorized as small, medium, or large. Data obtained were evaluated statistically using Kruskal Wallis, Mann Whitney U, chi-square, and one-sample chi-square tests with a significance level set at P < 0.05. Results: A total of 216 (32.4%) surfaces with overhanging restorations were detected in CBCT images. The number of overhanging surfaces with alveolar bone loss (71.3%) was higher than the control surfaces with bone loss (49.1%) (P < 0.05). The amount of bone loss adjacent to overhanging surfaces (2.28 ± 1.69 mm) was significantly higher compared to control surfaces (1.53 ± 1.73 mm) (P < 0.05). However, the same trend applied to the surfaces without overhang and their controls. The amount of bone loss was not correlated with the overhang size (P > 0.05). Conclusion: Approximal restorations with and without overhanging margins may often result in alveolar bone loss, the amount of which is not always correlated with the overhang size.

A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia.

BACKGROUND/PURPOSE: Radiological examination is indispensable in the diagnosis and follow-up of cemento-osseous dysplasia (COD). The aim of this retrospective study was to describe a series of COD cases, identify the frequencies of COD subtypes, and investigate the demographic and radiological characteristics in relation to subtypes. MATERIALS AND METHODS: Cone beam computed tomography (CBCT) images/reports of patients with a diagnosis of COD were included in the study. The data collected included information on the age, sex, subtype of COD, location of COD, and region involved. Information regarding the internal density, effects on surrounding structures, and presence of concomitant lesions was also collected. The data obtained were evaluated statistically. RESULTS: The study group included CBCT images of 142 patients (130 females (91.5%) and 12 males (8.5%)) with a mean age of 46.97 ±â€¯10.57 years. The mandible was involved in almost all cases (99.3%). The most common subtype was florid COD (51.4%) and lesions with hyperdense internal density (81.7%) were more commonly observed. Cortical thinning (78.2%) was a prominent feature. The frequency of root resorption in periapical COD cases (57.1%) was observed to be significantly higher (p < 0.05). All hypercementosis cases were associated with florid subtype (p < 0.05). In a minority of cases (6.3%), the lesions were associated with bone cysts and osteomyelitis. CONCLUSION: CBCT images clearly demonstrated the effect of COD lesions on surrounding structures. CBCT is an appropriate imaging modality for the diagnosis and follow-up of COD which is the most common fibro-osseous lesion in clinical practice.

Cross-contamination and infection control in intraoral digital imaging: a comprehensive review.

Dental health care workers are subjected to various infectious disease agents that are present in patients' saliva and blood which make infection control and universal prevention methods indispensable to the dental practice given that some of these diseases cause loss of work and time for dental staff and patients; some of them cause serious morbidity; and some of them currently have a poor prognosis and no effective treatments. Although dental radiographic procedures are not invasive, and there are no incidents such as injuries caused by dental instruments, they are a potential infection source because of contamination with saliva and blood, and comprehensive infection control procedures also apply to the radiology clinic. In addition, contact with a large number of patients in dental schools and clinics in a short period of time, and the fact that radiographic procedures are performed in the same environment as other dental procedures in dental offices increase the significance of infection control in dental radiology. Major advances in computer technology have enabled digital imaging systems to develop rapidly and to become common in dental practice as an alternative to conventional film-based imaging. The use of digital sensors in dental radiology introduced unique infection control challenges and required the revision and modification of existing infection control techniques. In this review, studies concerning the risk of cross-contamination and challenges of infection control with digital image sensors are comprehensively reviewed and infection control protocols that should be followed in intraoral digital imaging using both direct and indirect systems are thoroughly examined.

Effect of oral antiseptic agents on phospholipase and proteinase enzymes of Candida albicans.

OBJECTIVE: Candida-associated denture stomatitis is the most prevalent form of oral candida infections among the denture wearers. Generally, antiseptic oral rinses used in the treatment of these infections are considered as an adjunct or alternative antifungal treatment. Studies have suggested that the intraoral concentrations of antiseptics decrease substantially to the sub-therapeutic levels on account of the dynamics of the oral cavity. This condition yields the question about the minimum antiseptic concentration that effect the character or pathogenesis of Candida during treatment. The extracellular phospholipase and proteinase enzymes of Candida albicans are regarded to have a crucial role in the pathogenesis of human fungal infections. Therefore, the aim of this study was to investigate the effect of different sub-therapeutic concentrations of chlorhexidine gluconate, hexetidine and triclosan on the production of these enzymes by C. albicans strains isolated from 20 patients with denture stomatitis. METHODS: Phospholipase test was done by using Sabouraud dextrose agar with egg yolk, proteinase test was done by using bovine serum albumin agar. METHODS: Phospholipase test was done by using Sabouraud dextrose agar with egg yolk, proteinase test was done by using bovine serum albumin agar. RESULTS: Exoenzyme production of 20 strains which were brief exposured to sub-therapeutic concentrations of three antiseptic agents decreased significantly compared with the strains that were not exposured with antiseptic values (p<0.05). There was significant difference between the sub-therapeutic concentrations of each of three antiseptics (p<0.05). When the same concentrations of each antiseptic was compared, there were no significant differences between enzymatic activities (p>0.05). CONCLUSIONS: The results of this study show that sub-therapeutic levels of each antiseptic may modulate candidal exoenzyme production, consequently suppressing pathogenicity of C. albicans.

Radiologic Assessment of Periapical Health: Comparison of 3 Different Index Systems.

INTRODUCTION: The aim of this study was to evaluate observer variations and observer reproducibility in the interpretation of periapical health using the Strindberg system, the periapical index (PAI), and the probability index for radiologic assessment of periapical health. METHODS: Four observers read digital periapical images to evaluate the periapical health of 200 root-filled teeth. Each observer evaluated a tooth twice by using the Strindberg system, twice by using the PAI, and twice by using the probability index. Each observation session was held at 1-month intervals. Three scores were used for the evaluations conducted by using the Strindberg system. Both the PAI and the probability index were considered on 5-point scales and were also dichotomized. SPSS for Windows 15.0 software (SPSS Inc, Chicago, IL) was used for data analysis, and intra- and interobserver agreements were described by using kappa statistics. RESULTS: The average kappa values of intra- and interobserver agreement calculated for the Strindberg system were 0.53 and 0.36, respectively. The corresponding average kappa values were calculated as 0.48 and 0.39 for the PAI and 0.45 and 0.30 for the probability index. The highest mean proportion values of intra- and interobserver agreement were observed for the dichotomization of the PAI (88.9% and 87.0%, respectively) followed by the dichotomization of the probability index (86.8% and 82.9%, respectively). CONCLUSIONS: The Strindberg system has lower intraobserver variation compared with the PAI and the probability index, whereas PAI has lower interobserver variation compared with the Strindberg system and the probability index. The dichotomization of the PAI and the probability index provided higher intra- and interobserver agreement values in the radiologic assessment of periapical health.

A retrospective study of370 patients with oral lichen planus in Turkey

Objectives: Although several detailed studies concerning the patient profile and clinical features of oral lichenplanus have been undertaken all over the world in different populations, a similar study has not yet been conducted in a Turkish population. The purpose of this retrospective study was to describe the demographic and clinical characteristics of a group of patients with oral lichen planus in Turkey. Study Design: Charts of 370 patients, from the archive of Oral Diagnosis and Radiology Department of Marmara University Faculty of Dentistry (Istanbul, Turkey), with histologically confirmed clinical diagnosis of oral lichenplanus in the period 1990-2010 were retrospectively reviewed. Results: Of the 370 patients, 260 (70.3%) were women and 110 (29.7%) were men. The mean age was 49.84±13.41years (range of 16-83). The lesions were asymptomatic in 63 patients (17%). Nearly half of the patients (47.6%)had multiple sites of involvement. Predominantly red forms were the most frequent, affecting 60.5% of patients. Approximately 17% of the patients had symptoms of possible extraoral involvement. No evidence suggesting a connection between oral lichen planus and tobacco or alcohol use was found. Only one out of the 370 cases had histologically proven malignant transformation. Conclusions: The patient profile and clinical features of oral lichen planus in Turkey were generally similar to those described in other populations. The preponderance of the red forms and also the fact that majority of patients referredthemselves to our clinic highlighted the lack of awareness among Turkish health care providers about lichen planus (AU)

A retrospective study of 370 patients with oral lichen planus in Turkey.

OBJECTIVES: Although several detailed studies concerning the patient profile and clinical features of oral lichen planus have been undertaken all over the world in different populations, a similar study has not yet been conducted in a Turkish population. The purpose of this retrospective study was to describe the demographic and clinical characteristics of a group of patients with oral lichen planus in Turkey. STUDY DESIGN: Charts of 370 patients, from the archive of Oral Diagnosis and Radiology Department of Marmara University Faculty of Dentistry (Istanbul, Turkey), with histologically confirmed clinical diagnosis of oral lichen planus in the period 1990-2010 were retrospectively reviewed. RESULTS: Of the 370 patients, 260 (70.3%) were women and 110 (29.7%) were men. The mean age was 49.84 ± 13.41 years (range of 16-83). The lesions were asymptomatic in 63 patients (17%). Nearly half of the patients (47.6%) had multiple sites of involvement. Predominantly red forms were the most frequent, affecting 60.5% of patients. Approximately 17% of the patients had symptoms of possible extraoral involvement. No evidence suggesting a connection between oral lichen planus and tobacco or alcohol use was found. Only one out of the 370 cases had histologically proven malignant transformation. CONCLUSIONS: The patient profile and clinical features of oral lichen planus in Turkey were generally similar to those described in other populations. The preponderance of the red forms and also the fact that majority of patients referred themselves to our clinic highlighted the lack of awareness among Turkish health care providers about lichen planus.

Evaluation of demands and needs for dental care in a sample of the Turkish population.

OBJECTIVES: To evaluate the demands and needs for dental care and to identify the level of dental and periodontal status in patients of different age groups visiting the Faculty of Dentistry, Marmara University, Istanbul, Turkey. METHODS: A total of 1000 first-visit patients (517 female and 483 male) were examined and questioned. The main complaint of each patient was recorded and considered to be a measure of demand for dental care. The World Health Organization's (WHO) basic methods were used to determine the tooth-based and orthodontic normative treatment needs. Periodontal status was determined by using the Community Periodontal Index of Treatment Needs (CPITN). In addition, prosthetic normative needs were assessed. RESULTS: This study showed that patients in different age groups required different treatments and had different main complaints. In total, 89.3, 74.1 and 57.7% of the patients named periodontal, restorative and prosthetic care as their main complaint, respectively. Approximately 21% of the total did not need restorations and extractions, and only 12% of the sample did not have a normative periodontal treatment need. About half of subjects needed fixed partial dentures. CONCLUSIONS: Normative treatment needs of patients were very high. Therefore, a new national strategy for oral health must be devised for Turkey. This study can assist in setting the baseline for that strategy.

Periapical status and quality of root fillings and coronal restorations in an adult Turkish subpopulation.

OBJECTIVES: To investigate the quality of root fillings and coronal restorations and their association with periapical status in an adult Turkish subpopulation. METHODS: A total of 400 subjects were examined. Panoramic radiographs of all participants and additional periapical radiographs of affected teeth were processed. The frequency of root canal treatment and the periapical status of all root filled teeth were evaluated. The relationship between the radiographic quality of root fillings and coronal restorations was examined by chi-squared statistical analysis. RESULTS: A total of 9460 teeth were examined. The total number of root filled teeth was 890 (9.39%), and 658 (73.9%) had apical periodontitis (AP). There was a significant correlation between the presence of periapical pathology and inadequate root canal fillings (P<.05). Presence of AP in root filled teeth was associated with inadequate adaptation of the filling (OR=1.097; P=0.54), and with poor radiographic quality of the coronal restoration (OR=0.91; P=0.70), and with poor radiographic quality of the filling restoration (OR=0.97; P=0.92). Only 24.5% of the root fillings were adequate. The highest percentage of root fillings was found in maxillary right first molars (6.9%). CONCLUSIONS: The results demonstrate a low prevalence of root-filled teeth and poor quality of coronal restorations and root fillings consistent with a high prevalence of apical periodontitis in a Turkish subpopulation.

Serum cytokine and T regulatory cell levels in patients with burning mouth syndrome.

BACKGROUND: Burning mouth syndrome is a disorder usually associated with an unexplained, prolonged sensation of burning inside the oral cavity. Although the etiology is unknown, neural and psychologic factors and cytokines may be implicated in the pathogenesis of burning mouth syndrome. The aim of this study was to investigate the relationship between serum cytokine and T regulatory cell levels in patients with burning mouth syndrome with regard to depression and anxiety. METHODS: Thirty patients with burning mouth syndrome and 30 matched controls participated in the study. Serum cytokine levels were measured with cytometric bead array and T regulatory cells were defined as CD4(+)CD25(+)Foxp-3(+) cells by flow cytometry. The level of anxiety and depression were analyzed by means of the Speilberger State-Trait Anxiety Inventory and Zung Self-Rating Depression Scale. Visual analogue scale was used in the quantification of burning levels of patients. RESULTS: Serum IL-2 and TNF-alpha levels were significantly decreased in patients with burning mouth syndrome compared with controls [mean 16.79 +/- 8.70 vs. 37.73 +/- 41.05 pg / ml (P < 0.05) and mean 39.09 +/- 29.40 vs. 70.83 +/- 42.44 pg / ml (P < 0.01) respectively]. CONCLUSIONS: IL-2 and TNF-alpha might play a role in burning mouth syndrome. Burning mouth syndrome may occur as a sign of predisposition to autoimmunity. Presence of low levels of CD28(+) supports the provision that BMS might be a pre-autoimmune disease.

Efficacy of moclobemide in burning mouth syndrome: a nonrandomized, open-label study.

AIMS: To compare burning mouth syndrome (BMS) patients with age- and gender-matched controls for psychologic conditions, to analyze the effect of menstrual state on the intensity of burning, and to assess the efficacy of an antidepressant medication on the burning pain and psychologic status. METHODS: Ninety-four patients with BMS and 94 matched control subjects participated in the study. Anxiety and depression were analyzed by means of the Spielberger State-Trait Anxiety Inventory and Zung Self-Rating Depression Scale, and the severity of the burning sensation was measured by means of a visual analog scale (VAS). In female BMS patients and controls, the menstrual state was noted (menstruating, menopausal, or postmenopausal). BMS patients were treated with the antidepressant moclobemide (150 mg 2 times daily) for 3 months. Thereafter, anxiety, depression, and burning pain intensity were reassessed. Patient-perceived satisfactory improvement for burning sensation was assessed using a 5-point categorical rating of change scale. RESULTS: BMS patients had significantly higher anxiety and depression scores than controls (P < .05). After treatment, anxiety and depression scores as well as the VAS values for burning pain decreased significantly (P < .001). Thirty-seven patients reported good to very good improvement, and 44 reported satisfactory improvement. No adverse reactions were reported. CONCLUSIONS: The study confirmed earlier reports that BMS patients have higher anxiety and depression levels than controls. An antidepressant medication may be effective in alleviating the burning pain, at least in the short-term.

Phospholipase activity of Candida albicans isolates from patients with denture stomatitis: the influence of chlorhexidine gluconate on phospholipase production.

BACKGROUND AND OBJECTIVES: The extracellular phospholipases of Candida albicans are considered to play a significant role in the pathogenesis of human infections. Therefore 23 clinical oral isolates of C. albicans from patients with denture stomatitis and 22 commensal oral isolates obtained from the palatal mucosa of healthy subjects were assayed for phospholipase activity. It is generally accepted that chlorhexidine gluconate is an appropriate adjunct or an alternative to antimycotic therapy in the management of oral candidiasis. However, the intraoral concentrations of this antiseptic fluctuate considerably due to the dynamics of the oral cavity. So the second main objective of this study was to investigate the effect of brief exposure (30 min) to two sub-therapeutic concentrations (0.002% and 0.0012%) of chlorhexidine gluconate on the value of phospholipase production (Pz) of C. albicans. METHOD: An in vitro phospholipase production was done by plate assay method using an egg yolk-agar medium. RESULTS: No significant differences were found in the number of C. albicans isolates producing phospholipase between two groups. However, the mean value of Pz produced by the isolates from patients with denture stomatitis was significantly (p<0.05) higher than the commensals. Exposure of the isolates to 0.002% and 0.0012% chlorhexidine led to a significant (p<0.001 and p<0.01, respectively) reduction in the amount of phospholipase. CONCLUSION: The results of this study imply that sub-therapeutic levels of chlorhexidine may modulate candidal phospholipase activity, thereby suppressing pathogenicity of C. albicans.

Distribution and phospholipase activity of Candida species in different denture stomatitis types.

The aim of this study was to evaluate the correlation between frequency and phospholipase activity of Candida species and denture stomatitis according to Newton's classification. Seventy-five complete denture wearers were evaluated for the presence of yeasts on the palatal mucosa by culture method. In addition, the number of yeast isolates producing phospholipase and amount of this enzyme were determined using egg yolk agar plate method. According to Newton's classification, 25 denture wearers were with healthy palatal mucosa while 50 were with any types of denture stomatitis. The frequency of yeasts was linked to whether subjects had Type II or Type III, but not Type I denture stomatitis. Candida albicans was the most frequently isolated species in denture wearers with and without clinical signs of denture stomatitis and it was the only species produced phospholipase. Although the amount of phospholipase produced by the C. albicans isolates from denture wearers in control and Type II and III DS groups was not significantly different, there was statistically significant difference in the number of C. albicans isolates producing phospholipase between patients with and without clinical signs of DS.

Frontal linear scieroderma (en Coup de Sabre): a case report.

En coup de sabre is a type of linear scleroderma which presents on the frontal or frontoparietal scalp. En coup de sabre in children is associated with asymmetric growth and progressive facial disfigurement. The purpose of this report was to present the case of a 4-year-old girl with a 2-year history of en coup de sabre. The clinical presentation and radiographic findings are discussed.