Oral health status of patients with multiple myeloma

ABSTRACT Objective: To describe the oral health status of patients with multiple myeloma and compare to a control group. Materials and methods: The medical history of the studied subjects was obtained from the medical records and through interviews. Trained examiners evaluated the oral mucosa, teeth, periodontium and imaging aspects. The dental status was evaluated by the decayed, missing and filled teeth index. The presence of bone lesions was investigated with cone beam computer tomography images of the jaws. Results: The most common oral mucosa features were paleness (31%) and coated tongue (14.3%) in the multiple myeloma group (N = 42); and coated (21.4%) and fissured tongue (10.7%) in the control group (N = 28). The mean DMFT index of patients with multiple myeloma was high, but not significantly different from controls (14.57 versus 19.69, p = 0.975). Hypodense lesions suggestive of multiple myeloma were observed in the jaws of 73.8% of the patients. Hypodense lesions related to teeth were detected in 33.3% of the patients and in 53.6% of the controls (p = 0.832). Conclusions: The studied population of multiple myeloma patients presented many oral health issues that needed attention. Thus, oral care should be included in the routine treatment to improve the quality of the oral status in these patients.

Imaginological characterization of multiple myeloma lesions of the jaws through cone-beam computed tomography.

PURPOSE: To establish an evaluation protocol for the identification and description of the variations in multiple myeloma (MM) lesions of the jaws, by means of cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Tomography exams from 33 MM patients were evaluated in this retrospective observational study. The reconstructions were analyzed simultaneously, according to the established protocol, with the following description criteria: anatomic location, size, margins, inner aspect, relationship with adjacent structures, and presence or absence of a punched-out aspect. The exams were further subdivided into groups of patients using, or not bisphosphonates. RESULTS: There were osteolytic lesions in 100% of cases, most of which were extended to more than one anatomical region. Poorly defined margins were more frequent in the maxilla than in the mandible. Extensive bone resorption presenting multilocular areas was the most frequently observed aspect, being 86.2% for maxilla and 87.9% for mandible. In relation to bisphosphonates, patients who used the medication had more poorly defined bone margins and contortions (68.6%) than those who did not undergo drug therapy (31.4%). No well-defined lesions were observed (p = 0.34%). CONCLUSION: It was possible to establish a protocol for evaluation of MM lesions in CBCT images and to identify that when evaluated three-dimensional, lesions tend to be poorly defined and have no pattern of description, as described in two-dimensional "punched-out".

Bisphophonate alterations of the jaw bones in individuals with multiple myeloma.

OBJECTIVES: To verify quantitative differences of the mandibular cortical and trabecular bone between patients with multiple myeloma (MM) under bisphosphonate (BP) therapy and a control group never exposed to BP. METHODS: Clinical and demographic characteristics were collected through medical records and interviews. Mandibular cortical thickness (MCT) and fractal dimension (FD) were measured on cone beam computed tomography (CBCT) images, on the molar region, in both groups. Additionally, FD was measured on periapical digital intraoral radiography and results were compared to CBCT measurements. RESULTS: There were 33 patients with MM under BP therapy and 28 controls, with no significant differences in gender and age between groups. Pamidronate was used by all MM patients, either associated or not to other types of BP. The median MCT was higher in MM group exposed to BP (5.20 mm) than in controls (3.50 mm, p < 0.001). There were no significant differences in the median FD between patients in the MM group and controls, on CBCT (0.95 vs 0.90, p = 0.814) and periapical digital intraoral radiography (0.98 vs 0.96, p = 0.963), respectively, even when more than one type of BP was used. CONCLUSIONS: The MCT represents an useful tool in the detection of bone dimensional changes caused by BP, in patients with MM. Additional studies are necessary to improve the knowledge on the quantitative evaluation of trabecular jaw bone, in individuals with MM, under BP therapy.

Oral health status of patients with multiple myeloma.

OBJECTIVE: To describe the oral health status of patients with multiple myeloma and compare to a control group. MATERIALS AND METHODS: The medical history of the studied subjects was obtained from the medical records and through interviews. Trained examiners evaluated the oral mucosa, teeth, periodontium and imaging aspects. The dental status was evaluated by the decayed, missing and filled teeth index. The presence of bone lesions was investigated with cone beam computer tomography images of the jaws. RESULTS: The most common oral mucosa features were paleness (31%) and coated tongue (14.3%) in the multiple myeloma group (N=42); and coated (21.4%) and fissured tongue (10.7%) in the control group (N=28). The mean DMFT index of patients with multiple myeloma was high, but not significantly different from controls (14.57 versus 19.69, p=0.975). Hypodense lesions suggestive of multiple myeloma were observed in the jaws of 73.8% of the patients. Hypodense lesions related to teeth were detected in 33.3% of the patients and in 53.6% of the controls (p=0.832). CONCLUSIONS: The studied population of multiple myeloma patients presented many oral health issues that needed attention. Thus, oral care should be included in the routine treatment to improve the quality of the oral status in these patients.

Three-dimensional dental and craniofacial manifestations in patients with late diagnosis of mucopolysaccharidosis type II: report of 2 cases.

The objective of this study was to report the clinical evaluation results and 3-dimensional (3-D) dental and craniofacial characteristics observed in 2 male patients with mucopolysaccharidosis type II. The patients were evaluated clinically (soft tissue evaluation, evaluation of occlusion, periodontal and dental examinations) and by using craniofacial computed tomography, with evaluation of 3-D images in ITK-Snap v. 2.2 (Penn Image Computing and Science Laboratory, Philadelphia, PA; http://www.itksnap.org/) and 3-D Slicer (http://www.slicer.org/) software. Mandibular 3-D volumetric label maps were built from computed tomography scans of both patients and compared through superimposition on a healthy patient's mandibular images. Clinically, the patients presented the following oral manifestations: macroglossia, total open bite and generalized diastemas, and absence of caries. Patient 1 showed dental calculus and bleeding at the gingival margin. Patient 2 showed bleeding at the gingival margin, a permanent maxillary left central incisor missing as a result of trauma, and impacted permanent mandibular left and right second molars. 3-D images showed wide arches, prominent antegonial notches, a narrow mandibular body in the region of the antegonial notches, bilateral severe condylar hypoplasia, and enlarged coronoid processes. 3-D imaging and superimpositions revealed oral and skeletal displacements, contributing to the identification of changes in the course of mucopolysaccharidosis type II in patients with a late diagnosis.

Craniomaxillofacial morphology alterations in children, adolescents and adults with neurofibromatosis 1: A cone beam computed tomography analysis of a Brazilian sample

Background: Oral manifestations are common in neurofibromatosis 1 (NF1), and include jaws and teeth alterations. Our aim was to investigate the craniomaxillofacial morphology of Brazilian children, adolescents and adults with NF1 using cone beam computed tomography. Material and Methods: This study was conducted with 36 Brazilian individuals with NF1 with ages ranging from 4 to 75. The participants were submitted to anamnesis, extra and intraoral exam and cephalometric analysis using cone beam computed tomography. Height of the NF1 individuals was compared to the length of jaws and skull base. The results of the cephalometric measurements of the NF1 group were compared with a control group paired by age, gender and skin color. Results: Individuals with NF1 had lower maxillary length (p<0.0001), lower mandibular length (p<0.0001), lower skull base length (p<0.0001. In children and adolescents, the mandible was more posteriorly positioned (p=0.01), when compared with the control group. There was no association between jaws and skull base length with the height of the individuals with NF1. Conclusions: Brazilian children, adolescents and adults with NF1 have short mandible, maxilla and skull base. Moreover, children and adolescents present mandibular retrusion (AU)

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Oral and craniofacial manifestations in a Hunter syndrome patient with hematopoietic stem cell transplantation: A case report.

We described herein the oral and craniofacial features of a 7-year-old boy, diagnosed in utero with mucopolysaccharidosis II (MPS II), who was treated with hematopoietic stem cell transplantation (HSCT) at 70 days of age. The main oral clinical findings were the following: macroglossia, posterior cross-bite, crowding, pointed cuspid teeth, delayed tooth eruption, retained primary teeth, and enamel hypoplasia. The image examination showed: retention eruption, posterior primary teeth with short roots, absence of some permanent teeth, and stretching of the stylohyoid processes bilaterally. This patient showed the importance of early diagnosis and HSCT therapy in attenuating the clinical and radiographic oral and craniofacial manifestations of the MPS II patient.

Automatic cephalometric analysis: is it time to switch to a hands-free method?

Aim: To evaluate the reliability of the automatic cephalometric analysis in relation to the semi-automatic method. Methods: Fifty lateral cephalometric radiographs were selected and two dental surgeons performed the Steiner and Tweed analyses independently using the semi-automatic method on the Radiocef Studio 2® software suite (Radiomemory, Belo Horizonte, MG, Brazil), and the automatic method on the Kodak Dental Imaging Software (Carestream Health, Rochester, NY, USA). After thirty days, 30% of the sample was re-evaluated to assess intra-observer agreement. Ten angular and linear measurements of both analyses were selected, averaged for both observers and compared using Student's t-test with a significance level of 5% (α=0.05). Intra and inter-observer agreement were assessed through Intraclass Correlation Coefficient. Results: Intra-observer reproducibility was excellent for all measurements and inter-observer reproducibility was excellent for most of them. Significant differences (p<0.05) were found between automatic and semi-automatic methods for all measurements. Most of the measurements were significantly higher (p<0.05) with the automatic method. Conclusion: Semi-automatic cephalometric analysis can not be replaced with a completely automatic method

Cone-beam computed tomography versus digital periapical radiography in the detection of artificially created periapical lesions: A pilot study of the diagnostic accuracy of endodontists using both techniques.

PURPOSE: The aim of this study was to compare the diagnostic accuracy of previously trained endodontists in the detection of artificially created periapical lesions using cone-beam computed tomography (CBCT) and digital periapical radiography (DPR). MATERIALS AND METHODS: An ex vivo model using dry skulls was used, in which simulated apical lesions were created and then progressively enlarged using #1/2, #2, #4, and #6 round burs. A total of 11 teeth were included in the study, and 110 images were obtained with CBCT and with an intraoral digital periapical radiographic sensor (Instrumentarium dental, Tuusula, Finland) initially and after each bur was used. Specificity and sensitivity were calculated. All images were evaluated by 10 previously trained, certified endodontists. Agreement was calculated using the kappa coefficient. The accuracy of each method in detecting apical lesions was calculated using the chi-square test. RESULTS: The kappa coefficient between examiners showed low agreement (range, 0.17-0.64). No statistical difference was found between CBCT and DPR in teeth without apical lesions (P=.15). The accuracy for CBCT was significantly higher than for DPR in all corresponding simulated lesions (P<.001). The correct diagnostic rate for CBCT ranged between 56.9% and 73.6%. The greatest difference between CBCT and DPR was seen in the maxillary teeth (CBCT, 71.4%; DPR, 28.6%; P<.01) and multi-rooted teeth (CBCT, 83.3%; DPR, 33.3%; P<.01). CONCLUSION: CBCT allowed higher accuracy than DPR in detecting simulated lesions for all simulated lesions tested. Endodontists need to be properly trained in interpreting CBCT scans to achieve higher diagnostic accuracy.

Uncommon true isolated macrodontia of a maxillary tooth.

Macrodontia is a rare dental anomaly which consists on the presence of any tooth or teeth larger than the average. In the present report the case of a child with an uncommon true isolated macrodontia of a maxillary central incisor is presented. The maxillary left central incisor was considered a macrodontic tooth since its mesiodistal crown dimension was 12.41 mm while the mesiodistal crown dimension of the maxillary right central incisor was 10.06 mm. The radiographic examination confirmed an enlarged maxillary left central incisor and a normal developing dentition. The patient did not report esthetic complaints, however, due the presence of anterior open bite and crowding, he was referred to orthodontic clinic. Thus, it must be point out the importance of the radiographic diagnosis to support the clinical findings, helping to plan and provide better treatment for the patient.

Prevalence of oral trauma in Para-Pan American Games athletes.

The aim of this cross-sectional epidemiological survey was to assess the prevalence of oral trauma in athletes representing 25 countries competing at the most recent Para-Pan American Games (III PARAPAN) held in Rio de Janeiro, Brazil. The study was approved by the appropriate institutional review board. The examiners participated in standardization and calibration training sessions before the field phase began. Invitations were sent to >1200 participating athletes competing in eight sports and to the Medical Committee of the Para-Pan American Sports Organization before and during the III PARAPAN. A convenience sample of 120 athletes was recruited. After signing an informed consent, all athletes answered a questionnaire. Data were collected at the clinical examination and recorded in a specific trauma form. The mean age of the athletes was 32.5 years. Males comprised 79.2% of the sample; females 20.8%. The prevalence of oral trauma among the athletes was 47.5% (N = 57). However, only 15 athletes reported that these traumatic injuries were sports-related. The sport with the highest prevalence of oral trauma was judo (75%); the least was volleyball with no reported traumatic injuries. The most common traumatic injury was enamel fracture (27.4%). The teeth most affected were the maxillary permanent central incisors (N = 19), followed by the maxillary premolars (N = 8). On the basis of the results of this study of oral trauma among athletes examined at the III PARAPAN, a recommendation for enhanced educational efforts and the use of properly fitted mouthguards to prevent traumatic injuries among high-performance athletes with disabilities seems warranted.

Cone-beam computed tomography and radiographs in dentistry: aspects related to radiation dose.

Introduction. The aim of this study was to discuss the radiation doses associated with plain radiographs, cone-beam computed tomography (CBCT), and conventional computed tomography (CT) in dentistry, with a special focus on orthodontics. Methods. A systematic search for articles was realized by MEDLINE from 1997-March 2011. Results. Twenty-seven articles met the established criteria. The data of these papers were grouped in a table and discussed. Conclusions. Increases in kV, mA, exposure time, and field of view (FOV) increase the radiation dose. The dose for CT is greater than other modalities. When the full-mouth series (FMX) is performed with round collimation, the orthodontic radiographs transmit higher dose than most of the large FOV CBCT, but it can be reduced if used rectangular collimation, showing lower effective dose than large FOV CBCT. Despite the image quality, the CBCT does not replace the FMX. In addition to the radiation dose, image quality and diagnostic needs should be strongly taken into account.

Prevalence of dental trauma in Pan American games athletes.

The aim of this cross-sectional epidemiological survey was to assess the prevalence of dental trauma in athletes representing 42 countries competing at the most recent Pan American Games (XV Pan Am) held in Rio de Janeiro, Brazil in July of 2007, and to determine prior use and type of mouthguard among this group of athletes. The examiners participated in standardization and calibration training sessions before the field phase began. Invitations were sent to >5500 participating athletes competing in 41 sports and to the Medical Committee of the Pan American Sports Organization before and during the XV PAN. A convenience sample of 409 athletes was recruited. After signing an informed consent, all athletes answered a questionnaire. Data were collected at the clinical examination and recorded on a specific trauma form. The mean age of the athletes was 24.4 +/- 5.3 years. Males comprised 55% of the sample; females 45%. The prevalence of dental trauma among the athletes was 49.6% (n = 203) with no gender-based differences. Most of these injuries (63.6%) were related to activities during training or competition. Sports with the highest injury prevalence were wrestling (83.3%), boxing (73.7%), basketball (70.6%) and karate (60%). The most common injury was enamel fracture (39.8%); root fracture was the least common (0.4%). The teeth most affected were the maxillary permanent central incisors (n = 113), followed by the mandibular central incisors (n = 19). Based on the results of this study, nearly one-half of the subjects had experienced previous dental trauma; the majority related to sports activities. Furthermore, only 17% of the athletes reported prior mouthguard use; the most frequent mouthguards reported were boil-and-bite. These results suggest the importance of enhanced educational efforts and the use of properly fitted mouthguards to reduce dental trauma among athletes in international sports competition, especially in sports where mouthguards are not mandatory.

Estudo da relação entre a morfologia crânio-facial e o diâmetro do espaço aéreo faríngeo por meio de cefalometria / Study of relationship between craniofacial morphology and pharyngeal airway space by means of cephalometry

Este estudo avaliou a relação entre a morfologia crânio-facial e o diâmetro do espaço aéreo faríngeo por meio de cefalometria. Foram obtidas radiografias cefalométricas laterais de 52 voluntários (18 - 28 anos), com a cabeça em posição natural. A partir destas, foram obtidas medidas lineares e angulares referentes à morfologia crânio-facial e ao espaço aéreo faríngeo. Os diâmetros faríngeos posteriores ao palato mole e à língua apresentaram relação significativa com diversas características da morfologia facial, principalmente com o comprimento intermaxilar e o eixo de crescimento. A variável do espaço faríngeo que apresentou relação mais forte com o esqueleto facial foi o diâmetro posterior à língua, que se relacionou mais fortemente com o comprimento intermaxilar e com o eixo de crescimento.

Avaliação da acurácia de mensurações em imagens de tomografia computadorizada pelo software Dental Slice® e Dental scan / Evaluation of the accuracy of measurements in interative computerized tomography images by the Dental Slice® software and Dental Scan®

O objetivo neste trabalho foi avaliar a acurácia de medidas realizadas em imagens de tomografia computadorizada (TC) reconstruídas pelos softwares Dental Scan® e Dental Slice®. Foram utilizadas 16 mandíbulas humanas, das quais foram obtidas imagens axiais de TC, as quais foram reconstruídas pelos dois software avaliados. A altura e espessura óssea das regiões selecionadas foram realizadas e comparadas com os valores reais. Os valores obtidos foram avaliados estatisticamente pelo teste Anova verificando-se que tanto a altura como a espessura óssea mensuradas nas imagens reconstruídas pelo software Dental Scan® e Dental Slice® não apresentaram diferenças estatísticas quando comparados com os valores reais e entre os dois métodos (p>0.05). Concluimos que as mensurações ósseas nas imagens de TC reconstruídas pelos software são precisas e confiáveis.

Avaliação cefalométrica de paciente portador de displasia cleidocraniana / Cephalometric analisys of a patient with cleidocranial dysplasia

A displasia cleidocraniana é uma síndrome caracterizada por uma série de alterações dentárias e ósseas que tem como conseqüência uma desarmonia facial e estética para o paciente. Tem-se como objetivo neste trabalho fazer uma análise cefalométrica de um paciente de nove anos de idade, portador de displasia cleidocraniana, comparando os valores encontrados com os resultados-padrões relatados na literatura. Os resultados mostraram uma alteração maxilomandibular em relação à base do crânio, associada a um atraso na erupção dos dentes permanentes, características peculiares desta doença. Conclui-se que a análise cefalométrica é importante para um correto diagnóstico, planejamento e intervenção precoce nos pacientes portadores de displasia cleidocraniana.

Cleidocranial dysplasia is a syndrome characterized by severe dental and osseous abnormalities in which facial and esthetic disharmony is present. The aim of this study was to make a cephalometric tracing of a nine-years-old boy with cleidocranial dysplasia, comparing the values found with the standard ones reported in the literature. The patient showed a maxillo-mandibular alteration in relation to the cranial base and eruption failure of the permanent dentition. It can be concluded that the cephalometric analysis is very important for a correct diagnosis, planning and early intervention in patients with cleidocranial dysplasia.

Influência da espessura dos tecidos moles no diagnóstico de lesões ósseas produzidas / Influence of the soft tissue thickness in the diagnosis of produced bone lesions

O objetivo deste trabalho foi avaliar a influência da espessura dos tecidos moles na capacidade de diagnóstico de lesões ósseas periapicais. Para isso, foram utilizados segmentos posteriores de mandíbulas de suínos que foram dissecadas em três planos teciduais (osso, músculo e pele). Foram confeccionados cavidades ósseas na região periapical por meio de brocas esféricas. Essas cavidades foram aumentadas gradativamente e, em seguida, radiografadas com os tecidos posicionados. As imagens foram avaliadas por cinco avaliadores, e, após a análise estatística, pôde-se observar que a espessura dos tecidos não influenciou o diagnóstico das lesões porém este foi melhor para as lesões com, no mínimo, 1,5 mm de diâmetro.

Estudo do destino dado aos resíduos dos materiais radiográficos pelo Cirurgião-Dentista / Study of how Dentists dispose of residues of radiographic materials

A maioria dos consultórios e das clínicas odontológicas possui um aparelho de raios X para a realização de radiografias intrabucais e, consequentemente, gera resíduos químicos como as soluções de processamento, as lâminas de chumbo e as radiografias insatisfatórias que são frequentemente descartadas pelo cirurgião-dentista. Esses resíduos citados devem ser separados, acondicionados e identificados adequadamente para que possam ser coletados até a unidade de tratamento ou o destino final. O objetivo deste trabalho foi verificar o destino dado a esses resíduos pelos profissionais por meio de 800 questionários em 3 estados brasileiros. Após a tabulação dos dados observou-se a necessidade de orientação e conscientização dos profissionais para o correto manejo desses resíduos, baseando-se nas regulamentações da ANVISA.

Avaliação estatística de artigos publicados na área de Radiologia Odontológica / Statistic evaluation of published articles in Oral Radiology

Para saber se o valor do coeficiente de variação (CV) é considerado baixo, médio, alto ou muito alto, é importante avaliar a quantidade do experimento por meio da magnitude do erro experimental que este indica. Este estudo teve como objetivo analisar os artigos publicados na área de radiologia Odontológica, para calcular o coeficiente de variação médio e então classificá-lo como baixo, médio, alto e muito alto. Neste estudo, 394 artigos publicados no periódico Dentomaxillofacial Radiology foram avaliados e os dados como média e desvio padrão foram coletados, sendo o coeficiente de variação calculado. também foram coletados outros dados, como a utilização ou naõ de análises estatísticas, resultados apresentados em gráficos, testes estatísticos e medidas de dispersão utilizadas. Para os artigos avaliados que apresentaram desvio padrão, o coeficiente de variação para cada variável quantitativa foi calculado, obtendo-se o CV médio de todos os artigos de 15, 36 por cento com desvio padrão de 13,20 por cento. A importância de se realizar esta classificação é melhorar a precisão dos experimentos e manter a alta quantidade das pesquisas

Identificação de pacientes com risco de derrame na clínica odontológica por meio de radiografias panorâmicas / Identification of patients at risk of stroke in the clinic using panoramic radiography

A maioria dos acidentes vasculares cerebrais (AVC), comumente chamados de derrame, ocorre como resultado de aterosclerose envolvendo as artérias carótidas, devido à formação de ateromas. Diversos fatores concorrem para a formação destes, como hipertensão, diabete mellitus, obesidade, vida sedentária, entre outros. Na radiografia panorâmica, o ateroma pode ser visualizado como massa radiopaca localizada no espaço intervertebral C3-C4. Assim, esse exame pode ser útil para a identificação dessa condição. A realização deste trabalho objetivou relatar um caso de um paciente que procurou atendimento odontológico e foi diagnosticada a presença de ateromas pela radiografia panorâmica de rotina.