A three-year programme in oral diagnosis and treatment planning. A model using an interdisciplinary teaching team.

Diagnosis and treatment planning are considered to be the basis for successful clinical dentistry, however, these skills are difficult to teach and evaluate. At the Department of Diagnosis and Treatment Planning, Tel Aviv University Dental School, a 3-year teaching programme has been developed. The goals of the programme are to teach a systematic pattern of data collection from history, clinical examination, imaging modalities and models, and to use this data to identify the patient's problems and to arrive at a final diagnosis, to develop a treatment plan, taking into account all relevant information, and to consult experts when needed, to train in case presentation, and to deal with peer response. The program includes 20 h of lectures and 30 h of exercises in the 4th year, developing at least 8 full treatment plans per student in the fifth year, a 1 30-min weekly panel seminar during the final year, and a final integrative examination at the end of the 6th year.

An immunohistochemical study of p53 and PCNA in inflammatory papillary hyperplasia of the palate: a dilemma of interpretation.

OBJECTIVE: Inflammatory papillary hyperplasia of the palate (IPHP) or the granular type of denture stomatitis, is a non-neoplastic lesion characterized histologically by a significant epithelial hyperplasia and inflammatory infiltrate usually caused by trauma and Candida infection. p53 and proliferative cell nuclear antigen (PCNA) are cell-cycle regulators, that when overexpressed, are considered by many investigators as markers of malignant transformation. The objective of this study was to investigate the immunodetection of p53 and PCNA in IPHP, and to correlate these results with the degree of epithelial hyperplasia and inflammatory infiltrate. MATERIALS AND METHODS: In 12 cases diagnosed clinically as IPHP, Candida was cultured from the denture base and the palatal mucosa. Lesions were biopsied and stained with H&E for histomorphometric analysis of the epithelial width and inflammatory infiltrate. PAS and Gram stains were used for screening of Candida. Sections were immunostained with DO-7 for p53 and PC-10 for PCNA. Fifteen palatal biopsies obtained from autopsies of edentulous subjects with normal palatal mucosa served as controls. RESULTS: All cultures of swabs from both the palatal mucosa and denture base were positive for Candida. Candidal hyphae could not be identified in PAS stained sections. Small foci of Gram-positive organisms were found in two cases of IPHP. Epithelial width and inflammation were significantly higher in IPHP than in controls (P < 0.001). A three-fold increase in positively stained cells for p53 and a two-fold increase in positively stained cells for PCNA were seen in IPHP compared with controls (P < 0.001). CONCLUSIONS: Although a significant increase in the immunodetection of p53 and PCNA may indicate a malignant potential, IPHP has never been reported to undergo malignant transformation nor is it associated with cytologic signs of dysplasia. The increase in the epithelial width and inflammation degree is probably associated with the colonization of the denture bases with Candida organisms. The increased detection of p53 and PCNA can be a secondary effect of cytokines originating from both the inflammatory cells and the keratinocytes. Thus, immunodetection of p53 and PCNA by current immunohistochemical methods on archival tissues is neither specific nor sensitive enough to be used as indicators for malignant potential in the absence of cytological dysplastic changes or genetic proof of mutated cell cycle genes.

A novel system of human submandibular/sublingual saliva collection.

The assessment of submandibular/sublingual (sm/sl) saliva is a procedure of increasing significance. However, the collection of these fluids by traditional techniques is difficult and therefore often neglected. To collect sm/sl saliva, we have assembled a novel, universal system consisting of four parts-collecting tubing, a buffering chamber, a storing tube, and a suction device. Submandibular/sublingual saliva samples were collected from ten healthy and ten xerostomic individuals. The system showed intra-examiner reproducibility of 0.92 for healthy and 0.89 for xerostomic subjects, and inter-examiner reproducibility of 0.93 for normal subjects and 0.80 for xerostomic individuals. The flow rates obtained by the present collecting set-up were similar to those measured by all known previous methods that were published during the last 40 years. The system was also efficient, in that more than 90% of the fluid that entered the system was eventually collected in the storing tube for analysis. The system appears to collect relatively pure sm/sl fluids, since contamination of the collected sample by a stimulant solution swabbed repeatedly over the tongue during saliva collection was minimal. The system is reliable, safe, practical, and comfortable for the patient.

Clinical characteristics and treatment of patients with oral lichen planus in Israel.

Oral lichen planus (OLP) has a multiple-site involvement, with the buccal mucosa being the most prevalent. A possible relationship between OLP and the risk of malignancies in the involved site is documented. The characteristics of OLP have been studied in different populations; however, no similar studies have been conducted in any Jewish population. The purpose of this study was to evaluate the natural history of OLP in Israeli Jewish patients. Data were collected from 157 charts of patients with histologically confirmed OLP. No evidence suggesting a connection between OLP and diabetes, cardiovascular disease, smoking, alcohol use, or positive Candida culture was found. Skin involvement of lichen planus was found in one fifth of the patients. Symptomatic OLP was noted in half of the patients, mainly in those with the erosive form. In 65% of the patients with symptoms, improvement by more than 50% was shown within 2 weeks of steroid use. The transformation rate of 1.3% of OLP into malignancy was observed in the entire group. A constant follow-up for contributing symptoms and for early diagnosis of suspected transformed lesions is of utmost importance.

Bilateral asymmetry in dental discrete traits in human isolates: south Sinai Bedouin tribes.

Data are presented on dental morphology as adjudged from dental casts of children (boys and girls) 6-13 years of age from four Bedouin tribes of Southern Sinai (Gebeliya, Muzeina, Hamada and Aliquat) and a mixed group designated as "other tribes", (Awlad Said, Gararsha, Sawalcha, Haweitat and Beni-Wassal). Alginate was the impression material used and the casts were made of artificial stone poured into the irreversible hydrocolloid impression. A total of 352 casts were available for study. In the maxilla, 29 dental discrete traits of permanent teeth and 2 traits of deciduous teeth were observed, and in the mandible, 24 traits of permanent teeth and 2 traits of deciduous teeth; in all, 57 traits were observed. Only clear traits were considered. From the studied 57 traits only 30 morphological traits were used for the estimation of the asymmetry. Total symmetry was observed in 2 mandibular teeth and traits: a) Lateral incisor-LI-slight inclination; b) Canine-Cn-no lingual cingulum and in 3 maxillary teeth and traits a) Central incisor-CI-slight convexity of labial profile curvature; b) First premolar-PM1-intercuspal distance more than 3 mm; and c) Second molar,-M2-pit groove pattern similar to the first molar. Low values of asymmetry (1-5.1%) were observed in traits describing outline form and shape, surface outline, and number of cusps in three maxillary and two mandibular teeth (nine discrete traits). High values of asymmetry (12.7-37.0%) were observed regarding traits describing styles on slopes, ridges, pits, grooves and lingual tubercles in three maxillary and one mandibular teeth (15 discrete traits). The high rate in molars was higher than that in the incisors. A higher rate of asymmetry occurred in the maxilla than in the mandible.

Prevalence of torus palatinus in a population of young and adult Israelis.

The prevalence of torus palatinus, a common exostosis with a debatable pathogenesis, was epidemiologically investigated in a group of 1002 Israeli Jews. This protuberance was observed in 21% of the entire sample, with non-significant differences among different age groups. The smooth type of torus was noted in 72.9%, 68.1% were smaller than 2 cm, and 53.8% were located in the molar area only. The prevalence of torus palatinus in the combined molar-premolar area increased with age, whereas in the molar area it decreased, expressing a significant relation between location and age (p < 0.01). The prevalence of tori larger than 2 cm was much higher in the 21-year and older age groups than in the younger groups. The diverse prevalence of torus palatinus in some of the ethnic groups was also statistically significant (p < 0.05). The aetiology of this common osseous outgrowth is probably multifactorial, including environmental factors acting in a complicated and unclear interplay with genetic factors.

Oral health and treatment needs in a non-institutionalized elderly population: experience of a dental school associated geriatric clinic.

The purpose of this study is to report oral and dental findings in a population of independent geriatric patients, who were treated at the Geriatric Dental Clinic, School of Dental Medicine, Tel Aviv University. The study group consisted of 221 patients, 31.2% males and 68.8% females. The mean age was 75.3 years. Of the patients, 75% were edentulous. The most frequent complaint was pain associated with wear of dentures, and the most frequent mucosal lesion was traumatic ulcer (51%). Most dentures were of poor quality (77%). The mean denture age was 9.7 years, increasing as the patient's age increased. Denture hygiene was good in 59%, fair in 11% and poor in 30%. The mean number of visits at the Geriatric Clinic was 5.5 per patient.

Variables affecting dental fluctuating asymmetry in human isolates.

The aims of the present study are to 1) determine and describe levels of dental fluctuating asymmetry (FA) in a highly endogamous human group; 2) evaluate the effects of various FA measures on perceived FA levels and their interrelationships; 3) study the connections between dental variables (tooth size, class, position, type, location and dimension) and FA levels; and 4) estimate the interrelationships between dental FA measures. The study was carried out on 242 Bedouin boys aged 5 to 14 years. The results demonstrate that the main variables influencing dental FA levels within this population are tooth class (incisors, canine, premolars, molars) and position (mesial, distal) and that the interaction between the two is significant. When sample sizes are large enough and individual measures are needed for the statistical analysis, the use of a computational method based on absolute values is legitimate. Clear relationships between some FA dental traits are discerned through principal-components analysis.

Oral lesions in elderly denture wearers.

A total of 298 patients in geriatric institutions were surveyed; 62.8% were edentulous. The frequency of denture hyperplasia and of flabby ridge was related to denture quality which deteriorates with irregular dental visits. Denture stomatitis and inflammatory papillary hyperplasia of the palate were related to denture age only and not to quality. All denture-related lesion frequencies increased with patient age and denture age. The total frequency of soft tissue lesions was 16.7% in edentulous non-denture patients and 58.2% in patients with poor quality dentures. The lowest frequency of soft tissue lesions was in edentulous, non-denture patients. Poor oral hygiene increased the frequency of positive cultures for Candida from the dentures.

A clinical evaluation of materials used in registering interjaw relationships.

Three recording media used to relate stone casts for 15 dentate patients were compared for accuracy. Interjaw relationships at the maximum intercuspation position and the retruded contact position were recorded using impression plaster, wax, and Duralay acrylic resin. A Lucia programming jig was used in the retruded contact position. The vertical distance and horizontal deviation between the casts were measured from reference points on the casts using each recording material. The average percentage differences between the recording materials were calculated. Hand articulation was the most accurate method of relating the casts at maximum intercuspation. The most accurate recording medium was impression plaster, followed by dental wax and Duralay resin at the maximum intercuspation and retruded contact positions.

A clinical survey of oral soft tissue lesions in institutionalized geriatric patients in Israel.

A clinical survey of oral soft tissue lesions in 298 geriatric patients in Israel was conducted. White lesions were found in 9.5% of smokers and 2.19% of non-smokers. Varicosities increased from 11.1% to 41.1% between ages 50-99 years. Pigmentation, hairy tongue, and papillary atrophy of the tongue all increased with age. Hairy tongue was found in 12.8% of men and 4.5% of women.

Directional dental asymmetry in South Sinai Bedouin isolates.

Dental casts of 242 Bedouin children were used to study directional asymmetry (DA). Results of Student's t-test pair comparison showed that for permanent dentition, 4 out of 24 DA measures were statistically significant whereas for deciduous dentition, 8 out of 20 measures were significant (p less than 0.05). The magnitude of DA was on the average 1% of the total size of the tooth. No preference regarding dimension (buccolingual, mesiodistal) or jaw (maxilla, mandible) was detected for the DA. PCA results demonstrated the independent nature of DA measures in the dentition.

Migratory stomatitis.

Migratory stomatitis is a unique oral condition with several descriptive names. The diagnosis is based on the clinical appearance and the history of the lesions. The etiology of this entity is still open to debate. A review of the literature and a clinical description of a study group consisting of seven additional cases, in which long-term follow-up was done, are presented. Migratory stomatitis is suggested as the most suitable term to describe accurately the nature and the behavior of this condition.