Length and geometric patterns of the greater palatine canal observed in cone beam computed tomography.

The greater palatine canal is an important anatomical structure that is often utilized as a pathway for infiltration of local anesthesia to affect sensation and hemostasis. Increased awareness of the length and anatomic variation in the anatomy of this structure is important when performing surgical procedures in this area (e.g., placement of osseointegrated dental implants). We examined the anatomy of the greater palatine canal using data obtained from CBCT scans of 500 subjects. Both right and left canals were viewed (N = 1000) in coronal and sagittal planes, and their paths and lengths determined. The average length of the greater palatine canal was 29 mm (±3 mm), with a range from 22 to 40 mm. Coronally, the most common anatomic pattern consisted of the canal traveling inferior-laterally for a distance then directly inferior for the remainder (43.3%). In the sagittal view, the canal traveled most frequently at an anterior-inferior angle (92.9%).

The prevalence of concha bullosa and nasal septal deviation and their relationship to maxillary sinusitis by volumetric tomography.

The objective of this study was to determine the prevalence of concha bullosa and nasal septal deviation and their potential relationships to maxillary sinusitis. 883 CT scans taken at Creighton University School of Dentistry from 2005 to 2008 were retrospectively reviewed for the presence of concha bullosa, nasal septal deviation, and maxillary sinusitis. 67.5% of patients exhibited pneumatization of at least one concha, 19.4% of patients had a deviated septum, and 50.0% had mucosal thickening consistent with maxillary sinusitis. 49.3% of patients who had concha bullosa also had evidence of maxillary sinusitis. Only 19.5% of patients with concha bullosa also had nasal septal deviation, whereas 19.7% of patients with sinusitis also presented with nasal septal deviation. Although concha bullosa is a common occurrence in the nasal cavity, there did not appear to be a statistically significant relationship between the presence of concha bullosa or nasal septal deviation and maxillary sinusitis.

Developmental oronasal fistula of the incisive papilla.

Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used to describe the presence of a developmental fistulous tract that connects the oral and nasal cavities through an oral opening located at the incisive papilla. Reportedly, this condition is a rare developmental variant; approximately 40 cases have been reported in the literature. Because awareness of this entity is important to avoid misdiagnosis, this article presents the clinical and conebeam computed tomography findings of two cases. Based on a review of the development of the nasopalatine structures in man, the authors propose that this entity be classified as a developmental oronasal fistula of the incisive papilla.

Glandular odontogenic cyst of the mandible: from incidental radiographic discovery to prosthetic reconstruction.

A large multilocular radiolucent lesion involving the anterior mandible was noted incidentally in a 44-year-old woman who sought routine dental treatment. An incisional biopsy revealed that this lesion represented an uncommon developmental odontogenic cyst known as a glandular odontogenic cyst. The lesion was removed surgically, followed by reconstruction with a right anterior iliac crest bone graft. This article reviews the radiographic, clinical, and histopathologic appearance of this rare odontogenic cyst, as well as the surgical management and the patient's subsequent prosthetic rehabilitation.

Extirpation of the primary canine tooth follicles: a form of infant oral mutilation.

BACKGROUND: Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of eastern Africa, in which traditional healers and other village elders extirpate the primary canine tooth follicles of infants by using crude, often unsterilized, instruments or utensils. Traditional folklore suggests that the underlying tooth follicles, thought to resemble worms, are the cause of high temperature, vomiting, loss of appetite and diarrhea in infants. In addition to the serious and potentially fatal immediate postsurgical complications, many of those who undergo this practice exhibit characteristic long-term adverse dentoalveolar effects. Children in these families also may be at greater risk of undergoing other mutilation rituals because of their cultural background. CASE DESCRIPTION: We report on the clinical and radiographic findings in five siblings who apparently were subjected to IOM as infants before immigrating to the United States. CLINICAL IMPLICATIONS: Although the practice of IOM is believed to be exceedingly rare in developed countries, it is important that dentists and allied dental personnel who treat refugees from areas of the world in which IOM is endemic be aware of the social factors behind this practice as well as be able to recognize its dental and psychological sequelae.

Transitory paresis of the lateral pterygoid muscle during a posterior superior alveolar nerve block--a case report.

The posterior superior alveolar nerve (PSAN) is a major sensory branch of the maxillary division of the trigeminal nerve. A PSAN block is a dental nerve block used for profound anesthesia of the maxillary molars. Complications arising from the PSAN block include hematoma formation, transient diplopia, blurred vision, and temporary blindness. This article presents a case of temporary paresis in the lateral pterygoid muscle following a PSAN block that utilized a 27-gauge long needle. The anatomical parameters and pathogenesis of such a complication are reviewed.

Unilateral tongue atrophy.

A 64-year-old woman who sought routine dental treatment was noted to have unilateral atrophy of the tongue. The medical and dental significance of this manifestation is reviewed.

Clinically aggressive central giant cell granulomas in two patients with neurofibromatosis 1.

BACKGROUND: Neurofibromatosis 1 (NF1) is an autosomal dominantly inherited disorder caused by a spectrum of mutations affecting the Nf1 gene. Affected patients develop benign and malignant tumors at an increased frequency. Clinical findings include multiple cutaneous café-au-lait pigmentations, neurofibromas, axillary freckling, optic gliomas, benign iris hamartomas (Lisch nodules), scoliosis, and poorly defined soft tissue lesions of the skeleton. Kerl first reported an association of NF1 with multiple central giant cell granulomas (CGCGs) of the jaws. There have since been 4 additional published cases of NF1 patients with CGCGs of the jaws. CLINICAL CASES: We report on 2 patients who presented with NF1 and aggressive CGCGs of the jaws. In both cases, the clinical course was characterized by numerous recurrences despite mechanical curettage and surgical resection. CONCLUSIONS: We review proposed mechanisms to explain the apparent association between NF1 and an increased incidence of CGCGs of the jaws. While the presence of CGCGs of the jaws in patients with NF1 could represent either a coincidental association or a true genetic linkage, we propose that this phenomenon is most likely related to NF1-mediated osseous dysplasia. Compared to normal bone, the Nf1-haploinsufficient bone in a patient with NF1 may be less able to remodel in response to as of yet unidentified stimuli (e.g. excessive mechanical stress and/or vascular fragility), and consequently may be more susceptible to developing CGCG-like lesions. Alternatively, the CGCG in NF1 patients could represent a true neoplasm, resulting from additional, as of yet unidentified, genetic alterations to Nf1-haploinsufficient bone.

Comparison of clinician agreement during visualization of conventional and digitized bitewing radiographs.

Digital technology is becoming more common in dental practices. Indirect digitization of radiographs can be an alternative to direct digital systems. This study was designed to evaluate intra-observer, inter-observer, and inter-technique agreement of proximal caries diagnosis on bitewing radiographs before and after indirect digitization. Four bitewing radiographs were obtained from 50 dental students. Conventional films were digitized with a flatbed scanner at 150 and 300 dpi. Three observers recorded the presence and depth of caries on 1,642 proximal surfaces for the conventional and digitized radiographs. Radiographs were evaluated twice (one week apart), using each viewing technique. Intra-observer, inter-observer, and inter-technique agreement (Kw) were determined. The intra-observer, inter-observer, and inter-technique agreements of proximal caries diagnosis on bitewing radiographs before and after indirect digitization were moderate to good.

Sinonasal undifferentiated carcinoma of the maxillary sinus.

We describe the case of a 43-year-old man who was referred to our dental school"s acute care clinic with pain and swelling of presumed dental origin in the left maxillary quadrant. Radiographic examination revealed extensive dental decay and periodontal disease. On questioning, the patient admitted to paresthesia of recent onset. Paresthesia associated with pain or swelling of the jaws is an ominous sign that should alert the clinician to the possibility of an underlying aggressive neoplasm. In this case, biopsy of the lesion confirmed that the patient had a rare malignant tumour of maxillary sinus origin, a sinonasal undifferentiated carcinoma.

Etiology of xerostomia and dental caries among methamphetamine abusers.

This study reviews the peripheral effects of methamphetamine on the salivary acini, the pathogenesis of methamphetamine-induced xerostomia, and its anecdotal relationship to dental caries. Methamphetamine is a sympathomimetic central stimulant which is abused for its euphoric effects. Its pharmacological action is exerted indirectly by sustaining high levels of catecholamines in the synaptic cleft and directly by binding to the postsynaptic adrenergic receptors. Methamphetamine abusers report subjective perception of xerostomia, which cannot be explained by the direct peripheral action of methamphetamine on the secretory acini. The drug may cause a decrease in salivary flow rate by centrally inhibiting salivatory nuclei via stimulation of alpha-2 receptors in the brain. Drug mediated dehydration state may influence the perception of dry mouth in abusers. The decreased salivary flow rate, either due to a central inhibitory action of methamphetamine or generalised dehydration, likely contributes to the increased occurrence of dental caries. Five cases of methamphetamine abuse are presented, three of whom experienced rampant dental caries. A direct association between methamphetamine abuse and the occurrence of rampant caries was not clear.

Aberrant root formation: review of root genesis and three case reports.

The mechanism of root formation and tooth eruption is a complex process which is not fully understood. Prior to a tooth emerging into the oral cavity, root genesis is initiated by derivatives of the enamel organ. The dental follicle mediates an eruption pathway allowing for movement of the developing tooth in a coronal direction. As the tooth moves towards the oral cavity, root formation occurs passively in the resulting space. Failure of the enamel organ and dental follicle to properly coordinate may result in complications in the eruption process. This clinical report presents 3 cases of isolated, unerupted teeth with dysmorphology of the roots. The process of root development and tooth eruption is also briefly reviewed.

Radiographic diagnosis of supernumerary premolars: case reviews.

The literature reported prevalence of supernumerary teeth within the mandible and maxilla varies from 0.2-0.9%. This study reviews the formation and diverse clinical appearances of supernumerary premolars. We present case reports where supernumerary teeth were recognized as incidental findings during routine radiographic examination in patients with an age range of five to thirty-nine years. Cases are presented to illustrate that the initiation and development of supernumerary premolars are often delayed by a magnitude of years. Periodic examination is recommended for occurrence and clinical behavior. In the presented cases, displacement and resorption of the adjacent teeth was not evidenced. None of the supernumerary teeth demonstrated cystic transformation. The importance of differential radiographic diagnosis is discussed.