Diagnostic difficulties in a patient with multiple sclerosis who presents with cranial nerve palsies: an unusual complication of dental work.

A woman in her 60s with multiple sclerosis (MS) presented with right-sided ptosis, right sixth nerve palsy, right facial paraesthesia and signs of sepsis. She had a recent diagnosis of a dental abscess. Investigations revealed a right submasseter abscess leading to bacterial meningitis (Streptococcus intermedius) and a cavernous sinus thrombosis. She was managed in intensive care and underwent surgical drainage of the abscess. Anticoagulation for 6 months was planned. Cavernous sinus thrombosis is a very rare complication of a dental abscess, and even less frequently associated with submasseter abscesses. The case was complicated by a history of MS, to which the patient's symptoms and signs were initially attributed to. This case highlights the diagnostic pitfalls, and aims to enhance learning around similar cases. To the best of our knowledge, this is the first case report of a masseter/submasseter abscess leading to cavernous sinus thrombosis.

Odontogenic Sinusitis: Current Concepts in Diagnosis and Treatment.

Odontogenic sinusitis is a unique cause of sinus disease that deserves special consideration. An astute clinician can elicit historical findings such as recent dental work, and symptoms such as unilateral facial pain and foul drainage, despite a relatively benign oral cavity examination. Otolaryngologists and dental professionals who care for these patients must be able to interpret imaging studies for dental disorder such as periapical abscesses and periodontal disease. Treatment is frequently some combination of antibiotic therapy, dental procedures, and endoscopic sinus surgery. More prospective studies are needed to determine the best approach to caring for this patient population.

Chronic migraine headache and multiple dental pathologies causing cranial pain for 35 years: the neurodental nexus.

We report a case that illustrates how chronic migraine headaches and multiple dental pathologies caused severe and long-standing cranial pain that affected the quality of life of a man for more than 35 years. His case was investigated at several settings including the neurology outpatient clinic of the hospital without a definitive diagnosis or resolution. After investigations, multiple oral pathologies including two occult dental abscesses were diagnosed. Once both affected teeth and associated abscesses were surgically removed, with subsequent antibiotic therapy the headaches resolved.

El síndrome de Groves en el paciente endodóncico: implicaciones legales y para la práctica clínica / No disponible

El doctor J. E. Groves, psiquiatra estadounidense, en un artículo publicado en el New England Journal of Medicine en 1978, fue el primero en atreverse a plantear de forma sincera y abierta la existencia de pacientes a los que definió como "odiosos" o "indeseables" (hateful patient). El paciente endodóncico que padece el "síndrome de Groves" se caracteriza por provocar en el dentista sentimientos de contratransferencia tales como el odio, la aversión, el aborrecimiento, o, incluso, el recelo, el temor y el miedo, todo ello sin que el paciente pueda ser encuadrado en un cuadro psiquiátrico específico. En este artículo se analiza, desde un punto de vista muy personal, la epidemiología, etiología, formas clínicas, el diagnóstico diferencial y el manejo terapéutico de este síndrome cuando se presenta en pacientes que necesitan tratamiento endodóncico

No disponible

Knowledge and Practices of Family and Emergency Physicians in Managing Nontraumatic Dental Conditions: A Case-based Survey.

INTRODUCTION: Physicians are often patients' first point of contact for management of nontraumatic dental conditions (NTDCs). This study's aim was to evaluate the knowledge and practices of Ontario physicians in managing NTDCs, with a specific focus on antibiotic usage. METHODS: A Web-based survey featured 4 NTDC clinical scenarios: irreversible pulpitis, localized acute apical abscess with or without systemic involvement, and chronic apical abscess. The survey link was distributed to active Ontario family and emergency physicians. The sample group was asked questions about their management of and experience with NTDCs, and demographic and practice characteristics were collected. Descriptive and multivariate logistic regression analyses were undertaken (P ≤ .05). RESULTS: Sampled Ontario physicians tend to manage NTDCs in a manner that is not consistent with evidence-based care. For irreversible pulpitis and for localized acute apical abscess with or without systemic involvement, most physicians would prescribe an antibiotic (57.4%, 84.8%, and 96.3%, respectively), and 23.5% would prescribe an antibiotic for chronic apical abscess. Approximately half the sample (52.9%) felt discomfort in managing NTDCs, and 85.3% felt they were inadequately trained to manage NTDCs. CONCLUSION: Areas that present opportunities for improvement in the physician management of NTDCs were identified, including the incorporation of further NTDC training in medical curricula and continuing medical education courses, and development and dissemination of guidelines for physicians in managing NTDCs.

Antibiotic Prescriptions Associated With Dental-Related Emergency Department Visits.

STUDY OBJECTIVE: The frequency of antibiotic prescribing and types of antibiotics prescribed for dental conditions presenting to the emergency department (ED) is not well known. The objective of this study is to quantify how often and which dental diagnoses made in the ED resulted in an antibiotic prescription. METHODS: From 2011 to 2015, there were an estimated 2.2 million (95% confidence interval [CI] 1.9 to 2.5 million) ED visits per year for dental-related conditions, which accounted for 1.6% (95% CI 1.5% to 1.7%) of ED visits. This is based on an unweighted 2,125 observations from the National Hospital Ambulatory Medical Care Survey in which a dental-related diagnosis was made. RESULTS: An antibiotic, most often a narrow-spectrum penicillin or clindamycin, was prescribed in 65% (95% CI 61% to 68%) of ED visits with any dental diagnosis. The most common dental diagnoses for all ages were unspecified disorder of the teeth and supporting structures (44%; 95% CI 41% to 48%; International Classification of Diseases, Ninth Revision, Clinical Modification[ICD-9-CM] code 525.9), periapical abscess without sinus (21%; 95% CI 18% to 25%; ICD-9-CM code 522.5), and dental caries (18%; 95% CI 15% to 22%; ICD-9-CM code 521.0). Recommended treatments for these conditions are usually dental procedures rather than antibiotics. CONCLUSION: The common use of antibiotics for dental conditions in the ED may indicate the need for greater access to both preventive and urgent care from dentists and other related specialists as well as the need for clearer clinical guidance and provider education related to oral infections.

¿Retratamiento ortógrado o retrógrado? A propósito de un caso / Ortograde or retrograde retreatment? A case report

Actualmente un gran porcentaje de dientes tratados endodóncicamente necesitan un nuevo tratamiento por aparición o persistencia de la lesión periapical. Cuando un paciente presenta una periodontitis apical crónica tras un tratamiento de conductos, debemos decidir si realizamos un retratamiento convencional por vía ortógrada o procedemos a un retratamiento quirúrgico. Si analizamos la evidencia científica, actualmente no existe un consenso en cuanto a cuál es la vía de acceso idónea en un retratamiento. Sin embargo, aunque el tratamiento de elección suele ser en primer lugar por vía ortógrada, presentamos un caso de retratamiento quirúrgico retrógrado como primra opción

Currently, a large percentage of teeth treated endodontically require a new treatment due to the appearance or persistence of the periapical lesion. When a patient presents a chronic apical periodontitis after a root canal treatment, we must decide if we perform a conventional retreatment by orthograde or we proceed to a surgical retreatment. If we analyze the scientific evidence, there is no clear procedure in this regard, although there is a tendency to try to always carry out a conventional retreatment that is more conservative first and if it does not work to perform the surgical procedure. We present a case in which we acted a little differently but with a correct evolution

Avaliação de tratamentos endodônticos realizados por alunos de graduação com proservação de um ano / Evaluation of endodontical treatments performed by undergraduate students with one year proservation

O sucesso da terapia endodôntica depende do conhecimento teórico e prático dos princípios e passos clínicos dessa especialidade. O presente estudo teve como objetivo calcular o índice de sucesso endodôntico obtido pelos acadêmicos do último ano de graduação da UniCesumar. Para isso, foram realizadas avaliações clínica e radiográfica em pacientes atendidos no projeto de extensão PROENDO, no qual alunos de graduação realizaram procedimentos endodônticos na rede pública de saúde de Marialva-Paraná, nos anos de 2013 e 2014. Foram avaliados 33 dentes tratados endodonticamente. O tempo de proservação mínima foi de pelo menos um ano, em que foram submetidos à avaliação clínica e radiográfica por um profissional de Odontologia devidamente treinado e calibrado. O índice de sucesso endodôntico demonstrado pela pesquisa foi de 97%, o que indica que os acadêmicos estão recebendo um ensino de qualidade e os pacientes, tratamentos satisfatórios (AU).

The success of endodontic therapy depends on the theoretical and practical knowledge of principles and clinical steps in this specialty. The present study aimed to calculate the endodontic success rate obtained by undergraduated students of the final year of UniCesumar University. For this, clinical and radiographic evaluations were performed in patients who received treatment in the PROENDO extension project, in which the final year undergraduate students performed endodontic procedures in the public health network of Marialva-Paraná in the years of 2013 and 2014. Thirty-three endodontically treated teeth were evaluated. The minimum proservation time was at least one year, and they were submitted to clinical and radiographic evaluation by a trained professional. The rate of endodontic success demonstrated by the survey was 97%, which indicates that academics are receiving quality education and patients are receiving satisfactory treatments (AU).

Facial Palsy Masquerading as an Acute Dental Abscess.

Facial nerve palsy has specific symptomology, but varied aetiology. Prompt and thorough assessment is required to ascertain if upper or lower motor neurone damage has occurred. This report discusses a 6-year-old female, presenting in the Emergency Department with unilateral facial weakness. Initially thought to be facial swelling relating to her carious dentition, clinical assessment from the maxillofacial team identified that the patient had a unilateral facial palsy, later diagnosed as Bell's palsy. Her delayed presentation was due to initial misdiagnoses in primary care. This case report aims to highlight its aetiology, clinical features and appropriate management. Clinical relevance: To make the general dental practitioner aware of different causes of facial paralysis, and to provide GDPs with an algorithm to follow in the presentation of a facial palsy in the primary care setting.

Treatment of mandibular osteomyelitis in two red-necked wallabies (Macropus rufogriseus) by means of intensive long-term parenteral drug administration and serial computed tomographic monitoring.

CASE DESCRIPTION 2 female red-necked wallabies (Macropus rufogriseus) were evaluated because of sudden-onset mandibular swelling, ptyalism, and hyporexia. CLINICAL FINDINGS Physical examination revealed a mandibular swelling with a fluctuant center in both wallabies. Hematologic analysis revealed leukocytosis with a mature neutrophilia and monocytosis in one wallaby (case 1) and a slight neutrophilia, hyperglobulinemia, and high serum alanine aminotransferase activity in the other (case 2). Cytologic examination of the swelling revealed a uniform population of gram-negative rods in case 1 and neutrophilic inflammation in case 2. Radiography revealed a soft tissue mandibular swelling with osteolucency around mandibular incisor roots in both wallabies. Computed tomography revealed changes consistent with chronic active mandibular osteomyelitis and reactive bone formation, but also sequestra formation not appreciable via radiography. TREATMENT AND OUTCOME Long-term antimicrobial treatment was initiated with clindamycin (17 to 21 mg/kg [7.7 to 9.5 mg/lb], IV, q 12 h for 40 to 55 days) and high-dose benzathine penicillin G (80,000 U/kg [36,364 U/lb], SC, q 12 h for 150 days). Serial CT was performed to evaluate response to treatment and resolution of disease. A CT scan 18 months after the initial evaluation revealed complete resolution of osteomyelitis and sequestra. CLINICAL RELEVANCE Advanced imaging and long-term treatment and management were integral to the successful outcome for these wallabies, given that the osseous changes visible on CT images were not visible on standard radiographs, guiding therapeutic decision-making. This report provides new therapeutic and diagnostic monitoring information to assist clinicians with similar cases.

Chronic Suppurative Osteomyelitis of the Mandible Treated with Antibiotics Complemented with Surgical Treatment: A Case Report / Osteomielitis Crónica Supurativa en Mandíbula Tratada con Antibióticos y Cirugía: Reporte de Caso

ABSTRACT: Osteomyelitis is an infection that affects bone and bone marrow, it occurs due to inoculation of microorganisms either directly or by continuous accumulation through a hematogenous way. Female patient, 64 years old, presenting an increase of volume of the parotid masseteric region and right submandibular region, with approximately two weeks of evolution, which had a slightly fluctuating, hyperemic and hyperthermic indurated consistency; the patient complained of severe pain. CT scan and biopsy was indicated. It is imperative to identify the causative agent; the use of antibiotics must be complemented by surgical treatment to eliminate the possibility of a remaining infection.

RESUMEN: La osteomielitis es un proceso infeccioso que afecta al hueso y medula ósea y que se produce debido a la inoculación de microorganismos ya sea de manera directa, por continuidad o bien por medio de la vía hematógena. Paciente femenino de 64 años de edad que presentaba aumento de volumen en región submandibular derecha refiriendo dolor intenso con evolución de 2 semanas aproximadamente, el cual era de consistencia indurada ligeramente fluctuante, hiperémico e hipertérmico; la paciente se quejaba de dolor intenso, se indicó TC y biopsia. En estos casos para tener éxito en el tratamiento el uso de antibióticos debe complementarse con desbridamiento quirúrgico, aunado a un seguimiento estrecho para descartar la posibilidad de una infección remanente.

Absceso alveolar agudo en pacientes mayores de 19 años. Municipio Unión de Reyes / Acute alveolar abscess in patients elder 19 years old. Municipality Union de Reyes

Introducción: frecuentemente las infecciones de la cavidad bucal son el resultado del deterioro que provoca la caries con exposición de la pulpa dental. Una higiene dental descuidada o inadecuada, y complicaciones asociadas a enfermedades periodontales, son otras de las causas, que pueden incidir en la aparición de procesos infecciosos. Objetivo: caracterizar el comportamiento del absceso alveolar agudo en los pacientes mayores de 19 años en la consulta de urgencia estomatológica del poblado de Alacranes, Municipio Unión de Reyes. Materiales y Métodos: se realizó un estudio observacional descriptivo en pacientes mayores de 19 años, del área de Alacranes municipio Unión de Reyes. El universo de estudio estuvo constituido por los pacientes que acudieron a la consulta de urgencia estomatológica, de enero de 2011 a enero 2012. Con previo consentimiento informado la muestra la constituyó 135 pacientes, con patológica de absceso alveolar agudo, teniendo en cuenta las variables: edad, sexo, etiología y complicaciones. Los datos obtenidos fueron registrados en una base de datos y se procesaron estadísticamente. Resultados: los grupos de 20-29 años y el sexo masculino fueron los más afectados, con 38 % y 54.8 %, respectivamente. La causa fundamental fue la caries dental con un 91.8 %. La celulitis facial resultó la complicación más frecuente. Conclusiones: la etiología más usual del absceso alveolar agudo fue la caries dental. Los pacientes afectados que no recibieron una puntual asistencia sufrieron complicaciones (AU).

Introduction: frequently, oral cavity infections are due to the deterioration caused by caries with dental pulp exposition. An inadequate and careless dental hygiene and complications associated to periodontal diseases are other reasons the may lead to the occurrence of infectious processes. Objective: Characterise the behaviour of the absceso alveolar acute in the greater patients of 19 years in the query of urgency estomatológica of the populated of Alacranes, municipality Union de Reyes. Materials and Methods: a descriptive, observational study was carried out in patients elder 19 years old, in the health area Alacranes, municipality Union de Reyes. The studied universe was formed by the patients assisting to the dentist emergency consultation from January 2011 to January 2012. With previous informed consent, the sample was formed by 135 patients with acute alveolar abscess, taking into account the following variables: age, sex, etiology and complications. The obtained data were recorded in the database and statistically processed. Results: the most affected groups were the 20-29 years-old group and the male sex, with 38 % and 54.8 % respectively. Dental caries was the main cause with 91.8 %. Facial cellulitis was the most frequent complication. Conclusions: dental caries was the most usual etiology of the acute alveolar abscess. The affected patients who did not receive opportune health care suffered complications (AU).

Absceso alveolar agudo en pacientes mayores de 19 años. Municipio Unión de Reyes / Acute alveolar abscess in patients elder 19 years old. Municipality Union de Reyes

Introducción: frecuentemente las infecciones de la cavidad bucal son el resultado del deterioro que provoca la caries con exposición de la pulpa dental. Una higiene dental descuidada o inadecuada, y complicaciones asociadas a enfermedades periodontales, son otras de las causas, que pueden incidir en la aparición de procesos infecciosos. Objetivo: caracterizar el comportamiento del absceso alveolar agudo en los pacientes mayores de 19 años en la consulta de urgencia estomatológica del poblado de Alacranes, Municipio Unión de Reyes. Materiales y Métodos: se realizó un estudio observacional descriptivo en pacientes mayores de 19 años, del área de Alacranes municipio Unión de Reyes. El universo de estudio estuvo constituido por los pacientes que acudieron a la consulta de urgencia estomatológica, de enero de 2011 a enero 2012. Con previo consentimiento informado la muestra la constituyó 135 pacientes, con patológica de absceso alveolar agudo, teniendo en cuenta las variables: edad, sexo, etiología y complicaciones. Los datos obtenidos fueron registrados en una base de datos y se procesaron estadísticamente. Resultados: los grupos de 20-29 años y el sexo masculino fueron los más afectados, con 38 % y 54.8 %, respectivamente. La causa fundamental fue la caries dental con un 91.8 %. La celulitis facial resultó la complicación más frecuente. Conclusiones: la etiología más usual del absceso alveolar agudo fue la caries dental. Los pacientes afectados que no recibieron una puntual asistencia sufrieron complicaciones (AU).

Introduction: frequently, oral cavity infections are due to the deterioration caused by caries with dental pulp exposition. An inadequate and careless dental hygiene and complications associated to periodontal diseases are other reasons the may lead to the occurrence of infectious processes. Objective: Characterise the behaviour of the absceso alveolar acute in the greater patients of 19 years in the query of urgency estomatológica of the populated of Alacranes, municipality Union de Reyes. Materials and Methods: a descriptive, observational study was carried out in patients elder 19 years old, in the health area Alacranes, municipality Union de Reyes. The studied universe was formed by the patients assisting to the dentist emergency consultation from January 2011 to January 2012. With previous informed consent, the sample was formed by 135 patients with acute alveolar abscess, taking into account the following variables: age, sex, etiology and complications. The obtained data were recorded in the database and statistically processed. Results: the most affected groups were the 20-29 years-old group and the male sex, with 38 % and 54.8 % respectively. Dental caries was the main cause with 91.8 %. Facial cellulitis was the most frequent complication. Conclusions: dental caries was the most usual etiology of the acute alveolar abscess. The affected patients who did not receive opportune health care suffered complications (AU).

Tratamiento endodóntico no instrumentado en dientes deciduos: reporte de caso / Non instrumentation endodontic techniques in deciduous teeth. case report

Actualmente, se han publicado diversos casos cl¡nicos que describen la esterilizaci¢n de la lesi¢n pulpar en dientes deciduos como un tratamiento alternativo a la pulpectom¡a, evitando la exodoncia en dientes con necrosis pulpar y absceso. El procedimiento incluye: anestesia local, aislamiento absoluto, apertura cameral, remoci¢n de la pulpa cameral, ampliaci¢n de la entrada a los conductos, colocaci¢n de una pasta triantibi¢tica y la restauraci¢n. Se presenta el reporte de caso de una ni¤a de 4 a¤os de edad, la cual acude a la Cl¡nica Estomatol¢gica Central de la Facultad de Estomatolog¡a Roberto Beltr n de la Universidad Peruana Cayetano Heredia; con dolor, aumento de volumen en la regi¢n inferior izquierda y movilidad de la pieza 75. Radiogr ficamente se observa reabsorci¢n de la ra¡z distal de 1/3 y una lesi¢n osteol¡tica a nivel de la furcaci¢n. Por lo cual se decide realizar el tratamiento endod¢ntico no instrumentado de conductos, acompa¤ado de controles hasta los 12 meses, donde cl¡nicamente permanece asintom tico acompa¤ado con una regeneraci¢n de tejidos blandos, y radiogr ficamente una aposici¢n ¢sea en furca. Se concluye que el tratamiento endod¢ntico no instrumentado, muestra resultados prometedores y podr¡a ser una alternativa a la pulpectom¡a y/o exodoncia en dientes deciduos en algunos casos.

Now a days, clinical cases has been published in which describes the esterilization of pulpar lesi¢n on primary teeths as an alternative treatment to the pulpectomies avoiding the toot extractions on primary and necrotics or abscessed teeth. The procedure includes: local anesthesia, isolation with a rubber dam, remove the necrotic tissue from the coronal portionof the pulp chamber, enlarged of the canal orificie and a three mix paste placed over the pulpar floor. A case of 4 years old girl is presented in this work , that went to “Cl¡nica Estomatol¢gica Central de la Facultad de Estomatolog¡a Roberto Beltr n de la Universidad Cayetano Heredia”, with pain, mandibular left posterior swelling and mobility of her mandibular left second primary molar. X-ray shows 1/3 distal root resorption and furcation radiolucency. The clinical procedure ofnon- instrumented endodontic treatment was performed successfully and 12 months posterior controls was maded, in which soft tissue healing was showed, increased trabeculation in the furcation area, normal mobility and the patient was symptom-free. It concludes that this treatment shows promising results for the future pediatric dentistry and is an alterantive to pulpectomy and tooth extraction.

Caries enfermedad versus caries lesión: implicaciones diagnósticas y terapéuticas según el International Caries Consensus Collaboration Group / Caries disease versus caries lesion: diagnostic and therapeutic implications according to the International Caries Consensus Collaboration Group

La caries dental es la principal etiología de la pulpitis y la periodontitis apical. Ante un diente afectado por caries, el diagnóstico correcto de la extensión de la lesión cariosa y del grado de afectación pulpar es esencial para decidir entre el tratamiento endodóncico invasivo o un procedimiento operatorio preventivo y conservador. En la actualidad, el tratamiento de la lesión de caries debe basarse en los principios y las técnicas de la odontología mínimamente invasiva. Sin embargo, un problema importante que se aprecia cuando se lee literatura científica sobre la caries es que la terminología utilizada para referirse a la dentina cariada y a los procedimientos que se emplean para eliminar el tejido cariado no es uniforme. En este trabajo se abordan y se revisan los cambios propuestos por el grupo International Caries Consensus Collaboration (ICCC) en su reunión de Leuven (Bélgica) en 2015, en lo relativo a terminología, manejo de la caries y a las técnicas operatorias indicadas para el tratamiento de los diferentes tipos de lesiones de caries dentinaria

Dental caries is the main etiologic factor of pulpitis and apical periodontitis. When a tooth affected by caries must be treated, the correct diagnosis of the extent of carious lesion and the degree of pulp involvement is essential to decide between invasive endodontic treatment or preventive and conservative operative procedure. At present, the treatment of carious lesion should be based on the principles and techniques of minimally invasive dentistry. However, an important problem when reading scientific literature about dental caries is that the terminology used to refer to carious lesions and to the procedures used to remove the carious tissue is not uniform. The aim of this paper is to address and review the changes proposed by the International Caries Consensus Collaboration Group (ICCC), in its convention in Leuven (Belgium) in 2015, with regard to the terminology, management of caries, and operative techniques indicated for the treatment of the different types of dentine carious lesions

Calidad del tratamiento endodóncico en pacientes con diabetes mellitus tipo II / Quality of root canal treatment in type II diabetic patients

Objetivo: Evaluar la calidad de tratamiento de conductos radiculares (TCR) en una muestra de pacientes con diabetes mellitus tipo 2 y diferente grado de control de la glucemia. Material y Método: Se examinaron las radiografías panorámicas de 106 pacientes con diabetes mellitus tipo 2. El control glucémico se realizó midiendo los valores de hemoglobina glicosilada (HbA1c). La periodontitis apical (PA) fue diagnosticada como lesión radiolúcida periapical (LRP), mediante la utilización del índice periapical (PAI). Entre los análisis estadísticos realizados se encuentra el cálculo de la t-student y regresiones logísticas uni/ multivariantes. Resultados: Entre los pacientes con diabetes mellitus el 39% fueron pacientes con buen control glucémico (HbA1c < 6,5%) y el 61% fueron pacientes con peor control glucémico (HbA1c ≥ 6,5%). El 32% de los pacientes tuvieron al menos un diente con TCR y el 24% un TCR con LRP. En la muestra total el 3.2% de los dientes presentaban un TCR, de los cuales el 12% estaba asociado a una LRP (p > 0,5). Las LRP estuvieron presentes en el 25% de los TCR con inadecuada obturación tridimensional de los conductos radiculares (p > 0,05), en el 16% de los TCR con inadecuada obturación de la longitud radicular (p > 0,05), en el 27% de los TCR con inadecuada restauración coronal (p = 0,056), y en el 14% de los pacientes con peor control glucémico (p > 0,05). Conclusiones: Considerando la calidad del TCR y la restauración coronal como covariables, no se encontró una asociación significativa entre el estado periapical de los dientes con TCR y el control glucémico

Objectives: To evaluate the quality of root canal treatments (RCT) in a sample of type 2 diabetic patients with different grades of glycaemic control. Methods: The radiographic records of 106 type 2 diabetic patients were examined. Glycaemic control was assessed by mean of glycated haemoglobin (HbA1c) levels. AP was diagnosed as radiolucent periapical lesions (RPL) using the periapical index score (PAI). Statistical analysis were carried out using the Student t test, χ square test, and logistic regression analysis. Results: Amongst diabetic patients, 39% were well-controlled (HbA1c <6.5%) and 61% were poor-controlled. Thirty-two percent of patients had at least one root filled tooth (RFT), and 24% had at least one RFT with RPL. In the total sample, 3.2% of teeth were RFT, being 12% associated to RPLs (p > 0.5). RPLs were present in 25% of RFT with inadequate adaptation of root filling (p > 0.05), in 16% of RFT with inadequate length of root filling (p > 0.05), in 27% of RFT with inadequate coronal restoration (p = 0.056), and in 14% of poor-controlled diabetics (p > 0.05). Conclusions: Considering the quality of RCT and coronal restoration as covariates, no significant association between periapical status of RFT and glycaemic control has been found

Bronchogenic adenocarcinoma metastatic tumor mimicking a dentoalveolar abscess in the maxilla.

Intraosseous metastatic tumors (IOM) in maxilla are less frequent than the soft tissue metastatic tumors. Lung and bronchogenic metastatic tumors are uncommon in the maxilla. We present a maxillary bronchogenic metastasis with a rare clinical appearance. IOM was misdiagnosed as a dentoalveolar abscess and treated with antibiotics for 3 weeks. After not responding to antibiotics, the patient's general dental practitioner forwarded the patient to the Department of Oral and Maxillofacial Surgery. The associated tooth was extracted and the patient was recalled 1 week later. No signs of improvement were observed, and cytology, biopsy, and radiology diagnostics were performed. Cytologic results and biopsy could not differentiate a metastatic tumor from a salivary duct carcinoma. Ultimately, negative androgen receptors immunohistochemistry supported the diagnosis of bronchogenic metastatic adenocarcinoma. This case report stresses the importance of taking a thorough medical history. To our knowledge, this is the third bronchogenic IOM to the maxilla reported, mimicking a dentoalveolar abscess. General dental practitioners are among the first in contact with oral metastatic tumors and it is therefore important to report unusual clinical cases, as they present a diagnostic challenge for both the clinician and the pathologist.

The root of the problem: Occurrence of typical and atypical periapical pathoses.

BACKGROUND: A preponderance of periapical radiolucencies are of inflammatory etiology (radicular cysts or periapical granulomas) secondary to pulpal disease. In some instances, however, a suspected periapical inflammatory lesion is not a consequence of pulpal disease but instead represents a lesion of noninflammatory origin. The differential diagnosis for such lesions is broad, ranging from odontogenic cysts and tumors to metastatic disease. As the biological behavior of such lesions is varied, the distinction between inflammatory odontogenic periapical lesions and lesions of noninflammatory origin in a periapical location is critical. METHODS: A retrospective study of 5,993 archival periapical biopsies over a span of 15 years from the database of the Oral Pathology Biopsy Service in the Henry M. Goldman School of Dental Medicine at Boston University recorded the incidence of various lesions in a periapical location. RESULTS: Of the cases studied, 97.2% represented lesions of inflammatory origin with histopathologic diagnoses as follows: periapical granuloma (60.0%), radicular cyst (36.7%), periapical fibrous scar (0.27 %), and periapical abscess (0.23 %). The remaining 2.8% cases were lesions of noninflammatory origin with histopathologic diagnoses of odontogenic keratocyst (also known as keratocystic odontogenic tumor), benign fibro-osseous lesions, and ameloblastoma. One patient had Langerhans cell disease, and 1 had central giant cell granuloma. CONCLUSIONS: Although most periapical specimens biopsied represented expected inflammatory periapical lesions, the biological behavior of underdiagnosed lesions may have considerable consequences for both the patient and the clinician. PRACTICAL IMPLICATIONS: This article serves to inform clinicians regarding the diversity of lesions arising in the periapical region of the jaws, to assist in the formulation of differential diagnoses, and to highlight the importance of submission of lesional tissue for histopathologic evaluation and definitive diagnosis when biopsy is clinically indicated.