Eosinophilic ulcer of the tongue.

Two cases of tongue ulcers are presented. Histopathologic examination of biopsy specimens obtained from each case showed marked submucosal and muscular infiltration of polymorphonuclear eosinophils compatible with the diagnosis of eosinophilic ulcer of the tongue. The disease entity appears to be uncommon, yet, it should be recognized as benign since in both instances, healing was spontaneous.

Gingival manifestations of Wegener's granulomatosis.

Localized Wegener's granulomatosis is characterized by necrotizing granulomatous disease affecting the upper and lower respiratory tracts, mucosa, and skin. Without treatment, disseminated necrotizing vasculitis and focal necrotizing glomerulonephritis usually follow. Although oral lesions are relatively common, they have been infrequently described and have rarely been reported as the sole manifestation of this disease. In this report, we present two cases of early Wegener's granulomatosis which featured hyperplastic gingival lesions as the initial presenting lesion. Clinical findings and histological evaluation of tissue obtained from the gingival lesion following incisional and excisional biopsies supported the diagnosis of Wegener's granulomatosis. These cases illustrate that less-frequently occurring entities should be considered in the differential diagnosis of localized gingival lesions which fail to respond to conventional therapy.

Ectopic gingival sebaceous glands presenting as localized periodontitis.

The development of ectopic gingival sebaceous glands is a very unusual condition which is histologically similar to Fordyce's granules when they occur within the buccal or labial mucosa. In this report, we present a rare case of ordinarily innocuous, ectopic gingival sebaceous glands, which presented clinically and radiographically as localized advanced periodontitis. Histological and immunocytochemical evaluation of tissue removed from the periodontal lesion following excisional biopsy supported the diagnosis of an ectopic gingival sebaceous defect. This case illustrates the necessity of considering less frequently occurring entities in the differential diagnosis of localized lesions which appear to be periodontal in origin.

Dental aspects of cardiac transplantation.

This article does not cover all possible dental situations, but it is hoped that it will provide a framework on which a medical or dental consultant can develop his or her own comprehensive oral evaluation protocol for use in the screening of prospective cardiac transplant patients. It is always important for the dental consultant to remember a prospective recipient patient's primary health concern--that is, end-stage cardiac disease. The consultant should remember that many of the usual considerations for dental treatment planning must be modified and the significance of dental health placed into its proper perspective in the overall care of the cardiac transplant patient.

Diagnostic dilemma involving calcification in the parapharyngeal space: metastatic thyroid carcinoma masquerading as a deep lobe parotid mass.

As the parapharyngeal space is difficult to examine clinically, the radiographic distinction between deep lobe parotid masses and extraparotid tumors is essential in determining the surgical approach. We describe the case of a 53-year-old woman who presented with facial pain consequent to metastatic papillary thyroid carcinoma of the parapharyngeal space. A highly unusual pattern of calcification was present in the mass as observed by panoramic radiography and computed tomography. Parapharyngeal metastasis as the presenting feature of occult thyroid carcinoma has only been described four times previously in the medical literature.

Differential diagnosis of orofacial pain.

No attempt has been made to deal with all of the various diseases that the dentist has to consider when diagnosing orofacial pain. One of the most important causes of facial pain--so-called temporomandibular joint or myofascial pain dysfunction (MPD) syndrome--has not been mentioned, yet it accounts for many of the patients attending facial pain clinics. There are several textbooks devoted to the MPD and the reader is referred to these for a full description of the condition. Whenever a patient presents for evaluation of orofacial pain the dentist must remember: (1) to take a detailed history of the characteristics of the pain; (2) to complete a full examination of not only the teeth and the oral cavity but also the face, head, and neck; (3) not to assume that the patient in his chair necessarily has a dental condition producing his pain; (4) that if he is unaware of the existence of certain diseases he will never diagnose them!; and (5) to have no hesitation in referring a patient for evaluation rather than perform irreversible dental procedures.

Differential diagnosis of orofacial pain.

The successful diagnosis of orofacial pain depends on the following: 1. An accurate and detailed history of the pain 2. A detailed clinical examination of the face and associated organs 3. A thorough knowledge of those conditions that may produce facial pain In regard to the last requirement, Sir William Osler's maxim should always be remembered "What you don't know--you won't diagnose."

Controversies in oral medicine.

This article reviews two conditions commonly seen in oral medical practice. Aphthous ulceration and lichen planus are two very perplexing problems with controversies about etiology, pathogenesis, diagnosis, management, and, in the case of lichen planus, malignant potential.

Medical conditions of importance in dental practice.

Good dental practice requires that a dental practitioner be aware of those medical conditions that might present first with oral manifestations and those for which special considerations are required before dental treatment is rendered. In view of the rapid changes in the understanding and treatment of disease, it is essential that a dentist be current in his knowledge of medicine and be aware of the established and accepted methods of patient management.

Court presentation of bite mark evidence.

The uniqueness of an individual's bite mark is generally accepted. The use of bite mark analysis to identify or exclude those suspected of crimes is now a well established activity in forensic dentistry. Although the techniques for evaluating bite mark evidence are extremely sophisticated, it is important that the courtroom presentation of such evidence should be as simple as possible and be directed towards those who must judge it. Dentists likely to be involved in the courtroom presentation of bite mark evidence should: be certain that their local law enforcement personnel are frequently updated on the techniques to be used for producing the optimum evidence needed to evaluate bite marks; become acquainted with the current techniques of evaluating bite mark evidence and understand their difficulties and pitfalls; meet with the lawyers (prosecution or defence) before a courtroom appearance, briefing them on the significance of the particular findings; prepare clear and easily understandable visual aids to present to the court the techniques used in the analysis and the bases for the conclusion reached; and offer conclusions derived from the bite mark investigation.

Education in forensic odontology.

The present state of education in forensic odontology is surveyed. Courses in the subject within dental schools are directed mainly towards dental students (lectures, seminars, demonstrations), but also towards chairside assistants, dental hygienists and laboratory technicians. Extra-mural postgraduate education is directed towards private practitioners, but includes community dental health officers and colleagues serving in the defence forces; the question of 'qualification' is discussed. Finally, a wide range of non-dental personnel is approached (medical and law students, community health officers, forensic medical experts, police technicians etc.). The authors concur that independent departments of forensic odontology are now needed at all major dental schools; only here can the manpower and the facilities be developed to cope with this wide spectrum of education, and only here can recognized academic positions be ensured for those who--together with other specialists--must handle an increasing extra-mural case load, from which all material for education and research is subsequently to be derived.

Screening for oral cancer and precancer--a valuable new technique.

Many precancerous or cancerous oral lesions may resemble benign lesions and a definitive diagnosis on clinical grounds alone may be difficult, if not impossible, to make. The introduction of OralCDx, an oral brush biopsy procedure, permits the dental practitioner to determine which lesions contain atypical or dysplastic epithelial cells and require that a conventional scalpel biopsy be performed. This article reviews the features of the test, explains the clinical situations for which its use is recommended, and discusses the interpretation and significance of the biopsy reports.

Infectious diseases and the dental office.

Dentists and other health care workers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. In recent years there has also been widespread concern among the general public. Many infectious diseases, including HIV, hepatitis, tuberculosis and syphilis, are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. A knowledge of these diseases will allow the practitioner to recognize associated lesions and also to take appropriate steps to minimize the risk of transmission in the dental office.