Dentition and weight status in community-dwelling older adults.

BACKGROUND/OBJECTIVE: Tooth loss is common among older adults and can affect dietary intake and weight status. This study investigated associations between dentition status and body mass index (BMI) in older adults. MATERIALS AND METHODS: This was a cross-sectional study of data from a convenience sample of older adults (65-89 years) treated at an urban U.S. dental school clinic. Clinical and demographic data were obtained from electronic health records. Dentition status was determined based on data from odontograms. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) of having a non-normal weight status for each measure of dentition status, after adjusting for covariates. RESULTS: Patients (n = 1765) were 54.1% female, 51.5% White, 41.6% African American and 22.5% Hispanic/Latino. The median (interquartile range [IQR]) age was 71 (67.0-75.0) years; the mean (±SD) BMI was 28.5 (±5.7) kg/m2 ; 72.5% were overweight or obese. The median (IQR) number of remaining teeth was 20.0 (13.0-24.0); the median numbers of anterior and posterior occluding pairs of teeth were 5.0 (2.0-6.0) and 2.0 (0.0-5.0), respectively; and 44.9% had a functional dentition (≥21 teeth). Having a higher number of remaining teeth and more posterior occluding pairs were associated with lower odds of obesity (OR = 0.980, 95% CI = 0.964, 0.997, p = .022 and OR = 0.931, 95% CI = 0.885, 0.980, p = .006, respectively). Lack of a functional dentition was associated with higher odds of obesity (OR = 1.400, 95% CI = 1.078, 1.818, p = .012), after controlling for covariates. CONCLUSION: Older adults with tooth loss - especially loss of posterior occlusion and lack of a functional dentition - were more likely to be obese than of normal weight.

A user-centered approach to the development of a diet education tool for older adults with tooth loss.

BACKGROUND: Tooth loss is associated with suboptimal nutrient intake and greater risk of malnutrition. OBJECTIVE: To develop and field-test a stakeholder-informed diet education tool that addresses the unique needs of older adults with tooth loss who do not wear dentures. METHODS: An iterative user-centered approach was used. Initial content was developed based on findings from previous research. Stakeholder panels of older adults with 20 or fewer teeth, and dentists, were conducted at two time points to obtain feedback on the tool, which was revised following each panel. The tool was field-tested in a dental school clinic and evaluated using the Patient Education Materials Assessment Tool; it was further revised based on feedback. RESULTS: A diet education tool entitled "Eating Healthier With Tooth Loss" was developed. Sections for fruits and vegetables, grains, and proteins food groups, and one addressing socioemotional aspects of eating with missing teeth were included. Panel members provided constructive, positive feedback; recommendations for editing text, images, design, and content were integrated. Field-testing in the dental clinic with 27 pairs of student dentists and their patients resulted in scores of 95.7% for understandability and 96.6% for actionability, with over 85% agreement with each item. The tool was revised based on field-testing feedback. CONCLUSION: A diet education tool for older adults with tooth loss was developed using a user-centered approach, integrating the 'patient voice' and patient experiences with US dietary guidelines. Use of this tool is feasible in a dental clinic setting. Future research should explore usage in larger settings.

Non-Hodgkin's Lymphoma in the Oral Cavity.

We report a case of a diffuse large B-cell lymphoma of the maxilla. A patient presented with diffuse swelling of the right maxillary region following the extraction of an upper right maxillary tooth. The patient was referred for cone beam computed tomography (CBCT) to visualize the area in question in three dimensions. A massive destructive maxillary lesion was noted on CBCT examination suggestive of an aggressive lesion highly suspicious for a malignancy. A subsequent biopsy and immunochemistry were useful in confirming the diagnosis.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement.

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Large, expansile odontogenic cyst with bilateral maxillary sinus involvement.

Residual cysts are common odontogenic lesions of the tooth-bearing areas of the jaws. A case of an unusually large residual cyst that crosses the maxillary midline and occupies portions of the maxillary sinuses is being reported. Investigations included a panoramic radiograph, CT scan and a biopsy. The differential diagnoses were common odontogenic lesions, including cysts and benign tumors. The value of advanced imaging modalities is stressed when determining the presence and extent of lesions in complex structures such as the maxilla. The need to visualize the entire lesion beyond what may be seen on intraoral views, as well as panoramic radiographs, is discussed.

Temporomandibular Joint Imaging.

Prescriptions for imaging studies for temporomandibular disorders are based on the patient's complaint, history, and clinical findings. Appropriate selection criteria and justification for imaging examinations must be followed. Because the temporomandibular joint is composed of both hard and soft tissues, different studies are prescribed based on the clinically suspected condition. Current imaging modalities include panoramic radiographs, cone-beam computed tomography, and MRI. The entire examination must be interpreted, and the findings recorded in the patient record. No one imaging modalities is suitable for all patients. An oral and maxillofacial radiologist should be consulted when the interpretation of the study is beyond the scope of the practitioner.

Temporomandibular Disorders and Dental Occlusion: What Do We Know so Far?

Throughout the recorded history in the literature of temporomandibular disorders (TMD) there have been a variety of opinions as to its primary cause. Those supporting an occlusal basis of TMD opined that occlusal dysfunction is either the primary cause for or a significant etiopathogenic factor in the causation of TMD. Most of the current literature, however, points to evidence in another direction and questions the causal role of occlusion and occlusal disharmony in TMD etiopathogenesis. Recognition of this evidence-based literature is paramount in eliminating and preventing the chances of overtreatment of patients with TMD.

A Diabetic Patient with Acute Osteomyelitis Presenting with Jaw Pain and Submandibular Swelling.

This case scenario shows the value of applying relevant imaging and the selection of appropriate antibiotic via culture and sensitivity before prescribing especially when dealing with a patient with type 1 Diabetes Mellitus. When confronted with a diagnosis of acute osteomyelitis, it is always better to refer the patient to a hospital for admission where the management and any other intervention is easily accomplished. Admission to the hospital, culture and sensitivity, and appropriate intravenous antibiotics may have limited the progress of the infection and ultimately may have prevented the sequestration in this patient, limiting the degree of morbidity. Monitoring and control of blood glucose levels is an important part of the management in a patient from this scenario.

A Pregnant Patient (First Trimester) Reporting for Pain in Relation to the Maxillary Left First Molar Was Prescribed a Full Mouth Series Radiographs in the Dental Office.

This case scenario shows the value of conducting a thorough clinical examination that will direct appropriate radiographic selection and prescription criteria to be able to arrive at a diagnosis. Proper management of a patient's chief complaint and imaging needs during pregnancy is of utmost importance. It is prudent to limit ionizing radiation during the first trimester to what is minimally needed and defer elective imaging until after the birth of the baby. It is important for dental health care providers to do what is necessary for the patient for the emergent situation and postpone all elective imaging and follow the published FDA/ADA radiographic selection criteria.

Quantitative indices for cone-beam CT assessment of Medication-Related Osteonecrosis of the Jaw - a scoping review.

Objectives: It is not unusual for Medication-related osteonecrosis of the jaw (MRONJ) lesions that have similar clinical presentation and staging to have dissimilar radiographic extent of disease. The aim of this review was to explore the published scientific literature for quantitative indices that describe the cone-beam computerized tomography (CBCT) radiographic features of MRONJ lesions and assess their clinical utility. Method and Materials: A scoping review of the literature was performed to identify quantitative indices developed to describe the CBCT radiographic features of MRONJ lesions. Five electronic databases were included in the review: PubMed, Scopus, Web of Science, Trip medical database, and Cochrane Library. Articles published from the year 2003 onward were included in the review. Results: 367 articles were initially included in the review. 39 abstracts were screened for full-text assessment. The scoping review yielded 12 full length articles with169 cases reported. The Composite Radiographic Index score (CRI score) was identified as the most meaningful index in published literature that attempted to quantify qualitative radiographic changes (Walton, Grogan et al. 2019). However, lesions with similar CRI scores that corresponded to intermediate severity (3-5) may be very dissimilar radiographically in both nature and extent of radiographic changes, undercutting its clinical value. Conclusion: The CRI index score was the only relevant index for cross-sectional (one-time) assessment of established MRONJ lesions (non-stage 0). This scoping review yielded several critical questions regarding the clinical significance and prognostic implications of various radiographic changes in MRONJ, thereby identifying focus areas for future research.

Novel modified quantitative index for cone-beam CT assessment of medication-related osteonecrosis of the jaw - comparative analysis with original index.

Purpose: The main research goal was to address the critical need for an objective and quantitative index to describe the nature and extent of radiographic features of medication-related osteonecrosis of the jaw (MRONJ) lesions and complement the descriptive radiographic interpretation of the lesion and its clinical assessment. Method and Materials: A retrospective review of MRONJ patients assessed at our institution was performed to compare the Composite Radiographic Index (CRI), identified from a prior scoping review, with a proposed modification, the Modified CRI index ('Mod-CRI'). The Mod-CRI index was weighted to assign a higher score for diffuse radiographic involvement of a given lesion, and delineated MRONJ lesions into those with 'high' and 'low' severity. Twenty-two MRONJ cases imaged with CBCT were retrospectively assessed with both CRI and Mod-CRI indices and the two indices were compared for their ability to quantitatively describe cone-beam computerized tomography (CBCT) radiographic features and complement the clinical staging of the MRONJ lesion. Results: There was a statistically significant association between increased clinical stage and higher mod-CRI score (p = 0.040). The Mod-CRI index sorted the patients who scored intermediate scores with the CRI (n = 15) into either the low (n = 8) or high categories (n = 7). Conclusion: The Mod-CRI index eliminated the ambiguous intermediate-category-scores in the previously published CRI index and provided greater clarity to the interpretation of a given index score. Adopting the Mod-CRI could improve MRONJ assessment and enhance communication between the radiologist and the clinician.

Pathogenesis and Differential Diagnosis of Temporomandibular Joint Disorders.

Temporomandibular disorders (TMDs) are an umbrella term including disorders of the temporomandibular joint and muscles of the masticatory system. They are the most common nonodontogenic cause of pain in the orofacial region. A clear understanding of various conditions, underlying mechanisms, clinical presentation, and examination skills is required to effectively diagnose and manage these patients.

Facial pain and trigeminal neuralgia secondary to metastasis: A case report.

BACKGROUND AND OVERVIEW: Trigeminal neuralgia due to a metastatic lesion is a relatively rare occurrence. These cases pose a diagnostic challenge for the clinician due to a complex clinical presentation. CASE DESCRIPTION: The authors describe the case of a 65-year-old woman with left-sided facial pain and occasional numbness. The patient also reported autonomic features associated with facial pain, facial muscular weakness, and hearing and visual impairment. The patient's history of breast cancer, for which she was receiving treatment for bone metastasis, warranted diagnostic imaging. Magnetic resonance imaging with and without contrast was performed and revealed a possible metastatic lesion. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Unusual clinical features must be identified, and prompt appropriate imaging is instrumental in making at an accurate diagnosis and management plan.

Alternative Antibiotics in Dentistry: Antimicrobial Peptides.

The rise of antibiotic resistant bacteria due to overuse and misuse of antibiotics in medicine and dentistry is a growing concern. New approaches are needed to combat antibiotic resistant (AR) bacterial infections. There are a number of methods available and in development to address AR infections. Dentists conventionally use chemicals such as chlorohexidine and calcium hydroxide to kill oral bacteria, with many groups recently developing more biocompatible antimicrobial peptides (AMPs) for use in the oral cavity. AMPs are promising candidates in the treatment of (oral) infections. Also known as host defense peptides, AMPs have been isolated from animals across all kingdoms of life and play an integral role in the innate immunity of both prokaryotic and eukaryotic organisms by responding to pathogens. Despite progress over the last four decades, there are only a few AMPs approved for clinical use. This review summarizes an Introduction to Oral Microbiome and Oral Infections, Traditional Antibiotics and Alternatives & Antimicrobial Peptides. There is a focus on cationic AMP characteristics and mechanisms of actions, and an overview of animal-derived natural and synthetic AMPs, as well as observed microbial resistance.

Development of virtual radiology clinical competency evaluation amidst COVID-19 at a dental school.

OBJECTIVE: To describe and report on the use of virtual clinical competency examinations (VCCEs) for D3 dental students in a radiology clinic during the COVID-19 pandemic and relate the technology to other clinical and educational applications. METHOD AND MATERIALS: Paper-based clinical competency examinations (CCEs) were converted to three different VCCEs to closely replicate the CCEs. Existing grading rubrics were used to assess students' abilities to evaluate technical issues and interpret intraoral full-mouth series and panoramic radiographs. The grading rubrics were modified from their clinical versions to eliminate non-reproducible skills, such as patient management and application of selection criteria. Radiographs were selected from clinic records and anonymized. VCCEs were conducted via WebEx conferences that were scheduled via an appointment app. These experiences can be extended to virtual patient contacts, teleradiology, and telemedicine, as well as continuing dental education experiences. RESULTS: Approximately 200 VCCEs were administered by four oral and maxillofacial radiology faculty over a 10-week period. Both students and faculty managed the technology well, with few missed appointments. All students were successful in challenging the examinations and appeared to be satisfied with the experience. CONCLUSIONS: Although direct comparisons between the CCEs and the new VCCEs are difficult, as there was no time to pilot the VCCEs, students were successful in challenging the examinations and informally reported satisfaction with the experience. Although components of CCEs that could not be replicated on the VCEs could not be assessed, it is felt that the students had adequate experience in selection of radiographs and patient management prior to the COVID-19 lockdown. Additional benefits of the VCCEs included contact with students to check on their well-being. The experience indicates that VCCEs can be used in the future in hybrid models of oral & maxillofacial radiology education, clinical care, patient screening, and telemedicine. Moreover, the success of this demonstration points to potential for personalized distance learning in continuing dental education.

Fundamentals of Radiographic Interpretation for the Dentist.

Radiographic imaging is an integral part of the diagnostic process in clinical dentistry. This article provides the fundamentals of radiographic interpretation beginning with evidence-based guidelines on dental radiographic selection criteria and cone beam computed tomography use. The goal is to present to the reader with a systematic approach to radiographic interpretation such that no significant features are overlooked and an optimal differential diagnosis can be achieved. In addition, medicolegal considerations of radiographic acquisition, interpretation, and storage are discussed.

Physiologic and Pathologic Calcifications of Head and Neck Significant to the Dentist.

This article aims to help the practitioner identify structures found in routine three-dimensional imaging studies of the head and neck region and understand their significance and possible need for intervention. The prevalence of advanced imaging in dental practice, especially cone beam computed tomography, highlights the need to recognize and identify various high-density structures that are, in fact, soft tissue calcifications or alterations of normal bony anatomy. The wide range of these findings includes both benign and malignant pathologic entities as well as age-related calcifications and remodeling of normal anatomic structures and dystrophic calcifications.

Evaluation of diagnostic radiology acumen between 2 groups of clinical dental students.

PURPOSE: To evaluate and distinguish if an additional year of clinical experience increases the cognitive ability of dental students to accurately assess and interpret dental radiographs. METHODS: Radiological acuity was assessed between two groups of clinical dental students at Penn Dental Medicine (PDM). Group 1 was composed of 147 third-year dental students (D3), group 2 was composed of 145 fourth-year dental students (D4). A 65-question test comprising the length and breadth of radiographic anatomy and pathology was administered to both D3 and D4 students. The test was designed to test the participants' knowledge of radiographic technique, anatomy, and differential diagnosis. The null hypothesis was that there would be no significant differences between the two groups. RESULTS: STATA 15 software (StataCorp LLC, College Station, TX, USA) was used to statistically analyze the findings. Although, the mean correct score for group 1 was higher (60/65) than group 2 (59/65), there was no statistically significant difference between the performance of the groups. On average, group 1 outperformed the clinically more experienced group 2 on an individual question basis. The average overall number of correctly answered items compared to incorrectly answered items reflected this difference. CONCLUSION(S): An additional year of clinical dental education does not appear to correlate with any higher radiographic acumen. This may be due to tapering exposure to unique pathology and findings, as more routine findings are encountered daily and classroom instruction during the fourth year of dental school is limited. Early incorporation of new radiographic education tools that are clinically oriented may be one method to increase retention of knowledge accumulated in the initial didactic years of dental education.

Laser-Assisted Therapy for the Treatment of Peri-implantitis. Part I. Clinical Outcomes.

The purpose of this 12-month randomized, controlled clinical trial was to evaluate the efficacy of a monotherapy protocol with the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for treatment of peri-implantitis. Twenty patients with 36 implants exhibiting probing pocket depths (PPDs) > 4 mm and evidence of radiographic bone loss (RBL) were randomly divided into two groups. The test group was treated with the Nd:YAG laser, and the control group was managed with mechanical debridement only. Peri-implant clinical parameters were recorded at baseline and at 12 months after treatment. PPD, RBL, and bleeding on probing showed improvements after 12 months in the test and control groups. The laser therapy provided additional benefits of greater reduction in PPDs and increased bone level with no adverse outcomes. The results demonstrated that laser therapy could be a valuable modality for the treatment of peri-implantitis.

Expression of activated checkpoint kinase 2 and histone 2AX in exfoliative oral cells after exposure to ionizing radiation.

Gamma-H2AX (activated histone 2AX) and pChk2 (activated checkpoint kinase 2), which are DNA damage response molecules, are produced in irradiated cells and may be signature molecules of radiation exposure. We investigated their use as potential biomarkers to identify individuals exposed to ionizing radiation. We collected exfoliated oral epithelial cell samples from 100 healthy individuals undergoing routine dental radiographic examination (2.34 cGy) both before and after the radiograph using a non-invasive technique. The expression levels of pChk2 and gamma-H2AX in oral cells were assessed by immunohistochemical assay. Both biomarkers showed statistically significant increases in levels of expression after the radiation exposure (P < 0.001). This suggests that pChk2 and gamma-H2AX may serve as sensitive indicators of low-dose radiation exposure.