A possible late onset variation of Papillon-Lefèvre syndrome: report of 3 cases.

Three unusual cases of Papillon-Lefèvre syndrome with late onset of features and relatively mild periodontal disease are presented. These examples confirm some of the late onset of features and mild periodontal presentation of a previous case report. Bacteriologic associations, polymorphonuclear leukocyte chemotactic, phagocytic, and bactericidal activity, and therapeutics with regard to this syndrome are discussed.

Generalized radiopacities.

Lesions are grouped together based on their radiographic appearances. Although similar in radiographic appearance, lesions often are differentiated by the age of the patient when first detected, sex of the patient, and site predilection. In some cases, lesions can be differentiated further by their prevalence rates or unique radiographic signs.

Controversies in the diagnosis and treatment of temporomandibular disorders: an updated review of the literature.

The purpose of this literature review is to examine some of the controversies related to the diagnosis and treatment of temporomandibular disorders. The main issues are the role of occlusion as an etiologic factor of temporomandibular (TM) disorders and the diagnostic significance of various radiological findings with respect to TM disorders. Only further research by scientific methodology into these complex areas will aid in resolving these issues.

SU-E-I-06: Measurement of Skin Dose from Dental Cone-Beam CT Scans.

PURPOSE: To directly measure skin dose using point-dosimeters from dental cone-beam CT (CBCT) scans. To compare the results among three different dental CBCT scanners and compare the CBCT results with those from a conventional panoramic and cephalomic dental imaging system. METHODS: A head anthropomorphic phantom was used with nanoDOT dosimeters attached to specified anatomic landmarks of selected radiosensitive tissues of interest. To ensure reliable measurement results, three dosimeters were used for each location. The phantom was scanned under various modes of operation and scan protocols for typical dental exams on three dental CBCT systems plus a conventional dental imaging system. The Landauer OSL nanoDOT dosimeters were calibrated under the same imaging condition as the head phantom scan protocols, and specifically for each of the imaging systems. Using nanoDOT dosimeters, skin doses at several positions on the surface of an adult head anthropomorphic phantom were measured for clinical dental imaging. RESULTS: The measured skin doses ranged from 0.04 to 4.62mGy depending on dosimeter positions and imaging systems. The highest dose location was at the parotid surface for all three CBCT scanners. The surface doses to the locations of the eyes were ∼4.0mGy, well below the 500mGy threshold for possibly causing cataract development. The results depend on x-ray tube output (kVp and mAs) and also are sensitive to SFOV. Comparing to the conventional dental imaging system operated in panoramic and cephalometric modes, doses from all three CBCT systems were at least an order of magnitude higher. No image artifact was caused by presence of nanoDOT dosimeters in the head phantom images. CONCLUSIONS: Direct measurements of skin dose using nanoDOT dosimeters provided accurate skin dose values without any image artifacts. The results of skin dose measurements serve as dose references in guiding future dose optimization efforts in dental CBCT imaging.

Case report. Diagnosis and management of an anterior lingual mandibular salivary gland defect.

OBJECTIVES: To describe an anterior lingual mandibular salivary gland defect (ALMSGD). A review of the literature shows only twenty-five previously reported cases. METHODS: A twenty-six-year-old female was examined for comprehensive dental treatment when a well-circumscribed, corticated 1.5 cm diameter radiolucent lesion was noted in the mandibular left cuspid region. The patient's previous panoramic radiographs demonstrated that the lesion was present nine years ago and had not changed in size during this interval. RESULTS: The radiographic and clinical findings support the diagnosis of ALMSGD. Surgical intervention is not indicated due to the lack of symptoms and stability of the lesion. CONCLUSIONS: This case is unique because the patient is the youngest reported. It also supports the significance of a radiological diagnosis in the management of hard tissue lesions of the jaws and the importance of access to previous radiographs.

Panoramic radiography for temporomandibular joint arthrography: a description of arthropanoramograms.

TMJ arthrograms done with panoramic radiography, i.e., arthropanoramography, can demonstrate intracapsular disk displacement and perforation pathoses. These views are very practical for inferior synovial cavity arthrograms performed in the dental operatory since panoramic radiographic machines have become common in modern dental practices. Specific advantages of arthropanoramography include the decreased financial cost and decreased radiation exposure to the patient. Arthropanoramography does not replace tomography or videofluoroscopy in TMJ arthrography. It is, however, described as a simple alternative to the more conventional forms of arthrography.

Temporomandibular joint arthrography: a comparison between a fluoroscopic and a nonfluoroscopic technique.

A nonfluoroscopic temporomandibular joint arthrographic technique is contrasted with a more widely employed fluoroscopically guided technique. The nonfluoroscopic technique uses a posterior approach to joint injection, as contrasted with the lateral injection approach of the fluoroscopically guided technique. The advantages of the nonfluoroscopic technique are less radiation dose to the patient, less expensive and less sophisticated imaging equipment, and less potential for neurovascular trauma. The fluoroscopic technique offers greater control of the procedure, less patient and operator time, and the capability for a dynamic videofluoroscopic study. Both techniques appear to be safe and efficacious. Differences in anatomy, imaging modalities, patient radiation exposure, and potential complications are also discussed as part of this comparison.

Temporomandibular joint arthrography without fluoroscopy.

An arthrographic technique for the temporomandibular joint that can be performed in a dental surgical room is described. This technique utilizes a dental radiographic unit and extraoral cassettes for visualization of the needle tip in the inferior synovial space for arthrography. The radiographic visualization is combined with tactile discernment of the needle tip on the mandibular condyle. The successful application of these two methods makes fluoroscopy unnecessary. After an initial success rate of 81% (34 of 42 attempts), we have used the technique successfully in more than 100 cases. Most of the problems encountered with this technique can be attributed to initial operator inexperience. This technique is not suggested as a replacement for fluoroscopy. However, it is a convenient, economical technique that can be used in the dental surgical room by trained clinicians when arthrography is indicated to determine meniscal-condylar relationships and meniscal perforations.

Helicobacter pylori infection in dental workers: a seroepidemiology study.

The finding of Helicobacter pylori in dental plaque suggested that dental workers may be at increased risk of acquiring H. pylori infection from occupational exposure. A cross-sectional survey of 239 dental workers from 37 Texas cities (including 89 dentists, 44 dental hygienists, 98 dental assistants, and eight dental students) was conducted. H. pylori infection was determined by the presence of IgG antibodies to H. pylori, using a specific and sensitive ELISA. Participants ranged in age from 19 to 72 yr (mean 34 yr) and the duration of dental practice ranged from 1 to 48 yr (mean 12 yr). Type of dental occupation, duration of practice, type of practice (public or private), instrument used for cleaning teeth (ultrasonic scaler or curette), and prevalence of upper gastrointestinal symptoms were determined by self-administered questionnaires and interviews. Eighty-two percent had no symptoms referable to the upper gastrointestinal tract. The overall prevalence of H. pylori infection was 24%: 17% in dentists, 18% in dental hygienists, 34% in dental assistants, and 25% in dental students. The prevalence increased significantly with age (p < 0.05). The prevalence of H. pylori infection was significantly higher in non-whites, 29 of 63 (46%), than whites, 29 of 176 (16%) (p < 0.001). Logistic regression analysis (dependent variable H. pylori) revealed no significant association between H. pylori infection and the type, duration, or volume of practice, or the type of cleaning instrument used. We conclude that dental workers are not at increased risk to H. pylori infection.

Immediate biopsy versus a therapeutic trial in the diagnosis and treatment of vesiculobullous/vesiculoerosive oral lesions. Opposing viewpoints presented.

There are at least two treatment strategies in the diagnosis and treatment of oral vesiculobullous/vesiculoerosive disease. The relative merits of immediate biopsy and initial therapeutic trial regimens are debated.

Neurofibromatosis: oral and radiographic manifestations.

Oral manifestations of neurofibromatosis have been reported in only 4% to 7% of affected persons. All oral tissues, hard and soft, have been reported to be affected with tumors, but the tongue has been the most common site. We report on the oral and radiographic findings in twenty-two patients with neurofibromatosis. The prevalence of oral and radiographic findings in our sample was 72%, which is much higher than previously reported. The five most common findings are oral neurofibromas, enlarged fungiform papillae, intrabony lesions, wide inferior alveolar canals, and enlarged mandibular foramina.