The role of dentists as a stop-gap in the initial management of patients with delusional halitosis.

OBJECTIVE: This article proposes a 'stop-gap protocol'for the initial management of delusional halitosis, which dental practitioners can apply where a multidisciplinary team of dentists and mental health experts (psychiatrist and psychologist) cannot be assembled. METHODS: A 4-year prospective study of delusional halitosis patients managed with a 3-step 'Stop-gap protocol' is presented in this paper, to demonstrate our experience in applying the 'Stop-gap protocol'. RESULTS: Twenty three (23) patients diagnosed with delusional halitosis were managed with the 'Stop-gap protocol' within the study period. There were 13 (56.5%) males and 10 (43.5%) females, giving a male to female ratio of 1.3:1.Most of the patients were in the 3rd decade of life (n=10, 43.5%), the mean duration of the bad breath complaint was 5 years, with unknown trigger factor (n=19, 82.6%) in most of the patients and a mean psychological score of 7 ± 1.8. No clinical oral malodour was observed in all of these patients. A normal oral flora was observed in 13 (56.5%) of the cases and a low level of volatile sulphur compound (VSC) was found in 12 (52.2%) of the patients, with a mean VSC level of 22.3 ± 2 ppb. Twenty (87.0%) of the patients presented for follow up /counselling and the mean duration of follow up was 13 weeks. Three (13.0%) patients responded to referral to the joint clinic with mental health experts. CONCLUSION: Although we do not claim that the 'Stop-gap protocol' is comprehensive, it is hoped that this paper will serve as a useful guide for dentists practising in health facilities without mental health specialists and also to encourage the formation of multi-disciplinary teams in centres where they are present.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Orofacial surgical emergencies.

BACKGROUND: Orofacial surgical emergencies pose severe hazard to the individual. Medical and Dental clinicians should be able to recognise these conditions and initiate appropriate management before referral. OBJECTIVE: This article presents the common orofacial surgical emergencies and the initial measures for treatment, before referring to a specialist dental surgeon for definitive treatment. METHODS: Literature and related texts on the common orofacial surgical emergencies and the general principles for its management were reviewed. RESULTS: Acute dental abscess, trauma, bleeding and pain in the orofacial region are the most common orofacial surgical emergencies. They usually present first to the general dental or medical practitioner, who may be required to diagnose and render initial care to these patients. Thereafter, there may be need for referral to the appropriate specialties in dentistry to help treat these severe distressing and or life-threatening conditions. CONCLUSION: There is need for general medical or dental practitioners to be well-informed about the common orofacial surgical emergencies and how to diagnose, as well as provide initial treatment for these emergencies. However, the failure of clinicians to promptly diagnose and call for the assistance of a specialist dental surgeon when appropriate may result in fatal consequences.

Malignant tumours presenting after dental extraction: a case series.

OBJECTIVE: To present the clinical spectrum of malignant neoplasms detected after extraction of teeth. DESIGN: Retrospective study. SETTING: Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Nigeria. MAIN OUTCOME MEASURES: Demographic and clinical data of patients diagnosed with malignant neoplasms related to a history of tooth extraction. RESULTS: Twelve patients with histopathologically confirmed tumours detected after extraction of teeth were studied. There were 11 males and one female giving a male to female ratio of 11:1. They ranged in age from 15-85 years with a mean age of 53 years. Pain and swelling were the most common presenting complaints. The mandible was more often involved seven (58.3%) cases while five (41.7%) cases occurred in the maxilla. Squamous cell carcinoma (in 9 cases) was the most common malignant neoplasm among these patients. CONCLUSION: Malignant tumours can mimic periapical infections necessitating a high index of suspicion when faced with toothache of uncertain cause.

Delusional halitosis. Review of the literature and analysis of 32 cases.

Halitosis, or bad breath, is a feature of some oral and systemic diseases. However, there are apparently healthy individuals who complain of having bad breath which no one else can smell and for which no local or systemic condition can be found. This condition, referred to in this article as delusional halitosis, has identical features with a psychiatric disorder, monosymptomatic hypochondriacal psychosis. This paper reviews the literature on halitosis and oral psychogenic disorders and presents an analysis of 32 cases of delusional halitosis that presented at the University of Benin Dental Hospital, Nigeria, in the period 1984-1986.

Paediatric orofacial tumours: new oral health concern in paediatric patients.

OBJECTIVE: This study aims to determine the incidence, age, gender, orofacial sites and histological pattern of paediatric orofacial tumours in a Nigerian population. The yearly findings will be analysed to identify the interval for increase in the incidence of paediatric orofacial tumours. PATIENTS AND METHODS: A 21-year (1990 to 2010) retrospective analysis of paediatric orofacial tumours in children younger than 16 years was carried out in the Department of Oral Pathology/Oral Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. RESULTS: Of the 1013 diagnosed lesions within the study period, there were 137 (13.5%) paediatric orofacial tumours, among which 71 (51.8%) cases occurred within the last 6 years (2005 to 2010). There was male predilection for the lesions (78 males to 59 females, ratio = 1.3:1). The mean age was 9 + 4.3 years, with peak age group of 11 to 15 years (n=60, 43.8%). The mandible (n=44, 32.1%), followed by the maxilla (n=42, 30.7%) and orofacial soft tissue (n=19, 13.9%) were the most common sites. The benign tumours (n=72, 52.6%) were slightly more than the malignant tumours (n=65, 47.4%). There were more malignant tumours (n=23, 16.8%) than benign tumours (n=20, 14.6%) within the last 3 years (2008 to 2010) under review. Burkitt's lymphoma (n=38, 27.7%) was the commonest malignant lesion. CONCLUSION: This study showed a recent increase in the incidence of paediatric orofacial tumours, particularly due to a higher incidence of Burkitt's lymphoma.

Evaluation of oral and extra-oral factors predisposing to delusional halitosis.

OBJECTIVE: This study evaluated the role of patients' associated oral and extra-oral factors, as well as previous dental treatment, as possible predisposing (triggering) factors in the development delusional halitosis. METHOD: Forty-six patients diagnosed of delusional halitosis, over a consecutive period of 2 years (2003-2004) were selected for this study. Diagnosis was based on: use of standard halitosis questionnaire (to confirm the presence of psychological component) modified to obtain data on oral and extra-oral factors, as well as previous dental treatment linked by patients as cause of oral malodour; clinical assessment without objective evidence of oral malodour; absence of reliable third party to confirm patients' claim of oral malodour; and screening with sulphur monitor (RH-17 Series Halimeter, Interscan, Chatsworth, CA) that was within normal range (80-140ppb). RESULTS: All the 46 patients studied had normal halimeter measurement and no reliable third party to confirm the patients' claim of oral malodour. Twenty-four (52.2%) patients had associated possible predisposing factors. The most common associated factors were bitter taste (25.0%), oral deposits (20.8%), carious tooth (16.7%) and previous tooth extraction (16.7%). Associated factors were divided into oral, extra-oral and dental treatment. Patients' associated oral factors were significantly correlated as predisposing factors for delusional halitosis (p<0.01) CONCLUSION: This study shows significant correlation of patients' associated oral factors as the triggering event, which could predispose those individuals who may have underlying psychosomatic tendencies to developing delusional halitosis.

Case report of dentigerous cyst of lower incisor.

This paper reviews the pathogenesis, clinical features and the behaviour of dentigerous cyst. A case of mandibular dentigerous cyst involving the incisor tooth (an unusual site) is presented to illustrate this pattern of behaviour. A recurrent pyogenic granuloma in the region of the lower incisors prevented the eruption of the lower left incisor with subsequent cystic formation around the tooth. The histological and radiological presentation is consistent with that of a dentigerous cyst. The significance of the potential of the cyst lining is stressed. The cyst was enucleated with the associated tooth as the latter was not in a favourable position to erupt. There was no recurrence after one year of treatment.

Clarification on the differential diagnosis of giant cell containing lesions of the oral and maxillofacial regions.

A broader overview of the essential differences and overlap in the histopathology and clinical presentation of giant cell containing lesions are discussed. This is an attempt to eliminate some confusions attendant to their diagnosis and possible prognosis. These lesions occur both intraosseously and extraosseously. Langhans' type giant cells have been shown not to be an exclusive preserve of tuberculoid granulomas but also of giant cell lesions. The osteoclast like lesions with the exception of giant cell tumour (GCT) are treated by local curettage while the latter is treated by radical resection.