Service patterns associated with coronal caries in private general dental practice

OBJECTIVES: To describe the pattern of dental services associated with dental caries by level of carious lesion severity. METHODS: Data were collected by a mailed survey from a random sample of dentists from each State/Territory in Australia in 2003-2004. Dentists provided service data on patients treated on a typical clinical day for patients attending with a diagnosis of dental caries. RESULTS: Restorative rates were higher for insured patients, radiograph rates were higher for emergency visits, prophylaxis and topical fluoride rates were higher for non-emergency visits and at capital city locations with topical fluoride also higher for patients from higher socio-economic status areas, endodontic rates were higher for emergency visits and at non-capital city locations, while extraction rates were higher for males, uninsured patients and for emergency visits. Poisson regression models compared the rates of services from different service areas for initial and cavitated carious lesions with gross carious lesions, controlling for patient demographics, visit type, location and socio-economic status. Restorative services were provided at higher rates (P<0.05) for cavitated carious lesions (RR=2.38), radiographs were provided at lower rates for both initial (RR=0.28) and cavitated carious lesions (RR=0.31), both prophylaxis and topical fluoride services were provided at higher rates for initial carious lesions (RR=2.33 and 3.00, respectively), endodontic services were provided at lower rates for both initial (RR=0.03) and cavitated carious lesions (RR=0.07), and extractions were provided at lower rates for both initial (RR=0.23) and cavitated carious lesions (RR=0.16) compared to the reference category of gross caries. CONCLUSION: Service patterns varied by level of carious lesion severity with initial carious lesions managed by more preventive services, cavitated carious lesions with more restorative services, gross carious lesions with more radiographic, endodontic and extraction services. However, initial carious lesions tend to be managed with restorative rather than preventive service, suggesting scope for increased management by minimum intervention approaches.     

Endoperiodontal lesion. A case report

The purpose of this case report is to present an unusual endoperiodontal lesion on tooth 46 in an 8-year-old child. The absence of any carious process and the presence of the typical radiographic aspect of an infrabony defect, led us to consider the periodontal aetiopathogenesis. In spite of all this, an accurate periodontal probing of all the teeth and the use of the pulp tester for teeth 46 and 36 led us to diagnose properly a truly endodontic lesion. The endodontic treatment of the involved tooth achieved the complete healing of the lesion.     

良性淋巴上皮病变及其恶性变中上皮性成分的免疫组化研究

采用抗肌动蛋白单克隆抗体HHF35和抗细胞角蛋白单克隆抗体AE1/AE3对10例良性淋巴上皮病变和3例恶性淋巴上皮病变中上皮性成分的构成细胞进行了免疫组织化学研究。结果发现：良性淋巴上皮病变中上皮岛构成细胞在部分HHF35呈阴性，仅在外周可见少许HHF35阳性细胞。AE1／AE3抗体在上皮岛构成细胞中大部分呈阳性。恶性淋巴上皮病变中癌巢内AE1／AE3抗体呈弥漫阳性，HHF35抗体主要分布在癌巢外周细胞。讨论了良性淋巴上皮的发生、发展、诊断及鉴别诊断方面存在的问题。     

Microorganisms in closed periapical lesions

The purpose of this study was to investigate the microorganisms of strictly selected closed periapical lesions associated with both refractory endodontic therapy and pulpal calcification. Definitive criteria were established that assured complete clinical isolation of the periapical lesion from the oral and periodontal environment. A total of 13 criteria-referenced lesions were selected from 70 patients with endodontic surgical indications. A well controlled culturing method was used in all cases and samples were taken by one clinician at three separate sites during each surgery. Samples taken at the surgical window and within the body of the lesion served as controls, whilst a third sample was taken at the apex. In all 13 cases, samples taken from the apex yielded microorganisms comprising 63.6% obligate anaerobes and 36.4% facultative anaerobes. Prevalence of the isolated species was 31.8% for Actinomyces sp., 22.7%, Propionibacterium sp., 18.2% Streptococcus sp., 13.6% Staphlyococcus sp., 4.6% Porphyromonas gingivalis , 4.6% Peptostreptococcus micros and 4.6% Gram-negative enterics. The results of this investigation indicate that closed periapical lesions associated with calcified teeth or those resistant to root canal treatment harbour bacteria. The inability to eradicate all root canal microorganisms during root canal treatment, along with anatomical factors, may allow further bacterial colonization of the root apex and surrounding periapical tissues, and consequently prevent healing.     

8-Year Follow-up of Central Giant Cell Lesion Mimicking Apical Periodontitis

Introduction

Lesions of nonendodontic origin may mimic apical periodontitis. Central giant cell lesions (CGCLs) are aggressive or nonaggressive benign idiopathic intraosseous lesions of the jaw. This report describes a case of a CGCL in the periapical region of teeth #21–#26 of a 17-year-old female who sought orthodontic care because of a change in the position of tooth #23.

Methods

Clinical examination revealed mild facial asymmetry caused by increased volume in the mental region and cortical bone expansion but no cortical disruption. A panoramic radiograph showed a well-defined radiolucent osteolytic lesion involving teeth #21–#26. The cortical bone was not affected, and there was no root resorption. Incisional biopsy was performed, and the diagnosis was a CGCL. The lesion was enucleated surgically. CGCLs should be included in the differential diagnosis of jaw lesions that mimic apical periodontitis.

Results

The patient subsequently underwent orthodontic treatment successfully.

Conclusions

The 8-year clinical and radiographic follow-up confirmed lesion remission, no recurrence, and pulp vitality of all teeth.     

口腔粘膜癌前病变C—erbB—2蛋白产物检测

采用免疫组化染色和图像分析技术,检测了9例口腔上皮单纯增生,49例不同程度异常增生和21例鳞状细胞癌中C-erbB-2蛋白产物表达.结果显示.单纯增生中癌基因蛋白无明显异常,轻度异常增生中阳性表达略有增加.随着异常增生程度加重,C-erbB-2阳性细胞明显增多,染色程度显著增强.所有鳞状细胞癌标本均出现C-erbB-2蛋白过量表达.由此提示C-erbB-癌基因与口腔鳞状细胞癌的发生发展过程有关,其蛋白产物检测可作为评估口腔粘膜癌前病变恶变风险的一项有用指标.     

口腔颌面部肌间血管瘤不同病理分型的影像学表现

目的 ：探讨口腔颌面部高血循肌间血管瘤（IMH）的CT、MRI（包括磁共振动态增强）的表现特征与病理分型的关系。方法 ：回顾分析2001—2013年间18例经病理检查证实的口腔颌面部IMH患者的术前影像学资料。其中男3例,女15例,年龄5~57岁,平均年龄33.4岁。结果 ：CT、MR图像显示,6例患者累及多块肌肉,12例累及单块肌肉。好发于咬肌（6例）及舌体（6例）。3例患者影像学表现为高血循病变,磁共振动态增强的SI-time曲线为Ⅱ型：早期快速强化后出现平台期,病理分型为毛细血管型2例、混合型1例。15例患者影像学表现为低血循病变,SI-time曲线为Ⅰ型,病理分型为海绵血管型。4例发现静脉石。结论 ：IMH的 CT、MR影像学表现及其SI-time曲线分型,能进一步帮助诊断其病理分型。     

Evaluation of p53, PCNA, Ki-67, MDM2 and AgNOR in oral peripheral and central giant cell lesions

OBJECTIVES: Peripheral giant cell lesion (PGCL) and central giant cell lesion (CGCL) of the jaws have a distinct clinical behaviour. Whether such biological differences are supported by a distinct pattern of proliferation markers or cell cycle associated proteins expression is not known. Therefore the purpose of the present study was to compare the immunohistochemical expression of p53, MDM2, Ki-67, PCNA and the histochemical expression of argyrophilic nuclear organiser region (AgNOR) on PGCL and CGCL of the jaws. MATERIALS AND METHODS: Paraffin wax blocks of 14 cases of PGCL and 12 cases of CGCL were retrieved. A biotin-streptavidin amplified system was used for identification of the antigens. The AgNOR number was also evaluated. RESULTS: Ki-67 immunoreactivity was greater in the mononuclear cells of PGCL compared to CGCL. PCNA and AgNOR staining were similar in PGCL and CGCL. Prominent MDM2 immunoreactivity was observed in all tissues investigated. By contrast, there was no p53 immunoreactivity. CONCLUSIONS: Although CGCL present a more aggressive clinical behaviour, it has a decreased proliferative activity compared to PGCL. Finally, p53, MDM2, PCNA, Ki-67 immunohistochemical expression and AgNOR histochemical expression do not reflect their distinct biological behaviour.     

Human papillomavirus frequency in oral epithelial lesions

BACKGROUND: Oral human papillomavirus (HPV) prevalence varies according to geographical occurrence, the type of lesion, and the method of diagnosis. The polymerase chain reaction method (PCR) appears to be more sensitive and can be easily applicable to epidemiologic studies. OBJECTIVES: To determine the frequency of HPV and its genotypes in oral lesions among patients attending a reference clinic of a university hospital. METHODS: PCR was performed to identify HPV DNA from samples of oral epithelial lesions in 80 patients. For HPV DNA amplification, MY09/MY11 consensus primers were used and specific genotypes were identified through restriction fragment of length polymorphism (RFLP) pattern. RESULTS: HPV DNA was present in 11.3% of patients, and the identified genotypes were 6b, MM4 (W13B), and MM9 (PAP238A). CONCLUSIONS: HPV DNA frequency in patients with oral epithelial lesions was 11.3%. The genotypes MM4 and MM9 are uncommon in oral lesions, and they are characterized as high-risk HPV types in those types of lesions.     

Management of vascular lesions of the mouth and lips using a potassium titanyl phosphate (KTP) laser: review of patient satisfaction

We reviewed patient satisfaction with the management of oral vascular lesions using a potassium titanyl phosphate (KTP) laser. Questionnaires consisting of 10 questions were given to 95 patients who had had laser treatment for oral vascular lesions between September 2007 and July 2009. A five-point scale ranging from poor (1) to very good (5) was used for the responses. Seventy-one percent of patients responded. Overall, they were very satisfied with the process of laser treatment (mean score more than 4.5/5), but were less satisfied with the levels of comfort 24 h after the procedure (mean score 3.7/5), and after one week (mean score 4.2/5). As postoperative discomfort was highlighted as an area of dissatisfaction for some patients, modifications to aftercare instructions may improve this aspect of the service.     

Traumatic ulcerative gingival lesion

Abstract Gingival ulcers caused by tooth brushing in 13 patients with an average age of 29.9 years are presented. The lesions show characteristic clinical features not compatible with simple traumatic ulcers, e. g. running a more chronical course, the duration averaging 6.5 months. Repeated trauma and, in some cases, infection might explain the chronicity. The lesion is suggested to be designated traumatic ulcerative gingival lesion. As treatment, cessation of tooth brushing for 2 weeks and concomitant mouthrinses with chlorhexidine are recommended.     

单层上皮细胞角蛋白在口腔粘膜癌变过程中的表达

目的：探讨单层上皮细胞角蛋白ＣＫ１８和ＣＫ１９作为口腔癌前病变标志的可能性。方法：用ＬＳＡＢ免疫组化染色方法检测ＣＫ１８和ＣＫ１９在福尔马林固定,石蜡包埋的口腔正常粘膜,上皮单纯增生,轻度上皮导演增生,中度上皮异常增生,重度上皮异常增生和口腔鳞癌组织中的分布和表达强度,光镜观察染色切片,结果用秩和检验分析。     

下颌骨囊肿术后引流方式的探讨

目的 探讨下颌骨囊肿术后的最佳引流方式，减少术后并发症。方法 对比研究了111例下颌骨囊肿的病例，术后分别采用切口严密缝合加根管引流和单独严密缝合口内切口两种处理方式。结果 采用根管引流的55倒下颌骨囊肿出现并发症(瘘管形成)仅1例，占1．9％。而只采用严密缝合法的56例中，其中直径在3cm以下的下颌骨囊肿有1例出现并发症，占3．4％，而直径在3cm以上的并发症发生率高迭30．7％。结论 下颌骨囊肿术后尽量采用根管引流；对于直径3cm以下的下颌骨囊肿也可采用口腔内切口严密缝合法。     

Management of the oral manifestations of senile purpura in an edentulous patient: a case report

Senile purpura occurs because of a weakness of the vascular supporting tissues mainly caused by aging and is most often seen on the dorsal surface of the hands and the extensor surfaces of the forearms, and has also been observed in the oral mucosa of elderly patients. These red lesions present as sharply margined subcutaneous hemorrhagic spots and are due to trauma, such as damage to the endothelium of small blood vessels, or a coagulation defect. They can also be due to reduced perivascular support, or capillary fragility and permeability, or a combination of all of these factors. Oral manifestation of senile purpura can also be induced by long periods of medication use leading to fragile areas of the mucosa. The presence of senile purpura requires continuous follow‐up since drug‐induced purpura may cause plaque function alterations. An accurate diagnosis in elderly complete denture wearers can minimize bleeding and prevent possible development of ulcerations under the dentures, especially during the adaptation period to the prosthesis. This case report, presents the care and 3‐year follow‐up of a 66‐year‐old woman with complete dentures who presented with the oral manifestations of senile purpura caused by the continued use of several medications.     

开窗减压术治疗下颌骨大型囊性病变的临床研究

目的:通过开窗减压术治疗下颌骨大型囊性病变,探索其在下颌骨保存性功能外科中的应用价值。方法:回顾1999年10月～2004年10月治疗的107例下颌骨大型囊性病变开窗减压术病例,测量开窗减压术后病灶长径的变化,随访观察复发情况,评价临床治愈率。结果:开窗减压术治疗下颌骨大型囊性病变的总有效率为87.85%,牙源性角化囊肿的疗效优于囊性成釉细胞瘤,其中单房型角化囊肿疗效优于多房型者,单房或多房型囊性成釉细胞瘤之间疗效没有统计上差异。结论:开窗减压术是治疗颌骨大型囊性病变的有效方法。     

免疫抑制鼠根尖周炎的组织病理学研究

目的 :了解免疫抑制对根尖周炎致病作用的影响。方法 :32只SD大鼠分成两组 ,实验组每周 1次环磷酰胺 (70mg/kg)腹腔注射 ,并作尾静脉血白细胞计数 ;白细胞总数明显下降时 ,行下颌磨牙开髓术 ,术后 1、2、3、4周取材 ,摄X线牙片 ,测X线片所示根尖周稀疏区面积 ;制作组织切片 ,HE染色。结果 :用药前外周血白细胞密度为 (1132 0± 3882 )× 10 6/L ,用药后 (12 70± 4 4 9)× 10 6/L ,下降非常显著。术后 1、2、3、4周根尖阴影面积与对照组呈相似的动态过程。组织学观察 :两组呈相似的非特异性炎症反应过程。结论 :免疫抑制剂致外周血白细胞减少 ,对鼠根尖周炎病程无明显影响。     

Multiple teeth showing invasive cervical resorption – an entity with little known histologic features

Invasive cervical resorption is a relatively uncommon form of external root resorption, characterized by resorption of the cervical region of the root. There is progressive loss of cementum and dentine with replacement by fibrovascular tissue derived from the periodontal ligament, with deposition of cementum-like hard tissue. In most cases, a single tooth is involved. We report a case of invasive cervical resorption that resulted in loss of multiple teeth from two different quadrants. The case highlights the diagnostic difficulty that may arise in this uncommon lesion, the pathologic features of which may be mistaken for a fibro-osseous lesion or a low-grade sarcoma.     

Metastatic carcinoma of the mandible mimicking periapical lesion of endodontic origin

Abstract A case report describes a metastatic lesion of the mandible that was originally referred to the endodontist as possible periapical pathosis of endodontic origin. The symptoms and radiograpic findings were similar to that of a periapical abscess. However, a history of breast cancer aroused suspicion of this rare entity and a biopsy was taken. A diagnosis of poorly differentiated carcinoma, probably metastatic, was made by the pathologist.     

早期龋表层结构的超微观察

目的：研究早期龋表层结构。方法：采用细菌人工龋实验技术造成早期人釉质龋样损害，用扫描电镜（ＳＥＭ）观察损害的表层结构变化。结果：釉质龋的表层结构有三种形式：①相对完整的釉质区；②局部孔隙区；③不规则破坏区。在相对完整的表层釉鞘增大，晶体间的间隙增大。这些间隙为脱矿过程中矿物质丢失提供通道，出现龋损过程中，表层下的破坏比表层更为明显的典型病理改变。结论：早期釉质龋相对完整的表层概念值得商榷。