Is unilateral posterior crossbite associated with leg length inequality?

It has been suggested that malocclusions may influence whole body posture, including leg length, but the current scientific evidence to support this statement is poor. The aim of the present study was to investigate a possible association between leg length inequality (LLI) and unilateral posterior crossbite. A survey was carried out in young adolescents recruited from three schools. The sample included 1,159 subjects (633 males and 526 females) with a mean age of 12.3 years (range 10.1-16.1 years), who underwent an orthodontic and orthopaedic examination performed independently by orthodontists and orthopaedists. The data were analysed by means of logistic regression analysis. One hundred and twenty subjects (10.3 per cent) were diagnosed as having LLI. A unilateral posterior crossbite was found in 142 of the 1,159 subjects (12.2 per cent). Logistic multiple regression analysis, controlling for potential confounding variables, failed to reveal a significant association between LLI and unilateral posterior crossbite (odds ratio = 1.0, confidence limits = 0.6-1.9). A unilateral posterior crossbite does not appear to be associated with LLI, at least in young adolescents.     

Is there a difference between the thicknesses of the rami in mandibular asymmetry?

The purpose of this retrospective study was to investigate whether the thicknesses of the two rami differ in patients with mandibular asymmetry. Preoperative cone beam computed tomography scans of 78 patients with mandibular asymmetry were assessed for ramus thickness, mandibular length, and mandibular shift. The results showed that the ramus was thinner on the longer side than on the shorter side in 85.9% of the patients. On average, the longer side of the mandible was 2.74 mm longer (range 0.07–9.90 mm, standard deviation 1.92 mm) and 0.55 mm thinner (range ?0.61 to 2.02 mm, standard deviation 0.59 mm) than the shorter side (both P < 0.001). This study indicates a trend in the discrepancy in ramus thickness between the longer and shorter side of about 8% of the mean thickness of the ramus. Regression analysis showed that for every 1-mm increase in the length of the mandible, the thickness of the superior aspect of the ramus was reduced by 0.041 mm (P = 0.009) and the anterior aspect by 0.125 mm (P = 0.001). Age and sex did not have a significant influence on the thickness of the mandible. It is concluded that the longer side of the mandible tends to be thinner at the ramus than the shorter side in patients with mandibular asymmetry. The implication of this finding could be important in relation to the sagittal split ramus osteotomy.     

Is there a difference in the electromyographic activity of the masticatory muscles between individuals with temporomandibular disorder and healthy controls? A systematic review with meta-analysis

The diagnosis of temporomandibular disorders (TMD) is complex, and it is not yet clear in the literature whether the clinical changes associated with these disorders are also reflected in the electromyographic (EMG) activity of the muscles of mastication. To determine whether there is a difference in the electromyographic activity of the masticatory muscles between individuals with TMD and healthy controls. ScienceDirect, EMBASE, MEDLINE, PEDro, SciELO, CINAHL and LILACS databases from January 2000 to February 2019. Cross-sectional studies, crossover studies and randomised controlled trials evaluating EMG activity of right and left masseter and anterior temporal muscles in patients with TMD and healthy controls. Two independent assessors extracted data from the selected articles. The risk of bias was determined using a checklist for assessing methodological quality created based on the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology and International Society of Electrophysiology and Kinesiology. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 51 267 studies were retrieved, and 12 were included in this review. Only two studies enabled the comparative analysis of the results. The different EMG signal capturing, processing and analysis methods used constitute an important limitation to the comparative analyses of the results reported in the studies selected for the present review. This systematic review did not demonstrate evidence of significant differences in the EMG activity of the masticatory muscles between individuals with TMD and healthy controls.     

Association between shape of the mandibular condylar head and the occurrence of unilateral condylar fracture – A retrospective computed tomographic study

This retrospective study aims to evaluate the correlation between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture using computed tomography.Medical records of patients diagnosed with unilateral condylar fractures from the year 2012–2019 were reviewed. The shape of the condylar head on the non - fractured side was analysed using a Radiant Dicom Viewer. The analysis was done using both visual and analytical methods. In the analytical method, a horizontal line was drawn at the base of the curvature of the condylar head. The highest peak point of the head was marked, and a perpendicular line was drawn connecting the highest point to the horizontal line. The shape was categorized into four types as convex, flat, angled, and round based on these lines.201 CT scans were examined, of which 69 were excluded as they did not meet the inclusion criteria. The remaining 132 were included in our study. On examining the shape, flat-shaped condyle was seen in 57 scans (43.2%), followed by convex in 31 scans (23.4%), angled in 30 (22.7%) and round in 14 scans (10.6%). The relationship between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture was analysed using a chi-square test, which showed high statistical significance (p value 0.0001). The flat-shaped condylar head was more prone to fracture, and the round-shaped condylar head was least prone to fracture.In conclusion, the shape of the mandibular condylar head had a statistically significant association with the incidence of unilateral condylar fracture. The assessment of the shape of the condylar head can be taken as a guide to suspect condylar fractures and other associated mandibular fractures.     

Is there an association between low birth weight and caries in the primary dentition?

OBJECTIVES: An association between low birth weight and caries in the primary dentition has been suggested but not demonstrated. This study analyzed this association using data from a probability sample of US children 2-6 years of age. METHODS: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Variables included decayed and filled primary surfaces (dfs), birth weight, gestational age, and Apgar score (a surrogate measure of fetal well-being); maternal age, education, income; number of previous births, marital status, the existence of pregnancy complications, and cigarette smoking during the pregnancy. Data were analyzed using SUDAAN 8.0.2. RESULTS: Bivariate Poisson regression showed that children of mothers who were unmarried (incidence density ratio, IDR = 3.28), with less education (IDR = 1.43), who were 17 years of age or younger at birth (IDR = 1.51), and had 2 or fewer prenatal visits (IDR = 1.65) had a significantly ( p <0.05) greater risk of caries than the reference groups. Children of mothers with pregnancy-related hypertension (IDR = 0.14) had less than 20% the risk of caries than the reference group. Blacks (IDR = 1.37) and Mexican-Americans (IDR = 2.38) had greater risk of caries than whites, and children of low (IDR = 2.57) and middle income (IDR = 2.00) level families had higher caries risks than those of upper income families. Multivariate Poisson regression found only race-ethnicity, age, and income level to be statistically significant. CONCLUSIONS: This study did not support the association between low birth weight and caries of the primary dentition.     

Is the pattern of mandibular asymmetry in mild craniofacial microsomia comparable to non-syndromic class II asymmetry?

Clinical Oral Investigations - To compare the characteristics of mandibular asymmetry in patients with unilateral craniofacial microsomia (CFM) and class II asymmetry. Pretreatment cone-beam...     

Diagnostic performance of SPECT–CT imaging in unilateral condylar hyperplasia

Nuclear imaging plays an important role in the diagnostic path of patients with unilateral condylar hyperplasia (UCH). The purpose of this study was to determine the performance of single-photon emission computed tomography–computed tomography (SPECT–CT) in a large group of patients with suspected UCH. This study prospectively included 156 patients with a clinical presentation of progressive mandibular asymmetry. All patients underwent ^99 mTc-HDP SPECT–CT and extensive baseline and follow-up documentation. The relative activity of the ipsilateral condyle in relation to the contralateral condyle was calculated for both the mean and maximum count, and the diagnostic accuracy of different cut-off values was determined. The area under the receiver operating characteristic curve of the SPECT–CT scan was 0.892 for the mean count and 0.873 for the maximum count. The optimal cut-off of> 8% (SPECT–CT mean count) resulted in a sensitivity of 87.0% and a specificity of 88.6%. SPECT–CT showed good diagnostic performance in UCH; however the benefit of the CT scan is questionable and the potential disadvantages have to be weighed against the benefits when compared to standard SPECT scanning. When using SPECT–CT in the diagnostic path in UCH, a mean value cut-off of>8% for the relative activity between the condyles is most accurate.     

SPECT bone scintigraphy for the assessment of condylar growth activity in mandibular asymmetry: is it accurate?

The comparison of serial radiographs and clinical photographs is considered the current accepted standard for the diagnosis of active condylar hyperplasia in patients with facial asymmetry. Single photon emission computed tomography (SPECT) has recently been proposed as an alternative method. SPECT can be interpreted using three reported methods absolute difference in uptake, uptake ratio, and relative uptake. SPECT findings were compared to those from serial comparisons of radiographs and clinical photographs taken at the time of SPECT and a year later; the sensitivities and specificities were determined. Two hundred patient scans were evaluated. Thirty-four patients showed active growth on serial growth assessment. On comparison with serial growth assessment, the sensitivity and specificity of the three methods ranged between 32.4% and 67.6%, and 36.1% and 78.3%, respectively. Analysis using receiver operating characteristic (ROC) curves revealed area under the curve (AUC) values of <0.58. The average age (mean ± standard deviation) of patients with active growth was 18.6 ± 2.8 years, and average growth in the anteroposterior, vertical, and transverse directions was 0.94 ± 0.91 mm, 0.88 ± 0.86 mm, and 1.4 ± 0.66 mm, respectively. With such low sensitivity and specificity values, it is not justifiable to use SPECT in place of serial growth assessment for the determination of condylar growth status.     

Is there a doctor in the house?

The two cases presented deal with urgent situations experienced by persons unknown to the dentist in the area. It is likely that dentists, physicians, nurses, and other medical professionals will encounter persons in urgent need of medical attention in other venues. Certainly, it is possible for someone to experience an emergency in a ballpark, grocery store, church, or other public gathering. While these settings may not offer the advantage of a medical emergency kit, they do pose the same ethical requirement for those trained in medical management of urgent problems to step forward, identify themselves, and attempt to help the ill person. Fortunately, most non-air settings usually allow for contacting emergency medical help and prompt transport to hospitals. The public may never reach a general understanding of the extent to which doctors other than physicians are trained to handle medical emergencies. Similarly, when someone in a crowded theater yells, "Is there a doctor in the house?" he or she most likely is thinking about a physician. This does not mean that a dentist is excused from acting as a medically trained Good Samaritan. The ethical obligation of specific beneficence requires dentists to minister to the ill in medical emergencies unless a more qualified health care provider is present and identifies himself or herself. The ethical obligation of general beneficence requires dentists and other citizens to assist those in urgent circumstances whose needs do not call upon specialized knowledge or training. Fortunately, the law in this country is designed to protect those who do attempt to help those in need.     

Is there an association between fear avoidance beliefs,and pain and disability in patients with orofacial pain?

Numerous psychosocial factors have been shown to contribute to the development and perpetuation of orofacial pain. One well‐recognized model for explaining the link between psychosocial factors and chronic pain is the fear avoidance model. To date, this proposed link has not been studied in subjects with orofacial pain. During the initial evaluation of subjects with orofacial pain, we collected data on fear avoidance beliefs using the Fear Avoidance Beliefs Questionnaire, and disability and pain. At between 6 and 8 weeks follow‐up, we re‐collected these data, as well as data addressing subjects’ perceived change in their condition. Data were analyzed using correlation coefficients and linear regression. Fear avoidance beliefs at intake were inversely correlated with intake disability, There were no significant associations between fear avoidance beliefs at initial evaluation or in changes in fear avoidance beliefs during the 6–8 weeks follow‐up period; and changes in disability, pain or perceived change in condition at 6–8 weeks follow‐up. Of note, fear avoidance beliefs increased over the follow‐up period, despite improvements in all outcome measures. There was insufficient evidence to suggest that high levels of fear avoidance beliefs at initial evaluation are associated with higher levels of disability or pain at intake, or with change in disability, pain or perceived change in condition at 6–8 weeks follow‐up. Similarly, there was insufficient evidence to suggest that changes in fear avoidance beliefs during treatment are associated with any of these outcome measures.     

Is there a role for pentoxifylline and tocopherol in the management of advanced osteoradionecrosis of the jaws with pathological fractures? Case reports and review of the literature

Osteoradionecrosis (ORN) is an infrequent but serious complication of radiotherapy, especially in the head and neck region. It is a slowly progressive condition, with management in the early stages focused on symptom control, and surgery usually reserved for advanced ORN. However, established ORN is difficult to treat. The role of hyperbaric oxygen therapy has recently been contested. The use of pentoxifylline in the management of ORN was first described by Delanian in 2004, but its benefits have not been replicated in other studies. In cases of advanced ORN with pathological fractures, many centres still advocate surgical resection and reconstruction. However, in this group of patients who often have multiple medical comorbidities, many of whom have previously undergone significant surgery, a resective plan is not always ideal. This paper presents two successful cases of bony union after the use of pentoxifylline and tocopherol to manage grade III ORN of the mandible. Both patients had pathological fractures and orocutaneous fistulas and were deemed unsuitable for surgery. The possible reasons for the success of pentoxifylline and tocopherol are discussed, and a review of the current literature evidence of similar cases is presented. Pentoxifylline and tocopherol should be considered for the management of advanced ORN where surgical management is not appropriate.     

Is there an association between edentulism and nutritional state?

Edentulous people have difficulty chewing foods that are hard or tough in texture, even when wearing well-made dentures. These individuals typically modify their diets to compensate for loss of oral function. This practice leads to the question of whether the diet of edentulous individuals is adequate to maintain good general health. This overview summarizes articles that describe the changes in diet associated with edentulism. Such changes include reductions in fruits, vegetables, meats and other hard-to-chew foods and are associated with compromised nutrition. The evidence suggests that edentulous individuals lack specific nutrients and, as a result, may be at risk for various health disorders. The authors have recently shown that mandibular prostheses supported by only 2 implants may significantly improve nutritional status in edentulous patients.     

Is there a role for enucleation in the management of ameloblastoma?

This study aimed to determine the appropriate long-term management for ameloblastoma and the role of enucleation in the management of the subtypes of ameloblastoma (solid ameloblastomas, cystic ameloblastomas and peripheral ameloblastomas). They differ in their degrees of aggressive behavior and recurrence rates. This is an evidence-based study with review of relevant articles from PubMed, EMBASE and the Cochrane Library. Articles were categorized for quality according to the Oxford Center of Evidence-Based Medicine (CEBM). 58 articles met the inclusion criteria; their evidence level varied from IIA to V. No randomized control trials were identified. Solid and multicystic ameloblastomas have a high recurrence rate (60–80%) with simple enucleation and require more aggressive treatment. The treatment of choice is resection with 1-cm margins. This may require segmental resection in the mandible, and partial maxillectomy in the maxilla. For the unicystic ameloblastoma recurrence rates are high for simple enucleation. The intraluminal subtype of unicystic ameloblastoma may do well with enucleation, but the intramural subtype may not, and since these cannot be identified preoperatively more aggressive treatment is recommended, including peripheral ostectomy or enucleation with subsequent treatment of the surrounding bone with liquid nitrogen, Carnoy's solution, or similar physicochemical modality. The peripheral ameloblastoma has a different origin and responds to local excision.