Three cases of oral squamous cancer associated with leukocytosis, hypercalcemia, or both

Three examples of malignant neoplasms primary to the oral cavity and associated with paraneoplastic syndromes are presented. The first case is a squamous cell carcinoma of the maxilla associated with leukocytosis. The second case is a mandibular squamous cell carcinoma associated with hypercalcemia in the absence of bony metastases. The third case is a squamous cancer of the tongue that metastasized to the lumbar vertebrae and right second rib and was associated with both hypercalcemia and leukocytosis. There was no evidence of acute infection or leukemia that could be expected to account for leukocytosis. Hypercalcemia in the second case was defined as humoral hypercalcemia of malignancy by biochemical and clinical evaluations. To our knowledge, this is the first definitive report of a carcinoma primary to the oral cavity associated with humoral hypercalcemia of malignancy. In each case, the severity of hypercalcemia, leukocytosis, or both very closely correlated with tumor growth. Surgical excision of the tumors or regression of tumor mass due to aggressive anticancer drug administration resulted in decreases in leukocyte number, serum calcium level, or both. In contrast, recurrence or regrowth of tumors induced further development of hypercalcemia, leukocytosis, or both. It is therefore likely that humoral factors released by these oral carcinomas are responsible for the hypercalcemia, leukocytosis, or both.     

Association between sociodemographic, behavioral, and medical conditions and signs of temporomandibular disorders across gender: results of the study of health in Pomerania (SHIP-0)

PURPOSE: To examine whether there is a gender-dependent risk profile for signs of temporomandibular disorders (TMD) in a population-based sample. MATERIALS AND METHODS: Sociodemographic, behavioral, and medical factors were checked for associations with TMD in a cross-sectional study of 3,567 subjects aged 25 to 74 years in Germany. Data were collected from clinical examinations, interviews, and questionnaires. Logistic regression analyses were used to estimate factors associated with signs of TMD across gender. TMD signs included tenderness or pain on palpation of 3 or more masticatory muscles and tenderness or pain on palpation in 1 or both temporomandibular joints (TMJs). RESULTS: In women, muscle tenderness or pain was found to be significantly associated with general arthrosis/arthritis and lower back pain. In men, muscle tenderness or pain was significantly associated with school education > 11 years, various categories of loss of occlusal support, lip/tongue/cheek biting, and general arthrosis/arthritis. In women, TMJ tenderness or pain was associated with widowed status, bruxism, general arthrosis/arthritis, lower back pain, and sex-hormone replacement. In men, TMJ tenderness or pain was associated with multiple losses of posterior supporting zones, gout, and lower back pain. In women, there were inverse associations between loss of occlusal support in 3 posterior zones and muscle and TMJ tendernes. CONCLUSION: Except for some general health conditions and bruxism, the hypothesis of a gender-dependent risk profile for signs of TMD is partly supported. The results of this study indicate that TMD is a complex disorder associated with mixed etiologic factors between genders.     

Agranulocytosis associated with an infected mandibular fracture.

This report describes a case of agranulocytosis associated with an infected mandibular fracture. Because agranulocytosis is most frequently associated with drug sensitivity, drug therapy is usually stopped or changed when the disease is discovered. This case demonstrates the need to evaluate the causes of agranulocytosis before stopping or changing a patient's medications.     

Periodontal disease in sickle cell disease subjects

Various systemic diseases and conditions have been associated with an increase in periodontal disease severity. These studies indicate that host-response mechanisms influence the initiation and/or progression of inflammatory periodontal diseases. Diseases that have been associated with an increased severity of periodontal disease include various neutrophil abnormalities, Down's syndrome, diabetes, and recently, the acquired immunodeficiency syndrome. Sickle cell disease is strongly associated with a predisposition to various infections; therefore, the objective of this study was to determine whether sickle cell disease is also associated with an increase in the severity of periodontal disease. A total of 78 patients with sickle cell anemia (SS), hemoglobin SC disease (SC) or S Thalassemia were evaluated blind and compared with an appropriate control population using clinical and radiographic indices of periodontal disease severity. The results clearly indicate that, in this population of patients, sickle cell disease is not associated with increased levels of gingivitis or periodontitis.     

Management of gingival overgrowth associated with generalized enamel defects in a child

Gingival overgrowth is usually associated with systemic conditions or treatment (e.g. blood dyscrasias, anti-epileptic or immunosuppressive agents). A child is presented, who had enlarged gingiva associated with a generalized enamel defect (amelogenesis imperfecta (AI), hypoplastic type) and document the periodontal and restorative management of this case.     

Cleft lip and palate: thoughts about associated anomalies

During two years all new patients referred to the cleft palate team in Nijmegen, were examined by a clinical dentist, to evaluate the occurrence of associated anomalies or syndromes. In 33% of the patients with all types of clefts associated anomalies were found. A percentage of 56% was found for cleft palate only, and of 14% for cleft lip (palate). It is important to make a classifying diagnosis of these associated anomalies because they may have important implications for recurrence risks and prognosis. The percentage of associated anomalies is the highest in the group of patients with cleft palate only or submucous clefts. Therefore, the dentists have to be aware of the presence of submucous clefts and their consequences.     

Xerostomia: the missing diagnosis?

Xerostomia is a distressing condition which may be associated with a number of specific diseases, iatro genically induced following the administration of drugs or radiotherapy, or the result of inflammatory processes affecting salivary gland tissue. In this article epidemiological background is briefly reviewed and aetiological conditions associated with xerostomic states are summarized. The oral sequelae of xerostomia are discussed and approaches to diagnosis demonstrated. Treatment of xerostomia is basically supportive and the main elements are presented.     

Congenital osteolipoma associated with cleft palate: a case report

Congenital tumors of the oral cavity are uncommon. Teratoid tumors account for most of the reported cases and are infrequently associated with a cleft of the soft palate. Of the remaining tumors associated with pediatric cleft palate, congenital lipoma is rare. Lipomas of the oral cavity may show cartilaginous or osseous changes. These changes have not been reported in lipoma associated with cleft palate. A rare case of congenital osteolipoma associated with cleft palate and showing osseous change is presented here. The pathogenesis of the lesion and the osseous metaplasia are described. The present case is the second case of congenital lipoma associated with cleft palate in the literature.     

Clinical,radiographic, and histologic study of endodontic treatment failures

One hundred fifty cases of endodontic treatment failures were studied clinically, radiographically, and histologically. Fifty-seven percent of the teeth were asymptomatic. Pain alone and/or associated with swelling was present in 21% of the teeth. There was no correlation between the size of periradicular rarefaction and the occurrence or severity of clinical signs and/or symptoms. Stainable bacteria were demonstrated in 69% of the teeth and were present mostly in the canal. The severity of periradicular inflammation was related to presence of stainable bacteria in the canal. Swelling and pain or a draining sinus tract was often associated with stainable bacteria inside the canal. The development of a radicular cyst associated with an endodontically treated tooth that has failed is not necessarily the cause of endodontic treatment failure.     

Dentigerous cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia,Canada

The aim of this research is to analyze the prevalence of dentigerous cysts (DCs) in a population-based cohort in British Columbia, Canada, and to report unusual cases associated with DC. The database of the British Columbia Oral Biopsy Service was searched from 1998 to 2007. 2082 histologically confirmed DCs from 2029 patients were retrieved and retrospectively analyzed for incidence, age, gender and ethnicity. The results show that this is a common jaw cyst with male predilection, has a peak incidence in younger adults and is more common in Caucasians. Multiple DCs, representing 2.5% of the cases, are not associated with any syndromes or systemic conditions. 0.5% DCs were associated with other cysts or tumours at the same site or the opposite side of the jaw. The authors report the first series of cases presenting clinically as bilateral DCs, but histologically as an odontogenic tumour or another type of odontogenic cyst. DCs can co-exist with other more serious conditions, such as odontogenic keratocyst or cystic ameloblastoma. This association with more significant conditions indicates the importance of histologically confirming any jaw cyst, even when it presents clinically as a classic DC.     

An update on pain

Pain is a personal, subjective experience that involves sensory, emotional and behavioural factors. Most of us at some stage in our lives have experienced pain. The most common type of pain that springs to mind is the acute or 'healthy' inflammatory pain associated with a bee sting or toothache. But increasingly, in the western world, one in three of us will also experience chronic pain, or unhealthy 'nerve' pain, most commonly associated with backache, headaches or persistent post-surgical pain. As this is a persistent state and derives from the nerves themselves, it is significantly more of a challenge to treat. This article highlights some significant progress made in the assessment and treatment of patients with neuropathic pain. An improved understanding of chronic or neuropathic pain by practitioners and patients themselves, will undoubtably better equip those involved to recognise and manage the pain.     

Does chronic periodontitis cause coronary heart disease?: A review of the literature

BackgroundChronic periodontitis, or CP, has been associated with coronary heart disease, or CHD. This article reviews the available prospective CP-CHD evidence.Literature ReviewedIn nine cohort studies, CP was associated with a 15 percent greater risk of developing CHD. Conclusions from individual studies depended on study characteristics. Summary risk estimates for studies controlling for smoking intensity (five of nine studies) or health awareness (two of nine studies) or studies with more than 600 CHD events (three of nine studies) suggest that CP is either not at all or weakly associated with CHD. Summary risk estimates for the studies that did not control for these factors or that examined an insufficient number of CHD events reported a weak increase in CHD risk associated with CP (20 percent greater). These data suggest that the CP-CHD associations observed in smaller studies are due to insufficient control for lifestyle differences. In addition, one cohort study reported that edentulous people had a CHD risk similar to that of people with CP. Therefore, the plausibility of dental infection elimination affecting CHD risk appears limited.SummaryCurrent evidence supporting a causal CP-CHD link is weak. Rigorous methodological and analytical control of lifestyle factors such as smoking will be required to elucidate whether the CP-CHD disease association is either small or nonexistent.Clinical ImplicationsCigarette smoking destroys both oral and systemic health. Because of this strong common causal factor, oral and systemic health are linked. Dentistry should continue to play an important role in implementing smoking prevention and cessation programs.     

Three-dimensional network of microtubules in secretory ameloblasts of rat incisors

Secretory ameloblasts appear to contain isolated microtubules and microtubules arranged in bundles associated with filaments or sheets of filaments. The relation between isolated and bundled microtubules in secretory ameloblasts was investigated by serial sections. Some isolated microtubules entered microtubule bundles in adjacent sections. Microtubules which diverged from a bundle sometimes converged into another bundle in other sections. Microtubules were associated with filaments or sheets of filaments for varying distances. It is concluded that isolated microtubules frequently form bundles by joining with other microtubules, and thus, microtubules make a three-dimensional network throughout the whole cytoplasm which is probably concerned with the transport of secretion granules.     

Temporomandibular disorders: associated features

Temporomandibular disorder (TMD) encompasses a number of clinical problems involving the masticatory muscles or the temporomandibular joints. These disorders are a major cause of nondental pain in the orofacial region, and are considered to be a subclassification of musculoskeletal disorders. Orofacial pain and TMD can be associated with pathologic conditions or disorders related to somatic and neurologic structures. When patients present to the dental office with a chief complaint of pain or headaches, it is vital for the practitioner to understand the cause of the complaint and to perform a thorough examination that will lead to the correct diagnosis and appropriate treatment. A complete understanding of the associated medical conditions with symptomology common to TMD and orofacial pain is necessary for a proper diagnosis.     

Dentinogenesis imperfecta: a case report

Dentinogenesis imperfecta is an autosomal dominant disorder of tooth development characterized by the presence of opalescent dentin, resulting in a dusky blue to brownish discoloration of the teeth. This condition is genetically and clinically heterogeneous; it may affect only the teeth or it may be associated with the osteogenesis imperfecta. Dentinogenesis imperfecta has been subdivided into three types: type I is associated with osteogenesis imperfecta; in type II there is no associated osteogenesis imperfecta; and when the condition is associated with the Brandywine triracial isolate and large pulp chambers it is classified as type III. This report describes a 16-year-old female patient who showed the characteristic dental features of dentinogenesis imperfecta type II. The etiology and prevalence of the disorder, and a comprehensive treatment plan, will be briefly reviewed.     

Unerupted teeth associated with dentigerous cysts and treated with coronectomy: mini case series

There is a resurgence of interest in coronectomy, but its appropriate application in the management of third molar teeth has yet to be defined. Dentigerous cysts associated with unerupted teeth are most commonly associated with mandibular third molars. In this case series we evaluate outcome after coronectomy of teeth with associated dentigerous cysts in cases where the inferior dental nerve was thought to be at risk, or there was an increased risk of mandibular fracture. We retrospectively studied 21 consecutive patients treated by coronectomy for dentigerous cysts at the Oral Surgery Department at Guy's Hospital. The most commonly affected teeth were mandibular third molars (20/21). One patient had permanent injury to the inferior dental nerve, but no mandibular fracture or recurrence of cyst was reported. One patient required secondary retrieval of the retained root because of eruption. Coronectomy of unerupted teeth associated with dentigerous cysts is an effective treatment when there is high risk of injury to the inferior dental nerve injury or potential for mandibular fracture. Further work with larger numbers and longer follow-up is required to discover the long-term outcome of the electively retained root.     

Regional underreporting of associated congenital anomalies in cleft patients in the Netherlands.

OBJECTIVE: The Dutch Cleft Palate Association (DCPA) registers all patients with cleft lip or palate and associated congenital anomalies in the Netherlands. The aim of this study was to assess if early registration of cleft patients leads to underreporting of associated congenital anomalies and, if so, whether reregistration is necessary. METHODS: The DCPA registration of the birth cohort 1997 to 2001 was compared with the medical files of these cleft patients for prevalence, type, and moment of registration of associated congenital anomalies. To assess possible long-term underregistration, a second birth cohort of 1990 to 1991 was analyzed. RESULTS: The percentage of cleft patients with associated congenital anomalies was 26% in the DCPA database and 33% in the retrospective medical file review. A syndrome, sequence, or association was recognized in 8% of the cleft patients by the DCPA compared with 13% in our medical file review. Of all associated congenital anomalies diagnosed during a follow-up of 12 years, 53% were diagnosed in the first year of life. The cumulative percentage was 59% after 2 years, 62% after 3 years, 80% after 6 years, and 97% after 10 years. CONCLUSION: Early registration of cleft patients leads to underreporting of other associated anomalies. For a complete registration of associated congenital anomalies in cleft patients, reregistration at a later age is necessary.     

Tooth agenesis: newer concept

Developmental disturbances involving the oral cavity affect the growth and development of a child. Tooth agenesis may be associated with a number of documented syndromes or may present as an isolated entity. The presence or absence of teeth is decided by the influence of various genes and their signaling pathways. These syndromes appear due to chromosomal defects or due to mutations in the genes responsible for organogenesis. Identification of these mutations helps understand the underlying defect and plays an important role in their treatment strategies. This is a comprehensive review of literature on syndromic and nonsyndromic forms of dental agenesis and an attempt in enlisting various syndromes associated with dental agenesis.     

Non-syndrome associated multiple supernumerary teeth: a report of two cases

Multiple supernumerary teeth are usually associated with syndromes. On the contrary, multiple supernumerary teeth without association with any syndromes are very rare. This article presents a report of two cases with multiple supernumerary teeth not associated with any syndrome and emphasizes the routine advice of orthopantomogram whenever a single supernumerary tooth is detected irrespective of whether the patient has any syndrome or not.     

Is Trying to Quit Associated With Tooth Loss and Delayed Yearly Dental Visit Among Smokers? Results of the 2014 Behavioral Risk Factor Surveillance System

Background: The rate of periodontitis in the US population has been estimated to be close to 50%. Patients with periodontitis, especially those who smoke, suffer from a high rate of tooth loss. The purpose of this analysis is to evaluate predictors of poor oral health and oral health habits among smokers and determine if trying to quit smoking is associated with better oral health or oral health habits in smokers in the United States. Methods: Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. After limiting the dataset to smokers, the designated exposure was respondent’s report of trying to quit smoking (yes/no). Two logistic regression models were developed. One model identified factors associated with having a most recent dental visit longer than 1 year before the survey. The second model identified factors associated with loss of six or more teeth. Both models were controlled for confounding factors. Results: After controlling for confounding, among smokers in the 2014 BRFSS, trying to quit was associated with significantly lower odds of respondents having their most recent dental visit longer than a year before the survey (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.90 to 0.97) and was a significant risk factor for having lost six or more teeth (OR: 1.06; 95% CI: 1.02 to 1.10). Conclusions: Among smokers in the United States, trying to quit is associated with compliance with yearly dental visits and higher odds of lost teeth. Future research should investigate optimal approaches for providing smoking cessation services in the dental setting.