Palatal neurofibroma associated with localized periodontitis

BACKGROUND: Neurofibromatosis type 1 (NF1) is the most common form of neurofibromatosis. While typically considered a dermatologic disorder, intraoral signs of neurofibromatosis occur quite commonly. This clinical entity can be confused with periodontitis because of the presence of periodontal pockets. In this report, we present the case of a palatal neurofibroma with radiographic involvement in a patient with NF1. METHODS: A 40-year-old female patient was referred from her general dentist to evaluate advanced periodontitis in the maxillary left quadrant. The patient's medical history was significant for a soft tissue lesion excised from her back 11 years previously and diagnosed as a neurofibroma. Subsequent medical examination at that time confirmed a systemic diagnosis of NF1. A comprehensive periodontal evaluation was performed, and panoramic and periapical radiographs were taken. Teeth were tested for vitality. An incisional biopsy was completed for histopathologic examination. RESULTS: The periodontal evaluation revealed the presence of 6 to 9 mm probing depths adjacent to teeth #14 and #15. Panoramic and periapical radiographs showed a circumscribed 0.8x0.9-cm unilocular radiolucency superimposed over the root of tooth #13 and extensive horizontal bone loss on the distal side of #15. Incisional biopsy confirmed the presence of a neurofibroma, and because of the extent of the lesion, the patient was referred to the Oral and Maxillofacial Surgery service for complete excision. CONCLUSIONS: Neurofibromas can cause extensive destruction of alveolar bone, mimicking periodontitis. Due to the potential systemic and genetic implications, the diagnosis of neurofibroma requires appropriate medical referral.     

The Brisbane Statistical Division Survey of Adult Dental Health 1984. 3. Dental health status and treatment needs

Dental status and treatment requirements were investigated in 1504 subjects. Mean numbers of decayed, missing and filled (DMF) teeth for the various age groups were: 15–19 years, 6.2; 20–24 years, 10.6; 25–29 years, 15.8; 30–34 years, 18.1; 35–44 years, 20.4; 45–54 years, 23.0; 55–64 years, 26.2; and 65 years and older, 28.7. Total tooth loss did not occur in the 15–19 years or 20–24 years groups. In the 25–29 years group 2.6 per cent of subjects had lost all their teeth, 4.2 per cent in the 30–34 year group and 5.0 per cent in the 35–44 year group. The figures for the older age groups rose dramatically with almost 60 per cent of the 65 year and older age group having lost all their natural teeth. Treatment requirements for all age groups were low. In the 15–19 year age group 62.4 per cent of subjects had no treatment requirements. In other age groups the proportion was lower, ranging from 43.2 to 55.9 per cent. The periodontal condition of subjects was relatively good with only 3.3 per cent requiring complex treatment for severe forms of periodontal disease. A high proportion (over 50 per cent in all but the 15–19 year age group) required scaling and improved personal oral hygiene.     

Modulation of class II (DR and DQ) antigen expression on gingival Langerhans cells in vitro by gamma interferon and prostaglandin E2

The effect of human and murine gamma interferon (IFN-gamma) on Class II (DR and DQ) expression by human gingival Langerhans cells (LC) was examined using an organ culture system. Human and murine IFN-gamma increased the expression of both DR and DQ antigens during a 72-h period. Maximal levels of DR expression (100% of T6+ cells) were produced within 6 h of IFN-gamma treatment and were maintained during culture. DQ expression was maximal (100% of T6+ cells) at 18 h and was more labile than DR. The effect of IFN-gamma on DR and DQ was abrogated by prostaglandin E2 (PGE) while indomethacin, and inhibitor of PGE synthesis, mimicked the effect of IFN-gamma on DR and DQ expression. Gingival keratinocytes maintained their expression of DR for 72 h in the presence of gamma-IFN, but did not express DQ under any of the culture conditions used in this study. These results demonstrate that gamma-IFN induces differential expression of Class II antigens in the oral mucosa in vitro, and suggest that gamma-IFN and PGE may be involved in the control of DR and DQ antigen expression in vivo.     

The accuracy and efficacy of disinfection by spray atomization on elastomeric impressions

Five disinfectants applied by spray atomization were examined for possible dimensional distortion of elastomeric impression materials, polyether, polysulfide, and addition silicone, and the associated improved, type IV gypsum casts. The disinfectants did not affect, in a clinically significant manner, the three dimensions measured with an instrument accurate to 1 micron on improved gypsum casts that reproduced a stainless steel standard. The master cast represented two teeth of a fixed partial denture prepared for complete veneer retainers. The use of control casts from elastomeric impressions that were not treated with the disinfectants further supported previous investigations reporting the accuracy of dental casts as the function of the impression material. The use of a spray disinfectant will not appreciably alter the dimensional accuracy of improved stone casts made within elastomeric impressions. The most accurate stone cast system was produced by addition silicone impressions disinfected by a surface spray. It was also shown that four of the disinfectants applied by spray atomization were effective in disinfecting the surface of an elastomeric impression material contaminated with selected test organisms.     

Lymphocyte levels in subjects with and without amalgam restorations

The claim that mercury from dental amalgam produces "reduced immunocompetence" was examined by measuring the levels of the three major populations of lymphocytes on 37 subjects--21 with amalgam restorations and 16 without. The results of this study show no indication that amalgam restorations affect the human immune system nor do they support the "reduced immunocompetence" claim.     

Current surgical concepts for treating obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome is a relatively common disorder with potentially serious psychologic and physiologic consequences. A comprehensive method of evaluation is described. Presurgical tests are mandatory in order to logically direct surgical treatment. Current surgical treatment and new techniques are discussed.     

An evaluation of telehealth expansion in U.S. nursing homes

ObjectiveThis research brief contains results from a national survey about telehealth use reported in a random sample of U.S. nursing homes.Methods and MaterialsThe sample includes nursing homes (N = 664) that completed surveys about information technology maturity, including telehealth use, beginning January 1, 2019, and ending August 4, 2020. A pre/post design was employed to examine differences in nursing home telehealth use for nursing homes completing surveys prior to and after telehealth expansion, on March 6, 2020. We calculated a cumulative telehealth score using survey data from 6 questions about extent of nursing home telehealth use (score range 0-42). We calculated proportions of nursing homes using telehealth and used logistic regression to look for differences in nursing homes based on organizational characteristics and odds ratios.ResultsSignificant relationships were found between nursing home characteristics and telehealth use, and specifically, larger metropolitan homes reported greater telehealth use. Ownership had little effect on telehealth use. Nursing homes postexpansion used telehealth applications for resident evaluation 11.24 times more (P < .01) than did nursing homes pre-expansion.DiscussionAdministrators completing our survey reported a wide range of telehealth use, including approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes is on the lower end of the range.ConclusionsOne solution for the current pandemic is to encourage the proliferation of telehealth with continued relaxed regulations, which can reduce isolation and preserve limited resources (eg, personal protective equipment) while maintaining proper distancing parameters.     

Power density and external temperature of laser-treated root canals

The purpose of this study was to determine the power and time parameters for an argon laser that would result in the removal of pulpal tissue without excessively elevating the external temperature of the root. External temperatures were measured by attaching thermistors to the surfaces of the teeth at the cemento-enamel junction (CEJ) areas and at the root apices. Results indicate that a 1-W power setting with a pulse duration of 0.1 sec and a 1 sec interval between pulses produced a mean temperature rise of 0.89 +/- 0.27 degrees C at the cemento-enamel junction area and a mean temperature increase of 2.04 +/- 0.47 degrees C at the apex. A 2-W power setting with a 0.1 sec pulse duration and a 1 sec interval between pulses resulted in a mean temperature increase of 1.58 +/- 0.45 degrees C at the CEJ and a mean temperature rise of 2.59 +/- 0.20 degrees C at the apex. Based upon the results of this study, it was concluded that an argon laser operating at 1 or 2 W of power with a 0.1 sec pulse duration could be used to remove pulpal tissue without creating an excessive increase in the external temperature of the tooth.