Epithelial malignancies of the salivary glands: clinical experience of a single institution-a review

In this retrospective study we give a clinical review of our experience with different subtypes of salivary gland cancer. Between January 1983 and December 2002, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. There were 79 (51.0%) adenoid cystic carcinomas, 42 (27.1%) mucoepidermoid carcinomas, 12 (7.7%) adenocarcinomas, 10 (6.5%) polymorphous adenocarcinomas and 12 (7.7%) other tumor entities of smaller number. Complete resection was reached for 63.5% of patients with high grade carcinomas and for 80.0% of patients with low grade carcinomas. 26.2% of patients with high grade carcinomas and 13.3% of patients with low grade carcinomas received postoperative radiation. Overall survival rates at 5, 10 and 15 years were 65.9, 48.0 and 39.8% with significant difference for patients with high grade and low grade carcinomas. Histopathologic subtype, tumor stage and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation. In the future, patients with salivary gland carcinomas should be randomised for prospective multicentric clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer.     

Rhino-sinusitis related to endosseous implants extending into the nasal cavity. A case report

Rhino-sinusitis may develop as a result of an altered airflow in the nasal cavity causing irritation of the nasal mucosa. A patient is presented who developed recurrent rhino-sinusitis complaints following placement of endosseous implants in the maxilla. Inspection of the nasal floor revealed that two implants had perforated the floor of the nasal cavity. The part of the implants protruding in the nasal cavity was surgically resected via an endonasal approach whereupon the rhino-sinusitis complaints disappeared.     

Radiation doses of indirect and direct digital cephalometric radiography

AIM: The aim of this study was to measure organ doses and calculate the effective dose for indirect and direct digital cephalometric exposures. MATERIAL AND METHODS: Indirect digital cephalometric exposures were made of a Rando phantom head using a Cranex Tome multipurpose unit with storage phosphor plates from Agfa and the direct digital (Charge Coupled Device, CCD) exposures were made with a Proline Ceph CM unit. Exposure settings were 70 kV and 4 mAs for indirect digital exposures. Direct digital exposures were made with 70 kV, 10 mA and a total scanning time of 23 s. TLD700 dosemeters were used to measure organ doses, and the effective doses were calculated with (effective dose(sal)) and without inclusion of the salivary glands. A pilot study was carried out to compare diagnostic image quality of both imaging modalities. RESULTS: Effective doses were 1.7 microSv for direct digital and 1.6 microSv for indirect digital cephalometric imaging. When salivary glands were included in the calculation, effective doses(sal) were 3.4 microSv and 2.2 microSv respectively. Organ doses were higher for direct digital imaging, except for the thyroid gland, where the organ doses were comparable. Diagnostic image quality of indirect and direct digital cephalometric images seemed comparable. CONCLUSION: Effective dose and effective dose(sal) were higher for direct digital cephalometric exposure compared with indirect digital exposure. Organ doses were higher for direct digital cephalography. From preliminary data, it may be presumed that diagnostic image quality of indirect and direct digital cephalometric images are comparable.     

Dental treatment for children with chronic idiopathic thrombocytopaenic purpura: a report of two cases

Idiopathic thrombocytopaenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children. The condition is benign and self-limiting, with a high possibility of recovery. Only 15-30% of children with acute ITP develop the chronic form. Clinically, ITP presents with petechiae, ecchymoses, haematomas, epistaxis, haematuria, mucocutaneous bleeding, and occasionally, haemorrhage into tissues. Oral manifestations include spontaneous gingival bleeding, petechiae or haematomas of the mucosa, tongue or palate. Two paediatric case reports are described concerning female patients diagnosed with chronic ITP. Oral findings and dental procedures are described. Standard dental treatment was performed with a platelet count higher than 50,000/mm3. The importance of adequate dental plaque control techniques in order to prevent inflammation, potential bleeding and infection in these patients is emphasized. The paediatric dentist must be aware of the clinical appearance of ITP in order to recognize the condition and successfully manage the patient.     

Occupation-related allergies in dentistry

BACKGROUND: Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This case and others prompted regulatory and manufacturing changes in rubber products and increased awareness throughout the profession. However, other common dental chemicals cause allergic reactions and irritation and often are handled with insufficient precautions. Although recognition of NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is limited. OVERVIEW: Recent research indicates that the prevalence of NRL protein allergy may be decreasing. In contrast, occupation-related dermatoses associated with other dental products may be more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific information about the recognition and management of allergic and irritant reactions is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS: The prevalence of occupation-related dermatitis may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating personnel about proper skin care are essential to reversing this trend.     

Surface EMG of jaw elevator muscles: effect of electrode location and inter-electrode distance

This study addresses methodological issues on surface electromyographic (EMG) signal recording from jaw elevator muscles. The aims were (i) to investigate the sensitivity to electrode displacements of amplitude and spectral surface EMG variables, (ii) to analyse if this sensitivity is affected by the inter-electrode distance of the bipolar recording, and (iii) to investigate the effect of inter-electrode distance on the estimated amplitude and spectral EMG variables. The superficial masseter and anterior temporalis muscles of 13 subjects were investigated by means of a linear electrode array. The percentage difference in EMG variable estimates from signals detected at different locations over the muscle was larger than 100% of the estimated value. Increasing the inter-electrode distance resulted in a significant reduction of the estimation variability because of electrode displacement. A criterion for electrode placement selection is suggested, with which the sensitivity of EMG variables to small electrode displacements was of the order of 2% for spectral and 6% for amplitude variables. Finally, spectral and, in particular, amplitude EMG variables were very sensitive to inter-electrode distance, which thus should be fixed when subjects or muscles are compared in the same or different experimental conditions.     

Adaptation of salivary Lactobacillus strains to xylitol

OBJECTIVE: Acid production from sugars is one of the virulence factors of cariogenic bacteria. To eliminate this factor, many authors have suggested using sugar substitutes like xylitol, which is not fermented by most oral bacteria. The aim of this work was to investigate whether oral strains of lactobacilli unable to utilise xylitol could become able to utilise this polyol. DESIGN: Twenty-eight oral strains and six ATCC strains of lactobacilli were tested. None was initially able to produce acids from xylitol. Media containing only xylitol was used in order to see if an adaptation was possible. The acid production from xylitol was measured by recording the pH variations of the culture medium. The acids produced were identified by HPLC. RESULTS: After a 15-days culture, 10 strains produced acids. After a 40-days culture, 11 more strains produced acid. When acid production occurred, lactic, formic, acetic, propionic and butyric acids were the organic acids formed by all the strains. CONCLUSIONS: Adaptation of oral strains of lactobacilli to xylitol can occur in vitro.