Melanoma arising from the mucosal surfaces of the head and neck

Oral mucosal malignant melanoma is a rare disease. We reviewed 30 years of data from a tumor registry and identified 65 patients who had head and neck melanomas. Two thirds (43) of the 65 patients were identified as male, with the mean age in the sixth decade. Of the 65 patients, only 6 had melanoma that arose from the oropharyngeal mucosa. Of the lesions involving the oral mucosa, each lesion manifested itself as a mass or was associated with symptoms of discomfort; only one third (2) of the lesions were pigmented. The clinician must carefully examine the head, neck, and oral cavity, and any pigmented lesion that is not recognized as a specific entity, such as amalgam tattoo, should be biopsied. The more common presentation of amelanotic malignant melanoma requires a high index of suspicion for masses identified in the mouth and requires biopsy for definitive diagnosis. The prognosis for oral mucosal malignant melanoma is poor.     

Adhesion testing of a denture base resin with 5 casting alloys

PURPOSE: This study compared denture base resin shear bond strengths to silicoated Au-Pd, Au-Pd-Ag, Au-Ag-Pd-Cu, high-Pd, and Ni-Cr-Be alloys used to fabricate frameworks for hybrid implant prostheses. Microleakage between alloy and resin was also compared among groups after specimen fracture. MATERIALS AND METHODS: Twelve cylindrical specimens were cast for each alloy. Each specimen was made from a ring-shaped pattern (diameter [d] = 12 mm and height = 4 mm) and machined to achieve uniform hollow centers (d = 6.5 mm). Castings were abraded with 250-micron aluminum oxide and ultrasonically cleaned in distilled water before silicoating. Denture base resin was processed to the internal surfaces of the silicoated specimens. All specimens were thermocycled (1,000 cycles) between 4 degrees C and 50 degrees C, and placed in basic fuchsin dye for a week. A punch (d = 3.8 mm) driven at a cross-head speed of 0.5 mm/min was used to push out the resin specimens. The force required to cause failure was converted to the nominal shear bond strength for each specimen, and mean shear bond strengths for the 5 groups of specimens (N = 12) were compared using one-way analysis of variance and the Tukey-Kramer HSD multiple range test (alpha = 0.05). Six of the 12 debonded resin samples for each alloy were selected at random and evaluated for dye penetration. Using an 80-square grid, the percentage of dye penetration was evaluated with an optical microscope (x25) to determine the percentage of grid area penetrated by the dye. One-way analysis of variance was used to compare the degree of microleakage among groups. RESULTS: The mean resin-alloy shear bond strengths for the Au-Pd (9.6 +/- 3.7 MPa) and Au-Ag-Pd-Cu (9.2 +/- 1.5 MPa) alloys were significantly greater than mean resin-alloy shear bond strength for the Au-Pd-Ag alloy (5.6 +/- 1.9 MPa). No other significant differences in resin-alloy shear bond strengths were noted among the alloy groups. No significant differences were noted for dye penetration into the resin specimens bonded to any of the 5 alloys. The mean grid area penetrated by the dye was 25% when results for the alloys were pooled. CONCLUSIONS: Alloy type influences the shear bond strength of a denture base resin to silicoated alloys, but no difference in bond strength was found between Au-Pd, Au-Ag-Pd-Cu, high-Pd, and Ni-Cr-Be alloys. In addition, under the conditions of this study, all groups showed a similar degree of microleakage, which penetrated approximately 25% of the bonded specimen surface area.     

Restoring a Failed Prefabricated Post and Core With a Sleeve Casting: A Clinical Report

A clinical case is described, and a technique is explained for making a custom sleeve cast post and core to salvage a fractured crown previously treated with an unretrievable prefabricated post. The restorative problem was to design and fabricate some sort of cast post and core that could be cemented to the remaining post. The amalgam and cement in the pulp chamber and coronal portion of the root canal were carefully removed so that a direct pattern could be made to form a tube which would surround the coronal part of the existing post like a sleeve. This sleeve casting was designed to provide attachment for a core to support a new restoration. This direct pattern technique results in a retained core that joins the already cemented post and provides a sound core for the retention of a new crown.     

Trends in the Prevalence and Severity of Periodontal Diseases in the US: A Public Health Problem?

This article reviews trends in the prevalence and severity of periodontal diseases in US adults and examines the implications of these trends regarding the recognition of periodontal disease as a public health problem. Data from the National Center for Health Statistics (NCHS) examination surveys, 1960-62 and 1971-74, and the National Institute of Dental Research (NIDR) 1985-86 Survey of Employed and Senior Adults are examined. Issues of comparability and generalizability are discussed. Changes in the prevalence and severity of gingivitis and periodontitis are presented for the time periods 1960-62 to 1971-74 and 1971-74 to 1985-86. We concluded (1) it is difficult to document the changes occurring in the prevalence of gingivitis; however, given the available evidence, the prevalence and severity of gingivitis have probably declined; (2) it appears that periodontitis continues to affect approximately the same proportions of the overall US adult population; but with those affected, the extent and severity of the disease have declined; and (3) older adults continue to exhibit more disease and greater levels of severe disease than the younger age groups. Renewed efforts to clarify the epidemiologic confusion concerning trends in the prevalence and severity of periodontal disease should remain high on the agenda for public health dentistry.     

Using Silicone Impression Material and Acrylic Resin to Fabricate Remount Casts for Removable Partial Dentures

A technique is described for fabrication of a remount cast for a removable partial denture. This procedure consists of filling the occlusal/incisal third with acrylic resin and injecting polyvinylsiloxane impression material into the irreversible hydrocolloid impression. This technique provides a simple method for making a remount cast and enables the clinician to remove and easily place the partial denture on the cast during occlusal refinement procedures without damage to the removable partial denture or the remount cast.     

Occlusion (Part 2 of 2)

In the previous Journal of Esthetic and Restorative Dentistry's Talking with Patients, we defined occlusion and malocclusion and discussed when and why malocclusion is a concern. In this issue we will discuss the diagnosis and treatment of malocclusions.     

“Scalded mouth syndrome” caused by angiotensin converting enzyme inhibitors: Two case reports

Two cases of “scalded mouth syndrome” are presented and discussed. This condition is a rare side effect of angiotensin converting enzyme inhibitors. Angiotensin converting enzyme inhibitors are known to cause several other oral and extra-oral side effects. In scalded mouth syndrome, the patient's complaints concern a burning pain of the oral soft tissues. There are no clinical findings.