Oral manifestations of celiac disease. A case report and review of the literature

Celiac disease is a chronic intestinal disease caused by intolerance to gluten associated with poor digestion and absorption of the majority of nutrients and vitamins, which may affect both developing dentition and oral mucosa. The aim of this study is to make a brief review of the literature about celiac disease and to report on a clinical case, showing the impact it may have on the general and oral health. A 39-year-old woman reported the presence of diarrhea, nauseas, flatulence, colic, difficulty with falling asleep, lack of appetite and loose of 18 Kg in the last two years. She also noted the appearance of symptomatic lesions in the mouth. These lesions had a mean duration of a month and occurred in any region of the oral mucosa, particularly on the tongue. Multiples ulcerations were found in the sublingual caruncula region, at the vestibular fornix and at the lingual apex. Topical treatment was instituted for the oral lesions with immediately relief of the symptoms. The diagnosis of celiac disease was established by means of medical clinical exam, biopsy of the small intestine, and by the presence of specific antibodies in the blood. The patient has been instructed to follow a gluten-free diet. Multiprofessional action with the involvement of a gastroenterologist and other health professionals, such as dentists, is important for diagnosing the disease and guiding the patient with celiac disease to achieve a good quality of life.     

Surgical planning for resection of an ameloblastoma and reconstruction of the mandible using a selective laser sintering 3D biomodel

Ameloblastoma is a benign locally aggressive infiltrative odontogenic lesion. It is characterized by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, and the reported recurrence rates after treatment are high; the safety margin of resection is important to avoid recurrence. Advances in technology brought about great benefits in dentistry; a new generation of computed tomography scanners and 3-dimensional images enhance the surgical planning and management of maxillofacial tumors. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is important for treatment success. A case of mandibular follicular ameloblastoma is reported where a 3D biomodel was used before and during surgery.     

Accuracy of Root ZX II in locating foramen in teeth with apical periodontitis: an in vivo study

Introduction

This study was conducted in vivo to investigate the accuracy of Root ZX II in locating the apical foramen in teeth with apical periodontitis (AP).

Methods

Twenty-seven single-root teeth scheduled for extractions were selected; in AP group, there were 12 teeth with pulp necrosis and radiographic evidence of apical lesions, and VT group consisted of 15 vital teeth. After endodontic access, the coronal portion of the canal was flared, and electronic measurement was performed by using a 15 K-file until the device level reading “APEX” was reached. The file was fixed in place, and the tooth was extracted. The apical third of the root was shaved until exposure of the file. The distance from the file tip to the most coronal border of the apical foramen was obtained.

Results

The mean distance in AP group was +0.117 (standard deviation, 0.373) and in VT group was -0.105 (standard deviation, 0.218). The unpaired t test showed no difference between the groups when comparing the mean distances (P > .05). The apical foramen was accurately located within ±0.5 mm in 83% of the teeth in AP group and in 100% of VT group. Statistical analysis showed no difference between the groups (P = .1092).

Conclusions

The Root ZX II device was accurate in locating the apical foramen regardless of the presence of AP.     

AIRPOLISHING EFFECT ON BOVINE ENAMEL AND THE POSTERIOR REMINERALIZING EFFECT OF SALIVA. AN IN VITRO STUDY

Purpose:

The aim of the present study was to evaluate the alterations of surface microhardness and wear caused by the sodium bicarbonate jet on bovine enamel and the further remineralizing effect of artificial saliva.

Methods:

Fifteen enamel samples (4,0mm × 4,0mm) were used, which constituted the groups: no treatment (MI); treatment with sodium bicarbonate jet (MII and DI); treatment with sodium bicarbonate jet and immersion in saliva for one hour (MIII and DII), 24 hours (MIV and DIII) and 7 days (MV and DIV). Microhardness tests were carried out using a microdurometer in groups M and wear tests by a rugosimeter in groups D. The data were assessed by the one criterion variance analysis and Tukey test.

Results:

The mean value of microhardness, in KHN, in groups MI, MII, MIII, MIV and MV were 359,80; 335,46; 369,20; 377,73 and 341,86, respectively, whereas the mean values in μm, of wear for group DI, DII, DIII and DIV were 0,564; 0,519; 0,441 and 0,428, respectively.

Conclusions:

The sodium bicarbonate jet caused a wear and a reduction in microhardness on the enamel surface; saliva promoted the recovery of initial condition surface microhardness and reduced the wear; the repairing effect of saliva on the surface microhardness alterations occurred within one hour of treatment, having no significant statistical difference from the effect obtained in 24 hours; the best saliva repairing effect on the wear occurred with treatment of 24 hours.     

How may stressful experiences contribute to the development of temporomandibular disorders?

Temporomandibular disorders (TMD) comprise the most common cause of chronic facial pain conditions, and they are often associated with somatic and psychological complaints including fatigue, sleep disturbances, anxiety, and depression. For many health professionals, the subjectivity of pain experience is frequently neglected even when the clinic does not find any plausible biologic explanation for the pain. This strictly biomedical vision of pain cannot be justified scientifically. The purpose of this study is to demonstrate, by original articles from the literature and recent studies conducted in our own laboratory, the biological processes by which psychological stress can be translated into the sensation of pain and contribute to the development of TMD. The role of the hypothalamic–pituitary–adrenal axis, the serotoninergic and opioid systems in the pathogenesis of facial pain is exposed, including possible future therapeutic approaches. It is hoped that knowledge from apparently disparate fields of dentistry, integrated into a multidisciplinary clinical approach to TMD, will improve diagnosis and treatment for this condition through a clinical practice supported by scientific knowledge.     

Root surface conditioning with nicotine or cotinine reduces viability and density of fibroblasts in vitro

The purpose of study was to evaluate fibroblast attachment and cellular morphology on root surfaces chemically conditioned with nicotine or cotinine. A secondary objective was to determine if mechanical scaling and root planning of these chemically conditioned surfaces would alter cellular attachment. Root surface dentin specimens were prepared from uniradicular teeth of non-smoking patients. Specimens were randomly assigned to two experimental groups: no treatment (chemical conditioning only) and scaling and root planning after conditioning (SRPC). The concentrations of the tested substances were in the range of 0–1 mg/mL (nicotine) and 0–1 ?g/mL (cotinine). After a 24-h conditioning period, dentin slices were incubated with continuous lineage of fibroblastic cells from rat (McCoy cells) for another 24 h. Specimens were prepared for SEM analysis and microphotographs. The statistical analysis of the data indicated significant alteration of cellular morphology on fibroblasts that were grown on root surface exposed to nicotine concentrations greater than 1 ?g/mL. This effect of nicotine was not reduced by SRPC. On the other hand, in the SRPC group cellular density was greater. For cotinine-conditioned specimens, the greater concentrations also led to alteration on morphology, and these alterations were observed in the SRPC group as well. Cotinine did not induce significant changes on cellular density. The results indicated that fibroblasts are negatively influenced by nicotine present on the dentin substrate and also that scaling may reduce these effects. Cotinine treatment on root surfaces may alter cell morphology and density but these effects were less severe than that promoted by nicotine, and were not affected by scaling.     

Cardiovascular responses to different stages of restorative dental treatment unaffected by local anaesthetic type

Background: The aim of this study was to evaluate the cardiovascular effects of maxillary infiltration using 2% lidocaine with 1:100 000 adrenaline, 4% articaine with 1:200 000 adrenaline, and 4% articaine with 1:100 000 adrenaline in different stages during restorative dental procedures. Methods: Twenty healthy patients randomly received 1.8 mL of the three local anaesthetics. Systolic blood pressure, average blood pressure, diastolic blood pressure, and heart rate were evaluated by the oscillometric and photoplethysmograph methods in seven stages during the appointment. Results: Statistical analysis by ANOVA and Tukey tests of cardiovascular parameters did not show significant differences between the anaesthetic associations. There were significant differences for the parameters among different clinical stages. Conclusions: The variation of cardiovascular parameters was similar for lidocaine and articaine with both adrenaline concentrations and showed no advantage of one drug over the other. Cardiovascular parameters were influenced by the stages of the dental procedures, which showed the effect of anxiety during restorative dental treatment.     

Removable partial denture abutments restored with all-ceramic surveyed crowns.

All-ceramic crowns are used as alternatives to conventional metal-ceramic crowns for the restoration of single teeth. Traditionally all-ceramic restorations possessed physical properties that contraindicated their use in many treatment situations. The strength that zirconia ceramics exhibit seems to support the hypothesis that, in specific situations, an all-ceramic crown may be used to restore removable partial denture (RPD) abutments in areas previously reserved for metal or metal-ceramic restorations. Abutments for RPDs may now be fabricated with Procera AllZirkon with the classically prepared guide planes and rest seats. This article provides an overview of a technique for the fabrication of a zirconia-based crown to be used in conjunction with removable partial dentures using the Procera CAD/CAM technology.