- Email: [email protected]
Mucoceles
than 50% had a filling or cavity and more than one-third had had a tooth extracted. About two-thirds of the respondents rated their dental health as very important, and threefourths said they did not fear going to the dentist. Various relationships were noted between (1) parentreported measures of dental hygiene, preventive care, and parent-assessed overall dental health and (2) obesity and markers of systemic inflammation in the children. Statistical analysis revealed that dental hygiene, specifically the frequency of flossing, was significantly associated with glucagon-like protein-1 and resistin levels. Frequency of preventive dental care was significantly associated with interferon-g, interleukin IL-10, myeloperoxidase, and tumor necrosis factor-a. Overall dental health, as assessed by the parent, was significantly associated with E-selectin, haptoglobin, IL-1a, IL-6, IL-8, macrophage inflammation protein-1a, soluble vascular cell adhesion molecule -1, and vascular endothelial growth factor. Discussion.—An association was found between dental hygiene, obesity, and systemic inflammation in these children. Thus, preventive dental care should be pursued to enhance the overall health not only of children but also of the adults they will become.
Clinical Significance.—Clearly, more studies with larger and more diverse populations will be needed to confirm these relationships between dental hygiene, obesity, and systemic inflammatory markers. However, from what we have seen in adults, it makes sense that problems begin in childhood and simply become more marked with age. Dental health care for children should be proactive and considered part of the overall health of the individual. Pediatricians and dentists can work together to improve children’s health with respect to obesity and poor dental hygiene measures.
Frisbee SJ, Chambers CB, Frisbee JC, Goodwill AG, Crout RJ: Self-reported dental hygiene, obesity, and systemic inflammation in a pediatric rural community cohort. BMC Oral Health 10:21, 2010 Reprints available from SJ Frisbee, Dept of Community Medicine, School of Medicine, West Virginia Univ, Morgantown, WV; e-mail: [email protected]
Oral Medicine Mucoceles Background.—Mucoceles affect the minor salivary glands, usually of the lower lip, and often manifest as asymptomatic single or multiple, spherical, fluctuant nodules. The cause is believed to be mechanical trauma to the excretory duct of the glands that leads to transection or rupture, resulting in extravasation of mucin to connective tissue stroma. This is termed as the mucus extravasation phenomenon. Duct obstruction might also cause mucus to collect in the duct and/or acinus, termed mucus retention phenomenon. The elderly people are more likely to suffer mucus retention phenomenon, which is also rarer than mucus extravasation phenomenon. The extravasation causes a secondary inflammatory reaction that primarily involves mononuclear cells in the connective tissue, then a granulation tissue-type reaction can lead to the formation of a fibrous capsule surrounding the mucin deposit. The lesion resembles a cyst and may periodically discharge viscous fluid. In contrast, ranulas are cup-shaped flucuant lesions found on the floor of the mouth. They are linked to the sublingual or submandibular glands. They are often bluish and larger than mucoceles. Sometimes patients
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Dental Abstracts
Fig 1.—Distribution according to age of cases of mucoceles diagnosed between April 1980 and February 2003 at the Discipline of Stomatology Department of Biosciences and Oral Diagnosis, S~ao Jos e dos Campos Dental School, S~ao Paulo State University. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
Fig 2.—Turgid nodular lesions located on the lower lip. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
also have external swelling at the ranula site and suffer discomfort, interference with speech production and mastication, and difficulty in swallowing. Cases of mucocele diagnosed between 1980 and 2003 were analyzed to determine the prevalence of these lesions by age, gender, race, and site of occurrence. Methods.—A total of 173 mucocele cases were identified at the Discipline of Stomatology in Brazil. Data such as age, gender, race, and lesion site were recorded and compared over a period of 24 years.
Fig 3.—Mucocele of the gland of Blandin–Nuhn (ventral tongue). Pediculated turgid nodular lesion, measuring 3.0 cm in diameter. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
Fig 4.—Asymptomatic turgid nodular lesion located on the floor of the mouth, measuring 4.0 cm in diameter. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
Results.—Most cases (49.42%) occurred in patients aged 11 to 20 years, with fewer in persons from birth to age 10 years (26.43%), age 21 to 30 years (12.64%), and age 30 years plus (10.91%). The mean and median ages were 17 and 14 years, respectively (Fig 1). Female patients were affected in 60.12% of cases. The majority of subjects were white (71.68%), with 26.01% black and 2.31 Asian. The locations of the lesions were the lower lip (78% of cases; Fig 2), ventral tongue (9.83%; Fig 3), floor of the mouth (9.25%; Fig 4), soft palate
Fig 5.—Turgid nodular lesion located on the lower lip of an infant. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
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(0.58%), buccal mucosa (0.58%; Fig 5), and lingual frenum (0.58%). Discussion.—The clinical identification of oral lesions is important to determine whether they are neoplastic or non-neoplastic, to make an accurate diagnosis, and to formulate an appropriate treatment plan. The current data indicate that mucoceles are most common in white female subjects aged 11 to 20 years. They occur most often on the lower lip. Clinical Significance.—Mucoceles are carefully excised along with any adjacent minor salivary glands showing evidence of
involvement. They can recur and require surgical intervention. For ranulas, the sublingual gland is removed surgically and/or marsupialized. Because of these different treatments, it is essential to understand the characteristics of the various lesions and make an accurate diagnosis.
Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010 Reprints available from http://www.biomedcentral.com/1472-6831/ 10/15
Oral Surgery Surgeon experience and third molar surgical complications Background.—Third molar surgery is among the most common procedures done by oral and maxillofacial surgeons. Indications for such surgery include pain, recurrent swelling, and infection. These prompt a thorough clinical examination and study of a two-dimensional radiograph of the site. The decision to use local anesthesia, intravenous sedation, or general anesthesia is based on the difficulty anticipated, possible complications, patient preference, patient fear and/or anxiety, and the surgeon’s experience combined with the published guidelines for such cases. Some evidence has linked an increased incidence of postoperative complications to the surgeon’s experience (Table 1). The specific effect of the surgeon’s level of experience on the outcome of third molar surgery was evaluated. Methods.—The affected third molars were removed from 3236 patients aged 17 to 36 years. Data included information from the patient obtained at postoperative review appointments, demographic information, preoperative radiographic results, complexity of the surgery, occurrence of postoperative complications, and the surgeon’s level of experience. Seven specialists and 12 residents were responsible for the surgeries. Results.—Specialists treated a few more of the patients aged R30 years and those aged 17 to 20 years than residents did. Residents treated a higher proportion of women than the specialists. Just over 78% of the teeth
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Dental Abstracts
removed had roots that were radiographically found to be 2 mm or less from the inferior alveolar canal (IAC). Both surgeon groups removed approximately equal numbers of teeth close to the inferior alveolar nerve and equal numbers of fully erupted and partially erupted teeth. More fully affected teeth were removed by specialists than by residents. Residents removed more teeth that were horizontally affected, and specialists removed more that were mesioangularly affected.
Table 1.—Disadvantages of Non-Apprenticeship Training Models and Training Paradigms Disadvantages of non-apprenticeship training models
Increased time to train Costs of specialised audiovisual systems Cost and ethics of animal models Cost and availability of ‘mock’ or artificial models to operate upon Availability of consenting subjects Training paradigms
Animal models Cadaveric open dissection Plastinated staged prosections 3D virtual training models with haptic feedback 3D video of selected cases with commentary Direct clinical supervision with endoscopic monitoring of the operative site (Courtesy of Jerjes W, Upile T, Nhembe F, et al: Experience in third molar surgery: An update. Br Dent J 209:E1, 2010.)
Clinical Significance.—Clearly, more studies with larger and more diverse populations will be needed to confirm these relationships between dental hygiene, obesity, and systemic inflammatory markers. However, from what we have seen in adults, it makes sense that problems begin in childhood and simply become more marked with age. Dental health care for children should be proactive and considered part of the overall health of the individual. Pediatricians and dentists can work together to improve children’s health with respect to obesity and poor dental hygiene measures.
Frisbee SJ, Chambers CB, Frisbee JC, Goodwill AG, Crout RJ: Self-reported dental hygiene, obesity, and systemic inflammation in a pediatric rural community cohort. BMC Oral Health 10:21, 2010 Reprints available from SJ Frisbee, Dept of Community Medicine, School of Medicine, West Virginia Univ, Morgantown, WV; e-mail: [email protected]
Oral Medicine Mucoceles Background.—Mucoceles affect the minor salivary glands, usually of the lower lip, and often manifest as asymptomatic single or multiple, spherical, fluctuant nodules. The cause is believed to be mechanical trauma to the excretory duct of the glands that leads to transection or rupture, resulting in extravasation of mucin to connective tissue stroma. This is termed as the mucus extravasation phenomenon. Duct obstruction might also cause mucus to collect in the duct and/or acinus, termed mucus retention phenomenon. The elderly people are more likely to suffer mucus retention phenomenon, which is also rarer than mucus extravasation phenomenon. The extravasation causes a secondary inflammatory reaction that primarily involves mononuclear cells in the connective tissue, then a granulation tissue-type reaction can lead to the formation of a fibrous capsule surrounding the mucin deposit. The lesion resembles a cyst and may periodically discharge viscous fluid. In contrast, ranulas are cup-shaped flucuant lesions found on the floor of the mouth. They are linked to the sublingual or submandibular glands. They are often bluish and larger than mucoceles. Sometimes patients
150
Dental Abstracts
Fig 1.—Distribution according to age of cases of mucoceles diagnosed between April 1980 and February 2003 at the Discipline of Stomatology Department of Biosciences and Oral Diagnosis, S~ao Jos e dos Campos Dental School, S~ao Paulo State University. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
Fig 2.—Turgid nodular lesions located on the lower lip. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
also have external swelling at the ranula site and suffer discomfort, interference with speech production and mastication, and difficulty in swallowing. Cases of mucocele diagnosed between 1980 and 2003 were analyzed to determine the prevalence of these lesions by age, gender, race, and site of occurrence. Methods.—A total of 173 mucocele cases were identified at the Discipline of Stomatology in Brazil. Data such as age, gender, race, and lesion site were recorded and compared over a period of 24 years.
Fig 3.—Mucocele of the gland of Blandin–Nuhn (ventral tongue). Pediculated turgid nodular lesion, measuring 3.0 cm in diameter. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
Fig 4.—Asymptomatic turgid nodular lesion located on the floor of the mouth, measuring 4.0 cm in diameter. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
Results.—Most cases (49.42%) occurred in patients aged 11 to 20 years, with fewer in persons from birth to age 10 years (26.43%), age 21 to 30 years (12.64%), and age 30 years plus (10.91%). The mean and median ages were 17 and 14 years, respectively (Fig 1). Female patients were affected in 60.12% of cases. The majority of subjects were white (71.68%), with 26.01% black and 2.31 Asian. The locations of the lesions were the lower lip (78% of cases; Fig 2), ventral tongue (9.83%; Fig 3), floor of the mouth (9.25%; Fig 4), soft palate
Fig 5.—Turgid nodular lesion located on the lower lip of an infant. (Courtesy of Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010.)
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(0.58%), buccal mucosa (0.58%; Fig 5), and lingual frenum (0.58%). Discussion.—The clinical identification of oral lesions is important to determine whether they are neoplastic or non-neoplastic, to make an accurate diagnosis, and to formulate an appropriate treatment plan. The current data indicate that mucoceles are most common in white female subjects aged 11 to 20 years. They occur most often on the lower lip. Clinical Significance.—Mucoceles are carefully excised along with any adjacent minor salivary glands showing evidence of
involvement. They can recur and require surgical intervention. For ranulas, the sublingual gland is removed surgically and/or marsupialized. Because of these different treatments, it is essential to understand the characteristics of the various lesions and make an accurate diagnosis.
Hayashida AM, Zerbinatti DCZ, Balducci I, et al: Mucus extravasation and retention phenomena: A 24-year study. BMC Oral Health 10:15, 2010 Reprints available from http://www.biomedcentral.com/1472-6831/ 10/15
Oral Surgery Surgeon experience and third molar surgical complications Background.—Third molar surgery is among the most common procedures done by oral and maxillofacial surgeons. Indications for such surgery include pain, recurrent swelling, and infection. These prompt a thorough clinical examination and study of a two-dimensional radiograph of the site. The decision to use local anesthesia, intravenous sedation, or general anesthesia is based on the difficulty anticipated, possible complications, patient preference, patient fear and/or anxiety, and the surgeon’s experience combined with the published guidelines for such cases. Some evidence has linked an increased incidence of postoperative complications to the surgeon’s experience (Table 1). The specific effect of the surgeon’s level of experience on the outcome of third molar surgery was evaluated. Methods.—The affected third molars were removed from 3236 patients aged 17 to 36 years. Data included information from the patient obtained at postoperative review appointments, demographic information, preoperative radiographic results, complexity of the surgery, occurrence of postoperative complications, and the surgeon’s level of experience. Seven specialists and 12 residents were responsible for the surgeries. Results.—Specialists treated a few more of the patients aged R30 years and those aged 17 to 20 years than residents did. Residents treated a higher proportion of women than the specialists. Just over 78% of the teeth
152
Dental Abstracts
removed had roots that were radiographically found to be 2 mm or less from the inferior alveolar canal (IAC). Both surgeon groups removed approximately equal numbers of teeth close to the inferior alveolar nerve and equal numbers of fully erupted and partially erupted teeth. More fully affected teeth were removed by specialists than by residents. Residents removed more teeth that were horizontally affected, and specialists removed more that were mesioangularly affected.
Table 1.—Disadvantages of Non-Apprenticeship Training Models and Training Paradigms Disadvantages of non-apprenticeship training models
Increased time to train Costs of specialised audiovisual systems Cost and ethics of animal models Cost and availability of ‘mock’ or artificial models to operate upon Availability of consenting subjects Training paradigms
Animal models Cadaveric open dissection Plastinated staged prosections 3D virtual training models with haptic feedback 3D video of selected cases with commentary Direct clinical supervision with endoscopic monitoring of the operative site (Courtesy of Jerjes W, Upile T, Nhembe F, et al: Experience in third molar surgery: An update. Br Dent J 209:E1, 2010.)