L.R. Eversole

Ossifying fibroma: A clinicopathologic study of sixty-four cases

Sixty-four cases of neoplastic benign fibro-osseous lesions are presented, with clinical and radiographic follow-up in 23 instances. A marked predilection for female patients was observed, with the majority or cases arising in the molar-premolar region of the mandible. Radiographically, these neoplasms are well demarcated and may be radiolucent, radiolucent with central opacification (target appearance), or multilocular radiolucent. A benign fibro-osseous histopathologic pattern is observed with osseous, cemental, and/or ovoid-curvoid calcified deposits. This feature, along with confinement to tooth-bearing regions, supports a periodontal ligament origin. It appears that the distinction between cementifying and ossifying variants is academic, as no behavioral differences exist. The recurrence rate following curettage was found to be 28%.

Aggressive growth and neoplastic potential of odontogenic cysts: with special reference to central epidermoid and mucoepidermoid carcinomas.

An aggressive form of odontogenic cyst known as the keratocyst has been reviewed with a report on the findings of 70 new instances. Recurrence after 2 years of followup was found to be 20%. From both a review of the literature and original cases, carcinomatous and ameloblastomatous transformation in odontogenic keratocysts seems to be an extremely rare phenomenon. Alternatively, epidermoid carcinoma and mucoepidermoid carcinoma arising centrally within the jaws are often associated with other types of dental cysts. Review of 36 instances of central epidermoid carcinoma has disclosed that 75% were associated with a cyst lining; the 2‐year survival rate was found to be 53%. Central mucoepidermoid carcinoma was associated with a dental cyst or impacted tooth in 48% of the cases, and enjoyed a 100% 2‐year and 5‐year survival; however, 2 patients were recorded alive with disease at 4 months and 10 years, whereas another patient succumbed to disease 14 years post‐operatively.

Oral condyloma planus (hairy leukoplakia) among homosexual men: A clinicopathologic study of thirty-six cases

Thirty-six cases of oral condyloma planus (hairy leukoplakia) occurring in homosexual men are reported. The average age is 36.6 years, with a range from 24 to 51 years, and the disorder exhibits a predilection for the fourth decade. More than 86% of the cases are localized to the tongue (72% lateral border, 14% ventral surface). Microscopically, surface candidiasis could be detected with periodic acid-Schiff staining in 88% of the instances. Parakeratosis with koilocytotic atypia was the characteristic histologic finding; however, comparison with twenty-five cases of leukoplakias exhibiting parakeratosis and twenty-five cases of candidiasis among heterosexual individuals disclosed that koilocytotic changes are not specific for condyloma planus. Follow-up data were obtained in thirty-two cases with a mean of 11 months. During this period six patients died or were hospitalized with a diagnosis of acquired immunodeficiency syndrome.

Radiographic characteristics of cystogenic ameloblastoma

Radiographic patterns encountered in mandibular cystogenic ameloblastoma, a variant encountered among teen-agers and young adults, are described and correlated with age and recurrence after surgery. More than 75% of the cases are located in the posterior mandibular ramus area, and 50% are associated with an impacted third molar. The predominant radiographic patterns include unilocular and scalloped or macromultilocular pericoronal , interradicular , or periapical expansile radiolucencies.

Psychometric profiles and facial pain

The myofacial pain-dysfunction syndrome and atypical facial pain are the most prevalent chronic pain disorders of the facial region. Previously, the myofacial pain-dysfunction syndrome included all TMJ/masticatory muscle pain, jaw dysfunction, and joint clicking. We have segregated two major subgroups subsumed within this diagnostic classification and have assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Significant age and personality differences were uncovered when these subpopulations were compared to subjects with atypical facial pain (AFP). Both MFP and TMJID groups are relatively homologous, involving younger persons than AFP subjects. Alternatively, when MFP, TMJID, and AFP subjects were compared for differences in MMPI psychometric scales, MFP and AFP subjects exhibited significantly higher scores, particularly for hypochondriasis, depression, and hysteria, than did TMJID subjects. It is concluded that subcategorization of myofascial pain-dysfunction patients into a myogenic pain group and a TMJ internal derangement group is justified on the basis of psychometric differences. Furthermore, psychopathologic factors are more significant among MFP and AFP subjects than among TMJID patients.

Radiographic characteristics of central ossifying fibroma

Sixty-four instances of histologically documented ossifying and/or cementifying fibromas were evaluated. Adequate radiographs were available in 43 of the cases. Most of these benign fibro-osseous neoplasms occurred in women, with a predilection for the third and fourth decades. Six distinct radiographic patterns could be identified: (1) radiolucent, superimposed over teeth or residing in edentulous regions (28%); (2) radiolucent with opaque foci, lying in edentulous areas or superimposed over teeth (42%); (3) radiolucent, interposed between contiguous teeth (5%); (4) radiolucent with opaque foci, interposed between contiguous teeth (9%); (5) multilocular expansile (7%); and (6) aggressively expansile with opacification (9%). All lesions exhibited well-defined margins. Root resorption was a feature in 11% of the sample, and root divergence occurred in 17% of the cases.

Focal sclerosing osteomyelitis/focal periapical osteopetrosis: Radiographic patterns

Forty-one histologically documented instances of focal sclerosing osteomyelitis and focal periapical osteopetrosis have been evaluated for radiomorphologic characteristics. These reactive lesions exhibit five distinct patterns that include periapical focal opacifications, target lesions, radiolucencies, multiconfluent configurations, and opacifications with concomitant root resorption. While an irritational origin can usually be detected in chronic sclerosing osteomyelitis, the cause of focal periapical osteopetrosis remains enigmatic.

Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients

Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Previous studies may have included both of these disorders as MPDS/TMJDS. While some signs and symptoms are similar, the primary differentiation is based on meniscus displacement present with TMJID patients and pain distribution patterns between the two groups. While MFP/TMJID patients comprise the majority of the facial pain population, a third major group of patients is encountered, being classified under the diagnostic appellation of atypical facial pain (AFP). Patients with AFP usually complain of vague and wandering pain in the maxilla or mandible; however, no identifiable source of infection or organic disease can be uncovered. One hundred fifty patients seeking consultation and care for facial pain met the criteria for inclusion into one of three clinical groups. The groups were compared for age, sex, duration of symptoms, bruxism and/or clenching habits, and disturbed sleep patterns. Differences in surface electromyographic levels from the facial and cervical muscles were also examined. Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.

Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions.

OBJECTIVE This study was undertaken to compare and contrast biomarkers and ploidy data from maxillary gingiva leukoplakias associated with dentifrices and mouthrinses containing the herbal compound sanguinaria with other forms of oral benign and premalignant mucosal keratosis. STUDY DESIGN Representative archived specimens of benign keratosis, sanguinaria-associated keratosis, and keratosis with dysplasia were used for computerized image analysis and biomarker immunohistochemical assays to assess ploidy, DNA content, and p53 and proliferating cell nuclear antigen immunoreactivity of nuclei. RESULTS DNA content was significantly higher and higher numbers of cell populations with hyperploid nuclei were encountered in the dysplastic group than in the other two groups (P <.001). Sanguinaria-associated keratosis did not harbor significant numbers of p53-expressing nuclei, yet it showed a significant elevation in proliferating cell nuclear antigen-labeled nuclei in total, in the basal layer, and in the spinous layer in comparison with benign keratoses (P <.001). In addition, 1.5% of the sanguinaria-associated leukoplakia epithelial cell population was characterized by nuclei with a greater than 4-fold increase in DNA content. CONCLUSIONS Sanguinaria-associated keratoses show some marker and image analysis profiles similar to those of non-sanguinaria dysplastic lesions of the lip and mucosa. Preparations containing sanguinaria should be avoided until the risk for malignant transformation is determined.

The role of dental restorative metals in the pathogenesis of oral lichen planus

Twenty-four subjects with oral lichen planus and twelve control subjects without oral mucosal disease were patch tested with dental restorative metals and selected metallic salts. Twenty-one percent of the lichen planus population exhibited a positive skin response to one or more challenge materials, as compared to 8% of the control population. It is concluded that oral lichen planus subjects show a higher correlation with delayed hypersensitivity to dental metals than a control population; however, a cause-and-effect relationship cannot be substantiated.