Saadettin Dagistan

Differential diagnosis of denture-induced stomatitis, Candida, and their variations in patients using complete denture : a clinical and mycological study

Denture‐induced stomatitis usually occurs in persons who wear a complete or a partial denture. Among the many aetiological and predisposing factors, Candida spp. are believed to play an important role in the initiation and progression of the infection. Seventy cases who attended the clinics of the Dental Faculty, University of Atatürk, Turkey were investigated from the viewpoint of denture‐induced stomatitis. After questioning the patients for their personal information, they were examined clinically and smears were obtained from lesions of the palatal mucosa and the contiguous denture surface by calcium aliginate swabs, and inoculated onto Sabouraud dextrose agar supplemented with 1% chloramphenicol, and CHROMagar Candida. Individual yeast species were identified by a germ tube test, development of blastospores, chlamydospores and pseudohyphae and assimilation tests employing the commercial kit API 20C AUX system. According to the results obtained, 70% of the cases had denture‐induced stomatitis, and in 68% of them mycological culture results were positive. Candida albicans was the most frequently isolated fungus (68.75%). On the other hand, fungal growth was much more pronounced in the cultures made from the inner surface of the dentures. In conclusion, this study showed that candidal infections are not the predisposing factor in the occurrence of denture‐induced stomatitis, but they play a major role, as also some other factors, especially those related with dentures.

Reliability of mandibular cortical index and mandibular bone mineral density in the detection of osteoporotic women

OBJECTIVES Measuring the bone mineral density (BMD) of the femur and lumbar vertebrae has been the traditional method for determining osteoporosis in women. In this study, we tried to determine the relationships between mandibular dual-energy X-ray absorptiometry (m-DXA) values obtained with a new methodology, mandibular cortical index (MCI), total BMD values of the femur and lumbar vertebrae in 80 women with osteoporosis determined by DXA in conformity with T-score thresholds, as defined by the World Health Organization (WHO). METHODS m-DXA and panoramic radiography were performed on 80 women with osteoporosis. m-DXA was calculated by manual analysis of DXA scans. MCI was determined by the appearance of the mandibles on panoramic radiographs. DXA measurements of the skeletal BMD (femur and lumbar vertebras) and MCI values were also calculated. Correlations between these variables were assessed. RESULTS Although there were no correlations between skeletal BMD (total BMD values of the femur and lumbar vertebras) and mandibular measurements (mDXA and MCI), we found that there was a significant correlation between the skeletal BMDs (r = 0.355, P = 0.001). CONCLUSIONS It is concluded that no significant correlations were found between the mandibular and non-mandibular measures in women with osteoporosis.

Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis

OBJECTIVE The aim of the study was to compare the values of the antegonial index (AI), mental index (MI), panoramic mandibular index (PMI) and mandibular cortical index (MCI) in the panoramic radiographs of normal males and male patients with osteoporosis. METHODS In panoramic radiographs obtained from 40 male individuals (20 normal and 20 with osteoporosis), the mean was calculated for MI, AI, PMI and MCI index values measured in the right and left mandibles. The MI, AI and PMI index values were evaluated using the paired t-test, and MCI values were analysed using the chi(2) test. RESULTS MI (P < 0.001), AI (P < 0.01) and PMI (P < 0.05) values were significantly smaller in the group with osteoporosis; however, MCI (P > 0.05) was not significantly different. CONCLUSION MI, PMI and AI values, as radiomorphometric indices, were found to be smaller among male patients with osteoporosis, compared with normal patients in this study. It is suggested that these indices, used as an ancillary method in the diagnosis of osteoporosis in women, could also be useful for male patients. Further studies, of larger groups are needed on this subject, including of the MCI, which in this study showed no significant difference.

Dental Panoramic Radiography in the Diagnosis of Osteoporosis

Osteoporosis is common in the elderly and the dentist is often the only healthcare professional that they visit regularly. Since dental panoramic radiographs (DPRs) are widely used for routine examinations when planning treatment, this study evaluated whether the presence of osteoporosis might be apparent in a population of patients who underwent DPR. The mandibular cortical index (MCI) and a new method of measuring the mandibular radiographic density (m-RD), which used DPR that incorporated an aluminium step-wedge, were compared with the total vertebral bone mineral density (v-BMD) of the lumbar vertebrae measured using dual energy X-ray absorptiometry (DXA) in 25 osteoporotic women. Although there was only a weak correlation between m-RD and v-BMD, significant correlation was found between MCI and v-BMD. Since both m-RD and MCI were related to v-BMD, dental radiographic density and MCI may be useful in clinical dental practice to identify osteoporotic women with previously undetected low BMD.

Investigating biofilm production, coagulase and hemolytic activity in Candida species isolated from denture stomatitis patients.

OBJECTIVE Oral candidiasis, in the form of Candida-associated denture stomatitis, represents a common disease in a large percentage of denture wearers, and Candida albicans remains the most commonly isolated species. In this study, we aimed to evaluate biofilm production, coagulase and hemolytic activity of Candida species isolated from denture stomatitis patients. MATERIALS AND METHODS This study included 70 patients (31 female, 39 male). Forty-eight of the patients were found to have a positive culture. A total of 48 Candida isolates representing five species, C. albicans (n=17), C. glabrata (n=10), C. krusei (n=9), C. kefyr (n=7) and C. parapsilosis (n=5), were tested. Their coagulase activities were evaluated by a classical tube coagulase test with rabbit plasma. A blood plate assay on 3% enriched sheep blood Sabouraud-dextrose agar (SDA) was used to determine their in vitro hemolytic activities. Biofilm production was determined by a visual tube method. RESULTS Twenty-one Candida isolates exhibited coagulase activity, and the coagulase activities of the C. albicans (64.7%) isolates were higher than other species. C. albicans, C. glabrata, C. kefyr and C. krusei species demonstrated beta hemolysis. C. parapsilosis strains failed to demonstrate any hemolytic activities. Fifteen (88.0%) of the C. albicans strains were biofilm positive. Six (35.2%) of these strains were strongly positive, 8 (47.0%) C. albicans strains were moderately positive and 1 (5.8%) C. albicans strain was weakly positive. Sixteen (51.6%) of the non-albicans Candida strains were biofilm positive while 15 (48.3%) did not produce biofilms. CONCLUSION The results of this present study indicate coagulase, hemolytic activity and biofilm production by Candida spp. isolated from patients with denture stomatitis. Investigations of these virulence factors might be helpful in gaining information about the possible virulence of oral Candida species related to denture stomatitis.

The importance of cone beam CT in the radiological detection of osteomalacia

Although osteomalacia is one of the most common osteometabolic diseases among the elderly, there is no case in the literature that presents the effects of osteomalacia in detail using cone beam CT (CBCT). While thin and porous bones are the most common radiographic sign of the disease, the radiological hallmarks are pseudofractures (Loosers zone). We coincidentally detected osteomalacia in a 23-year-old female and we showed the pseudofracture on CBCT images. In the present case, we aim to present the images of osteomalacia that were detected by CBCT in detail. CBCT has an important value in screening for osteomalacia.

No correlation between mandibular and non-mandibular measurements in osteoporotic men

Background: Screening for low bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) has been the traditional method for determining osteoporosis. Panoramic radiography is widely used in dentistry. Purpose: To determine the relationships between the values of dental panoramic indices (the mental index (MI), antegonial index (AI), panoramic mandibular index (PMI)) and the values of skeletal BMD (femoral BMD (f-BMD), and vertebral BMD (v-BMD)) in 25 osteoporotic men. Material and Methods: In the panoramic radiographs obtained from a total of 25 male individuals with osteoporosis, the means were calculated for MI, AI, and PMI values measured in the right and left mandible. DXA measurements of the femur and lumbar vertebrae BMD were also calculated. The correlation between these variables was assessed. Results: No correlation was found between the BMD values of the femur and lumbar vertebrae and values of MI, AI, and PMI. Conclusion: No significant correlation was found between the mandibular and non-mandibular measurements in men with osteoporosis. MI, AI, and PMI indices should not be used in the evaluation of the skeletal status, because they are not reliable tools in screening for osteoporosis.

The osseous and dental changes of patients with chronic renal failure by CBCT

OBJECTIVES The aim of the present study was to evaluate the osseous changes of the jaws of patients with chronic renal failure (CRF) by CBCT. METHODS On CBCT scans obtained from 15 patients with CRF and 15 control patients (7 males and 8 females), the mean was calculated for the antegonial index (AI), mental index (MI), panoramic mandibular index (PMI) and mandibular cortical index (MCI). The MI, AI and PMI, pulp chamber size, number of teeth with pulp calcification and lamina dura loss were compared using the paired t-test, and the MCI values were analysed using the χ(2) test. RESULTS There were no statistically significant differences in the PMI, MI and AI values in patients with CRF and the control group. With regard to MCI, the cortical margins of the mandible were more porous in patients with CRF than in the control group, and also soft-tissue calcifications, lamina dura loss and radiolucent defects were more common in patients with CRF. There were no statistically significant differences in pulp chamber size and pulp calcifications between patients with CRF and the control group. CONCLUSIONS Radiographic changes in the jawbones of patients with CRF may be commonly seen. CBCT is a valuable diagnostic tool for the evaluation of osseous findings, pulp chamber, soft-tissue calcifications and MCIs and allows indices measurement in three dimensions without any superposition.

Ultrasonography in the evaluation of the mid-palatal suture in rapid palatal expansion

OBJECTIVES Orthodontists usually evaluate the mid-palatal sutural opening with occlusal radiography. The purpose of this article is to evaluate the sutural opening with ultrasonography (USG) in a series of patients undergoing rapid palatal expansion (RPE). METHODS The study included 87 USG images and 87 occlusal radiographs from 29 healthy patients (mean age, 13.9 years; range, 11-20 years; boys, 12; girls, 17) who required RPE treatment. The sutural opening was assessed with USG, and the amount of sutural expansion as mesiodistal length was measured immediately after appliance practice (T0), 10 turns (T1) and 20 turns (T2) during the expansion period. Sutural expansion evaluated by occlusal radiographs was scored at every stage. Measurements obtained by USG and scores observed in the occlusal radiographs were compared by non-parametric Kendalls tau test. RESULTS Both USG and radiographic images revealed normal anatomical structure during pre-expansion (stage T0). On USG, sutural expansion was seen in 19 patients at stage T1. There was no expansion at this stage in ten patients. At stage T2, on USG and radiography, an increase in the amount of expansion was observed in 19 patients with sutural expansion at stage T1 and sutural expansion was observed in 5 patients without sutural expansion at stage T1. No expansion was observed at both stages T1 and T2 in five patients. USG measurements and occlusal scores in both T1 and T2 turns showed statistically significant correlation (p < 0.001). CONCLUSIONS The results indicate that USG might be a useful method to assess mid-palatal sutural opening in patients undergoing RPE.

Retrospective morphometric analysis of the infraorbital foramen with cone beam computed tomography

Objective: The aim of our study is to examine the morphometric characteristics of the infraorbital foramen (IOF) and its anatomic localization by using cone-beam computerized tomography (CBCT). Materials and Methods: In our study, the anatomic characteristics of the IOF were identified by studying retrospectively the CBCT images of one hundred twenty-five (125) patients. These characteristics were assessed statistically in terms of age, gender, and right-left side. Results: In our study, 42% of them had IOF in circular form and 58% in oval form. Of them 66.90% of those in oval form were in oblique direction, 28.30% of them were in vertical direction, and 4.80% of them were in horizontal direction. The mean vertical diameter of the IOF was found as 3.71 ± 0.61 mm and its mean horizontal diameter was found as 3.17 ± 0.56 mm. The mean distance of IOF to midline were measured as 25.10 ± 2.17 mm, distance to upper edge of the orbita was measured as 41.91 ± 2.77 mm, distance to infraorbital edge was measured as 5.63 ± 1.77 mm, distance to the lateral nasal wall was measured as 9.32 ± 2.68 mm, distance to spina nasalis anterior was measured as 17.97 ± 3.99 mm, thickness of the soft tissue on the foramen was measured as 11.52 ± 2.40 mm, and distance between the right and the left IOF was measured as 50.20 ± 3.90 mm. Accessory foramen was found in 56.60% ratio. Conclusion: This study reveals that CBCT may guide for local anesthesia applications and for other invasive procedures in order to prevent the damage of the neurovascular structures during maxillofacial surgery by identifying the distances of anatomic points such as IOF having surgically importance.