Shlomo Calderon

Absence of Tooth Staining With Doxycycline Treatment in Young Children

The aim of the study was to determine if doxycycline causes tooth staining in young children. A dentist examined 31 randomized children who had been treated with doxycycline and 30 children who had not received doxycycline. Mean age of the children was 10.4 ∓ 2.1 years. Mean age at receipt of the first doxycycline treatment was 4.1 ∓ 1.6 years, and mean number of doxycycline courses was 2.0 ∓ 1.3. No tooth staining was detected by the dentist in any of the children in either group. These findings indicate that treatment with doxycycline in children aged 2 to 8 years is not associated with tooth staining.

Complications of maxillary sinus augmentations in a selective series of patients

OBJECTIVESnThe purpose of this case series was to describe late complications of maxillary sinus augmentation procedures, including paranasal sinusitis and oroantral fistula, and to discuss the definitive surgical methods of treatment.nnnSTUDY DESIGNnThe case series included 13 patients hospitalized for a failed lateral-approach maxillary sinus augmentation, performed by a dental practitioner, with or without simultaneous implant placement. Data on patient gender and age, presenting signs and symptoms, radiographic appearance, method of repair, and follow-up were recorded.nnnRESULTSnThere were 7 female and 6 male patients aged 53-74 years. Twenty-six of the total 34 implants inserted failed, of which 7 were displaced into the sinus. All patients had maxillary sinusitis, and 2 also had an inflammation of other paranasal sinuses. Ten patients presented with an oroantral fistula. Review of the files of the referring practitioner revealed the preoperative presence of chronic maxillary sinusitis in 4 patients and an odontogenic cyst in 1. Caldwell-Luc operation served as the definitive surgical treatment. All fistulas were successfully closed by a palatal rotation advancement flap (8 patients) or a buccal flap (2 patients).nnnCONCLUSIONSnThorough clinical and radiographic evaluation is necessary before sinus procedures to minimize complications. Total elimination of sinusitis and other pathologic conditions is recommended before maxillary sinus augmentation and implant surgery.

The clinical spectrum of Actinomyces-associated lesions of the oral mucosa and jawbones: correlations with histomorphometric analysis

OBJECTIVESnTo characterize the clinical manifestations of Actinomyces-associated lesions of the oral mucosa and jawbones, and to correlate the clinical course and treatment requirements with the findings of histomorphometric analysis.nnnSTUDY DESIGNnThe study was a 10-year retrospective analysis of archived cases with microscopic identification of Actinomyces infection. Actinomyces colonies were identified, using hematoxylin-eosin, Gram, and periodic acid-Schiff stains, exhibiting filamentous morphology with color variation between center and periphery. Only colonies with adjacent tissue reaction (inflammation, fibrosis) were analyzed. Actinomyces density (AD) was calculated by dividing total number of colonies by tissue surface, Actinomyces relative surface (ARS) was calculated by dividing total bacterial surface by tissue surface.nnnRESULTSnThe study included 106 cases (48 male, 58 female; aged 13-84 years, mean 50.5 years). Cases presented a wide clinical spectrum, involving jawbone and/or oral soft tissues. Cases included osteomyelitis associated with bisphosphonates, osteoradionecrosis, osteomyelitis unrelated to radiation or bisphosphonates, periapical lesions, odontogenic cysts, periimplantitis, and lesion mimicking periodontal disease. The AD correlated with median length of antibiotic treatment (R = 0.284; P = .028).nnnCONCLUSIONSnBecause we were able to identify 106 such cases, the results indicate that Actinomyces-associated lesions may not be as rare as would be expected from the relatively low number of cases in the literature. Actinomyces-associated lesions presented in a wide spectrum of clinical settings and a variety of contributing factors. Quantitative analysis of the number of bacterial colonies (representing bacterial load) could help in evaluating the aggressive potential of the lesion and help in treatment planning.

Palatal rotation-advancement flap for delayed repair of oroantral fistula: A retrospective evaluation of 63 cases

OBJECTIVEnTo review our 17-year clinical experience with delayed oroantral fistula repair by palatal rotation-advancement flap, and to report its advantages, disadvantages, and complications.nnnSTUDY DESIGNnThe records of 63 patients with late oroantral fistula treated by palatal rotation-advancement flap from 1984 to 2002 were reviewed. Eleven had undergone unsuccessful closure with a buccal flap. Data recorded were patient age and sex, cause of fistula, signs and symptoms, interval from appearance of fistula to repair, fistula size, radiographic appearance, method of repair, and immediate and late complications.nnnRESULTSnThere were 35 women and 28 men aged 21 to 71 years (mean 50.3 years). Surgery was performed 3 months to 20 years after injury (mean 1.8 years). Twenty-four patients had acute maxillary sinusitis and 39 had chronic sinusitis. The main causes of oroantral fistula were extraction of the second and first molars and pathological lesions within the sinus. Average fistula size was 2.3 cm x 1.6 cm. Fifty-one repairs were preceded by Caldwell-Luc operation. All fistulas were successfully closed with the palatal rotation-advancement flap, with minimal complications on long-term follow-up.nnnCONCLUSIONnThe palatal rotation-advancement flap is recommended for the late repair of oroantral fistula owing to its good vascularization, excellent thickness and tissue bulk, and easy accessibility; it also allows for the maintenance of the vestibular-sulcus depth. It is particularly indicated in cases of unsuccessful buccal flap closure.

Solitary central osteoma of the jaws: a diagnostic dilemma

Osteomas are relatively rare benign osteogenic neoplasms, characterized by the proliferation of compact and/or cancellous bone. Osteomas can develop as peripheral (periosteal) masses attached to the cortical plates or as central lesions arising from endosteal bone surfaces. Although multiple osteomas of the jaws are a hallmark of Gardner syndrome (familial adenomatous polyposis), nonsyndromic cases are typically solitary. A search of the literature identified 91 well documented cases of solitary osteoma of the jaws published since 1955: 93.4% were peripheral and only 6.6% central, a ratio of 14:1 in favor of peripheral osteomas. Solitary central osteomas of the jaws seem to be very rare, with only 6 such cases reported since 1955. Adding the 4 new cases described here brings the total to 10 central osteomas, 30% occurring in the maxilla and 70% in the mandible. Whereas peripheral osteomas are fairly easy to diagnose, central osteomas pose a more challenging diagnostic problem and need to be differentiated from other similar lesions of the jaws, such as central ossifying fibroma, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, cementoblastoma, and complex odontoma. With such a low number of cases of central osteoma reported, the objectives of the present report are to describe 4 new cases, analyze the clinical and radiographic characteristics, and discuss the features which distinguish these lesions from other similar lesions of the jaws.

Decompression of odontogenic cystic lesions: clinical long-term study of 73 cases

OBJECTIVEnThe aim of this study was to evaluate the effectiveness of decompression as the initial treatment for odontogenic cysts.nnnSTUDY DESIGNnPre- and postdecompression panoramic radiographs of 57 patients treated for 73 odontogenic cysts were reviewed for reduction parameters. Findings were evaluated against time of decompression and clinical and histopathologic data.nnnRESULTSnDecompression reduced lesion area by a mean of 79.3%. The reaction was good in 60% of cysts, moderate in 29%, and poor in 11%. Mean decompression time was 9.2 ± 5.2 months; it was 7.6 months in patients ≤18 years old and 10.2 months in older patients (P < .0001). Mean rate of reduction was 0.14 in cysts <10 cm(2) and 0.10 in cysts >20 cm(2) (P = .0884); by age, values were 0.14 in patients ≤18 years old and 0.09 in older patients (P < .05).nnnCONCLUSIONSnDecompression is effective in reducing odontogenic cysts. A shorter decompression period is needed for young patients. For aggressive lesions, secondary definitive surgery is recommended.

Thermal sensory and pain thresholds in the tongue and chin change with age, but are not altered in burning mouth syndrome

Background: Burning mouth syndrome (BMS) is a chronic orofacial pain syndrome that occurs in middle‐aged and postmenopausal women and poses a therapeutic challenge to dermatologists and dentists. It has been suggested previously that BMS is a small‐fiber neuropathy.

Upper lip changes and gingival exposure on smiling: Vertical dimension analysis

INTRODUCTIONnOur objectives were to evaluate and quantify upper lip soft-tissue changes in the vertical dimensions both at rest and at maximum smile, and to examine the correlation between upper labial vestibular attachment height and maxillary gingival exposure on smiling.nnnMETHODSnSeventy-two volunteers (36 men, 36 women) aged 20 to 40 (mean, 30.49 years) were recruited for this study. For each subject, 9 measurements of upper lip position and maxillary incisor crown height at rest and in maximum smile were recorded.nnnRESULTSnA statistically significant sexual dimorphism was apparent in most of the measured variables. Relaxed external upper lip length was 3.1 mm shorter in the women than in the men. The mean maxillary central incisor display at rest was 1.78 mm greater in the women than in the men. A high smile line was 2.5 times more prevalent in the women. The upper lip was shortened by 30% in subjects with a high smile line compared with 23% in subjects with a low smile line.nnnCONCLUSIONSnThe following findings were observed in subjects with a high smile pattern: (1) short upper lip length, (2) low smiling/resting upper lip length ratio, (3) inferior attachment of the upper labial vestibule, and (4) prominent upper lip vermilion.