Takuro Wada

Oral signs as indicators of possible osteoporosis in elderly women

The relationship between oral signs and osteoporosis was investigated to assess the possibility of using this as an indicator of postmenopausal osteoporosis. Sixty-four women between the ages of 50 and 70 years were evaluated. Osteoporotic signs consisted of thoracic spine fracture as demonstrated on lateral chest radiographs. Oral signs were the number of teeth present, mandibular cortical width, alveolar bone resorption, and the morphologic classification of the inferior cortex on panoramic radiographs. The number of teeth present (N) was highly related to the probability of thoracic spine fracture and was used to derive the probability equation for the presence of thoracic spine fracture: probability value = 1/(1 + e-z), Z = 18.68-0.29 age -0.27N. A probability value higher than 0.5 suggests the possibility of thoracic spine fracture. It was concluded that this equation could serve as a simple and useful tool for dentists to assess the possibility of latent osteoporosis.

Tooth loss and mandibular osteopenia.

The relationship between mandibular bone mass and tooth loss was studied in 269 patients who had neither metabolic disease nor local lesions affecting the mandibular cortex. In all of the subjects, the outline of the mental foramen was distinctly disclosed on unilateral or bilateral panoramic radiographs. Mandibular bone mass was evaluated by determining the mandibular cortical width in the mental region with the use of panoramic radiographs. The relationships of mandibular cortical width to patient age and sex and the number of teeth present were also investigated. In male subjects, there was no significant correlation between the number of teeth present and the mandibular cortical width. Among women in their seventh decade, those with 15 or more teeth showed significantly greater mandibular cortical width than those with fewer teeth. Decrease of mandibular bone mass was positively correlated with tooth loss in female subjects.

Primary intraosseous carcinoma: Review of the literature and diagnostic criteria

Twenty-four reports describing 39 cases of primary intraosseous carcinoma (PIOC) were reviewed and the clinicopathologic features were summarized. The mean age of the patients at the time of diagnosis was 51.0 years, and the male: female ratio was 2:3. The posterior mandible was the predominant site; in no patient was a lesion observed in the posterior maxilla. Twenty-five of 31 patients (80.6%) showed swelling of the oral mucosa. However, ulcer formation was observed in only 3 of 36 patients. Pain, sensory disturbances, and metastasis to regional lymph nodes were observed in 25 of 34 patients (73.5%), 9 of 15 patients (60%), and 13 of 33 patients (39.4%), respectively. Radiographically, most lesions produced bone resorption with ill-defined margins (51.6%) or with well-defined margins (19.4%). The diagnostic criteria proposed for PIOC are absence of ulcer formation, except when caused by other factors; histologic evidence of squamous cell carcinoma without a cystic component or other odontogenic tumor cells; and absence of another primary tumor on chest radiographs obtained at the time of diagnosis and during a follow-up period of more than 6 months.

An analysis of mandibular bone complications in radiotherapy for T1 and T2 carcinoma of the oral tongue

PURPOSE To examine the incidence of mandibular bone complication in patients who underwent radiotherapy for T1 and T2 carcinomas of the oral tongue and to analyze the factors contributing to its occurrence. METHODS AND MATERIALS The clinical records of 148 patients with T1 and T2 carcinoma of the oral tongue treated with radiotherapy alone between 1978 and 1989 were examined retrospectively. Interstitial brachytherapy, used as the major treatment modality, was performed using cobalt needles, radium needles, or iridium hairpins. The prescribed dose at the plane 5 mm from the plane of the radioactive sources was 65-70 Gy in interstitial brachytherapy alone, and 50-60 Gy in the combined treatment with external irradiation. An external irradiation dose of 30 Gy was usually used. RESULTS Eleven of the patients showed radiation-induced mandibular bone complication. Two (1 T1, 1 T2) had been treated with interstitial brachytherapy alone, and nine (2 T1, 7 T2) with the combination of external irradiation and interstitial brachytherapy. The incidence of radiation complication of bone was significantly higher in the patients with T2 tumors (p = 0.04) and in those who received the combined treatment (p < 0.01). Multivariate analysis revealed that the total dose (p = 0.04) and dose rate of interstitial brachytherapy (p = 0.03) were significant factors contributing to radiation bone complication. A significant difference in the incidence of bone complication was also seen between patients who received a total dose of 90 Gy or more and those who received less than 90 Gy (p < 0.01), as well as between patients who were treated with 0.55 Gy/h or higher and those who were treated with less than 0.55 Gy/h (p = 0.03). CONCLUSION A significant increase in the incidence of bone complication was found at the total dose of 90 Gy or more and at the dose rate of 0.55 Gy/h or higher. In combined treatment with external irradiation and interstitial brachytherapy, the interstitial brachytherapy dose of 60 Gy appears to be the threshold at which mandibular bone complication is induced when the external irradiation dose is 30 Gy.

Possible identity of diffuse sclerosing osteomyelitis and chronic recurrent multifocal osteomyelitis. One entity or two.

On the basis of the findings of nine of our patients and our review of previously reported cases of diffuse sclerosing osteomyelitis and chronic recurrent multifocal osteomyelitis, we discuss the similarity of these two entities. Our nine patients had initially been given diagnoses of diffuse sclerosing osteomyelitis on the basis of their clinicopathologic findings. However, technetium 99m-MDP bone scans performed on four of them revealed multiple bone lesions leading to the diagnosis of chronic recurrent multifocal osteomyelitis. Furthermore, no clear difference between clinical features in the patients with multiple bone lesions and those in the patients with diffuse sclerosing osteomyelitis was found. We conclude that diffuse sclerosing osteomyelitis is an expression of chronic recurrent multifocal osteomyelitis.

Radiographic characteristics of the calcifying odontogenic cyst

4 additional cases of calcifying odontogenic cysts (COC) were reported, together with the radiographic interpretation of 138 cases from the literature. From the review of the literature and of our own cases, the root resorption is one of the most common diagnostic findings as is cystic radiolucency accompanied by radiopacities. Other radiographic characteristics, such as loculation, tooth divergency and bone resorption were emphasized.

Chronic recurrent multifocal osteomyelitis involving the mandible

A patient with chronic recurrent multifocal osteomyelitis is presented for the first time in the dental literature. On the basis of the initial diagnosis of diffuse sclerosing osteomyelitis of the mandible, the clinical course was protracted and refractory to surgical and antibiotic therapies. The literature is reviewed to evaluate the relationship between chronic recurrent multifocal osteomyelitis and diffuse sclerosing osteomyelitis. Distinguishing features between the two entities could not be found. It is recommended that a skeletal survey be performed when the diagnosis of diffuse sclerosing osteomyelitis is established.

A case of desmoplastic variant of a mandibular ameloblastoma

Abstract Radiographically, typical ameloblastomas have a multilocular or unilocular radiolucent appearance with fairly well-defined margins. Adjacent teeth may be tilted or displaced and root resorption is commonly observed. This article reports a case of an ameloblastoma having an unusual radiographic appearance in spite of the typical histology.

Simple bone cyst : evaluation of contents with conventional radiography and computed tomography

To evaluate whether gas is present in the cavity of simple bone cysts, the clinical and histologic findings of 53 patients with simple bone cysts were examined and compared with an experimental model. The model consisted of a dry mandible with the medullary bone removed and the resulting cavity injected with water. Although an air-liquid level was observed on all radiographs for the experimental model, none was observed in the clinical cases of simple bone cysts. When the experimental cavity was completely filled with water, the density in the cavity was similar to that of the surrounding water on computed tomography, but when it was filled with air, the density was lower than that of the surrounding water. In contrast, in simple bone cysts said to contain air at surgery, the cavity contents were not consistent with the density for gas on computed tomography. These results indicate that the operative finding of air in the cavity of simple bone cysts may have been in error at least in some cases.

Digital image processing of periapical radiographs

Periapical radiographs were processed digitally with an image-processing system. In processed images obtained with an aperture of 100 X 100 micron 2, some radiographic information was lost because the aperture was too large for processing of periapical radiographs. Greater noise and more artifacts were also present and occasionally disturbed the interpretation. Therefore, we conclude that digital image processing of periapical radiographs is not always useful. Improvement of contrast was obtained, however, and this seemed to be effective for low-contrast radiographs.