Abstract: Lip paresthesia during mandibular molar orthodontic distalization is rare. When it occurs, it is often related to excessive dimensions of the mandibular second molar roots. In this clinical report, we describe a patient who developed lip paresthesia during orthodontic treatment. The paresthesia was relieved by immediate interruption of the forces applied to the mandibular second molars and pharmacologic therapy. Before fixed orthodontic treatment proceeds in patients with large tooth roots, it is important to diagnose the relationship between the roots and the mandibular canal to prevent nerve numbness and damage.
Abstract: Periodontal disease (Pd) is characterized by extensive alveolar bone loss, that occurs as a consequence of the impairment of the normal bone remodelling. Bone remodelling is regulated by the correct balance between osteoclast and osteoblast formation and activity. Alveolar bone loss could be due to an increased bone resorption by osteoclasts or a decreased bone formation by osteoblasts (OBs) or both. Although the role played by osteoclasts in increasing bone resorption in Pd is already known, the behaviour of OBs in this disease is poorly understood. In the present study we hypothesized that activity and survival of OBs, locally present in alveolar bone of Pd patients, are altered. Thus, we studied the activity and survival of OBs obtained from alveolar bone fragments of Pd patients. The results, obtained in OBs from the patients were compared with those from OBs obtained from healthy donors. We demonstrated that OBs from Pd patients weakly express OB phenotype in respect to the control cells. In particular, the alkaline phosphatase activity and the collagen type I production, as well as the formation of mineralized nodules, typical markers of differentiated OBs, were significantly lower in Pd patients. Interestingly, we also demonstrated that OBs from the patients were more sensitive to the apoptotic effect induced by TNF-related apoptosis-inducing ligand (TRAIL). TRAIL, a member of the TNF superfamily, induces apoptosis by interacting with its death receptors, (DR4, DR5). However, its activity can be modulated by two decoy receptors, DcR1 and DcR2. Thus, the sensitiveness of TRAIL induced apoptosis is determined by the ratio of death and decoy receptor. We demonstrated that OBs from Pd patients showed an imbalanced ratio between death and decoy TRAIL receptors due to the down-regulation of DcR2 expression. Furthermore, the levels of TRAIL in the serum of the same patients were significantly higher than those detected in the controls. In conclusion, we show for the first time that the alveolar bone loss in Pd patients could be due to the increased TRAIL-mediated apoptosis of OBs.
Abstract: PURPOSE: The purpose of this study was to evaluate the effect of submucosal administration of dexamethasone sodium phosphate on discomfort after mandibular third molar surgery. PATIENTS AND METHODS: Sixty-one consecutive patients requiring surgical removal of a single mandibular impacted third molar under local anesthesia were randomly placed into 3 groups. After the onset of local anesthesia, the experimental groups received dexamethasone at 2 different doses (4 or 8 mg) as submucosal injection, and the control group received no drug. Standardized surgical and analgesic protocols were followed. Maximum interincisal distance and facial contours were measured at baseline and at postsurgery days 2 and 7. Pain was objectively measured by counting the number of analgesic tablets required. The patients' perception of the severity of symptoms was assessed with a follow-up questionnaire (PoSSe scale). RESULTS: On the second postoperative day, facial edema showed a statistically significant reduction in both dexamethasone 4-mg and dexamethasone 8-mg groups compared with the control group, but no statistically significant differences were observed between the 2 dosage regimens of dexamethasone. By contrast, there was no statistically significant difference between all groups when postoperative swelling was evaluated at day 7 (P > .50). The treatment group had a limited and nonsignificant effect on pain and trismus when compared with the control group at the 2 times of evaluation. CONCLUSIONS: Parenteral use of dexamethasone 4 mg, given as an intraoral injection at the time of surgery, is effective in the prevention of postoperative edema. Increasing the dose to 8 mg provides no further benefit.
Abstract: This study describes how a dilacerated upper central incisor was repositioned in the dental arch in an adult patient with proper surgical and orthodontic management avoiding use of prosthetic implants. The results were sustainable long term in both periodontal and aesthetic terms.
Abstract: Linear IgA disease (LAD) is an acquired subepidermal bullous disorder, characterized by linear deposition of IgA along the basement membrane. Although the oral cavity is involved in up to 50% of cases, its exclusive involvement is very rare. The case of a 57-year-old woman with 13 months history of desquamative gingivitis chiefly located in the maxilla gingiva is presented. She had been diagnosed by her dental practitioner with an oral infection one year previously and had been receiving local anti-inflammatory and antibiotic medication, with no improvement. She was referred to our Oral Pathology Department, where the biopsy performed revealed a submucosal blister with chronic infiltrate. Direct immunofluorescence showed a linear deposition of IgA in the basal membrane zone, and a diagnosis of LAD was rendered. The patient was treated with topical cortisone, triamcinolone and systemic oral methylprednisolone at a daily dose of 32 mg, and continued at decreasing doses for 3 months. At the most recent check-up, 7 months after initial presentation, she was no longer taking any medication and remained asymptomatic and disease-free.
