Tarnjit Saini - Academia.edu (original) (raw)

Papers by Tarnjit Saini

Oral health & preventive dentistry, 2005

This study reviews the peripheral effects of methamphetamine on the salivary acini, the pathogene... more This study reviews the peripheral effects of methamphetamine on the salivary acini, the pathogenesis of methamphetamine-induced xerostomia, and its anecdotal relationship to dental caries. Methamphetamine is a sympathomimetic central stimulant which is abused for its euphoric effects. Its pharmacological action is exerted indirectly by sustaining high levels of catecholamines in the synaptic cleft and directly by binding to the postsynaptic adrenergic receptors. Methamphetamine abusers report subjective perception of xerostomia, which cannot be explained by the direct peripheral action of methamphetamine on the secretory acini. The drug may cause a decrease in salivary flow rate by centrally inhibiting salivatory nuclei via stimulation of alpha-2 receptors in the brain. Drug mediated dehydration state may influence the perception of dry mouth in abusers. The decreased salivary flow rate, either due to a central inhibitory action of methamphetamine or generalised dehydration, likely ...

El EBINYO es una forma de mutilacion oral infantil (MOI), ampliamente practicada en zonal rurales... more El EBINYO es una forma de mutilacion oral infantil (MOI), ampliamente practicada en zonal rurales del Este de Africa, donde los curanderos tradicionales y otros ancianos de la aldea extirpan los foliculos primarios del diente canino utilizando utensilios burdos, frecuentemente no esterilizados. El floklore tradicional sugiere que los foliculos dentales subyacentes, de los que se cree que asemejan a gusanos, son la causa de la fiebre, vomitos perdida de apetito y diarrea en los ninos. Ademas de las complicaciones graves y potencialmente letales de esta cirugia, muchos presentan complicaciones posquirurgicas inmediatas letales, mientras que otros de los que se someten a esta practica exhiben efectos dentoalveolares adversos caracteristicos a lo largo plazo. Los ninos en estas familias tambien podrian presentar un mayor riesgo de otros rituales de mutilacion debido a su contexto cultural. Comunicamos los hallazgos clinicos y radiologicos en cinco hermanos que fueron sometidos a MOI sie...

Pediatric dentistry

The mechanism of root formation and tooth eruption is a complex process which is not fully unders... more The mechanism of root formation and tooth eruption is a complex process which is not fully understood. Prior to a tooth emerging into the oral cavity, root genesis is initiated by derivatives of the enamel organ. The dental follicle mediates an eruption pathway allowing for movement of the developing tooth in a coronal direction. As the tooth moves towards the oral cavity, root formation occurs passively in the resulting space. Failure of the enamel organ and dental follicle to properly coordinate may result in complications in the eruption process. This clinical report presents 3 cases of isolated, unerupted teeth with dysmorphology of the roots. The process of root development and tooth eruption is also briefly reviewed.

General dentistry

Digital technology is becoming more common in dental practices. Indirect digitization of radiogra... more Digital technology is becoming more common in dental practices. Indirect digitization of radiographs can be an alternative to direct digital systems. This study was designed to evaluate intra-observer, inter-observer, and inter-technique agreement of proximal caries diagnosis on bitewing radiographs before and after indirect digitization. Four bitewing radiographs were obtained from 50 dental students. Conventional films were digitized with a flatbed scanner at 150 and 300 dpi. Three observers recorded the presence and depth of caries on 1,642 proximal surfaces for the conventional and digitized radiographs. Radiographs were evaluated twice (one week apart), using each viewing technique. Intra-observer, inter-observer, and inter-technique agreement (Kw) were determined. The intra-observer, inter-observer, and inter-technique agreements of proximal caries diagnosis on bitewing radiographs before and after indirect digitization were moderate to good.

Journal (Canadian Dental Association), 2006

We describe the case of a 43-year-old man who was referred to our dental school"s acute care... more We describe the case of a 43-year-old man who was referred to our dental school"s acute care clinic with pain and swelling of presumed dental origin in the left maxillary quadrant. Radiographic examination revealed extensive dental decay and periodontal disease. On questioning, the patient admitted to paresthesia of recent onset. Paresthesia associated with pain or swelling of the jaws is an ominous sign that should alert the clinician to the possibility of an underlying aggressive neoplasm. In this case, biopsy of the lesion confirmed that the patient had a rare malignant tumour of maxillary sinus origin, a sinonasal undifferentiated carcinoma.

General dentistry

A 64-year-old woman who sought routine dental treatment was noted to have unilateral atrophy of t... more A 64-year-old woman who sought routine dental treatment was noted to have unilateral atrophy of the tongue. The medical and dental significance of this manifestation is reviewed.

General dentistry

The posterior superior alveolar nerve (PSAN) is a major sensory branch of the maxillary division ... more The posterior superior alveolar nerve (PSAN) is a major sensory branch of the maxillary division of the trigeminal nerve. A PSAN block is a dental nerve block used for profound anesthesia of the maxillary molars. Complications arising from the PSAN block include hematoma formation, transient diplopia, blurred vision, and temporary blindness. This article presents a case of temporary paresis in the lateral pterygoid muscle following a PSAN block that utilized a 27-gauge long needle. The anatomical parameters and pathogenesis of such a complication are reviewed.

International journal of dentistry, 2010

General dentistry

Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used... more Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used to describe the presence of a developmental fistulous tract that connects the oral and nasal cavities through an oral opening located at the incisive papilla. Reportedly, this condition is a rare developmental variant; approximately 40 cases have been reported in the literature. Because awareness of this entity is important to avoid misdiagnosis, this article presents the clinical and conebeam computed tomography findings of two cases. Based on a review of the development of the nasopalatine structures in man, the authors propose that this entity be classified as a developmental oronasal fistula of the incisive papilla.

General dentistry

A large multilocular radiolucent lesion involving the anterior mandible was noted incidentally in... more A large multilocular radiolucent lesion involving the anterior mandible was noted incidentally in a 44-year-old woman who sought routine dental treatment. An incisional biopsy revealed that this lesion represented an uncommon developmental odontogenic cyst known as a glandular odontogenic cyst. The lesion was removed surgically, followed by reconstruction with a right anterior iliac crest bone graft. This article reviews the radiographic, clinical, and histopathologic appearance of this rare odontogenic cyst, as well as the surgical management and the patient's subsequent prosthetic rehabilitation.

International Journal of Dentistry, 2010

The greater palatine canal is an important anatomical structure that is often utilized as a pathw... more The greater palatine canal is an important anatomical structure that is often utilized as a pathway for infiltration of local anesthesia to affect sensation and hemostasis. Increased awareness of the length and anatomic variation in the anatomy of this structure is important when performing surgical procedures in this area (e.g., placement of osseointegrated dental implants). We examined the anatomy of the greater palatine canal using data obtained from CBCT scans of 500 subjects. Both right and left canals were viewed () in coronal and sagittal planes, and their paths and lengths determined. The average length of the greater palatine canal was 29 mm ( mm), with a range from 22 to 40 mm. Coronally, the most common anatomic pattern consisted of the canal traveling inferior-laterally for a distance then directly inferior for the remainder (43.3%). In the sagittal view, the canal traveled most frequently at an anterior-inferior angle (92.9%).

International Journal of Dentistry, 2010

The objective of this study was to determine the prevalence of concha bullosa and nasal septal de... more The objective of this study was to determine the prevalence of concha bullosa and nasal septal deviation and their potential relationships to maxillary sinusitis. 883 CT scans taken at Creighton University School of Dentistry from 2005 to 2008 were retrospectively reviewed for the presence of concha bullosa, nasal septal deviation, and maxillary sinusitis. 67.5% of patients exhibited pneumatization of at least one concha, 19.4% of patients had a deviated septum, and 50.0% had mucosal thickening consistent with maxillary sinusitis. 49.3% of patients who had concha bullosa also had evidence of maxillary sinusitis. Only 19.5% of patients with concha bullosa also had nasal septal deviation, whereas 19.7% of patients with sinusitis also presented with nasal septal deviation. Although concha bullosa is a common occurrence in the nasal cavity, there did not appear to be a statistically significant relationship between the presence of concha bullosa or nasal septal deviation and maxillary s...

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2004

Background: Neurofibromatosis 1 (NF1) is an autosomal dominantly inherited disorder caused by a s... more Background: Neurofibromatosis 1 (NF1) is an autosomal dominantly inherited disorder caused by a spectrum of mutations affecting the Nf1 gene. Affected patients develop benign and malignant tumors at an increased frequency. Clinical findings include multiple café-au-lait cutaneous pigmentations, neurofibromas, axillary freckling, optic gliomas, benign iris hamartomas (Lisch nodules), scoliosis, and poorly defined soft tissue lesions of the skeleton. Kerl first reported an association of NF1 with multiple central giant cell granulomas (CGCGs) of the jaws. There have since been 4 additional published cases of NF1 patients with CGCGs of the jaws. Clinical Cases: We report on 2 patients who presented with NF1 and aggressive CGCGs of the jaws. In both cases, the clinical course was characterized by numerous recurrences despite mechanical curettage and surgical resection. Conclusions: We review proposed mechanisms to explain the apparent association between NF1 and an increased incidence of CGCGs of the jaws. While the presence of CGCGs of the jaws in patients with NF1 could represent a coincidental association or a true genetic linkage, we propose that this phenomenon is most likely related to NF1-mediated osseous dysplasia. Compared to normal bone, the Nf1-haploinsufficient bone in a patient with NF1 may be less able to remodel in response to as of yet unidentified stimuli (e.g. excessive mechanical stress and/or vascular fragility), and consequently may be more susceptible to developing CGCG-like lesions. Alternatively, the CGCG in NF1 patients could represent a true neoplasm, resulting from additional, as of yet unidentified, genetic alterations to Nf1haploinsufficient bone.

The Journal of the American Dental Association, 2008

Background. Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of ... more Background. Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of eastern Africa, in which traditional healers and other village elders extirpate the primary canine tooth follicles of infants by using crude, often unsterilized, instruments or utensils. Traditional folklore suggests that the underlying tooth follicles, thought to resemble worms, are the cause of high temperature, vomiting, loss of appetite and diarrhea in infants. In addition to the serious and potentially fatal immediate postsurgical complications, many of those who undergo this practice exhibit characteristic long-term adverse dentoalveolar effects. Children in these families also may be at greater risk of undergoing other mutilation rituals because of their cultural background. Case Description. We report on the clinical and radiographic findings in five siblings who apparently were subjected to IOM as infants before immigrating to the United States. Clinical Implications. Although the practice of IOM is believed to be exceedingly rare in developed countries, it is important that dentists and allied dental personnel who treat refugees from areas of the world in which IOM is endemic be aware of the social factors behind this practice as well as be able to recognize its dental and psychological sequelae.

Journal of Oral and Maxillofacial Surgery, 2010

with a chief complaint of painful ulcerations of the oral cavity. The lesions had been present fo... more with a chief complaint of painful ulcerations of the oral cavity. The lesions had been present for at least several weeks and apparently had been slowly increasing in severity over this period. The patient had previously presented to a walk-in medical clinic for evaluation and was initially prescribed amoxicillin. When no clinical improvement was noted, she was switched to Augmentin (amoxicillin and clavulanate), prescribed nystatin troches and chlorhexidine rinses and advised to see a dentist. On initial presentation, the patient presented with multiple large crater-like erosions involving the palatal attached mucosa (figure 1a). The erosions were largely devoid of fibrin coating, except immediately along the border with the adjacent unaffected mucosa. In focal areas along the lateral margins of the erosions, an erythematous, raised, somewhat granular presentation was noted that resembled immature granulation tissue. The maxillary anterior attached gingiva had a somewhat granular appearance with linear ulcerations between the central incisors and interproximally between the left maxillary central and lateral incisors (figure 1b). The interdental papilla had a "punched out" necrotic appearance, but lacked a fetid odor. The palatal lesions were moderately painful to palpation. The patient denied having any similar vaginal or rectal lesions. The patient also reported that she had recently started to experience small pruritic erythematous skin lesions involving her arms (figure 2), legs and chest. Application of lateral pressure to the

Dentomaxillofacial Radiology, 2008

A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two... more A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two siblings incidentally recognized during volumetric CT examination. Although the pathogenesis of ectopic enamel formation is not known, possible mechanisms to account for this phenomenon are discussed in the context of current knowledge regarding root genesis. The radiographic presentation of enamel pearls and its clinical significance is also discussed. The observation of multiple enamel pearls in two siblings raises the possibility of a hereditary association in the formation of enamel pearls.

AIDS Patient Care and STDs, 2006

Rampant dental caries is a characteristic finding in methamphetamine abusers. The popularity of m... more Rampant dental caries is a characteristic finding in methamphetamine abusers. The popularity of methamphetamine, particularly among the gay community where it is linked to the spread of HIV, its ready availability, and rapid spread across the nation have placed methamphetamine use in an epidemic status in many communities unaccustomed to dealing with drug abuse. We present a case of a 25-year-old male "meth" abuser of unknown HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) status to promote recognition by the health care team of the association of rampant dental caries with methamphetamine abuse for appropriate intervention to ensure successful treatment and prevention of disease progression. 146 working in the prison system in these states have noticed an extremely destructive rampant caries pattern among their patients who have a history of MA abuse. 1,15 This caries pattern is distinctive in that, initially, it involves the buccal smooth surface of the posterior teeth and the interproximal of the anterior teeth progressing to complete destruction of the coronal portion of the tooth. Methamphetamine abusers rapidly develop tolerance and a psychological addiction that is extremely resistant to treatment. 10 Because MA use is spreading eastward across the United States, knowledge of the drug coupled with the ability to recognize signs and symptoms of abuse should be increasingly important to health care personnel. Recognition of the association of rampant dental caries with MA abuse is important for early intervention to ensure

Oral health & preventive dentistry, 2005

This study reviews the peripheral effects of methamphetamine on the salivary acini, the pathogene... more This study reviews the peripheral effects of methamphetamine on the salivary acini, the pathogenesis of methamphetamine-induced xerostomia, and its anecdotal relationship to dental caries. Methamphetamine is a sympathomimetic central stimulant which is abused for its euphoric effects. Its pharmacological action is exerted indirectly by sustaining high levels of catecholamines in the synaptic cleft and directly by binding to the postsynaptic adrenergic receptors. Methamphetamine abusers report subjective perception of xerostomia, which cannot be explained by the direct peripheral action of methamphetamine on the secretory acini. The drug may cause a decrease in salivary flow rate by centrally inhibiting salivatory nuclei via stimulation of alpha-2 receptors in the brain. Drug mediated dehydration state may influence the perception of dry mouth in abusers. The decreased salivary flow rate, either due to a central inhibitory action of methamphetamine or generalised dehydration, likely ...

El EBINYO es una forma de mutilacion oral infantil (MOI), ampliamente practicada en zonal rurales... more El EBINYO es una forma de mutilacion oral infantil (MOI), ampliamente practicada en zonal rurales del Este de Africa, donde los curanderos tradicionales y otros ancianos de la aldea extirpan los foliculos primarios del diente canino utilizando utensilios burdos, frecuentemente no esterilizados. El floklore tradicional sugiere que los foliculos dentales subyacentes, de los que se cree que asemejan a gusanos, son la causa de la fiebre, vomitos perdida de apetito y diarrea en los ninos. Ademas de las complicaciones graves y potencialmente letales de esta cirugia, muchos presentan complicaciones posquirurgicas inmediatas letales, mientras que otros de los que se someten a esta practica exhiben efectos dentoalveolares adversos caracteristicos a lo largo plazo. Los ninos en estas familias tambien podrian presentar un mayor riesgo de otros rituales de mutilacion debido a su contexto cultural. Comunicamos los hallazgos clinicos y radiologicos en cinco hermanos que fueron sometidos a MOI sie...

Pediatric dentistry

The mechanism of root formation and tooth eruption is a complex process which is not fully unders... more The mechanism of root formation and tooth eruption is a complex process which is not fully understood. Prior to a tooth emerging into the oral cavity, root genesis is initiated by derivatives of the enamel organ. The dental follicle mediates an eruption pathway allowing for movement of the developing tooth in a coronal direction. As the tooth moves towards the oral cavity, root formation occurs passively in the resulting space. Failure of the enamel organ and dental follicle to properly coordinate may result in complications in the eruption process. This clinical report presents 3 cases of isolated, unerupted teeth with dysmorphology of the roots. The process of root development and tooth eruption is also briefly reviewed.

General dentistry

Digital technology is becoming more common in dental practices. Indirect digitization of radiogra... more Digital technology is becoming more common in dental practices. Indirect digitization of radiographs can be an alternative to direct digital systems. This study was designed to evaluate intra-observer, inter-observer, and inter-technique agreement of proximal caries diagnosis on bitewing radiographs before and after indirect digitization. Four bitewing radiographs were obtained from 50 dental students. Conventional films were digitized with a flatbed scanner at 150 and 300 dpi. Three observers recorded the presence and depth of caries on 1,642 proximal surfaces for the conventional and digitized radiographs. Radiographs were evaluated twice (one week apart), using each viewing technique. Intra-observer, inter-observer, and inter-technique agreement (Kw) were determined. The intra-observer, inter-observer, and inter-technique agreements of proximal caries diagnosis on bitewing radiographs before and after indirect digitization were moderate to good.

Journal (Canadian Dental Association), 2006

We describe the case of a 43-year-old man who was referred to our dental school"s acute care... more We describe the case of a 43-year-old man who was referred to our dental school"s acute care clinic with pain and swelling of presumed dental origin in the left maxillary quadrant. Radiographic examination revealed extensive dental decay and periodontal disease. On questioning, the patient admitted to paresthesia of recent onset. Paresthesia associated with pain or swelling of the jaws is an ominous sign that should alert the clinician to the possibility of an underlying aggressive neoplasm. In this case, biopsy of the lesion confirmed that the patient had a rare malignant tumour of maxillary sinus origin, a sinonasal undifferentiated carcinoma.

General dentistry

A 64-year-old woman who sought routine dental treatment was noted to have unilateral atrophy of t... more A 64-year-old woman who sought routine dental treatment was noted to have unilateral atrophy of the tongue. The medical and dental significance of this manifestation is reviewed.

General dentistry

The posterior superior alveolar nerve (PSAN) is a major sensory branch of the maxillary division ... more The posterior superior alveolar nerve (PSAN) is a major sensory branch of the maxillary division of the trigeminal nerve. A PSAN block is a dental nerve block used for profound anesthesia of the maxillary molars. Complications arising from the PSAN block include hematoma formation, transient diplopia, blurred vision, and temporary blindness. This article presents a case of temporary paresis in the lateral pterygoid muscle following a PSAN block that utilized a 27-gauge long needle. The anatomical parameters and pathogenesis of such a complication are reviewed.

International journal of dentistry, 2010

General dentistry

Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used... more Various terms (including patent nasopalatine fistula and patent nasopalatine duct) have been used to describe the presence of a developmental fistulous tract that connects the oral and nasal cavities through an oral opening located at the incisive papilla. Reportedly, this condition is a rare developmental variant; approximately 40 cases have been reported in the literature. Because awareness of this entity is important to avoid misdiagnosis, this article presents the clinical and conebeam computed tomography findings of two cases. Based on a review of the development of the nasopalatine structures in man, the authors propose that this entity be classified as a developmental oronasal fistula of the incisive papilla.

General dentistry

A large multilocular radiolucent lesion involving the anterior mandible was noted incidentally in... more A large multilocular radiolucent lesion involving the anterior mandible was noted incidentally in a 44-year-old woman who sought routine dental treatment. An incisional biopsy revealed that this lesion represented an uncommon developmental odontogenic cyst known as a glandular odontogenic cyst. The lesion was removed surgically, followed by reconstruction with a right anterior iliac crest bone graft. This article reviews the radiographic, clinical, and histopathologic appearance of this rare odontogenic cyst, as well as the surgical management and the patient's subsequent prosthetic rehabilitation.

International Journal of Dentistry, 2010

The greater palatine canal is an important anatomical structure that is often utilized as a pathw... more The greater palatine canal is an important anatomical structure that is often utilized as a pathway for infiltration of local anesthesia to affect sensation and hemostasis. Increased awareness of the length and anatomic variation in the anatomy of this structure is important when performing surgical procedures in this area (e.g., placement of osseointegrated dental implants). We examined the anatomy of the greater palatine canal using data obtained from CBCT scans of 500 subjects. Both right and left canals were viewed () in coronal and sagittal planes, and their paths and lengths determined. The average length of the greater palatine canal was 29 mm ( mm), with a range from 22 to 40 mm. Coronally, the most common anatomic pattern consisted of the canal traveling inferior-laterally for a distance then directly inferior for the remainder (43.3%). In the sagittal view, the canal traveled most frequently at an anterior-inferior angle (92.9%).

International Journal of Dentistry, 2010

The objective of this study was to determine the prevalence of concha bullosa and nasal septal de... more The objective of this study was to determine the prevalence of concha bullosa and nasal septal deviation and their potential relationships to maxillary sinusitis. 883 CT scans taken at Creighton University School of Dentistry from 2005 to 2008 were retrospectively reviewed for the presence of concha bullosa, nasal septal deviation, and maxillary sinusitis. 67.5% of patients exhibited pneumatization of at least one concha, 19.4% of patients had a deviated septum, and 50.0% had mucosal thickening consistent with maxillary sinusitis. 49.3% of patients who had concha bullosa also had evidence of maxillary sinusitis. Only 19.5% of patients with concha bullosa also had nasal septal deviation, whereas 19.7% of patients with sinusitis also presented with nasal septal deviation. Although concha bullosa is a common occurrence in the nasal cavity, there did not appear to be a statistically significant relationship between the presence of concha bullosa or nasal septal deviation and maxillary s...

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2004

Background: Neurofibromatosis 1 (NF1) is an autosomal dominantly inherited disorder caused by a s... more Background: Neurofibromatosis 1 (NF1) is an autosomal dominantly inherited disorder caused by a spectrum of mutations affecting the Nf1 gene. Affected patients develop benign and malignant tumors at an increased frequency. Clinical findings include multiple café-au-lait cutaneous pigmentations, neurofibromas, axillary freckling, optic gliomas, benign iris hamartomas (Lisch nodules), scoliosis, and poorly defined soft tissue lesions of the skeleton. Kerl first reported an association of NF1 with multiple central giant cell granulomas (CGCGs) of the jaws. There have since been 4 additional published cases of NF1 patients with CGCGs of the jaws. Clinical Cases: We report on 2 patients who presented with NF1 and aggressive CGCGs of the jaws. In both cases, the clinical course was characterized by numerous recurrences despite mechanical curettage and surgical resection. Conclusions: We review proposed mechanisms to explain the apparent association between NF1 and an increased incidence of CGCGs of the jaws. While the presence of CGCGs of the jaws in patients with NF1 could represent a coincidental association or a true genetic linkage, we propose that this phenomenon is most likely related to NF1-mediated osseous dysplasia. Compared to normal bone, the Nf1-haploinsufficient bone in a patient with NF1 may be less able to remodel in response to as of yet unidentified stimuli (e.g. excessive mechanical stress and/or vascular fragility), and consequently may be more susceptible to developing CGCG-like lesions. Alternatively, the CGCG in NF1 patients could represent a true neoplasm, resulting from additional, as of yet unidentified, genetic alterations to Nf1haploinsufficient bone.

The Journal of the American Dental Association, 2008

Background. Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of ... more Background. Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of eastern Africa, in which traditional healers and other village elders extirpate the primary canine tooth follicles of infants by using crude, often unsterilized, instruments or utensils. Traditional folklore suggests that the underlying tooth follicles, thought to resemble worms, are the cause of high temperature, vomiting, loss of appetite and diarrhea in infants. In addition to the serious and potentially fatal immediate postsurgical complications, many of those who undergo this practice exhibit characteristic long-term adverse dentoalveolar effects. Children in these families also may be at greater risk of undergoing other mutilation rituals because of their cultural background. Case Description. We report on the clinical and radiographic findings in five siblings who apparently were subjected to IOM as infants before immigrating to the United States. Clinical Implications. Although the practice of IOM is believed to be exceedingly rare in developed countries, it is important that dentists and allied dental personnel who treat refugees from areas of the world in which IOM is endemic be aware of the social factors behind this practice as well as be able to recognize its dental and psychological sequelae.

Journal of Oral and Maxillofacial Surgery, 2010

with a chief complaint of painful ulcerations of the oral cavity. The lesions had been present fo... more with a chief complaint of painful ulcerations of the oral cavity. The lesions had been present for at least several weeks and apparently had been slowly increasing in severity over this period. The patient had previously presented to a walk-in medical clinic for evaluation and was initially prescribed amoxicillin. When no clinical improvement was noted, she was switched to Augmentin (amoxicillin and clavulanate), prescribed nystatin troches and chlorhexidine rinses and advised to see a dentist. On initial presentation, the patient presented with multiple large crater-like erosions involving the palatal attached mucosa (figure 1a). The erosions were largely devoid of fibrin coating, except immediately along the border with the adjacent unaffected mucosa. In focal areas along the lateral margins of the erosions, an erythematous, raised, somewhat granular presentation was noted that resembled immature granulation tissue. The maxillary anterior attached gingiva had a somewhat granular appearance with linear ulcerations between the central incisors and interproximally between the left maxillary central and lateral incisors (figure 1b). The interdental papilla had a "punched out" necrotic appearance, but lacked a fetid odor. The palatal lesions were moderately painful to palpation. The patient denied having any similar vaginal or rectal lesions. The patient also reported that she had recently started to experience small pruritic erythematous skin lesions involving her arms (figure 2), legs and chest. Application of lateral pressure to the

Dentomaxillofacial Radiology, 2008

A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two... more A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two siblings incidentally recognized during volumetric CT examination. Although the pathogenesis of ectopic enamel formation is not known, possible mechanisms to account for this phenomenon are discussed in the context of current knowledge regarding root genesis. The radiographic presentation of enamel pearls and its clinical significance is also discussed. The observation of multiple enamel pearls in two siblings raises the possibility of a hereditary association in the formation of enamel pearls.

AIDS Patient Care and STDs, 2006

Rampant dental caries is a characteristic finding in methamphetamine abusers. The popularity of m... more Rampant dental caries is a characteristic finding in methamphetamine abusers. The popularity of methamphetamine, particularly among the gay community where it is linked to the spread of HIV, its ready availability, and rapid spread across the nation have placed methamphetamine use in an epidemic status in many communities unaccustomed to dealing with drug abuse. We present a case of a 25-year-old male "meth" abuser of unknown HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) status to promote recognition by the health care team of the association of rampant dental caries with methamphetamine abuse for appropriate intervention to ensure successful treatment and prevention of disease progression. 146 working in the prison system in these states have noticed an extremely destructive rampant caries pattern among their patients who have a history of MA abuse. 1,15 This caries pattern is distinctive in that, initially, it involves the buccal smooth surface of the posterior teeth and the interproximal of the anterior teeth progressing to complete destruction of the coronal portion of the tooth. Methamphetamine abusers rapidly develop tolerance and a psychological addiction that is extremely resistant to treatment. 10 Because MA use is spreading eastward across the United States, knowledge of the drug coupled with the ability to recognize signs and symptoms of abuse should be increasingly important to health care personnel. Recognition of the association of rampant dental caries with MA abuse is important for early intervention to ensure