Pain After Tooth Extraction Masking Primary Extranodal Non-Hodgkin’s Lymphoma of the Oral Cavity

Maligni su limfomi u usnoj šupljini rijetki i čine približno 3,5 posto svih malignih promjena u oralnoj regiji. Opisan je slučaj primarnog non-Hodgkinova limfoma na lijevoj strani mandibule. Nakon što je pacijentu izvađen donji lijevi umnjak, perzistirala je spontana i intermitentna bol na lijevoj strani donje čeljusti. Intraoralnim pregledom ustanovljeno je da sporo cijeli postekstrakcijska alveola. Panoramska radiološka snimka pokazala je radiolucenciju s nepravilnim rubovima u stražnjoj mandibularnoj regiji na lijevoj strani. Nakon desetodnevne terapije antibiotikom, bol se smanjila, ali postekstrakcijska je alveola još neadekvatno cijelila. Inicijalno je bila pogrešno postavljena dijagnoza kroničnog osteomijelitisa. Na temelju histološkog i imunohistokemijskog nalaza postavljena je konačna dijagnoza - difuzni velikostanični limfom B-imunofenotipa. Nakon kombinacije radioterapije i kemoterapije, kod pacijenta se postigla potpuna remisija te su se povukli svi klinički znakovi bolesti. Dijagnosticiranje ekstranodularnog limfoma čeljusti je izazov, jer gotovo uvijek postoji sumnja na malignu tvorbu, a često je prikriven oralnim i dentalnim patološkim stanjima. Stomatolog je vrlo važan u ranom otkrivanju malignih limfoma usne šupljine.Malignant lymphoma of the oral region are uncommon and account for approximately 3.5% of all oral malignancies. In this report, a case of primary non-Hodgkin lymphoma of the left mandible is presented. The spontaneous and intermittent pain of the left mandible had continued after third left molar extraction. Intraoral examination revealed healing retardation of the postextraction socket. A panoramic radiograph revealed a radiolucency in the posterior mandibular region with irregular margins. After the 10-day course of antibiotics the spontaneous pain diminished, but the inadequacy of the healing at the extraction site was still present. We initially misdiagnosed it as chronic osteomyelitis. Based on the histological and immunohistochemical examination, we made the diagnosis of diffused large cell lymphoma of the B-cell type. After the combination of chemotherapy and radiotherapy patient showed complete remission with the disappearance of all clinical evidence of disease. The diagnosis of extranodal lymphoma of the jaw may be chalenging, because frequently there is a low index of clinical suspicion and malignant tumor may mimic common oral and dental pathological conditions. Dentists can play the important rule in the early detection of the malignant lymphoma of the oral cavity

The Interaction of the Professional, Psychological and Sociological Aspect in Planning Dental Rehabilitation

Svaki bi stomatolog u prvome redu trebao misliti na zdravlje i interese svojega pacijenta te ga potpuno i iskreno izvijestiti o potrebi i mogućnosti terapije. Kako pacijenti nemaju znanja iz područja struke, ne mogu sami odlučivati o vrsti i tijeku terapije. Uloga stomatologa je izraditi vrstan plan terapije te pripremiti pacijenta na rehabilitaciju i uputiti ga u očekivane rezultate. Planirati terapiju složen je i zahtjevan posao. On nužno traži sjedinjenje spoznaja iz područja prakse i znanosti sa sociopsihološkim pristupom pacijentu, ali i temeljima medicinske etike.The priority of each dentist should be the health and care, as well as the welfare of his patient. The dentist should explain the therapeutical process, inform the patient in detail about the chosen therapy and keep him updated. The patients, usually lacking professional knowledge, or insufficiently informed, are unable to choose the type and the course of the therapy. The role of the dentist is to prepare the therapy plan, as well as the rehabilitation of the patient, and to instruct him as to the desired results. Preparing the therapy plan is a very demanding part of the process, which necessarily unites practical knowledge and scientific and socio -psychological approach to the patient, medical ethics included

A Finding of Diffuse Cellular Non-Hodgkin Lymphoma in the Oral Cavity - Case Presentation Dg: Diffuse giant cell Non-Hodgkin lymphoma B-immunophenotype

Definicija: Non-Hodgkinovi limfomi (NHL) heterogena su skupina limfoproliferativnih neoplazmi što ih obilježava pojava maligno promijenjenih limfocita u limfnome čvoru, a rjeđe primarno u drugim organima. Heterogenost bolesti očituje se u raznovrsnom kliničkom očitovanju bolesti, raznovrsnim laboratorijskim parametrima, histološkome nalazu, imunološkom podrijetlu malignih stanica, reagiranju na terapiju i u prognozi bolesti. Bolest se najčešće očituje bezbolnim povećanjem limfnih žlijezda, a rjeđe poremećajima u drugim organskim sustavima zbog limfomske infiltracije organa. Difuzni velikostanični NHL B-imunofenotipa spada u limfome srednjega stupnja malignosti. Javlja se u srednjoj i starijoj životnoj dobi, obično s diseminiranom pojavom limfnih čvorova, a do 70% bolesnika ima infiltraciju koštane srži limfomskim stanicama. Difuzni limfomi velikih stanica vrlo često su lokalizirani, a česta je infiltracija gastrointestinalnog trakta i središnjega živčanog sustava. U radu opisujemo dijagnosticiranje difuznoga velikostaničnog NHL B imunofenotipa koji je otkriven nakon neadekvatnoga cijeljenja postekstrakcijske alveole. Pacijent se javlja zbog otekline i izrasline iz postekstrakcijske alveole u području donjega umnjaka lijevo i anestezije brade. Zub je vađen zbog bolova zuba i zubnoga mesa. Navodi da od otprilike prije 6 mjeseci osjeća “utrnutost” brade lijevo. Tada je liječen kod specijalista oralne medicine laserskom terapijom, te navodi djelomično poboljšanje, ali se anestezija područja, bolovi i oticanje javljaju ponovno, te se tada odluči za ekstrakciju donjega umnjaka. Kod nas je prvotno liječen kohleacijom i antibioticima. Tjedan dana nakon tretmana poboljšanje, ali se nakon remisije ponovo javljaju bolovi i otok. Tada se uzme detaljnija anamneza iz koje se sazna da je pacijent nekoliko mjeseci prije pri operaciji ingvinalne hernije imao problem s koagulacijom i da su mu povišeni jetreni enzimi sa sumnjom na hepatitis. Kod nas se tada uzme biopsija te pošalje na PHD. U području glave i vrata ne nađe se palpabilnih limfnih čvorova. Prigodom raščlambe prve biopsije nalaz je suspektan na maligni limfom te se pacijent šalje na daljnju obradbu na hematopatologiju gdje se uzima ponovna biopsija. Radi se o difuznom velikostaničnom Non-Hogkin limfomu B imunofenotipa. Pacijent je na obradbi Kliničkoga zavoda za hematologiju te je nakon potrebne terapije bolest u remisiji.Definition: Non-Hodgkin lymphomas (NHL) are a heterogenetic group of lymphoproliferative neoplasms characterised by the occurrence of malignantly changed lymphocytes in a lymph node, and rarely primary in other organs. The heterogenicity of the disease is interpreted in the diverse clinical manifestations of the disease, diverse laboratory parameters, histological finding, immunological origin of the malignant cells, reaction to therapy and disease prognosis. The disease is most frequently interpreted by painless enlarged lymph nodes, and more rarely with disturbances in other organic systems due to lymphomic infiltration of organs. Diffuse giant cell NHL B-immunophenotype belongs to the group of lymphomas of moderate degree of malignancy. It occurs in middle-aged and older age groups, usually with disseminated lymph nodes, and up to 70% of patients have infiltration of the bone marrow by lymphoid cells. Diffuse lymphomas of giant cells are very often localised and infiltration of the gastrointestinal tract and central nervous system is a frequent occurrence. In this study we describe the method of diagnosing diffuse giant cell NHL B-immunophenotype, which was detected after inadequate healing of postextraction alveola. The patient was admitted because of a swelling and growth from the post-extraction alveola in the area of the lower left wisdom tooth and anaesthesia of the chin. The tooth was extracted because of pain in the tooth and gingiva. The patient informed us that approximately 6 months ago he had felt “tingling” on the left side of the chin. At that time he was treated with laser therapy by a specialist in oral medicine, after which partial improvement occurred. However anaesthesia of the area, pain and swelling recurred, and it was decided to perform extraction of the lower wisdom tooth. The patient was treated in this Department initially with cochleation and antibiotics. Improvement occurred one week after treatment. However, after the remission pain and swelling recurred. A detailed history was taken and it was learnt that a few months beforehand, during an operation for an inguinal hernia, a problem had occurred with coagulation, and renal enzymes were raised and hepatitis suspected. A biopsy was then taken in our Department and sent for PHD. Palpable lymph nodes were not found in the area of the head and neck. During analysis of the first biopsy the result was suspect for malignant lymphoma and the patient was sent for further treatment by a haematopathologist, where a further biopsy was taken. The finding showed diffuse giant-cell Non-Hodgkin lymphoma B-immunophenotype. The patient is presently undergoing treatment in the Clinical Department of Haematology, and after appropriate therapy the disease is in remission

Postextraction pain treatment possibilities

Postekstrakcijska bol je komplikacija koja se javlja nakon vađenja zuba. Najčešće nastaje u molarnoj regiji donje čeljusti. U ovome radu uspoređene su dvije metode liječenja postekstrakcijske boli: konzervativna i kirurško - konzervativna metoda. Svrha rada bila je odrediti najdjelotvorniji način liječenja te komplikacije. Istraživanje je provedeno na trideset pacijenata sa simptomima postekstrakcijske boli. Petnaest pacijenata liječeno je konzervativnom metodom, a petnaest kirurško - konzervativnom metodom. Pacijenti su klinički praćeni do prestanka simptoma. Dobiveni rezultati pokazuju da je kirurško - konzervativna metoda liječenja djelotvornija jer u kraćem vremenu smiruje simptome boli.Postextraction pain or alveolitis sicca dolorosa is a complication which appears after tooth extraction, usually in the molar region of the lower jaw. In this paper two methods were compared: conservative and surgical-conservative method. The research was carried in order to establish which method is more advantageous and more effective. The pain treatment lasted for one year. Thirty patients were treated and each of them were separately conducted during three weeks after the treatment. Fifteen patients were submitted to conservative therapy, and fifteen others to surgical-conservative therapy. The results (tables and charts) show that both methods are effective and that both methods lead to symptom termination. However, surgical- conservative method appeared to be more effective, because in the first seven days after the therapy, approximately 75% of the patients no longer had alveolitis symptoms

Comparison of the Bond Strengths of Zinc Phosphate, Glass-Ionomer, and Compomere Cement for Dowel Cementation

Unatoč dosad mnogim provedenim istraživanjima, ne postoji jedinstvena ocjena koji je cement najbolji za cementiranje konfekcijskih kolčića. Svrha rada bila je ispitati i usporediti retenciju konfekcijskih kolčića cementiranih s trima različitim vrstama cemenata: cink-fosfatnim, stakleno-ionomernim i kompomernim. Prikupljeno je 30 zuba i endodontski preparirano do dubine od 7 mm i ISO promjera 140. Podijeljeni su u 3 skupine od 10 uzoraka. S pomoću triju navedenih vrsta cemenata u njih su cementirani kolčići od čelične žice. Pošto se je cement stvrdnuo, izmjerena je vlačna sila potrebna za izvlačenje kolčića iz korijenskoga kanala. Za cink-fosfatni cement iznosila je 175±33,17 N, za stakleno-ionomerni 235,5±46,93 N, a za kompomerni 275,63±96,42 N. Kolčići cementirani kompomerom imaju znatno jaču retenciju od kolčića cementiranih cink-fosfatnim ili stakleno-ionomernim cementom. Stakleno-ionomerni cement mnogo jače retinira od cink-fosfatnoga cementa. Prednosti cink-fosfatnog cementa jesu manja osjetljivost na pogrješke u radu i razmjerna jeftinoća, te još uvijek u mnogim kliničkim okolnostima ostaje cement izbora.In spite of numerous previous studies, there is no final conclusion on which type of cement is the best for dowel cementation. The purpose of this study was to compare the retention of dowels cemented with three different cement types: zinc phosphate, glass-ionomer, and compomere. Thirty teeth were divided into 3 groups, root-canals were prepared to ISO 140, to 7 mm depth and dowels were cemented. After 40 hours the tensile force needed to dislodge the dowels was recorded. For zinc phosphate it was 175±33.17 N, for glass-ionomer 235.5±46.93 N, and for compomere 275.63±96.42 N. The dowels cemented with compomere had significantly higher tensile strength than those cemented with zinc phosphate or glass-ionomer cement. Glass-ionomer cement had significantly higher tensile strength than zinc phosphate cement. The advantages of zinc-phosphate are its low price and simple usage. Thus, in many clinical situations it may be the cement of choice

Application of Tomographic Methods in the Diagnosis of Pathological Changes of the Jaw

The aim of this study was to evaluate the frequency of specific diagnostic methods used for diagnosis of oral pathologies. The sample consisted of 198 patients (98 man and 100 women) with formulated diagnosis, confirmed postoperatively by histopathological verification. In 74.7% of subjects only X-ray diagnostic examination was used. Both X-ray and computed tomography (CT) examinations were used in 18.7% of subjects. Magnetic resonance imaging (MRI) wasn’t performed in any subject. In 6.6% of subjects neither X-ray nor CT was performed. The study reported on statistically significant differences in the distribution of specific diagnostic methods according to age groups (p=0.026). Also, there was statistically significant differences in the distribution of diagnostic methods according to diagnostic groups (p=0.053). In the group of 37 subjects, in whom both X-ray and computed tomography were used, the majority had carcinomas, followed by fractures and inflammatory cysts

Analysis of Impacted and Retained Teeth Operated at Department of Oral Surgery, School of Dental Medicine, Zagreb

The purpose of the present study is to see whether we follow global guidelines for operative procedures and diagnoses for impacted and retained teeth, and to compare these results with older results in Croatia. Operative protocols from Department of Oral Surgery, School of Dental Medicine, Zagreb in the period from 1997 till 1999 were used in the present study. 4756 patients were operated (total of 4857 diagnosis were set). Of all diagnoses, 24.89% (N=1209) belongs to dens impactus, 5.13% (N=249) to dens semiimpactus, 6.05% (N=294) to dens retentus and 0.64% (N=31) to dentitio difficilis. These four diagnoses make 36.71% of all 4857 set diagnoses. Most commonly impacted teeth are: 8– (38.64%), –8 (35.88%), 8+ (10.9%) and +8 (9.29%). Most commonly retained teeth are: 3+ (19.1%) and +3 (18.8%), while in the remaining two diagnoses –8 and 8– are most commonly diagnosed and operated teeth. Impacted teeth are in 97.90% of the cases operated by alveolotomy procedure. With semiimpacted teeth alveolotomy was conducted in 94.12% cases, and 5.10% of such teeth were extracted. With retained teeth alveolotomy was conducted in 65.21%, corticotomy in 23.01% and extraction in 8.77% of the cases. With dentitio difficilis alveolotomy was applied in 46.88%, extraction in 37.50%, circumcision in 9.38% and corticotomy in 6.25% of the cases. Intra muscular corticosteroids (Dexamethason) were used in 2.80% of the cases, most commonly with dens impactus and dens retentus diagnosis. PHD was done in 4.21% cases. Although its use is on the increase, Dexamethason is still rarely used in everyday practice, despite global guidelines for the postoperative use of corticosteroids. PHD analysis is used most commonly with retained teeth since they usually come with follicular cysts. Anesthesia without epinephrine was used in only 1.80% of the operating procedures, because the epinephrine solution used at Oral Surgery Department is 1:160000

Analysis of Impacted and Retained Teeth Operated at Department of Oral Surgery, School of Dental Medicine, Zagreb

The purpose of the present study is to see whether we follow global guidelines for operative procedures and diagnoses for impacted and retained teeth, and to compare these results with older results in Croatia. Operative protocols from Department of Oral Surgery, School of Dental Medicine, Zagreb in the period from 1997 till 1999 were used in the present study. 4756 patients were operated (total of 4857 diagnosis were set). Of all diagnoses, 24.89% (N=1209) belongs to dens impactus, 5.13% (N=249) to dens semiimpactus, 6.05% (N=294) to dens retentus and 0.64% (N=31) to dentitio difficilis. These four diagnoses make 36.71% of all 4857 set diagnoses. Most commonly impacted teeth are: 8– (38.64%), –8 (35.88%), 8+ (10.9%) and +8 (9.29%). Most commonly retained teeth are: 3+ (19.1%) and +3 (18.8%), while in the remaining two diagnoses –8 and 8– are most commonly diagnosed and operated teeth. Impacted teeth are in 97.90% of the cases operated by alveolotomy procedure. With semiimpacted teeth alveolotomy was conducted in 94.12% cases, and 5.10% of such teeth were extracted. With retained teeth alveolotomy was conducted in 65.21%, corticotomy in 23.01% and extraction in 8.77% of the cases. With dentitio difficilis alveolotomy was applied in 46.88%, extraction in 37.50%, circumcision in 9.38% and corticotomy in 6.25% of the cases. Intra muscular corticosteroids (Dexamethason) were used in 2.80% of the cases, most commonly with dens impactus and dens retentus diagnosis. PHD was done in 4.21% cases. Although its use is on the increase, Dexamethason is still rarely used in everyday practice, despite global guidelines for the postoperative use of corticosteroids. PHD analysis is used most commonly with retained teeth since they usually come with follicular cysts. Anesthesia without epinephrine was used in only 1.80% of the operating procedures, because the epinephrine solution used at Oral Surgery Department is 1:160000

Simetrična fibrozna hiperplazija nepca

Bilateral symmetrical fibrous palate hyperplasia is not a common case in the literature. The cause of this pathological change is not completely known. The development of hyperplasia may also be associated with a genetic mutation in the gingival soft tissue or gingival injury. We present a case of a 47-year-old patient who developed a formation that manifested bilaterally in the hard palate. After the excision, there were no histological elements in the material that indicated aggressive behavior of the formation. The clinical and histological diagnosis was the bilateral symmetrical palate hyperplasia, which is a very rare condition.Bilateralna simetrična fibrozna hiperplazija nepca nije često opisana u literaturi. Uzrok te patološke promjene nije u cijelosti poznat. Razvoj hiperplazije može također biti povezan s genetskom mutacijom mekoga tkiva gingive ili njezinom ozljedom. Opisujemo slučaj 47-godišnjeg pacijenta koji je razvio formaciju koja se obostrano očitovala u tvrdom nepcu. Nakon izrezivanja u tkivu nije bilo histoloških elemenata koji bi upućivali na agresivno ponašanje tvorbe. Klinička i histološka dijagnoza formacije t vrlo je rijetka obostrana simetrična hiperplazija nepca