Epithelioid Haemangioendothelioma of the mandibular gingiva:case report and literature review

Introduction:Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that exhibits the potential for recurrence and metastasis but rarely involves the oral cavity.Presentation Of Case:We report the management and long term follow up of recurrent EHE in a 23- year-old woman. The lesion initially presented as a small area of erythematous gingival swelling with localised bone loss around the lower anterior teeth. It was treated by buccal and lingual stripping of the gingival tissues. The patient suffered local recurrence after 7 years and was treated with a wider surgical excision of the buccal and lingual gingivae, conserving the adjacent teeth and bone with an excellent cosmetic outcome. Over 21 years later, there have been no further recurrences.Discussion:This case highlights the management challenges of EHE and is the only case in the literature to have reported a case of mandibular gingivae with a long review period of 21 years.Conclusion:Oral EHE is an unpredictable lesion with a relatively benign course, unlike non-oral EHE where up to one third of cases may metastasise. Because of the propensity to recur locally after excision and curettage, a wide local excision with close clinical follow has been suggested in the literature as the treatment of choice for oral lesions. However, the lack of metastases from oral lesions, the small size, mandibular site and bland histology in this case suggests that a limited soft tissue excision and bone curettage, with long term follow-up would be appropriate for similar gingival lesions in future

Challenges in X-ray diagnosis: a review of referrals for specialist opinion

The aim of this study was to determine the common reasons why a dental professional might request a second opinion on a dental radiograph from a Dental and Maxillofacial (DMF) radiologist. The study was a retrospective analysis of consecutive referrals for an opinion received by post or email by one DMF radiologist based in a UK dental hospital. The study period was from March 2009 to November 2015. Referrals came from a mixture of sources: Mainly from general dental practitioners and specialists working in primary care, but with some referrals from hospital-based practitioners. An enormous range in diagnoses were made by the DMF radiologist, but the ten most frequent diagnostic categories contributed 57.5% of the total. Normal anatomy and anatomical variations in normal anatomy made up the largest category. Common dental disease was often diagnosed, but idiopathic osteosclerosis and maxillary antrum pathosis were both frequent reasons for seeking a second opinion. This service evaluation may assist in developing curricula for undergraduates and in designing continuing education courses. It also highlights a service that may avoid unnecessary referrals to hospital specialists but which currently is not commissioned by the NHS.</p

Interference of partial visual analysis of root filling quality and apical status on retreatment decisions

OBJECTIVE: The presence of periapical radiolucency has been used as a criterion for endodontic treatment failure. However, in addition to the inherent limitations of radiographic examinations, radiographic interpretations are extremely subjective. Thus, this study investigated the effect of partial analysis of root filling quality and periapical status on retreatment decisions by general dentists. MATERIAL AND METHODS: Twelve digitalized periapical radiographs were analyzed by 10 observers. The study was conducted at three time points at 1-week intervals. Radiographs edited with the Adobe Photoshop CS4 software were analyzed at three time points: first, only root filling quality was analyzed; second, only the periapical areas of the teeth under study were visualized; finally, observers analyzed the unedited radiographic image. Spearman's coefficient was used to analyze the correlations between the scores assigned when the periapical area was not visible and when the unedited radiograph was analyzed, as well as between the scores assigned when root fillings where not visible and when the unedited radiograph was analyzed. Sensitivity, specificity, positive and negative predictive values between partial images and unedited radiographs were also used to analyze retreatment decisions. The level of significance was set at 5%. RESULTS: The visualization of the root filling on the unedited radiograph affected the interpretation of the periapical status and the technical quality of the fillings has a greater influence on the general dentist's decision to prescribe endodontic retreatment than the periapical condition. CONCLUSION: In order to make endodontic diagnosis, radiographic interpretation process should not only emphasize technical aspects, but also consider biological factors

Surfing the spectrum - what is on the horizon?

Diagnostic imaging techniques have evolved with technological advancements - but how far? The objective of this article was to explore the electromagnetic spectrum to find imaging techniques which may deliver diagnostic information of equal, or improved, standing to conventional radiographs and to explore any developments within radiography which may yield improved diagnostic data. A comprehensive literature search was performed using Medline, Web of Knowledge, Science Direct and PubMed Databases. Boolean Operators were used and key-terms included (not exclusively): terahertz, X-ray, ultraviolet, visible, infra-red, magnetic resonance, dental, diagnostic, caries and periodontal. Radiographic techniques are primarily used for diagnostic imaging in dentistry, and continued developments in X-ray imaging include: phase contrast, darkfield and spectral imaging. Other modalities have potential application, for example, terahertz, laser doppler and optical techniques, but require further development. In particular, infra-red imaging has regenerated interest with caries detection in vitro, due to improved quality and accessibility of cameras. Non-ionising imaging techniques, for example, infra-red, are becoming more commensurate with traditional radiographic techniques for caries detection. Nevertheless, X-rays continue to be the leading diagnostic image for dentists, with improved diagnostic potential for lower radiation dose becoming a reality

Discourse and Regulation Failures: The Ambivalent Influence of NGOs on Political Organizations

In the last decades, NGOs have become an important participant in the work of political organizations (e.g., national authorities, the EU or the UN). This development brings many opportunities and also some challenges, including discourse failure which is one of the topics discussed in this paper. We present a case study that illustrates the interdependence of discourse failure and regulations failure. We conclude that discourse failure is frequently not merely an accidental by-product, but rather, a non-intended consequence of deliberate NGOs’ campaigns. We make particular note of probable discourse failure when campaigns attempt to deal with complex issues in an environment rife with wide-spread prejudices and where the NGO’s work is transparent. In this situation, regulation failure may be consequent upon discourse failure. We present collectively binding commitments for NGOs and binding services enforced by political organizations to prevent discourse failure. In conclusion, we argue that the field of political economy can benefit from this challenging environment if it systematically researches the interdependencies between discourses and regulations.In den letzten Jahrzehnten kamen NGOs als wichtige Akteure im politischen Regelsetzungsprozess hinzu (z. B. in der EU, der UN und auch auf den nationalen Ebenen). Aus dieser Entwicklung ergeben sich für die Zivilgesellschaft vielfältige Chancen, allerdings auch einige Herausforderungen. Zu den Herausforderungen zählt unter anderem Diskursversagen, woraus häufig Regulierungsversagen resultiert. Der Beitrag präsentiert eine Fallstudie, die das Zusammenspiel aus Diskurs- und Regulierungsversagen aufzeigt. Das Beispiel illustriert, dass Diskursversagen nicht nur ein zufälliger Nebeneffekt von öffentlichen Diskursen ist, sondern eine nicht-intendierte Folge zielgerichteter Kampagnen von NGOs sein kann. Insbesondere Kampagnen, die sich mit komplexen Themen auseinandersetzen, über die es in der Öffentlichkeit weitverbreitete Vorurteile gibt, neigen zu Diskursversagen. Durch transparente Kampagnen seitens der NGOs wird dies sogar begünstigt. Zur Überwindung dieser Defizite stellt der Beitrag verschiedene Bindungsmechanismen für NGOs und Bindungsservices durch Behörden und Politik vor. Abschließend zeigt der Beitrag auf, dass die Politische Ökonomik davon profitieren kann, wenn sie systematisch das Zusammenspiel zwischen Diskurs und Regulierung erforscht