Melkersson-Rosenthal syndrome (MRS) is a rare disease characterized by a triad of clinical signs: painless orofacial edema, recurrent facial paralysis, and fissured tongue. The classic triad appears in only 8% to 45% of cases. Monosymptomatic and oligosymptomatic forms are more frequent. Diagnosis of MRS is based on clinical history and examination findings, although some microscopic examinations may contribute. The objectives of this article are to report a case of MRS in a 63-year-old man and review the literature on the condition, offering comparative analysis of characteristics, behaviors, and therapeutic approaches. The patient described unilateral, painless, recurrent tongue edema, totaling approximately 10 episodes over a 1-year period. At the initial examination, the tongue was edematous and fissured but not swollen. Later images provided by the patient confirmed tongue swelling, and a diagnosis of MRS was established based on the presence of 2 of the 3 clinical signs of the classic triad. The patient received no drug therapy, but he was educated about the nature of the condition, provided with dietary recommendations, and scheduled for regular follow-up examinations. The dentist plays an important role in the diagnostic process for MRS, since the most significant changes occur in the orofacial region. Due to the rarity and diverse clinical presentations of MRS, there are few studies on the topic, and it is difficult to establish standardized treatment protocols. Most patients do not require treatment; when intervention is necessary, it is usually due to edema, which typically responds well to corticosteroid therapy.
The coronoid process plays a key role in mandibular function, but its morphometric characteristics remain underexplored. This cross-sectional study aimed to perform a detailed morphometric analysis of the coronoid process using cone beam computed tomography (CBCT). Coronoid height, condylar height, coronoid thickness, and coronoid-zygomatic distance were mea-sured bilaterally on CBCT images of 194 women and 149 men aged 18 to 86 years. The coronoid-condylar ratio (CCR) was analyzed in terms of the coronoid-condyle index, in which a CCR of 1.07 or less (≤ 1.07) is considered normal; a CCR greater than 1.07 and up to 1.15 (1.07 < CCR ≤ 1.15) is considered suggestive of pathology and should be investigated; and a CCR greater than 1.15 (> 1.15) is considered indicative of coronoid process hyperplasia. Statistical analyses included Student t test, analysis of variance, and Tukey tests for parametric measurements and Mann-Whitney U, Kruskal-Wallis, and Bonferroni tests for nonparametric measurements. A significance level of 5% was adopted. The measurements revealed that the coronoid process height was significantly greater in men than in women, but there were no statistically significant differences between age groups. The greatest condylar heights were observed in men, but the difference from the heights in women was only significant on the right side. Condylar height measurements differed with age; values decreased significantly on both sides beginning at 35 years. The coronoid thickness and coronoid-zygomatic distance were significantly reduced in individuals 35 years and older but did not differ between the sexes. There was a predominance of CCRs ≤ 1.15 on both sides, and CCRs > 1.15 were concentrated in patients aged 54 years or older. This study provides CBCT-based morphometric reference data on the coronoid process, highlighting variations by sex and age that may support diagnosis and improve surgical planning in cases of suspected anatomical alterations.
Molar-incisor hypomineralization (MIH) poses clinical management challenges due to enamel fragility and hypersensitivity, and treatment is often more complicated in pediatric patients, who may show less cooperation. This case series describes a minimally invasive restorative approach with a semidirect occlusal replica technique that uses high-viscosity glass ionomer cement (GIC) to manage MIH-affected molars. Three children, aged 8 to 12 years, who had severe MIH affecting permanent first molars were treated using the semidirect replica technique. The procedures were focused on preserving tissue, minimizing discomfort, and restoring function. Diagnostic impressions were used to fabricate wax-ups, which were then used to produce silicone matrices that would replicate occlusal anatomy. Under conditions of relative isolation, high-viscosity GIC was applied to the molars via the matrices. All patients tolerated the procedures well, and local anesthesia was required in only 1 patient. The restorations showed anatomical accuracy and functional stability. The patients reported immediate relief of hypersensitivity, and no restorative failures or complications were observed at the 6-month follow-up examinations. The semidirect occlusal replica technique with high-viscosity GIC is a clinically feasible and effective method for restoring MIH-affected molars in the mixed dentition period, reducing chair time, delivering functional recovery, and ensuring patient comfort.
Congenital granular cell epulis (CGCE), also known as newborn epulis and Neumann tumor, is a rare benign tumor characterized by neoplastic connective tissue proliferation. It typically occurs as a single mass in the maxillary anterior region of the alveolar ridge and seems to have a predilection for females. This case report describes a minimal intervention approach to CGCE that focused on the biopsychosocial well-being of the infant and family. Clinical examination of a 3-month-old male infant with gingival swelling that had been present since birth revealed a reddish, multilobulated, sessile lesion on the anteroinferior alveolar ridge. The lesion had a smooth surface, regular contours, and a gingiva-like consistency. No other symptoms or systemic comorbidities were reported, and the infant's respiratory and feeding functions were unaffected. A conservative management approach with clinical monitoring was chosen. At 6 months, partial resolution was noted, and by 9 months, the lesion had completely resolved, coinciding with the eruption of the mandibular incisors. Although CGCE commonly stabilizes postnatally, surgical excision is frequently performed, especially when it affects respiration or feeding. This case demonstrates an uncommon mandibular CGCE in a male patient and highlights the effectiveness of minimal intervention. The resolution observed after 9 months supports the potential success of conservative management, reducing financial, psychosocial, and risk impacts on the family while ensuring the infant's well-being.
Oligodontia is an uncommon developmental anomaly characterized by the congenital absence of 6 or more permanent teeth. It can significantly affect esthetics, function, and psychosocial well-being, especially in growing children. During growth, interim prosthetic options help restore appearance and function until definitive rehabilitation is possible. A 13-year-old girl who was congenitally missing multiple permanent teeth demonstrated no associated systemic or syndromic features. Clinical and radiographic findings confirmed nonsyndromic oligodontia affecting both arches. The mandibular anterior segment was missing 5 teeth. To address the patient's esthetic concerns and maintain space for future restorations, an interim removable clear retainer (Essix appliance) incorporating acrylic prosthetic teeth was fabricated. The acrylic segment was designed on a working cast and incorporated into a vacuum-formed thermoplastic retainer. The appliance provided immediate esthetic improvement, comfortable function, and satisfactory retention. Follow-up examinations 24 hours, 1 week, and 1 month after treatment revealed excellent tissue adaptation and patient acceptance. Removable clear retainers with prosthetic teeth offer a conservative, esthetically pleasing, and well-tolerated interim option for young patients with oligodontia. They maintain space, support function, and provide psychosocial benefits during the growth years while preserving the possibility for future definitive restorative options.
The clinical significance of an anatomical structure called the canalis sinuosus, which carries the anterior superior alveolar nerve, is evident in studies highlighting its potential to mimic a root lesion, leading to the possibility of inappropriate endodontic treatments, as well as the possibility of damage to undetected nerve branches during dental implant placement and even postsurgical paresthesia. When a radiographic examination was conducted prior to surgical extraction of impacted third molars in a 23-year-old woman, panoramic radiography showed a radiolucent image resembling resorption at the middle root third of the maxillary left lateral incisor. Following pulpal sensitivity tests, additional radiography, and cone beam computed tomography, it was determined that the radiolucency was a canalis sinuosus masquerading as an inflammatory root lesion. This case underscores the critical importance of anatomical knowledge during diagnosis, as familiarity helps to prevent errors in radiographic interpretation and avoid inappropriate treatment.
The aim of this study was to investigate the associations between socioeconomic factors; gestational factors; and knowledge, attitudes, and practices related to maternal and child oral health (MCOH) and the presence of periodontal disease and caries in women with high-risk pregnancies. A total of 135 women (mean [SD] age: 27.4 [6.7] years) with high-risk pregnancies were interviewed regarding their knowledge about MCOH in 2 domains: oral health and breastfeeding. The variables collected included education level, oral hygiene practices, diet, frequency of dental visits, and fear that dental treatment might harm the baby. Multiple regression models were applied (P < 0.05). In general, study participants had more than 9 years of schooling (57.8%), visited the dentist at least once a year (68.9%), consumed sweets up to 3 times a day (54.8%), were not afraid that dental treatment might pose a risk to the baby (77.8%), and had periodontal disease (79.0%). The mean (SD) number of decayed, missing, and filled teeth in 113 participants who underwent caries examinations was 8.50 (5.38). Women with lower levels of education had more decayed teeth (P = 0.017). Among 81 women who underwent periodontal examinations, those who visited the dentist at least 3 times a year had significantly higher probing depths and clinical attachment loss (P < 0.05). The mean (SD) total knowledge score was 1.87 (2.09), comprising 0.84 (1.55) in the oral hygiene domain and 1.03 (1.20) in the breastfeeding domain. Pregnant women who were older than 27 years (P = 0.004) and those who received oral hygiene instructions (P = 0.028) had higher total knowledge scores. Knowledge of oral hygiene was not associated with periodontal disease (P = 0.855) or caries (P = 0.838). Participants had low levels of knowledge about MCOH, but the oral hygiene knowledge score was not associated with periodontitis or caries.
Since the inception of pickleball in 1965, approximately 19% of the US population has engaged in the sport. Although pickleball was initially intended as a safe activity for children, the vast majority of players are older adults. Within the last 5 years, there has been a conspicuous surge in pickleball-related injuries. The objective of this review is to explore the literature on head and neck injuries associated with pickleball. In studies published from 2018 through October 2025, the reported incidence of head and neck injuries arising from participation in pickleball activities ranged from 2.6% to nearly 20%, mainly involving trauma to the face and eyes. Severe injuries to the head included concussion, affecting 15% of children and 0.5% of adult players, with isolated cases of nasal, orbital, skull, and mandibular fractures. Five pickleball-related deaths were also recorded. With the increasing number of individuals playing pickleball, it remains likely that oral healthcare providers will assess patients with sports-related head and neck injuries and possible traumatic brain injury. To reduce the incidence of injury to the head and neck, clinicians should recommend the use of assorted protective equipment, particularly eyewear, a mouthguard, and a helmet.
Developmental defects of enamel (DDEs) are clinical conditions that affect the mineral structure and integrity of dental enamel, leading to adverse effects such as dentinal hypersensitivity and significant esthetic impairment. Amelogenesis imperfecta, fluorosis, molar-incisor hypomineralization, and hypoplasia are all considered DDEs. In addition to having various etiologies that may influence the choice of treatment, DDEs also require personalized treatment plans based on the depth and color of the lesion. Studies on DDEs have explored minimally invasive dentistry techniques that preserve as much dental structure as possible and provide a satisfactory esthetic resolution for the patient. The objective of this literature review is to share information about minimally invasive strategies for the diagnosis and treatment of DDEs.
Marginal gingival leukoplakia, often referred to as ring around the collar leukoplakia, appears to have unique features compared with other leukoplakias, including higher rates of recurrence and malignant transformation. However, this type remains poorly described in the scientific literature. Therefore, this systematic review aimed to describe the clinicopathologic characteristics and treatment outcomes of marginal gingival leukoplakia. This review, which followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, included searches in major databases and the gray literature. The methodologic quality (risk of bias) of each included study was assessed with the appropriate JBI (Joanna Briggs Institute) checklist. The search identified 17 studies matching the inclusion criteria. The studies included in the analyses comprised a total of 66 patients (39 women and 27 men) with a mean age of 60 years. Lesions were predominantly homogenous (30.3%) and often involved adjacent teeth (66.7%). Proliferative verrucous leukoplakia was diagnosed in 33.3% of the patients. Treatments included scalpel excision (74.2%) and laser excision (15.1%), with recurrence in 45.4% of cases and malignant transformation in 24.2%. Histopathologically, hyperkeratosis was the most common feature (48.1%), and mild epithelial dysplasia was present in 21.2% of lesions. Marginal gingival leukoplakia is relatively uncommon and might belong to the proliferative verrucous leukoplakia spectrum. High recurrence rates and a considerable risk of malignant transformation highlight the need for individualized treatment plans. Further research is necessary to improve the understanding and management of this condition. PROSPERO registration: CRD42023440004.
Bartter syndrome is a renal disease with repercussions on the masticatory system, such as modification of the oral microbiota due to persistent emesis. The present case report describes the oral rehabilitation of a patient who had Bartter syndrome, cerebral palsy, diabetes, and significant oral limitations, including restricted mouth opening (less than 3 cm), xerostomia, loss of vertical dimension, and communication difficulties. In addition, there was an esthetic concern about the absence of the maxillary anterior teeth, which were lost during intubation for a surgical procedure. The patient received endodontic treatment and a removable prosthesis with an attachment system in the maxillary arch and an indirect acrylic resin overlay in the mandibular arch. Oral rehabilitation with a maxillary removable prosthesis was a viable, more affordable alternative to fixed crowns for this patient, improving her masticatory function and esthetics, minimizing the consequences of her systemic conditions, and enhancing her quality of life.
This study evaluated and compared the perceptions of general dentists, pediatric dentists, and orthodontists regarding the need for transverse maxillary expansion for Class I malocclusions with posterior crossbite. An electronic survey consisting of digitally manipulated intraoral images depicting 8 clinical scenarios was distributed to 10,000 general dentists, 8734 pediatric dentists, and 2400 orthodontists. A total of 566 practitioners responded (2.7% response rate): 85 general dentists, 339 pediatric dentists, and 142 orthodontists. For each case, participants assessed the need for expansion, type of expansion, and referral preferences. Statistical analyses included chi-square tests and multivariable logistic regression, which were adjusted for specialty, years of experience, and geographic region. Significant differences in perception were observed in 6 of the 8 cases (P < 0.05), primarily influenced by specialty training. Orthodontists demonstrated significantly higher odds of recommending expansion than general dentists, particularly in more complex presentations. Pediatric dentists more frequently opted for referral rather than treatment. Neither years of practice nor geographic region significantly influenced diagnostic decisions. Survey reliability demonstrated moderate to substantial agreement across repeated cases (κ = 0.424 to 0.677), and power analysis indicated sufficient sample size and effect sizes for most scenarios. These findings suggest that specialty training strongly influences the perceived need for transverse maxillary expansion, highlighting a potential need for enhanced orthodontic diagnostic education in dental and pediatric residency programs to promote consistency in the diagnosis and management of transverse discrepancies across dental specialties.
This study examined the demographics, practice characteristics, service mix, and barriers faced by general and pediatric dentists in the provision of orthodontic care to the pediatric population, including children enrolled in Medicaid programs. A 31-item questionnaire was developed and distributed by email to 567 members of the Academy of Gp Orthodontics and the American Orthodontic Society. Analyses included descriptive and inferential statistical methods: chi-square, Kruskal-Wallis, and Student t tests; analysis of variance; and Spearman correlation. A value of (P < 0.05) was considered statistically significant. Thirty-four practitioners (6.0%), the majority male (58.8%), completed the survey. The mean (SD) age of respondents was 53.3 (11.8) years, and on average they had been practicing 23.3 (12.9) years. Respondents primarily practiced in suburban areas (47.1%), and most identified as general dentists (85.3%). Only 23.5% reported providing orthodontic services to children enrolled in Medicaid. The most common reasons for not participating in the program included low reimbursement rates, difficulty with billing, and patient noncompliance. Although time dedicated to orthodontic services varied, the majority (55.9%) allocated 10% to 25% of their practice time to such treatments. Most respondents (79.4%) referred cases to orthodontists, mainly Class III malocclusions (30.6%) and open bites (23.6%). General and pediatric dentists increase access to orthodontic services by evaluating patients, rendering care, and, when appropriate, referring patients to specialists. Respondents to this survey reported multiple barriers to providing orthodontic care, particularly for the Medicaid population. These findings underscore the need for reforms to address financial and administrative barriers to orthodontic care, particularly for underserved populations.
Patients with a midline diastema smaller than 2 mm are often treated with orthodontic elastics applied on composite resin esthetic buttons bonded to incisors or incorporated in clear removable trays. However, these methods of applying elastics for diastema closure have shortcomings, including the additional clinical steps of etching the facial tooth surface and bonding for composite resin buttons; occlusal derangement and dependence on patient compliance for trays; and compromised esthetics for both treatment approaches. This article presents an alternative technique that overcomes the limitations of those methods by applying orthodontic elastics directly on the central incisors without the use of esthetic buttons or removable trays. The technique can lead to tipping of the incisors and therefore is restricted to treatment of diastemas up to 2 mm. The technique is straightforward to perform with readily available materials and can be performed by a general dentist. Once the desired space closure is achieved, the corrected position of the incisors can be retained with a resin-bonded splint to counter labial tipping movement and aid in root alignment. In some cases, esthetic restorations such as laminate veneers are indicated to close the redistributed interdental spaces, and the contact areas of the restorations could serve as a form of retention.
