OBJECTIVE:This study aimed to evaluate the structural characteristics of the posterior mandibular alveolar bone in individuals with type 2 diabetes mellitus (T2DM) using cone-beam computed tomography (CBCT) based radiomic analysis. STUDY DESIGN:A total of 98 CBCT scans (49 T2DM, 49 healthy controls) were retrospectively analyzed. A 7 × 7 × 7-mm region of interest (ROI) distal to the mental foramen was segmented using 3D Slicer (version 5.7.0), and radiomic features were extracted via the SlicerRadiomics extension. Interobserver reliability was confirmed by an intraclass correlation coefficient (ICC) of 0.96. Statistical analysis was performed with SPSS version, 28.0, and a logistic regression model was built to evaluate the discriminative power of features (P < .05). RESULTS:Significant radiomic differences were identified between diabetic and healthy groups, including surface area, entropy, maximum, uniformity, contrast (GLCM, NGTDM), and small area emphasis (P < .05). Male subjects exhibited greater mesh volume, sphericity, energy, kurtosis, and uniformity, whereas female subjects showed elevated entropy, maximum, coarseness, contrast, and small area emphasis. Age correlated positively with sphericity (r = 0.217, P = .041) but had no independent impact on the other features. Predictive modeling achieved 61% test accuracy and an area under the curve of 0.66, with shape, first-order, and texture features being the most influential predictors. CONCLUSIONS:CBCT based radiomics revealed distinct structural alterations in the mandibular bone of patients with T2DM. Although predictive performance was moderate, radiomic features demonstrated potential as sensitive imaging biomarkers for early detection and risk stratification of diabetes-related bone changes.
INTRODUCTION:Orofacial granulomatosis (OFG) is a rare inflammatory disorder of the oral and perioral tissues that may occur in isolation or as an early manifestation of Crohn's disease (CD). Its variable presentation often delays recognition of the underlying systemic disease. CASE REPORT:An 8-year-old boy presented with persistent perioral erythema, lip swelling, cobblestone-like gingival changes, and gastrointestinal symptoms, including constipation and perianal discomfort. Initial differential diagnoses included OFG and angioedema. Early lab tests and labial mucosa biopsy were nonspecific, delaying diagnosis. Repeat biopsies of mandibular gingiva and buccal mucosa revealed noncaseating granulomatous inflammation, confirming OFG. Elevated anti-Saccharomyces cerevisiae antibodies (ASCA IgG) prompted endoscopy, which confirmed CD 9 months after initial oral symptom onset. Systemic therapy with infliximab led to rapid and substantial improvement of oral lesions, perioral swelling, and functional impairment. CONCLUSION:This case highlights that OFG can represent an early presentation of CD, emphasizing the need for careful biopsy, longitudinal follow-up, and multidisciplinary evaluation. It also demonstrates the effectiveness of biologic therapy with infliximab in managing severe OFG and preventing long-term orofacial complications.
Sellar spine (SS) is a developmental anomaly of the pituitary fossa resulting in a bony spur projection anteriorly from the dorsum sellae. Etiology remains unclear; however, the most prevalent hypothesis is that it is a remnant of the notochord. SS is a rare entity with a few reported cases exclusively in neuroradiological and neurosurgical literature. It can be asymptomatic in many patients; however, it may cause various endocrinological and ophthalmological symptoms because it impinges on the pituitary gland. The current case report presents an incidental finding of SS in a 12-year-old male whose cone beam computed tomography was taken for dental treatment. Follow-up imaging taken after 3 years revealed an increase in the size of the spine, validating the previous claims that SS will grow over time. This case report presents an early detection of SS in a preadolescent, providing an opportunity for long-term follow-up to evaluate its temporal evolution, and will help establish the clinical profile of these patients. Furthermore, it highlights the role of oral radiologists in the early identification of the SS when viewing cone beam computed tomography.
OBJECTIVE:Oral manifestations and salivary gland involvement in individuals with non-Sjögren sicca (non-SjD) or Sjögren disease (SjD) remain poorly characterized. We assessed the clinical, histopathological, and ultrasonographic features of individuals with non-SjD and compared them with those of patients diagnosed with SjD. STUDY DESIGN:A cross-sectional comparative study was conducted at two Brazilian referral centers. Patients underwent clinical assessment, measurement of unstimulated salivary flow, evaluation of oral dryness, serological testing, minor salivary gland biopsy, and major salivary gland ultrasonography based on OMERACT scoring criteria. SjD classification was determined according to the 2016 ACR/EULAR criteria. Data were analyzed descriptively and analytically. RESULTS:Among the 176 patients included (122 with SjD and 54 with non-SjD), salivary hypofunction (77.5%; P = .002), presence of germinal centers (13.8%; P = .017), and moderate-to-severe inflammation in minor salivary gland biopsies (83.7%; P < .001) were significantly more frequent in the SjD group. OMERACT gray-scale ultrasound scores were also higher in the SjD group. In non-SjD patients, age was associated with nonspecific histological changes, including acinar atrophy, duct dilation, fibrosis, and adipose tissue infiltration. CONCLUSION:Non-SjD and SjD differed primarily in inflammatory severity and ultrasound findings. Age-related glandular degeneration was more pronounced in non-SjD, indicating potentially distinct clinicopathological profiles.
OBJECTIVE:This study aimed to characterize the clinic-radiographic features of patients with simple bone cyst (SBC) of the jaw treated surgically, with a focus on surgical outcomes. STUDY DESIGN:A retrospective analysis was conducted on 72 patients who underwent surgical management for SBC at the West China Hospital of Stomatology, Sichuan University, China. Data collected included demographic, clinical, radiographic, surgical, and follow-up records. RESULTS:Seventy-two patients were included (mean age, 20.54 ± 12.78 years); a modest female predominance was observed (62.5%). Most cases (91.7%) were asymptomatic; all lesions occurred in the mandible, and three cases (4.2%) were bilateral. Lesions were anatomically distributed across the anterior (n = 28), premolar (n = 20), molar (n = 18), and angle-ramus (n = 9) regions. Typical radiographic features included scalloped margins between adjacent tooth roots without root resorption or displacement, as well as cortical bone thinning without jaw expansion or cortical perforation. All patients underwent curettage, and the cavity contents were predominantly hemorrhagic or serous (86.7%). Follow-up imaging demonstrated progressive bone regeneration at the treated sites within 3 to 24 months postoperatively, with no cases of permanent nerve injury or pathologic fracture. CONCLUSION:SBC predominantly affects adolescents and demonstrates characteristic radiographic features; however, surgical intervention remains indispensable for definitive diagnosis. Curettage proved to be an effective therapeutic strategy, resulting in low recurrence rates and favorable postoperative outcomes.
OBJECTIVE:To evaluate the shape distortion of five high-density dental materials across buccal slices (BS), central slices (CS), and lingual slices (LS) reconstructed by the Portray 3D stationary intraoral tomosynthesis (sIOT) device and compare with those observed in periapical radiography (PA). STUDY DESIGN:Cylindrical specimens (5.5 × 5.5 mm) of amalgam, cobalt-chromium alloy, gutta-percha, titanium, and zirconia were fabricated and positioned in a standardized phantom, with their long axis perpendicular to the image receptor. Images were acquired using the sIOT device, producing BS, CS, and LS; PA images were also obtained. Eight equally distributed radii of each cylinder were measured using ImageJ software. Shape distortion was assessed by comparing measured radii across imaging modalities and to actual dimensions. Two one-way repeated-measures ANOVAs with Sidak post-hoc tests (α = 0.05) were used to analyze (1) differences among imaging modalities, and (2) variations among sIOT slices. RESULTS:sIOT showed significant distortion compared to PA across all materials. CS most closely approximated actual dimensions, while BS and LS consistently underestimated radii. PA preserved cylindrical shape, whereas sIOT reconstructions displayed radial nonuniform distortion patterns. CONCLUSION:sIOT slices consistently produced lower mean radius values than PA, indicating a tendency to minify rather than magnify images. Distortion was most pronounced in peripheral slices, reflecting a nonuniform shrinkage effect. These findings underscore sIOT's limitations in preserving the shape of high-density objects.
Objective - To evaluate osteopontin (OPN) expression in oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) and explore its prognostic relevance. Study Design - This cross-sectional study analyzed 120 cases from 2017 to 2022, including OPMD with varying degrees of epithelial dysplasia and OSCC. Immunohistochemical staining for OPN was performed, and clinicopathologic variables such as patient demographics, lesion site and size, clinical presentation, and histopathologic features were evaluated. Statistical analyses were conducted to assess associations between OPN expression and clinicopathologic parameters. Results - Patients ranged from 22-92 years (mean: 59.3), with a slight female predominance (54.2%). The lateral tongue was the most affected site, and leukoplakia was the predominant clinical presentation. Mean lesion size was 15.8 mm, with mean duration of 23.2 months. OPN expression was detected in 68.2% of cases, with high intensity staining in 46.7%. While stronger OPN expression was noted at OSCC invasion fronts, no significant association was found between OPN levels and epithelial dysplasia grade. Conclusions - OPN does not appear to correlate with epithelial dysplasia or malignant transformation in OPMD. However, its overexpression at OSCC invasion fronts compared to adjacent areas suggests a role in early invasion, potentially helping identify initial lesions with more aggressive behavior.
OBJECTIVE:This study investigates the effects of botulinum toxin type A (BoNT-A) injections on mandibular bone morphology in bruxism patients through the use of panoramic radiography. STUDY DESIGN:Sixty patients were assessed and categorized into three groups: bruxism with BoNT-A injection, bruxism without BoNT-A injection, and healthy controls. Morphological classifications (G0-G3), mandibular angle depth (AMD), antegonial notch depth (AND), and cortical thickness (CT) were evaluated at baseline and after a six-month period. RESULTS:The BoNT-A group demonstrated substantial decreases in G2 and G3 categories and enhancements in cortical thickness relative to noninjected and control groups (P < .05). However, no significant alterations were detected in AND values. CONCLUSION:The data indicate that BoNT-A diminishes problematic mandibular bone apposition and facilitates cortical remodeling by decrease excessive occlusal stresses. Panoramic radiographs can function as an effective instrument for both diagnosing bruxism and assessing treatment results.
Dentists are often the first healthcare providers to observe subtle orofacial and behavioral changes that may reflect underlying neurological diseases, including altered salivary flow, dysphagia, oral burning sensations, unusual orofacial movements, or tremors and pain, among others. These are symptoms of conditions such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and other systemic disorders with neurological involvement, which are frequently misattributed to local or functional causes, thereby delaying diagnosis and care. As the frequency of neurodegenerative and neuromuscular conditions rises with aging, the dental setting offers a critical opportunity for early recognition and referral. This clinical review summarizes orofacial manifestations, dental care challenges, and referral strategies across different neurological and systemic diseases. Organized by disease stage and functional impairment, the review provides practical tools for decision-making. Guidance on screening, behavioral adaptation, and care coordination is also provided, including multiple practical tables, figures, and chairside screening tools to support early recognition and referral. Finally, the review advocates for improved training, interdisciplinary collaboration, and progressive integration of artificial intelligence, machine learning, and other emerging technologies (e.g., biosensors, salivary biomarker platforms, or high-density electrophysiologic tools) to support clinicians in recognizing neurological diseases.
OBJECTIVES:This study evaluated the structural validity, internal consistency, and test-retest reliability of a newly developed patient-reported experience measure (PREM) for individuals with painful temporomandibular disorders. This PREM was developed to assess the experience of patients while receiving healthcare. STUDY DESIGN:This study had a cross-sectional design. A total of 139 patients completed the PREM following clinical visits, with 50 repeating it 2 weeks later. Exploratory factor analysis (EFA), Cronbach α coefficient, and interclass correlation coefficient were utilized to assess the structural validity, internal consistency, and test-retest reliability, respectively. RESULTS:EFA identified a 5-factor structure with 21 items. These domains were "emotional support," "respect for patient centred values," "information, communication and education," "access to care," and "coordination of care." The Cronbach α was 0.7285, indicating good internal consistency, and the intraclass correlation coefficient for the total score was 0.732, reflecting good test-retest reliability. CONCLUSIONS:The PREM is a brief tool, which shows potential in assessing patient experiences in facial pain services. It may also support audits and clinical research. Further psychometric validation is recommended.
OBJECTIVES:This study aims to develop an advanced deep learning model that automatically determines third-molar developmental stages in panoramic radiographs using the Demirjian classification, improving the accuracy and objectivity of dental age estimation for forensic and clinical applications. STUDY DESIGN:A total of 888 panoramic radiographs from individuals aged 7 to 30 were annotated by 2 experts based on Demirjian's A-H staging system. The proposed model, MorphMaskFormer, is built upon the classical UNet architecture, incorporating a lightweight transformer attention module inspired by Mask2Former. The model performs both binary (tooth/background) and multi-class (A-H stages) segmentation. Its performance was evaluated using IoU, Dice coefficient, Precision, Recall, and inference time, and compared against UNet, ResUNet, DeepLabV3+, PSPNet, and SegNet. RESULTS:MorphMaskFormer outperformed all baseline models, achieving a Dice score of 0.9461, IoU of 0.8985, and the fastest inference time at 78.59 ms. In multi-class segmentation, it showed high accuracy for stages A, D, and H, with an overall component accuracy of 72.41%. CONCLUSIONS:MorphMaskFormer enables precise pixel-level segmentation of dental developmental stages, reducing inter-observer variability and shortening evaluation time. Its high accuracy and efficiency make it a scalable tool that enhances diagnostic confidence and supports critical clinical and forensic age-estimation decisions.
AIM:This study evaluated whether fractal analysis of periapical radiographs can detect periradicular disease. MATERIALS AND METHODS:Sixty periapical radiographs of mandibular molars were divided into four groups based on the Periapical Index (PAI) (n = 15 per group; scores 1-4). Fractal analysis of periapical and furcation regions was performed using the box-counting method in ImageJ. Multiple region of interest (ROI) sizes were tested (20 × 20, 25 × 25, 30 × 30, 40 × 40, 50 × 50, 60 × 60, 70 × 70, 20 × 50, and 20 × 40 pixels) to determine the best correlation with PAI scores. Statistical analyses included one-way analysis of variance with Tukey's post hoc test, Student t-test, and ROC analysis (p < 0.05). External validation was conducted using 33 additional radiographs. RESULTS:Fractal dimension (FD) values from periapical ROIs (20 × 20, 25 × 25, and 30 × 30) and bifurcation ROIs (20 × 20 and 25 × 25) significantly differed between healthy (PAI 1-2) and diseased (PAI 3-4) teeth (P < .05). ROC analysis supported the diagnostic value of these ROIs, with the highest AUC for the bifurcation 20 × 20 ROI. In the internal dataset, periapical and bifurcation 20 × 20 ROIs achieved the highest accuracies (0.82 and 0.80, respectively), and the bifurcation 20 × 20 ROI showed the greatest sensitivity (0.93). External validation confirmed the robustness of the bifurcation 20 × 20 ROI (accuracy 0.76, sensitivity 0.65, and specificity 0.88). CONCLUSION:Fractal analysis can identify periradicular disease on periapical radiographs. Diagnostic accuracy depends on the analyzed region and ROI size, with the 20 × 20-pixel bifurcation ROI yielding the best performance.
OBJECTIVES:Dental defects were evaluated in high-risk neuroblastoma survivors (HRNBLs) who underwent myeloablative conditioning with 1 of 2 high-dose chemotherapy (HDC) regimens prior to autologous peripheral blood stem cell transplantation (PBSCT), without exposure to total body irradiation. The regimens compared were busulfan/melphalan (BuMel) and carboplatin/etoposide/melphalan (CEM). STUDY DESIGN:Clinical records from 2019-2022 of HRNBL survivors at the Children's Hospital at Westmead were reviewed. Dental defects were assessed using orthopantomograms and quantified using Holtta's defect index (HDI). RESULTS:Thirteen BuMLP and thirteen CEM patients were included. Mean age at HDC was 3.0 ± 1.1 years and mean age at assessment was 11.3 ± 3.2 years. The study population presented with a mean HDI of 45.6 (±18.8). BuMLP presented with a mean HDI of 51.9 (±18.8) compared to CEM with a mean HDI of 39.4 (±17.3), although this was not statistically significant. All subjects demonstrated altered root development (P = .04), while 65.4% (n = 17) presented with microdontia and 69.2% (n = 18) exhibited dental agenesis. CONCLUSION:HRNBLs show a high prevalence of dental defects after HDC. Impacts of BuMLP versus CEM require further investigation.
BACKGROUND:Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, affects multiple systems, including the oral cavity, with ulcers, taste changes, and mucosal lesions. Existing studies are limited in scope, highlighting the need for large-scale studies to clarify the prevalence and clinical relevance of these oral outcomes. MATERIALS AND METHODS:We conducted a retrospective cohort study using the TriNetX Research Network to analyze COVID-19 patients from 2020 to 2025. Queried oral conditions, including ulcers, taste alterations, salivary disturbances, and mucosal lesions. Propensity score matching was used to balance age, sex, and comorbidities. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with significance set at P < .05. RESULTS:Among 4,875,258 adults with COVID-19, the most common oral outcomes were taste alteration (0.588%), aphthous ulcers (0.106%), salivary disturbances (0.053%), and stomatitis (0.025%). Compared with age, sex, and co-morbid matched controls, COVID-19 was associated with a higher risk of taste alteration (OR = 10.11; P < .0001) and herpetic oral lesions (OR = 1.46; P < .0001), while other oral conditions were less frequent. Anti-COVID-19 medication use was associated with a lower incidence of taste alteration (0.14% vs 0.54%; P < .0001) and higher records of aphthous ulcers and herpetic lesions. CONCLUSION:COVID-19 is associated with a significantly increased risk of taste alteration and herpetic oral lesions, while anti-COVID-19 medication use is associated with lower odds of taste alteration.
OBJECTIVE:Although mucoepidermoid carcinoma is one of the most common salivary gland malignancies, its involvement in the jaws is exceedingly rare. This report's purpose is to describe the histologic and demographic features of intraosseous mucoepidermoid carcinoma (IMEC) and to add evidence to support a potential relationship with glandular odontogenic cysts (GOCs). STUDY DESIGN:Cases of patients diagnosed with IMEC were obtained from Oral Pathology Laboratory, Inc, at New York-Presbyterian Queens from 1985 to 2024. Slides and clinical information were reviewed. RESULTS:Fourteen patients with IMEC were identified who had an average age of 58.6 years and a slight female predilection. IMEC was equally present in both jaws. Twelve patients were classified as having low-grade tumors with cystic areas composed of an admixture of epidermoid and mucous cells, 6 cases of which had areas resembling GOCs. Two patients had high-grade tumors demonstrating anaplasia and perineural invasion. One high-grade tumor had areas that resembled a GOC. Four of the 7 presentations of IMEC (6 low-grade and 1 high-grade) with GOC features were from the mandible. CONCLUSIONS:We describe the common and uncommon histopathologic features of IMEC while also demonstrating that GOC-type areas often are seen as a component of these tumors. Therefore, all lesions identified as GOCs should be carefully analyzed to rule out the early development of an IMEC.
OBJECTIVE:This study aimed to identify whether immunonutritional biomarkers as prognostic factors are related to the prognosis of the conservative management of medication-related osteonecrosis of the jaw (MRONJ). STUDY DESIGN:This retrospective observational study investigated the prognostic factors, including the immunonutritional biomarkers, that are associated with the conservative treatment outcomes of patients with MRONJ enrolled from 2010 to 2023. RESULTS:A total of 77 lesions were included, of which 38 (49%) showed complete healing of the MRONJ. On the multivariate logistic regression analysis, hemoglobin (>11.8 g/dL; odds ratio [OR] = 6.77; 95% confidence interval [CI], 1.95-23.50, P = .003), albumin (>4.0 g/dL; OR = 8.43; 95% CI, 2.12-33.60; P = .003), prognostic nutritional index (PNI; >46.6; OR = 6.53; 95% CI, 1.18-23.50; P = .004), and the hemoglobin, albumin, lymphocyte, and platelet (HALP) score (>20.46; OR = 4.77; 95% CI, 1.48-15.40; P = .009) were significantly associated with complete healing of MRONJ. CONCLUSION:The results indicate that immunonutritional biomarkers such as albumin, hemoglobin, PNI, and HALP scores obtained from the laboratory data in daily clinical practice were found to be significantly associated with treatment outcomes of MRONJ.
BACKGROUND:Anti-tumor necrosis factor-alpha (anti-TNF-α) therapies are efficacious in managing immune-mediated inflammatory diseases, however, long-term use has been associated with notable adverse events. As patients use expands, understanding the spectrum of oral adverse events (OAEs) has become essential. MATERIALS AND METHODS:We conducted a retrospective cohort study using the TriNetX research network. A 5‑year observation window identified patients prescribed anti‑TNF-α therapies. Patients with prior oral conditions, concurrent cancer therapies, or antiresorptive exposure were excluded. OAEs were categorized into xerostomia, mucosal disorders, infectious disorders, gingival hyperplasia, medication-related osteonecrosis of the jaw (MRONJ), and oral squamous cell carcinoma (OSCC). Propensity score matching (1:1, age/sex) compared anti‑TNF-α users with unexposed controls. RESULTS:In a cohort of 1,645,751 individuals receiving anti‑TNF‑α therapy, OAEs were frequent, with oral lichenoid lesions (1.27%, 20,135), candidiasis (1.09%, 17,475), xerostomia (0.87%, 14,024), stomatitis (0.68%, 10,904), and oral herpes (0.39%, 6,343) most commonly observed. Less frequent events included MRONJ (0.01%, 173), gingival hyperplasia (0.02%, 285), and OSCC (0.07%, 1,074). Compared with the general population, anti‑TNF‑α therapy significantly increased the odds of most mucosal and infectious conditions (P < .001), though oral lichen planus showed no association. Interestingly, OSCC exhibited an inverse association (OR = 0.75, P < .0001), suggesting a potential protective effect. CONCLUSION:These findings highlight the importance of routine oral health surveillance and robust pharmacovigilance amongst patients on anti‑TNF-α therapies.
Objective This study aims to develop an AI-powered detection system for identifying dental anatomy—specifically tooth numbers and names—using YOLO (You Only Look Once) models to enhance diagnostic efficiency and automation in dentistry Study design An annotated dataset of 724 high-resolution digital intraoral dental photographs (505 for training, 112 for validation, 107 for testing), obtained from Kaggle and Roboflow, was used. Multiple YOLO versions (YOLOv8l, YOLOv9c, YOLOv10l, YOLO11l) were implemented. Model performance was evaluated based on recall, precision, F1 score, and mean Average Precision (mAP@50). Results YOLOv8l achieved the highest F1 score (96.7%) and recall (97.8%). YOLO11l yielded the best precision (96.6%) and highest mAP@50 (98.4%). All models demonstrated strong potential in detecting teeth accurately from high-resolution images. Conclusion YOLO-based models offer an effective solution for automatic detection of dental anatomy. Their integration into telemedicine and digital dentistry platforms can streamline diagnostic workflows, reduce manual workload, and expand access to dental care, particularly in underserved regions.
Background As an update to the 2012 American Dental Association and US Food and Drug Administration “Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure,” this resource provides decision-making guidance on the use of various imaging modalities for general and pediatric dental care practitioners. Types of Studies Reviewed The American Dental Association Council on Scientific Affairs convened an expert panel of 6 members along with an expert consultant group of 18 members to develop evidence-based guidance on dental imaging. A systematic review of the literature was conducted to identify relevant systematic reviews and organizational guidelines addressing 9 clinical questions. The recommendations presented were developed by means of a non-Delphi process (ie, reaching consensus through a structured process). Results Due to limitations in the available evidence, consensus recommendations rather than formal guidelines were developed. A thorough evaluation of the patient history and clinical findings should precede radiographic examinations. Previously obtained images should be reviewed, and all imaging modalities, especially cone-beam computed tomography, should be used judiciously to minimize cumulative radiation exposure to the patient. Conclusions and Practical Implications Clinicians should base imaging decisions on the patient’s medical and dental histories, clinical examination findings, disease risk assessment, and the presence of specific clinical conditions. When used appropriately, radiographic imaging contributes to dental treatment decisions and results in optimal patient care.
