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INTRODUCTION There is a wide variation in the knowledge related to oral radiology. This study aims to assess the prior knowledge of radiology among freshman dental students prior to beginning any formal dental school instruction. MATERIALS AND METHODS 139 newly matriculated freshman dental students were asked to complete a seven-question radiology take home survey regarding their prior knowledge. The questionnaire was built within their course site and was presented prior to beginning the radiology lectures. RESULTS The responses were varied for all seven questions based on previous experiences and existing knowledge. Significant variation was noted in responses to Q4, Q6, and Q7 as opposed to Qs 1-3 and 5. Many students believed that the acquisition of radiographs should be selective. The acquisition of radiographs in pregnant women yielded comments in line with the belief that dose and frequency of radiation exposure would impact the health of the pregnant woman and developing fetus. Additionally, many students agreed with the statement regarding orthodontists over-radiating children as reported in the New York Times. Perceptions based on social media and news outlets needs to be addressed and changed in a dental school setting based on evidence. CONCLUSION Dental school instruction must use the cues from surveys similar to that used in this research and structure their instruction to increase the critical teaching of radiology. The eventual goal of such an instruction would be to have a scientifically accurate information and remove the perceptions that the students came with when they began their dental education.

In the context of the COVID-19 pandemic, vaccination-induced behavioral complacency in adherence to COVID-19 appropriate behavior emerged as a significant concern. This study was conducted among a convenience sample of 540 oral health care professionals in India and the United States. This was a retrospective pretest-post-test design, a choice to eliminate response-shift bias, where the participants responded online on their adherence or otherwise to COVID-19 precautionary measures before and after vaccination. The difference between post-test and retrospective pretest scores was used in assessing the magnitude of complacency demonstrated by the individual as a function of getting vaccinated, and the process was validated using exploratory factor analysis (EFA) with principal axis factoring and confirmatory factor analysis (CFA) on two randomly split subsets of the overall sample. It was observed that there had been a decline in the adherence to all the considered COVID-19 precautionary measures from the time before vaccination to the time of achievement of the fully vaccinated status. EFA performed on the randomly split sub sample of 240 subjects returned a two factor solution with five items in factor 1 and seven items in factor 2. Items in both the factors demonstrated adequate internal consistency in reliability analysis (Cronbach's alpha 0.84 and 0.82, respectively). The two factor solution obtained in EFA demonstrated good model fit in CFA [RMSEA (90%CI) - 0.077 (0.063-0.092); TLI - 0.872; CFI - 0.897; SRMR - 0.056]. These results highlight the vaccination-induced complacency in observing COVID-19 appropriate behavior among oral health professionals in India and the United States.

Dental caries is a dynamic, preventable, reversible, complex biofilm-mediated, multifactorial disease that involves a series of demineralization/neutrality/remineralization of dental hard tissue in primary and permanent dentition. An imbalance in the continuum with a net demineralization over time results in the initiation of caries lesions. Visual inspection and intraoral radiographs are vital in caries detection, although they are of suboptimal sensitivity for early caries lesions. Shifting toward a conservative, noninvasive approach to caries management has resulted in the development of innovative-sensitive technologies. These newer techniques may serve as adjunct for the dental practitioner in detecting earliest changes in tooth structure.

This article aims to help the practitioner identify structures found in routine three-dimensional imaging studies of the head and neck region and understand their significance and possible need for intervention. The prevalence of advanced imaging in dental practice, especially cone beam computed tomography, highlights the need to recognize and identify various high-density structures that are, in fact, soft tissue calcifications or alterations of normal bony anatomy. The wide range of these findings includes both benign and malignant pathologic entities as well as age-related calcifications and remodeling of normal anatomic structures and dystrophic calcifications.

Imaging in orthodontics has evolved from cephalometric and extraoral films, manual cephalometric tracings, to digital imaging and intraoral scanners. Software-assisted cephalometric tracings and three-dimensional image analysis have become routine in orthodontic diagnosis and treatment planning. Determination of biologic boundaries of orthodontic treatment and evaluation of temporomandibular joints and airway became part of orthodontic assessment. Use of advanced imaging and software to digitally plan the orthognathic surgery and accurately predict a successful outcome are now integral to orthodontic practice. This article discusses radiographic methods used in cephalometric analysis and craniofacial growth and development for a predictable orthodontic assessment and treatment planning.

The objective of this systematic review was to evaluate the risks of medication-related osteonecrosis of the jaw (MRONJ) in fibrous dysplasia (FD) and McCune-Albright syndrome (MAS) patients treated with bisphosphonates.A systematic review of the literature was performed by searching PubMed and Embase databases using MeSH terms (fibrous dysplasia of bone, "fibrous dysplasia, polyostotic," osteonecrosis, jaw, therapeutics, diphosphonates, denosumab, teriparatide, estrogens, hormones, raloxifene hydrochloride, calcitonin, cathepsin K) and non-MeSH terms (antiresorptive therapy, antiresorptives, bisphosphonate, estrogen therapy, hormone therapy, bazedoxifene, cathepsin K inhibitor). Articl es were limited to human studies, in English language, in which patients were on antiresorptives for at least 1 year. PRISMA statement guidelines were used to eliminate non-relevant studies. The PICOT question asked was, "Does exposure to bisphosphonates and other antiresorptives cause occurrence of MRONJ in fibrous dysplasia and fibrous dysplasia/McCune-Albright syndrome patients followed up for at least 1 year?"Eight eligible articles were included in the quantitative synthesis after articles were screened using a PRISMA flowchart. There were 12 reported occurrences of MRONJ among a combined total of 312 fibrous dysplasia and fibrous dysplasia/McCune-Albright syndrome patients (3.85%).Patients with fibrous dysplasia or fibrous dysplasia/McCune-Albright syndrome have a low incidence of MRONJ and may apparently have low susceptibility to spontaneous development of MRONJ.

PURPOSE To evaluate and distinguish if an additional year of clinical experience increases the cognitive ability of dental students to accurately assess and interpret dental radiographs. METHODS Radiological acuity was assessed between two groups of clinical dental students at Penn Dental Medicine (PDM). Group 1 was composed of 147 third-year dental students (D3), group 2 was composed of 145 fourth-year dental students (D4). A 65-question test comprising the length and breadth of radiographic anatomy and pathology was administered to both D3 and D4 students. The test was designed to test the participants' knowledge of radiographic technique, anatomy, and differential diagnosis. The null hypothesis was that there would be no significant differences between the two groups. RESULTS STATA 15 software (StataCorp LLC, College Station, TX, USA) was used to statistically analyze the findings. Although, the mean correct score for group 1 was higher (60/65) than group 2 (59/65), there was no statistically significant difference between the performance of the groups. On average, group 1 outperformed the clinically more experienced group 2 on an individual question basis. The average overall number of correctly answered items compared to incorrectly answered items reflected this difference. CONCLUSION(S) An additional year of clinical dental education does not appear to correlate with any higher radiographic acumen. This may be due to tapering exposure to unique pathology and findings, as more routine findings are encountered daily and classroom instruction during the fourth year of dental school is limited. Early incorporation of new radiographic education tools that are clinically oriented may be one method to increase retention of knowledge accumulated in the initial didactic years of dental education.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the current coronavirus disease 2019 (COVID-19) pandemic, is not only highly infectious but can induce serious outcomes in vulnerable individuals including dental patients and dental health care personnel (DHCPs). Responses to COVID-19 have been published by the Centers for Disease Control and Prevention and the American Dental Association, but a more specific response is required for the safe practice of oral and maxillofacial radiology. We aim to review the current knowledge of how the disease threatens patients and DHCPs and how to determine which patients are likely to be SARS-CoV-2 infected; consider how the use of personal protective equipment and infection control measures based on current best practices and science can reduce the risk of disease transmission during radiologic procedures; and examine how intraoral radiography, with its potentially greater risk of spreading the disease, might be replaced by extraoral radiographic techniques for certain diagnostic tasks. This is complemented by a flowchart that can be displayed in all dental offices.

Clinicians should be knowledgeable about the anatomy of the oral cavity and variations of normal because of oral and systemic health connections. This article presents an overview of normal and variations of normal anatomy of the oral cavity.

To describe and report on the use of virtual clinical competency examinations (VCCEs) for D3 dental students in a radiology clinic during the C OVID-19 pandemic and relate the technology to other clinical and educational applications.Paper-based clinical competency examinations (CCEs) were converted to three different VCCEs to closely replicate the CCEs. Existing grading rubrics were used to assess students' abilities to evaluate technical issues and interpret intraoral full-mouth series and panoramic radiographs. The grading rubrics were modified from their clinical versions to eliminate non-reproducible skills, such as patient management and application of selection criteria. Radiographs were selected from clinic records and anonymized. VCCEs were conducted via WebEx conferences that were scheduled via an appointment app. These experiences can be extended to virtual patient contacts, teleradiology, and telemedicine, as well as continuing dental education experiences.Approximately 200 VCCEs were administered by four oral and maxillofacial radiology faculty over a 10-week period. Both students and faculty managed the technology well, with few missed appointments. All students were successful in challenging the examinations and appeared to be satisfied with the experience.Although direct comparisons between the CCEs and the new VCCEs are difficult, as there was no time to pilot the VCCEs, students were successful in challenging the examinations and informally reported satisfaction with the experience. Although components of CCEs that could not be replicated on the VCEs could not be assessed, it is felt that the students had adequate experience in selection of radiographs and patient management prior to the COVID-19 lockdown. Additional benefits of the VCCEs included contact with students to check on their well-being. The experience indicates that VCCEs can be used in the future in hybrid models of oralmaxillofacial radiology education, clinical care, patient screening, and telemedicine. Moreover, the success of this demonstration points to potential for personalized distance learning in continuing dental education.

Current experimental and clinical data are inadequate to conclusively predict the oncogenicity of uncommon BRAF mutants and their sensitivity towards kinase inhibitors. Therefore, the present study aims at estimating sensitivity profiles of uncommon lung cancer specific BRAF mutations towards clinically approved as well as experimental therapeutics based on computationally derived direct binding energies. Based on the data derived from cBioportal, BRAF mutants displayed significant mutual exclusivity with KRAS and EGFR mutants indicating them as potential drivers in lung cancer. Predicted sensitivity of BRAF-V600E conformed to published experimental and clinical data thus validating the usefulness of computational approach. The BRAF-V600K displayed higher sensitivity to most inhibitors as compared to that of the BRAF-V600E. All the uncommon mutants displayed higher sensitivity than both the wild type and BRAF-V600E towards PLX 8394 and LSN3074753. While V600K, G469R and N581S displayed favorable sensitivity profiles to most inhibitors, V600L/M, G466A/E/V and G469A/V displayed resistance profiles to a variable degree. Notably, molecular dynamic (MD) simulation revealed that increased number of interactions caused enhanced sensitivity of G469R and N581S towards sorafenib. RAF kinase inhibitors were further classified into two groups as per their selectivity (Group I: BRAF-V600E-selective and Group II: CRAF-selective) based on which potential mutation-wise combinations of RAF kinase inhibitors were proposed to overcome resistance. Based on computational inhibitor sensitivity profiles, appropriate treatment strategies may be devised to prevent or overcome secondary drug resistance in lung cancer patients with uncommon mutations.

Exposure to adversity can accelerate biological aging. However, existing biomarkers of early aging are either costly and difficult to collect, like epigenetic signatures, or cannot be detected until late childhood, like pubertal onset. We evaluated the hypothesis that early adversity is associated with earlier molar eruption, an easily assessed measure that has been used to track the length of childhood across primates. In a preregistered analysis ( n = 117, ages 4 to 7 y), we demonstrate that lower family income and exposure to adverse childhood experiences (ACEs) are significantly associated with earlier eruption of the first permanent molars, as rated in T2-weighted magnetic resonance images (MRI). We replicate relationships between income and molar eruption in a population-representative dataset (National Health and Nutrition Examination Survey; n = 1,973). These findings suggest that the impact of stress on the pace of biological development is evident in early childhood, and detectable in the timing of molar eruption.

Radiographic imaging is an integral part of the diagnostic process in clinical dentistry. This article provides the fundamentals of radiographic interpretation beginning with evidence-based guidelines on dental radiographic selection criteria and cone beam computed tomography use. The goal is to present to the reader with a systematic approach to radiographic interpretation such that no significant features are overlooked and an optimal differential diagnosis can be achieved. In addition, medicolegal considerations of radiographic acquisition, interpretation, and storage are discussed.

Radiographic changes of the oral and maxillofacial hard tissues can be an indication of an underlying systemic disease. In this article, the range of individual disease entities that have both systemic and dental manifestations are reviewed. Images for many conditions are provided to illustrate the radiographic changes. A summary of the most common jaw affected, radiographic and pathognomonic findings, and management aspects is listed in a table format within this article for quick reference.

The purpose of this article is to synthesize different technologies that are available for the creation of a virtual patient, "the digital clone" because the data can be used for diagnosis as well as treatment planning. The role of facial scans, 3-dimensional intraoral scans as well as the cone beam computed tomography in the creation of a digital clone is discussed in detail. A step-by-step guide is created for the reader for integration of the intraoral scan data with the cone beam computed tomography Dicom data to create a digital clone.

Oral medicine practice includes the diagnosis and nonsurgical treatment of oral and orofacial diseases and oral manifestations of systemic conditions. Oral medicine specialists in medical and dental settings often require imaging in assessment and treatment of these conditions. This article reviews imaging that may be used in practice, particularly as relevant for facial pain, bone conditions, and salivary gland disease. It reviews imaging that may be considered in a hospital setting for assessment of admitted patients, patient evaluation before surgical procedures, and provision of dentistry in a hospital setting for patients who cannot submit to treatment in an outpatient setting.

Raloxifene is a selective estrogen receptor modulator (SERM) that is used to manage osteoporosis in women. Because of its tissue selectivity, raloxifene has fewer side effects than estrogen therapy; however, raloxifene-associated osteonecrosis of the jaw (ONJ) has recently been reported. While most of the reported cases were treated with antiresorptive therapy in addition to raloxifene, ONJ can also occur with the isolated use of raloxifene. This report presents a case where there was no prior exposure to bisphosphonates, in which the patient incidentally had florid cemento-osseous dysplasia (FCOD). Raloxifene-associated ONJ has never been reported before in a patient with FCOD. It is unclear whether the presence of FCOD increases the risk of ONJ. Case report: Clinical and radiographic findings regarding an African-American patient with FCOD and raloxifene-induced ONJ are described. The patient underwent a battery of investigations and surgical debridement of the area in question. She has remained disease free in the 2 years following the treatment. Conclusions: The aim of this report is to shed some light on a serious complication of raloxifene, a medication that is increasingly encountered in dental practices. Dental practitioners should use this knowledge to increase their awareness of possible ONJ development after the use of raloxifene. Brief recommendations and guidance in general dental practice for management of patients on raloxifene are also presented.

Nasal airway obstruction affects up to one-third of Americans and is one of the most common complaints by patients to otolaryngologists. Nasal airway obstruction and obstructive sleep apnea syndrome (OSAS) are closely related. The aim of this study was to use the 3D imaging software, ITK-SNAP as a platform to define a gold standard for anatomically accurate boundaries of the nasal airway in 3D CBCT and to create a more reliable and precise 3D CBCT segmentation of the nasal airway for assisting diagnosis, treatment, and monitoring of nasal airway obstruction and OSAS.After review of the literature to identify established parameters using CBCT and CT technology for the segmentation of the nasal airway, and the existing drawbacks, a gold standard for locating the anatomical boundaries of the nasal airway using CBCT is proposed. This new method aims at standardization of segmentation and quantification, allowing for more reliable comparison between studies. ITK-SNAP software was used to segment three CBCT samples of healthy patients aged 21 to 59 years, who were patients of record, with CBCT obtained for either orthodontic, endodontic, or prosthodontic treatment planning purposes.br /Results: The literature search identified 11 studies describing nasal airway parameters utilizing CBCT and CT. A great variation was detected on where the anatomical boundaries for the nasal airway were selected. A new standard in the identification of anatomical boundaries of the nasal airway is proposed for consistent segmentation and quantification using 3D CBCT by using the following landmarks: the inferior ANS-PNS border, the anterior nares border, the posterior sella-PNS border, and superiorly the border in alignment with the base of the skull (excluding the ostia, frontal, ethmoidal, and sphenoidal air cells). The three segmented samples were volumetrically measured, and statistically analyzed. The mean average Hounsfield unit intensity using the CBCT samples in this study was 629 with a standard deviation of 190.br /Conclusion: The literature indicates a lack of a gold standard using CBCT technology for the segmentation of the nasal airway. With the proposed standard in this study, it is possible to quantify the nasal airway volume and thereby its reduction. For the general dental practitioner, this is an important aspect during the evaluation of overall airway assessment. This information can be useful in the diagnosis and treatment of airway compromised dental patients. (Quintessence Int 2021;52:154-164; doi: 10.3290/j.qi.a45429).

Orofacial pain (OFP) disorders affect the maxillofacial complex and typically involve other locations in the head and neck. Common etiologies of OFP disorders include odontogenic sources, temporomandibular disorders, neuropathic pain, chemosensory disorders, and headaches. Less commonly, benign and malignant neoplasms can be associated with OFP complaints. Patients with OFP symptoms require a thorough evaluation and are often referred to additional healthcare providers for interprofessional management. In those OFP patients whose symptoms do not respond to conventional treatment(s), whose symptoms change over time, or who report positive responses to review of systems questions that suggest more extensive involvement, further investigation is warranted. To the best of our knowledge, this is the first case report of nasopharyngeal extramedullary plasmacytoma, a localized malignant neoplasm, associated with persistent OFP.

Commercial intraoral rectangular collimators are available for collimating to size 2 image receptor. The benefits of reducing the x-ray beam to match the area of the image detector in adult intraoral radiography are endorsed internationally. However, in pediatric dentistry the image receptor can be further decreased to size 1 and 0.For this study size 1 and 0 rectangular collimators were fabricated using 1.65-mm lead sheets (Rotometals). The custom-fabricated collimators were fixed to the plastic body of a Rinn (Dentsply) Universal Collimator attachment. Aperture sizes were extrapolated based on the active imaging area of size 1 and 0 digital image receptors. A dose area product (DAP) measuring device was used to determine the change in radiation absorbed dose as a function of the imaging field of view.DAP measurements were evaluated in the 31.7 cm2 conventional round collimation, Rinn 12.0 cm2 Universal rectangular collimator, and in the manufactured size 1 (8.25 cm2) and size 0 (5.72 cm2) rectangular collimators. The size 1 collimator had a 32% DAP reduction from the size 2, and a 53% reduction for the size 0.Size 1 and size 0 rectangular collimators can be independently manufactured and utilized in pediatric dentistry. This study suggests that a considerable radiation dose reduction is possible in pediatric intraoral imaging when using the size 1 and 0 matched collimation. Since the pediatric population is vulnerable to radiation exposure, any measurable reduction has a potential for long-term health benefits and is therefore clinically significant.

Replacing conventional round intraoral collimators with rectangular collimators provides a considerable radiation dose reduction in adult patients. This study aimed to determine the radiation dose reduction via mathematical phantom when converting from round to appropriately sized rectangular collimation in children ages 5 to 15 years.Virtual full mouth series (FMX) were simulated using a commercially available radiation dose software. This software is designed to calculate patient radiation doses from x-ray exams for various age pediatric and adult mathematical phantoms. For this pediatric study an 18-image FMX was simulated for the 15-year-old and a 12-image FMX was simulated for the 5-year-old and 10-year-old pediatric phantoms. An area of 12.0 to 16.8 cm2 represented rectangular collimation, while a 20.4 to 31.7 cm2 area represented typical round collimation.Effective doses decreased in all ages by nearly 60% when switching from 31.7 cm2 round to 12.0 cm2 rectangular collimation. Reduction in absorbed doses to the thyroid (70% to 73%), salivary glands (62% to 78%), and active bone marrow (60% to 62%) were also noted when switching from the largest to smallest collimation.This study suggests the use of rectangular collimators provides clinically relevant dose reduction for pediatric patients, even when altering from smaller round to rectangular collimation with equivalent beam quality, and this information can be utilized in all dental practices.

Although the American Joint Committee on Cancer developed its first cancer-specific staging system in 1959, the TNM classification, as it has become known, has undergone many revisions mainly due to the advancements in both diagnosis and management of cancer, Although the basic purpose of the cancer staging system has remained fundamentally unchanged, the ease with which the cancer can be staged has evolved with newer methods. This article reviews cancer evaluation for staging, as well as the introduction of a new staging method effective as of 2018.

In a time when orthodontists are getting away from paper charts and going digital with their patient data and imaging, practitioners need to be prepared for a potential hardware failure in their data infrastructure. Although a backup plan in accordance with the Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may prevent data loss in case of a disaster or hard drive failure, it does little to ensure business and practice continuity. Through the implementation of a common technique used in information technology, the redundant array of inexpensive disks, a practice may continue normal operations without interruption if a hard drive fails.

The maxillofacial region is complex in its anatomy and in its variation in the presentation of neurologic disorders. The diagnosis and management of neurologic disorders in clinical practice remains a challenge. A good understanding of the neurologic disorder in its entirety helps dentists in the diagnosis and appropriate referral to a specialist for further investigations and management of the condition. Neurologic disorders described in this article are under broad categories of sensory and motor disturbances as well as movement disorders and infections. This article summarizes the most common maxillofacial neurologic disorders that dentists might encounter in clinical practice.

Periapical pathoses represent changes noted at the apices of teeth within the alveolar process that are suspected on examination, visualized via imaging, and confirmed via histopathology. They can be bone forming or destructive. There are pathologic entities that show both types of changes at the apical regions. These lesions must be identified if they are odontogenic in origin because treatment modalities differ. This article discusses identification of radiopaque and radiolucent lesions noted on radiographs. The common opacities and lucencies are described. When required, advanced imaging is used to depict changes within the bone near the periapical regions of mandibular and maxillary teeth.

OBJECTIVES: Drug reference databases provide information on potential drug-related medical complications in a dental patient. It is important that database entries and recommendations are supported by evidence-based original studies focused on drug-related dental management complications. The aim of this study was to review and identify database drug categories associated with evidence-based drug-related medical complications during dental treatment DATA SOURCES: Relevant publications on adverse drug reactions and dental management complications were thoroughly reviewed from the literature published between July 1975 and July 2019. MATERIAL AND METHODS. We reviewed the drug reference database ‘Lexicomp online for dentistry’ to identify medications associated with highest propensity to trigger drug-related dental management complications and correlated these with published original studies in PubMed(®), EMBASE(®), and Scopus(®) databases that associated drug actions with dental treatment complications. RESULTS: Fifty-four publications (1.2% of all full text articles) reported original studies that directly tested drug associations with dental management complications. The cautions in the drug reference database on drug-related dental treatment mainly focused on local anesthetic precaution (p

To evaluate the efficacy of diagnostic imaging for temporomandibular joint rheumatoid arthritis (TMJ RA). Inflammation of the TMJ has a high correlation (17%) with the late stages of RA. Clinical recognition of TMJ RA using diagnostic imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and cone beam computed tomography (CBCT), is limited to osseous and soft tissue components of the TMJ. Positron emission tomography (PET) and positron emission tomography/CT (PET/CT) are novel technologies that have shown increasing relevance in the detection and management of TMJ RA.Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA, 2009) guidelines, and using databases such as PubMed, Ovid Medline, Google Scholar, Web of Science, Scopus, and EBSCOhost, 94 publications were identified, and 27 studies were selected for this systematic review. A flowchart of the comprehensive study selection was generated. Quality assessment and data extraction were performed independently by three reviewers.It was noted that two-dimensional radiographs, CBCT, multidetector CT, and MRI are the most commonly used methods in TMJ RA assessment, although they are not useful for determination of active disease. MRI has excellent contrast resolution and can acquire dynamic imaging for demonstration of the functionality of the TMJ. CT and ultrasound imaging also have specific indication in imaging the TMJ. PET used in conjunction with CT is the only imaging modality that can quantify TMJ RA in active disease.PET/CT images provide unique quantitative information that cannot be obtained from any other imaging modalities.

BackgroundUse of various bone graft substitutes are advised to prevent bone loss, periodontal problems, and enhance bone formation after surgical removal of the mandibular third molar. Choice of gr...

To determine the risk of developing meningiomas after exposure to various types of dental ionizing radiation at diagnostic levels.A literature review was conducted using databases such as PubMed, Scopus, Google Scholar, CINAHL, Clinical Key, and Web of Science. Data extracted from the studies were tabulated and a meta-analysis was performed using all relevant data.Twelve articles related to the topic that met the selection criteria were initially included in the systematic review. After evaluating the methodology and statistical analysis of each study, six were ultimately included in the meta-analysis. A forest plot created using RevMan v5.3 software (Cochrane Collaboration) produced a weighted odds ratio of 1.13 (95% confidence interval, 1.06 to 1.19) for meningioma risk.Studies in the recent past have found a positive association between exposure to ionizing radiation and risk of developing meningiomas. In this study, no association was found between dental x-ray exposure and the development of meningioma. The data were weighted heavily for one of the subgroups due to a larger patient pool as noted via the forest plot. Regardless of the weighting, the majority of the subgroups showed no significant association, further strengthening this conclusion.

Disinfection is a crucial aspect of patient care in dentistry. In the pre-19th century era, natural elements like acids, sulfur, mercury, and various alkaline metals were valued for their ability to obliterate pathogens. More recently aerosols, sprays, and disinfectant wipes with more powerful chemicals including quaternary ammonium compounds and aldehydes have become popular. As aerosols fall out of favor due to their health and environmental risks, disinfectant wipes are becoming the most trusted form of clinical sanitization. This article explores the history as well as the current practice of disinfection in the dental profession and further explores the variations in the use of surface disinfection based on the published literature. The current practice guidelines as recommended by agencies like Centers for Disease Control (CDC) were studied and summarized for this review.

Teeth are housed in mandible and maxilla and are known to undergo variations in clinical presentation depending on the degree of abnormality during growth and development. It is essential to identify these variations in normal anatomy so that appropriate treatment can be initiated to address the anomaly. Some normal anatomic variations are harmless and best left alone, whereas others require intervention. Radiology plays a vital role in identification of such anomalies. This article focuses on the diagnostic radiographic interpretation and strategies to include pertinent differential diagnosis. Also discussed is the importance of advanced imaging and its appropriateness in the diagnosis and interpretation.

This article provides the reader with the knowledge and skills of identification and diagnostic interpretative skills using planar images, tomographic images, CBCT, MDCT, pertinent MR images, as well as bone scans and PET images. The goal is to provide sufficient in-depth knowledge of the technique, anatomy, and radiographic identifiers for the diagnosis of local and systemic pathoses. The information will train the reader to be an advocate of selection criteria as well as a follower of the "Image Gently" campaign and philosophy supported by the organized dentistry in the United States, especially in Diagnostic Radiology.

The common aspect of all granulomatous diseases is the typical form of chronic inflammatory response with distinct microscopic granulomas that are formed secondary to either definitive etiologic agents, like bacteria, fungal, or parasitic, or due to an unknown etiologic agent, such as trauma, autoimmune, or even neoplastic process. Although they can be histologically distinct, granulomatous diseases demonstrate a variety of clinical features that may not seem to be inflammatory. Two types of granulomas are typically encountered: foreign body granulomas and immune granulomas. The differences between the two types of granulomas lie in the pathogenesis.

This article discusses the radiographic manifestation of jaw lesions whose etiology may be traced to underlying systemic disease. Some changes may be related to hematologic or metabolic disorders. A group of bone changes may be associated with disorders of the endocrine system. It is imperative for the clinician to compare the constantly changing and dynamic maxillofacial skeleton to the observed radiographic pathology as revealed on intraoral and extraoral imagery.

The aim of this article is to investigate, study, and summarize cone beam computed tomography (CBCT)-related guidelines offered by relevant organizations and associations within North America to provide the dental practitioner a clearer direction on the practice of CBCT-related procedures in North America.Scientific databases including PubMed, Science Direct, Scopus, MedLine, and Web of Science were used for the search of relevant literature on the CBCT guidelines developed in North America. In addition, the World Wide Web was searched for comparative CBCT guidelines nationally or internationally using the same search strategies.In 1999, the American Dental Association (ADA) recognized Oral and Maxillofacial Radiology as the ninth dental specialty in the United States. The American Academy of Oral and Maxillofacial Radiology (AAOMR) issued their first statement on the use of CBCT in 2008. There have since been several statements issued, independently or jointly with other specialty organizations, related to the use and interpretation of the CBCT volumes. The guidelines identified Oral and Maxillofacial Radiologists (OMR) as providers of interpretative services, portrayed as key players in the dissemination of information related to CBCT, implementation of CBCT-related services and radiation protection, as well as interpretation assistance for CBCT volumes, especially medium to large volumes covering anatomical areas of head and neck, considered beyond the scope of a general dentist. Regulations concerning radiation-producing devices are promulgated through state health codes and practice acts. Selection criteria and interpretation of imaging studies are left to the clinician's choice and abilities.

OBJECTIVES: The objective of the study was to determine the radiation dose reduction achieved when rectangular collimation was used on various round collimators. In addition, we evaluated the tissue doses imparted to various head and neck organs. METHODS: To evaluate the variation in radiation output based on the variable geometric configurations, the kerma area product (KAP) was measured using a commercially available KAP-meter with an internal ion chamber capable of detecting both radiation dose (µGy) and the primary X-ray beam area. The KAP was measured using standard 20.4, 25.7, and 31.7 cm(2) round collimators with and without rectangular X-ray field restrictors. To evaluate the potential change in patient scatter radiation dose, an adult head phantom was loaded with thin strips of gafchromic film. A full mouth X-ray series was acquired with various geometric configurations. The films were quantified using a calibration factor to yield absorbed organ doses for the eyes, thyroid, and salivary glands. RESULTS: With the use of rectangular collimator, the KAP for a 31.7 cm(2) round collimator was reduced by up to 60% while the 20.4 cm(2) round collimator elicited a reduction from up to 40%. In the organ study, results of up to 81% reduction in scatter radiation dose were observed. CONCLUSIONS: Although, US FDA regulations allow a maximum beam size of 38.5 cm(2) on the patient skin, this study suggests that the use of rectangular collimators provide clinically relevant dose reduction for patients, even when using smaller round collimation, hence the use of rectangular collimation for all intraoral radiographic procedures is highly recommended.

Temporomandibular disorder (TMD) is prevalent in special needs patients. Clinical examination of the temporomandibular joint (TMJ) complex and imaging in this patient population can be challenging due to patient disposition and cooperation. We report a case of a 29-year-old male with neurologic and behavioral special needs who required advanced maxillofacial imaging for a suspected TMD under general anesthesia, which has not been reported previously. This article intends to serve as a resource for health care providers who may encounter similar clinical situations.

Supernumerary teeth are an uncommon occurrence that have the ability to arise anywhere in the dental arch. Mesiodens is a specific type of supernumerary tooth that occurs in the vicinity of the maxillary central incisors. Mesiodens are the most common among all supernumerary teeth, almost always impacted, and may also be seen in various positions based on the eruption status. The formation of mesiodens is a much-debated topic and many theories have been proposed. The reports also include its common radiographic findings and a pertinent literature review. This study reports a case of an impacted, inverted mesiodens incidentally discovered on a preimplant examination of maxilla. This article demonstrates the scope of eruption of an impacted and inverted mesiodens. Various methods of treatment plan are discussed and a new classification system of mesiodens is proposed.

Manufacturing technologies for biologics rely on large, centralized, good-manufacturing-practice (GMP) production facilities and on a cumbersome product-distribution network. Here, we report the development of an automated and portable medicines-on-demand device that enables consistent, small-scale GMP manufacturing of therapeutic-grade biologics on a timescale of hours. The device couples the in vitro translation of target proteins from ribosomal DNA, using extracts from reconstituted lyophilized Chinese hamster ovary cells, with the continuous purification of the proteins. We used the device to reproducibly manufacture His-tagged granulocyte-colony stimulating factor, erythropoietin, glucose-binding protein and diphtheria toxoid DT5. Medicines-on-demand technology may enable the rapid manufacturing of biologics at the point of care.

This article deals with identification and descriptions of intraoral and extraoral anatomy of the dental and maxillofacial structures. The anatomic landmarks are highlighted and described based on their radiographic appearance and their clinical significance is provided. Cone beam CT-based images are described in detail using the multiplanar reconstructions. The skull views are depicted via line diagrams in addition to their normal radiographic appearance to make identification of anatomic structures easier for clinicians. The authors cover most of the anatomic structures commonly noted via radiographs and their descriptions. This article serves as a clinician's guide to oral and maxillofacial radiographic anatomy.

To investigate the relationship in dental cone-beam CT (CBCT) between the manufacturer-reported image pixel data and a modified conversion to CT number densities in Hounsfield unit (HU).A standardized CT phantom was imaged using typical clinical parameters on CBCT from three manufacturers (Carestream 9300The DICOM header data show that a modified rescale y-intercept was applied to both the Carestream and Planmeca image data yielding manufacturer-produced results in HU. The Morita pixel data were unmodified and report in shades of grey or grey values (GV). The Carestream manufacturer-derived HU measurements showed good correlation in air (-1000 HU), but all other materials ranged from 2.6 to 13.5 σ from the specified phantom value. Results in the modified conversion technique images fell within 1.0-2.4 σ from the specified phantom values.While more studies are needed to test for regularity, this study suggests that our modified technique could be a means of getting more accurate quantitative data from dental CBCTs.

Cone beam computed tomography (CBCT) was introduced to the dental profession at the beginning of the new millennium and has become an integral part of dental practice, especially within the surgical specialties. With advances in technology and the introduction of new-generation digital detectors, the concomitant increase in pixel resolution provided the ability to discern fine details of the anatomy. This article focuses on the methodology of CBCT interpretation and reporting. Details of reviewing the volume thoroughly are described with relevant citations. The article summarizes the overall methodical interpretation of CBCT data that is essential to every dentist who uses the technology.

We report a case of a diffuse large B-cell lymphoma of the maxilla. A patient presented with diffuse swelling of the right maxillary region following the extraction of an upper right maxillary tooth. The patient was referred for cone beam computed tomography (CBCT) to visualize the area in question in three dimensions. A massive destructive maxillary lesion was noted on CBCT examination suggestive of an aggressive lesion highly suspicious for a malignancy. A subsequent biopsy and immunochemistry were useful in confirming the diagnosis.