Hatem Amer

BACKGROUND: Every effort needs to be made to better understand the current state of practice and trends relating to root caries management which will be of benefit to dentists universally in the practice of dentistry.

AIM: This article presents a multicountry questionnaire survey of the current state of practice in the management of root caries among dentists in nine different countries to get a wider range of opinions and perspectives.

METHODOLOGY: A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among groups.

RESULTS: The results showed statistically significant differences among dentists in most questionnaire aspects. Bleeding is the greatest obstacle facing dentists when restoring root surface lesions. Reported survival rates reflect uncertainty about the material and/or approach of choice in the management of root surface caries.

CONCLUSION: This questionnaire survey revealed the current status of management of root surface caries in clinical practice in various countries. Substantial attention is required to bridge the knowledge gap and address the current void of uncertainty as relates to root caries management by providing a common ground for communication between dentists from all around the globe. In all, this work found a degree of consensus at the international level on what appears to work well among the dental practices surveyed and identified several issues with existing approaches that need to be addressed in future studies.

BACKGROUND: The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries.

AIM: The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes.

METHODOLOGY: A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups.

RESULTS: Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars.

CONCLUSION: This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.

Central giant cell granuloma (CGCG) is classified by the World Health Organization as a benign bone lesion. It is found anteriorly in the mandible, with most of the cases crossing the midline. In total, 70% of CGCGs are encountered in young females. Fibro-osseous lesions are a group of pathologies that encompass neoplastic, dysplastic and reactive entities. Juvenile ossifying fibroma, which can be further categorized into juvenile trabecular ossifying fibroma (JTOF) and juvenile psammomatoid ossifying fibroma, represents an aggressive neoplastic example of these fibro-osseous lesions. JTOF occurs in children at almost equal ratios in both sexes, affecting the maxilla more than mandible. This study aims to report a peculiar case of a hybrid lesion comprising CGCG and JTOF in the mandible of a nine-year-old female patient. Clinical, radiographic and histopathological findings were assessed. Clinical examination revealed an intraoral swelling extending from the right impacted third molar area to the left first molar area. Computed tomography showed a well-defined multilocular radiolucency with diffuse flecks of radioopacities. Histopathologically, the lesion comprised fibrous connective tissue encompassing numerous multinucleated giant cells and other areas of cell-rich connective tissue stroma containing bands of osteoid matrix and anastomosing immature bone trabeculae intermixed with scattered clusters of multinucleated giant cells. We hereby report a case of a rare hybrid lesion comprising CGCG and JTOF.

OBJECTIVES: This study aimed to investigate the changes that occur in the oral mucosa of shisha smokers and compare them to cigarette smokers, nonsmokers and smokers of both shisha and cigarettes and to detect whether these changes could be detected biochemically in saliva.

METHODS: Four groups of subjects were included in our study (16 in each group); cigarette smokers, shisha smokers, nonsmokers and smokers of both. A salivary sample and a mucosal biopsy were obtained from each subject. Salivary detection of CYFRA 21-1 was performed on each salivary sample. The mucosal biopsy was examined by routine H&E techniques. Furthermore, immunohistochemical expression of p53 was studied in all cases.

RESULTS: A statistically significant difference in p53 expression was present between nonsmokers and the three smoker groups. However, no statistically significant variation was present between the 3 smoker groups. Furthermore, no statistically significant changes were found in the CYFRA 21-1 levels among the four groups.

CONCLUSION: Shisha smoking has the same damaging effect on the oral mucosa as cigarette smoking. Furthermore, no correlation was detected between the histological findings and the salivary biomarker used (CYFRA 21-1).

Ameloblastic fibro-odontoma (AFO) is an uncommon, benign, mixed odontogenic tumour occurring predominantly in children and adolescents. The purpose of this study was to report an unusual case of AFO in the mandible of a five-year-old male patient showing evidence of chondroid tissue formation. Clinical, radiographic, histopathological and immunohistochemical findings were presented. Intraoral examination revealed a swelling extending from the right deciduous lateral incisor to the left second molar area. Computed tomography (CT) showed a large, well-demarcated multilocular radiolucency with radiopaque deposits. Histologically, the lesion was composed of connective tissue stroma resembling the dental papilla, with epithelial islands, and amorphous masses of enamel and dentin consistent with a diagnosis of AFO, as well as, evidence of large areas showing cartilaginous tissue formation. Immunohistochemistry using cytokeratin, vimentin and s-100 were helpful in determining the origin of the different odontogenic tissues. Surgical excision of the lesion was performed. The patient has been monitored and the lesion has not recurred. We report the first case of AFO showing an unusual behaviour of chondroid tissue formation.

Primordial odontogenic tumors are a rare recently described mixed odontogenic tumor composed histopathologically of dental papilla like tissue and enamel organ like tissue. Only nine cases have been documented worldwide and we are reporting the tenth case which is from Egypt. A 2-year-old Egyptian boy that presented with an asymptomatic swelling of the mandible which appeared with multilocular radiolucency associated with an impacted developing tooth on a computerized tomography (CT) scan. The lesion was excised and diagnosed as a primordial odontogenic tumor. The patient was followed up for two years with no recurrence. Differentiation of primordial odontogenic tumors from other odontogenic tumors, which resemble it histopathologically is crucial to avoid unnecessary aggressive treatment.

Ameloblastic carcinoma (AC) is an extremely rare malignant odontogenic tumour arising from odontogenic epithelium. It was classified into primary type and secondary type. A previous study revealed that primary ameloblastic carcinoma cases were associated with more favourable prognosis than secondary cases. The aim of the present work was: to report the clinical, histopathological, immunohistochemical, and ploidy status, and therapeutic details of four cases of primary AC, and to review the literature with regard to clinical, follow-up, prognosis, histopathological, and immunohistochemical information of primary AC. The Medline database was searched using the term ameloblastic carcinoma and primary type. The review of English literature revealed that primary ameloblastic carcinoma favours the posterior mandible with profound male predilection and appears as an ill-defined radiolucency. Metastasis and invasion are more likely to occur in maxillary cases. The treatment of choice is wide surgical resection with or without cervical lymph node dissection. Adjuvant postoperative radiotherapy is beneficial in incomplete resection cases and advanced soft tissue invasion. The most specific diagnostic methods of AC, as concluded from review, are α-SMA in epithelial cells in conjunction with Ki-67 index value and SPF more than 11.5%.