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Estimated HIV infected world wide?
31-35 million
2.3-2.8 became infected in 2009
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HIV induced oral lesions in adults?
- Candidiasis (erythematous/pseudomembraneous)
- Hairy leukoplakia
- Kaposi sarcoma
- non-hodgkin's lymphoma
- periodontal disease (NUG/NUP)
risk in inverse to CD4 count
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Name the 8 identified Herpes viruses?
- HSV-1
- HSV-2
- VZV
- EBV
- CMV
- HH6
- HH7
- HH8
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Pathophysiology of HSV-1?
Primary infection: virus transported via retrograde axonal transport to regional sensory ganglia (V), where latency begins
can be shed in saliva
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Clinically aparent recurrent infections are estimated to occur in __% to __% of indviduals harboring latent HSV-1.
15-40
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Triggers to HSV?
- Sunlight
- Trauma
- Menses
- Fever
- Immunosuppression
- Irritation by dental instruments
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Three clinical forms of recurrent HSV-1?
- 1. Herpes labialis
- 2. Intraoral recurrence (gingiva or hardpalate)
- 3. Recurrence mimicking a primary infection
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HSV-1 proposed as a potential etiologic factor of pulpal necrosis
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VZV establishes latency where?
Neuronal ganglia (cranial nerve, dorsal root, and autonomic ganglia)
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An estimated 13% of zoster cases involve the head and neck.
may lead to pulpal death
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Taurodontism prevalence
3%
failure of epithelial root sheath differentiation
most cases molar
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How does taurodontism complicate endo?
ID of canal can be compromised
Affected teeth more prone to manipulative fracture
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Three types of Dens in dente?
- 1. Enamel lined
- 2. Enamel lined blind sac that invades the root
- 3. Invades the root and has secondary foramen
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Prevalence of dens-in-dente?
.04%-10%
involves maxillary lateral incisors
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Clinical significance of densindente?
- 1. inc risk of bacteria induced necrosis
- 2. NRSCT difficult due to complexity
use CaOH, ultrasonics, GP warm vertical
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Den evaginatus prevalence?
Asian 15%
premolar and molar
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Clinical significance of dens evaginatus?
narrow shelf of enamel, easily penetrated
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Types of DI?
DI Type 1: assoc with osteogen imperfecta, type 1 collagen defect
DI Type II/III: DSPP gene defect
Type II most common 1:6000-8000
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Clinical findings of DI?
Amber-brown to blue-gray hue, cracking or loss of enamel, attrition.
Radio Type I/II: bulbous crown structure, cervical constriction, short roots, obliterated pulp chamber
Radio Type III: pulp chamber normal or enlarged, PARLs present
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Paget disease of bone (PDB) is a...
heterogenous, focal, progressive bone disease characterized by active bone turnover
men over 40 (1%)
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Affected sites for PDb?
pelvis, skull, vertebra, femur, and tibia
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Affected bones of PDB manifest an initial ______ phase, followed by a mixed __________/__________, which progresses to a disorganized __________ phase
osteolytic
osteolytic/osteosclerotic
osteosclerotic
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Clinical signs of PDB?
osseous distortion or expansion, mild to moderate depp aching bone pain
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Skull involvement?
22%
vestublar involvment in 89%
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Dental abnormalities of PDB?
Malocclusion, hypercementosis, tooth mobility, root resorption, pulp calcification, osteomyelitis, poor fitting prsthesis,
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PDB is cotton wool appearance
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PDB radiographic findings?
Hypercementosis, local thickened PDL space, root resorption, pulpal obliteration
Hyperparathyroidism is generalized widening PDL space
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Most prevalent form of rickets is caused by mutations affecting the PHEX gene, termed X-linked hypophosphatemia.
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XLH dental findings?
- Enlarged pulp chamber and pulp horns
- hypocalcified dentin
- short roots
- taurodontism
- poor defined lamina dura
- hypoplastic alveolar ridge
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What is pathognomonic for XLH?
Promininent pulp horns extending up to the dentinoenamel junction
causes spontaneous dental abscesses
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Most serious type of thalassemia?
Beta, known as Cooley anemia
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A characteristic "rodent" or "chipmunk" facies may be observed (maxillary protusion or expansion, bossing of skull, prominent cheek bones)
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Percent of AA heterozygous for SCA trait?
13%
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Sickle red cell lifespan?
10-30 days
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Percent of patients with head and neck manifestations?
79-100%
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Risk of osteomyelitis of the jaws in SCA?
200 times
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