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Statement of Problem: Little is known about the extent to which hydrogen peroxide as used for tooth bleaching could be carcinogenic to the oral mucosa., Purpose: The purpose of this systematic review and meta-analysis was to evaluate whether hydrogen peroxide as used for tooth bleaching has carcinogenic effects on the oral mucosa., Material and Methods: PubMed, Web of Science, Scopus, and Embase electronic databases were searched. Studies evaluating different outcomes potentially related to the carcinogenic effects of hydrogen peroxide for tooth bleaching on the oral mucosa were included. Risk of bias was assessed by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Risk Of Bias in Non-randomized Studies of Interventions (ROBINS-I), or Risk of Bias 2 (RoB 2) tools. The strength of the evidence was assessed by using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. The quantitative analysis was performed with means, standard deviations, and 95% confidence intervals (CIs). Heterogeneity was analyzed by using I-squared statistics., Results: Thirteen articles comprising 5 animal and 8 clinical studies met the inclusion criteria. Three of the 5 animal studies associated the bleaching agents with a carcinogen and demonstrated an enhancement of the carcinogenic effect, but probably with the bleaching agent acting only as a promoter. Five clinical studies concluded that the bleaching agents did not cause mutagenic stress on the oral mucosa by using the micronucleus test. The meta-analysis demonstrated that the frequency of micronuclei did not differ significantly between baseline and 30 days after bleaching (mean difference: 0.48; 95% CI, -1.49, 2.46; P=.63)., Conclusions: This systematic review indicated that hydrogen peroxide does not appear to have carcinogenic effects on the oral mucosa., (Copyright © 2022 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Dental restorations and removable dental prostheses have been considered as risk factors for potentially malignant disorders of the oral mucosa. It remains unclear whether amalgam, composite resins, and prosthesis materials can induce potentially malignant disorders., Purpose: The purpose of this clinical study was to determine the relationship between the presence of amalgam and composite resin restorations, crowns and fixed partial dentures, and removable prostheses in potentially malignant disorders., Material and Methods: The data of 6041 participants in the population-based Studies of Health in Pomerania (SHIP) were accessed. Potentially malignant disorders had been clinically diagnosed by calibrated dentists and documented with photographs. Dental treatment was subdivided into restored and replaced teeth. Dental restorations were subclassified as buccal composite resin or amalgam restorations. Prosthetic treatment was subclassified into removable partial or complete prostheses and definitive restorations with crowns and fixed partial dentures., Results: In the maxilla, participants with removable prostheses had a higher incidence of potentially malignant disorders than participants not undergoing treatment with removable prostheses (OR 2.12; 95% CI: 1.08-4.18), but not in the mandible (OR 1.30; 95% CI: 0.67-2.53). The surfaces with composite resin restorations were associated with a slightly higher risk of mucosal lesions than those without the restorations (OR 1.04; 95% CI: 1.01-1.07). No significant association was found between amalgam restorations and mucosal lesions., Conclusions: Participants with removable prostheses have a higher risk of potentially malignant disorders. Composite resin restorations are associated with a higher risk of mucosal lesions, whereas no significant association was found between amalgam restorations and mucosal lesions., (Copyright © 2022 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Tuberculosis (TB) of the oral cavity may be overlooked in the differential diagnosis of oral lesions and can be misdiagnosed and managed incorrectly. A 66-year-old man with complete dentures presented with a nonhealing mucosal ulcer in the upper lip. Despite the treatments performed by a local medical clinic, the ulcerative lesion on the denture-bearing area had not improved over 5 months. A partial excisional biopsy was performed to investigate further. Histopathologic examination revealed granulomatous inflammation caused by TB, and a chest radiograph showed consolidation and cavitation of the upper lobes. The patient was diagnosed with pulmonary TB. This clinical report describes the management of oral TB mimicking a traumatic denture ulcer in a patient with long-term complete denture use., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Studies that evaluated the strength of complete dentures reinforced with glass-fiber mesh or metal mesh on a cast with a simulated oral mucosa are lacking., Purpose: The purpose of this in vitro study was to compare the mechanical properties of maxillary complete dentures reinforced with glass-fiber mesh with those of metal mesh in a new test model, using a simulated oral mucosa., Material and Methods: Complete dentures reinforced with 2 types of glass-fiber mesh, SES mesh (SES) and glass cloth (GC) and metal mesh (metal) were fabricated. Complete dentures without any reinforcement were prepared as a control (n=10). The complete dentures were located on a cast with a simulated oral mucosa, and a load was applied on the posterior artificial teeth bilaterally. The fracture load, elastic modulus, and toughness of a complete denture were measured using a universal testing machine at a crosshead speed of 5 mm/min. The fracture load and elastic modulus were analyzed using 1-way analysis of variance, and the toughness was analyzed with the Kruskal-Wallis test (α=.05). The Tukey multiple range test was used as a post hoc test., Results: The fracture load and toughness of the SES group was significantly higher than that of the metal and control groups (P<.05) but not significantly different from that of the GC group. The elastic modulus of the metal group was significantly higher than that of the control group (P<.05), and no significant differences were observed in the SES and GC groups., Conclusions: Compared with the control group, the fracture load and toughness of the SES and GC groups were higher, while those of the metal group were not significantly different., (Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Precise treatment planning before implant surgery is necessary to identify vital structures and to ensure a predictable restorative outcome., Purpose: The purpose of this study was to compare the accuracy of implant placement by using 3 different types of surgical guide: bone-supported, tooth-supported, and mucosa-supported., Material and Methods: Thirty acrylic resin mandibles were fabricated with stereolithography (SLA) based on data from the cone beam computerized tomography (CBCT) scan of an edentulous patient. Ten of the mandibles were modified digitally before fabrication with the addition of 4 teeth, and 10 of the mandibles were modified after fabrication with soft acrylic resin to simulate mucosa. Each acrylic resin mandible had 5 implants virtually planned in a 3-D software program. A total of 150 implants were planned and placed by using SLA guides. Presurgical and postsurgical CBCT scans were superimposed to compare the virtual implant placement with the actual implant placement. For statistical analyses, a linear mixed models approach and t-test with the 2-sided alpha level set at .016 were used. All reported P values were adjusted by the Dunn-Sidak method to control the Type I error rate across multiple pairwise comparisons., Results: The mean angular deviation of the long axis between the planned and placed implants was 2.2 ±1.2 degrees; the mean deviations in linear distance between the planned and placed implants were 1.18 ±0.42 mm at the implant neck and 1.44 ±0.67 mm at the implant apex for all 150 implants. After the superimposition procedure, the angular deviation of the placed implants was 2.26 ±1.30 degrees with the tooth-supported, 2.17 ±1.02 degrees with the bone-supported, and 2.29 ±1.28 degrees with the mucosa-supported SLA guide. The mean deviations in linear distance between the planned and placed implants at the neck and apex were 1.00 ±0.33 mm and 1.15 ±0.42 mm for the tooth-supported guides; 1.08 ±0.33 mm and 1.53 ±0.90 mm for the bone-supported guides; and 1.47 ±0.43 mm and 1.65 ±0.48 mm for the mucosa-supported SLA surgical guides., Conclusions: The results of this study show that stereolithographic surgical guides may be reliable in implant placement and that: 1) there was no statistically significant difference among the 3 types of guide when comparing angular deviation and 2) mucosa-supported guides were less accurate than both tooth-supported and bone-supported guides for linear deviation at the implant neck and apex., (Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Statement of Problem: Oral mucosa can distort under impressions. To reduce or control mucosal distortion, modern impression techniques aim to reduce or control the impression pressure. If changing seating velocity significantly changes pressure, then this effect should be considered for clinical impressions of mucosa., Purpose: The purpose of this study was to investigate the relationship between seating velocity and pressure generation during simulated impressions., Material and Methods: Vinyl polysiloxane impression material (Express) was placed between 2 approximating discs in a universal testing machine. The velocity at which the discs approximated was varied. The 7 selected seating velocities were 0.75 mm/s, 1 mm/s, 1.25 mm/s, 1.5 mm/s, 2 mm/s, 2.5 mm/s, and 3 mm/s. The pressure generated at the center of the disk was recorded. Five separate recordings were made for each velocity. One-way ANOVA and post hoc tests (Tukey B and Dunnett T3) (alpha=.05) were used to evaluate peak pressure data at each velocity., Results: The mean (SD) of the recorded pressures for each velocity were 239 (6.67) KPa, 273 (14.89) KPa, 347 (11.97) KPa, 425 (19.73) KPa, 487 (17.84) KPa, 547 (21.25) KPa, and 624 (32.60) KPa, respectively. As the velocity increased, there was a significant (P<.001) concurrent increase in peak pressure., Conclusions: In this in vitro experiment, changing the velocity of seating had a significant effect on the peak pressure produced during simulated impressions.

This article describes a method of making impressions for tooth-mucosa-supported removable partial dentures using a single impression procedure. Through the use of border-molded custom trays, selectively relieved, and application of pressure on residual ridge areas, the objectives of maximum tissue coverage and selective tissue placement of primary stress-bearing areas are fulfilled. With a single impression procedure, treatment time is reduced and laboratory errors commonly encountered with the altered cast impression technique can be minimized or eliminated.

Metastatic malignant melanoma of the oral cavity is rarely reported in the dental literature. This retrospective study identified metastatic oral lesions in 3.0% of 809 patients with melanoma treated at the National Institutes of Health between 1953 and 1989. Fifteen cases met established rigorous criteria for metastatic tumors and were reviewed for disease course and outcome. Nine white men and six white women, with an average age of 40.6 years, had cutaneous primary tumors predominantly of the trunk and head and neck region that commonly presented as moles that were enlarging, bleeding, or showing both of these signs. A mean of 4.2 years elapsed between primary tumor and oral metastasis diagnosis. Tongue, buccal mucosa, and parotid gland were the predominant oral sites. Enlarging oral masses, pigmented lesions, and nonhealing extraction sites with masses were common oral presentations. Surgery, chemotherapy, radiation therapy, and immunotherapy were used in various combinations for treatment of the primary lesion and oral metastasis. Prognosis, although poor, was highly variable.

Two different impression procedures were used to reproduce the maxillary tissue form of five edentulous patients. One procedure used modeling plastic to mold the borders of spaced trays while the tissue contour was recorded with regular-body polysulfide. The second procedure used tissue treatment material to mold the borders of selectively spaced trays while the impression was completed in lightbody polysulfide. Each procedure was repeated three times for the same patient. Comparison of the profiles of the casts at premolar and molar coronal sections showed that (1) there was no significant difference in results between the procedures, (2) peripheral tissues were readily displaceable with the least manipulation, and (3) the second procedure is recommended because of convenience to the patient and time efficiency for the clinician.

A rare case of pedunculated hemangioma of the oral mucosa has been reported. Clinically, it was diagnosed as a fibroma induced by irritation, but histologic examination followed to excisional biopsy demonstrated that it was a cavernous hemangioma.

Oral complications during cancer therapy are a common source of discomfort and a potential source of systemic infection. We report the results of a 2 1/2-year prospective follow-up study on the incidence of oral complications in 214 pediatric patients with cancer. Overall, the incidence of ulcers in these patients ranked highest followed by gingivitis. Children with sarcomas had more ulcers (p = 0.03) and Candida infections (p = 0.03) than those with leukemia. The rate of gingivitis among patients with leukemia was five times higher than in patients with sarcoma (p = 0.02). Candida infections in children with solid tumors occurred four times more often than in patients with leukemia (p = 0.02). This study shows that oral complications are a frequent cause of morbidity in children with cancers and are more common in some cancers than in others. Oral complications may be prevented or diminished in severity by identifying the risk groups and developing preventive and treatment strategies.

A master cast that simulates the mucosa around implant fixtures and abutments facilitates implant prosthesis fabrication. It is helpful if this simulation is not altered during laboratory procedures. A technique is described for a master cast that includes a removable mucosal component. This technique can be applied when either implant or abutment analogs are positioned in the cast.

Non-Hodgkin's lymphomas are tumors of the immune system that uncommonly evolve as primary lesions of the oral cavity. A case of a primary lymphoma in the right cheek that had invaded the surrounding tissues is presented.

The initial oral findings and treatment in 50 cases of mucous membrane pemphigoid are presented. Histologic and immunologic studies were undertaken in each case to confirm the clinical diagnosis. The treatments prescribed are summarized and illustrate that topical steroids are effective, but in some cases systemic steroid therapy with or without other immunologically active drugs is required. A significant number of patients had extraoral manifestations of the disorder.

Oral mucositis and hepatic veno-occlusive disease (HVOD) are common complications after bone marrow transplantation (BMT). Forty-seven patients were prospectively examined for development of ulcerative oral mucositis (UOM) and HVOD after allogeneic BMT. In 17 patients (36%) UOM developed between 2 days before and 18 days after transplant (median 4 days after BMT). In seven patients (15%) HVOD developed with onset between 3 and 21 days after transplant (median 18 days after BMT). In a time-dependent analysis, in patients given busulfan plus cyclophosphamide or busulfan, etoposide, and cyclophosphamide UOM was 19 times more likely to develop than in patients treated by cyclophosphamide plus total body irradiation or by cyclophosphamide alone (p less than 0.001). Patients in whom UOM developed were 6.5 times more likely to develop HVOD than those in whom UOM did not develop (p less than 0.03). The sensitivity (86%), specificity (73%), and negative predictive value (97%) of UOM to predict HVOD were high, but the positive predictive value (35%) was low. The association of UOM and HVOD support the concept that both are toxic effects of treatment. Patients with hepatic abnormalities but without UOM are unlikely to have HVOD, and other causes of the hepatic dysfunction should be investigated.

A brief review of normal maxillary growth and the dysfunctional pathoanatomy of velopalatine clefts is presented. A plan of management for patients with these deformities is proposed; this is based on the degree to which the deformity departs from normal. The authors stress the importance of early, complete reconstitution of the soft palate and avoidance of the use of vomer flaps in the closure of the hard palate. The influence of the vomer, nasal septum, and labionasal musculature on postnatal facial development is discussed.

Topical drug therapy for ulcerative and vesiculobullous diseases of the oral mucosa has generally proved unsatisfactory because of the turbulent and changing nature of the oral cavity. The construction and use of an intraoral drug delivery system using custom carriers to deliver topical medication is described. The delivery system presented overcomes many of the obstacles associated with topical drug administration for oral lesions and provides a therapeutic alternative to systemic agents.

Oral leiomyomas are considered to be rare neoplasms, but they may be encountered more frequently than generally believed. Three types of leiomyomas are commonly described: solid leiomyomas, angiomyomas, and epithelioid leiomyomas. Three cases of solid leiomyoma are presented, all of which occurred in the anterior mandibular mucobuccal fold. Leiomyomas can be easily confused with other spindle-cell tumors. The necessity of using special stains, especially Mallory's phosphotungstic acid hematoxylin, is discussed.

In accordance with microscopic and clinical criteria established for superficial melanomas of the skin (superficial spreading melanoma, lentigo maligna melanoma, acral-lentiginous melanoma), three oral lesions have been evaluated. The literature on oral melanomas has also been reviewed, with special attention given to those cases that had pre-existing melanosis. One patient with a diagnosis of superficial spreading melanoma eventually died of his untreated lesion 11 years after its first appearance. Two patients had lesions diagnosed as acral-lentiginous melanoma (a group which also includes volar and subungual melanomas) that exhibited aggressive, recurrent behavior. These lesions had microsocpic features similar to lentigo maligna melanoma but did not behave in a manner consistent with that diagnosis. Electron microscopic study of one acral-lentiginous melanoma demonstrated malenosomes and premelanosomes that were like those seen in normal melanocytes and nevus cells. The superficial or radial growth phase of many oral melanomas has apparently gone unrecognized. Melanosis has been reported to be a common feature of invasive oral melanomas but has not generally been related to the natural history of these lesions. Oral lesions with a prolonged intra-epithelial or radial growth phase would be expected to have a better prognosis than nodular melanomas, but meaningful survival data are not available because of the infrequency with which oral melanomas have been subclassified.

Benzydamine hydrochloride rinse reduced pain associated with radiation mucositis when it was used during the course of radiation therapy. Fewer patients using benzydamine rinse required systemic analgesics. All patients using benzydamine tolerated the rinse well and continued with regular rinsing throughout the course of radiation therapy. Benzydamine hydrochloride is currently undergoing clinical trials in the United States for application for approval from the Food and Drug Administration.

Fifteen cases of soft-tissue myxoma of the paraoral-oral structures have been presented. Eleven cases were garnered from an extensive review of the literature, and four previously unreported cases are described. The myxomas were slow-growing, insidious, infiltrative tumors which occurred in all age groups, with an average patient age of 38 years. Most frequent locations were the cheek, floor of the mouth, and palate. The lesions were present from 2 weeks to 6 years prior to treatment. In this series all the myxomas were treated by surgical excision, with no evidence of recurrences or metastases. The recommended therapy is surgical resection with adequate margins. Other myxomatous lesions which may mimic a myxoma are mentioned.

A case of herpes zoster limited to the right palate and the edentulous alveolar ridge in the absence of concurrent skin lesions or predisposing systemic disease is presented. Because of the relative rarity of isolated mucous membrane lesions of this viral disease, the tendency for intraoral vesicles to break down and ulcerate early, and, in this patient, the additional clinical findings of marked swelling and induration, malignancy rather than herpes zoster was suspected; cytologic smear furthered the suggestion of the former. A biopsy provided the definitive diagnosis.

Oral carcinoma in situ (CIS) as a histopathologic entity was studied in seventy-seven patients to determine the clinical and histologic parameters of the disease. There were forty-nine male and twenty-eight female patients, with 45.1 per cent of the lesions being described clinically as white, 15.9 per cent as red, and 8.5 per cent as a combination of the two. The high-risk sites for CIS were floor of the mouth (23.2 per cent of all lesions), tongue (22.0 per cent), and lips (in males only, 19.5 per cent). Histologically, there was a considerable range of variation in surface keratinization, thickness of epithelium, and certain cytologic alterations. The most consistent of all cytologic changes was loss of orientation of cells. There is no information available concerning possible regression of oral CIS, as is known for CIS of uterine cervix. Furthermore, there is no information concerning the frequency of or the period of transition from oral CIS to invasive carcinoma or whether all oral carcinoma is preceded by CIS. Further studies on this disease are essential.

Patients undergoing cytotoxic chemotherapy and radiation therapy often experience severe oral complications during and after treatment despite supervised oral hygiene and conventional antimicrobial regimens. The antimicrobial compound chlorhexidine is an effective topical prophylactic agent against oral mucositis and candidiasis. Oral mucositis developed in four patients who underwent bone marrow transplantation; the condition was severe enough to prompt use of chlorhexidine. In each case, there was clinical resolution of mucositis and a concomitant decrease in the oral microbial burden 1 week after chlorhexidine use began. This strongly suggests that, in addition to its value in protecting these severely immunocompromised patients from oral infection, chlorhexidine also offers a therapeutic benefit in the resolution of existing oral infections and of mucositis.

Two new cases of squamous acanthoma are presented, and the their clinical characteristics are compared to the eight cases previously reported. These two additional examples of this lesion are clinically similar to those previously reported. However, one of the two cases exhibits resolution after the removal of sources of trauma, thus lending support to the previously proposed theory of traumatic etiology.

Material has been presented to show the potential problem in continuous denture wearing. Commercial booklets for patient education have been reviewed and found to be in need of revision. Dental schools are not in agreement in the subject of continuous denture wear. The need for unanimity is evident, and if this is to be achieved, patient education publications must be revised. A maximum effort is needed to educate edentulous patients about oral tissue health, and especially the length of time that dentures should be worn.

A method of connecting "fixed partial denture" prostheses to osseointegrated implant fixtures has been described. The advantages of this system of restoration for partially and fully edentulous mouths are that it is more effective in addressing the problems of (1) stress-control on abutments, (2) a back-up system for abutment failures, (3) esthetics, and (4) control of bacterial plaques around abutments. To accomplish this procedure, the application of convertible periodontal prosthesis techniques with modifications to some existing implant systems is undertaken. The disadvantages of this method seem insignificant when one considers the complexities and risks involved with the present array of implant prosthesis alternatives. Some patients and dentists might consider the necessity of the prosthesis being detachable as one disadvantage. In reality, the prosthesis can be used as a fixed restoration until the patient has fully adapted to the new proprioception and appearance. A large percentage of patients feel uncomfortable with the word "removable" because it immediately creates a perception of unsightly metallic clasp display, palatal coverage, tongue interference, and negative body image. The use of the term "detachable" coupled with the doctor's offer to perform this task for the patient "whenever necessary" will usually relieve the patient's anxiety and allow the treatment to proceed. Once neuromuscular and esthetic adaptation have occurred and the patient has accepted the prosthesis, daily detaching and home-care hygiene by the patient will follow without incident. Esthetic improvement is obvious (Fig. 3).

Described is the case of a healthy 30-year-old Caucasian man who presented with marked unilateral loss of alveolar bone and tooth mobility on the left side. The history and clinical signs and symptoms were consistent with the diagnosis of congenital arteriovenous anastomosis.

A case of acute (toxic) epidermal necrolysis is reported in the dental literature for the first time. This severe, life-threatening mucocutaneous syndrome resembles severely scalded skin. Sloughing vesiculobullous oral lesions are a frequent component. Staphylococcus aureus and drug reactions may cause separate entities presenting clinically as acute epidermal necrolysis. This case of drug-induced epidermal necrolysis ina child was successfully treated with methicillin and hydrocortisone.

Among the various traditional beliefs and practices of the peoples of the Southeast Asia region is the practice of inserting talismans under the skin in various parts of the human body. In the orofacial region, these talismans (also called charm needles or charm pins) are also seen, usually as incidental radiographic findings. These talismans are believed to enhance the beauty of the wearers, as well as to provide protection to the wearers against harm. It is also believed that they could help the wearer obtain favorable business deals inasmuch as they are believed to have a "spell-like" influence on the business counterparts. In the present series, 67% of the patients are female and 66% of them are Muslim. Very little is known about the possible ill effects of these talismans because there is no report of these radiographic findings in major dental journals. In the present series of 12 cases representing a total of 65 talismans, only one talisman was surgically removed. We believe that generally no definitive treatment is required. However, we believe that the existence of these talismans should be made known so that they will not be misdiagnosed and mismanaged.

Some of the conditions of the soft tissues related to complete dentures encountered during a period of 25 years at a university clinic were presented and discussed from the standpoint of the clinical prosthodontist. During this time, over 1,000 denture patients were treated each year. For some conditions, a method of management was offered with treatment by sound prosthodontic principles rather than unneccessary medication. That denture fabrication involves much more than mere mechanical procedures is an understatement. Complete dentures are foreign objects in the oral cavity that are accepted and tolerated by the tissue to a degree that is surprising. As prosthodontists, we can gain satisfaction from the realization that the incidence of oral cancer due to dentures is less than extremely low. At the same time, we must be ever mindful of the statement by Sheppard and associates. "Complete dentures are not the innocuous devices we often think they are." Every dentist must remember that one of his greatest missions is to serve as a detection agency for cancer. The information discussed indicates (1) the need for careful examination of the mouth, (2) the value of a rest period of 8 hours every day for the supporting tissues, and (3) the importance of regular recall visits for denture patients. Robinson stated that while the dental laboratory technician can be trained to aid the dentist in the fabrication of prosthetic devices, his lack of knowledge of reactions and diseases of the oral tissues limits him to an auxiliary role. Complete prosthodontics is a highly specialized health service that greatly affects the health, welfare, and well-being of the patient. It can be rendered only by the true professional who is educated in the biomedical sciences.

This article illustrates the signs and symptoms, diagnostic criteria, and dental treatment for Sjögren's syndrome. Suggestions are offered in the treatment of xerostomia or SS.