Alarmins, also called danger-associated molecular patterns （DAMPs）, are molecules that are rapidly released from necrotic cells. They serve as early warning signals for the surrounding cells and tissues and cause inflammatory reactions by accumulating immune cells, such as neutrophils and macrophages. This type of inflammation is called “sterile inflammation” and is not accompanied by infection with pathogenic organisms. Interleukin-1α （IL-1α） is a typical alarmin. Its precursor （pIL-1α） is synthesized inside the cell and enzymatically cleaved to generate N-terminal propiece IL-1α （ppIL-1α） and C-terminal mature IL-1α （mIL-1α）. pIL-1α and ppIL-1α are preferentially localized in the nucleus due to the presence of nuclear localizing sequence （NLS）. pIL-1α is cleaved by proteases such as calpain and secreted outside the cells where it functions as a cytokine by binding to IL-1 receptor type 1 （IL-1R1）. Interestingly, pIL-1α is also released from damaged cells and binds to the same receptor. On the other hand, both pIL-1α and ppIL-1α contribute to the transcriptional regulation of some genes in the nucleus. Hence, based on these properties, IL-1α is recognized as a dual-functional cytokine. This review summarizes recent knowledge on the role of IL-1α as an alarmin.
Carotid calcified lesions present on panoramic images are arteriosclerotic involving vascular lesions. Arteriosclerosis caused by cerebrovascular disease, which is the fourth leading cause of death in Japan, and arteriosclerotic heart disease account for the majority of sudden deaths in Japan. We believe that panoramic radiographic images can be used to determine the presence or absence of carotid calcification, explain the possible pathogenesis of vascular lesions, and encourage individuals to consult physicians in order to prevent the onset of arteriosclerosis. Atherosclerosis typically affects the carotid artery, which may develop into calcifications. Panoramic images can be used to observe calcification of the affected carotid area. From examinations, we can deduce if the calcification of the carotid artery is related to secondary vascular lesions or not. This article explains the importance of diagnosing carotid calcified lesions from panoramic images from our previous studies. Furthermore, we employ a larger sample size for examinations, and perform suitable analysis to demonstrate the relationship between carotid calcification and the risk factors for arteriosclerosis. As a result, we propose a diagnostic imaging system which can accurately diagnose and predict carotid calcifications.
In the current complex social environment, the number of patients with dental psychosomatic disorders who visit dental university hospitals is increasing, and not only physicians but also dentists are struggling to deal with such cases. There are many women, including many cases with xerostomia, and the number has been increasing year by year in clinical statistics. In this study, we conducted a survey of 45 healthy dental hygienist school students as a preliminary step to designing a pilot study for patients. The purpose was to collect basic data for application to diagnosis based on the degree of oral moistness and the state and trait anxiety scale by the State-Trait Anxiety Inventory. Various measurements were performed in a short time before and after clinical training. The oral moistness was statistically investigated according to the characteristic anxiety scale, divided into a characteristic high-anxiety group and a characteristic low-anxiety group. As a result, we clarified the changes in the degree of moisture in the oral cavity by differences of anxiety tendency even among healthy subjects, and obtained suggestions for use in future diagnosis and research.
Dentigerous cysts are common odontogenic cysts of the jaw associated with an unerupted tooth. However, even if a dentigerous cyst is diagnosed, histopathological diagnosis occasionally shows odontogenic tumor. We examined 15 cases diagnosed as dentigerous cyst, showing a radiolucent area in the jaw. One of the treatment choices is cyst removal with open wound or marsupialization that promotes new bone by reducing the intracystic pressure. However, the marsupialization hole gradually reduces leaving a cyst cavity, which often becomes infected due to food impaction, leading to pain and discomfort. We present a novel technique employing an easy-to-use wire obturator for patients with dentigerous cysts. This study analyzed and clinically evaluated demographic data, lesion site, treatment method, postoperative course, etc. of 15 patients with dentigerous cysts treated with a wire obturator. The wire obturators were maintained for 2-9 months and irrigated once every 4-8 weeks in the outpatient clinic to prevent closure of the marsupialization hole. After marsupialization, the patients were taught how to carry out appropriate oral hygiene procedures including instructions on brushing and daily rinsing, allowing them to clean the cystic cavity and follow good oral hygiene procedures by themselves at home. We radiographically evaluated their bone healing in all cases without pain, discomfort and infection. These results suggest that this wire obturator provides an effective technique for the treatment of dentigerous cysts.
Supernumerary teeth occur in 0.9-2.6％ of cases and most frequently in the maxillary anterior or molar region. The presence of bilateral supernumerary teeth in the mandibular third molar region is rare. Here, we report a case of bilateral impacted supernumerary teeth in this region. The patient was a 27-year-old man who presented to our hospital with the chief complaint of right mandibular second molar pain. Radiological examination showed radiolucency around the right mandibular second molar root and odontoid radiopacity in the mandibular third molar region bilaterally. We diagnosed apical periodontitis of the right mandibular second molar and bilateral mandibular horizontal impacted third molars associated with impacted supernumerary teeth. We extracted the right mandibular second molar, both mandibular third molars, and the impacted supernumerary teeth with the patient under general anesthesia. The postoperative course was uneventful and the patient remains well 17 months after surgery.
Lipomas are common benign tumors, though intraosseous lipomas of the jaws are relatively rare. We report a case of intraosseous lipoma in the anterior mandible. A 30-year-old female was referred to our department for extraction of impacted wisdom teeth. Radiograph examination showed a well-demarcated multilocular radiolucent lesion with sclerotic margin and intralesional radiopacities. The lesion was located between the right lower canine and the left lower first premolar, apart from the apices of the teeth. The lesion was enucleated under general anesthesia. Histopathologically, the lesion consisted of mature adipocytes and scattered trabecular lamellated bones without evidence of malignancy. A pathological diagnosis of intraosseous lipoma was made. After surgery, dysesthesia of the lower lip was observed, but it improved in about 4 months.
Necrotizing fasciitis is a serious infection characterized by rapid necrosis of the fascia and subcutaneous tissue. We report a case of deep cervical abscess, which was considered to be necrotizing fasciitis caused by apical periodontitis of the right maxillary third molar. The patient was a 59-year-old Japanese man who visited our hospital complaining of swelling and pain in his right lower jaw. Diffuse swelling with redness was observed from the right lower jaw to the neck. He was diagnosed with cervical cellulitis due to apical periodontitis in the right maxillary third molar. The patient immediately was treated with an antimicrobial as well as incision and drainage. At that time, extensive necrotic tissue was observed along the fascia, and bacterial tests revealed Peptostreptococcus micros. Since cervical necrotizing fasciitis was suspected, necrotic tissues were removed and washed as appropriate. Then, dermatoplasty on the cervical skin defect and extraction of the causative teeth were performed. For successful treatment of cervical necrotizing fasciitis, early diagnosis and aggressive surgical procedures are important, because deep cervical abscesses often become fatal if they become serious.
Glandular odontogenic cyst （GOC） is a rare odontogenic cyst and is categorized as a developmental odontogenic cyst. Herein, we report a case of GOC developing in the maxilla. The patient was a 25-year-old man who complained of swelling of the left buccal region. CT images showed a unilocular radiolucent lesion extending from the maxillary anterior region to the maxillary sinus. The lesion included an impacted tooth, and root resorption of 21, 22, 23 and 24 was observed. A biopsy suggested that it was GOC. He underwent cystectomy with root canal filling and apicoectomy of the 21, 22, 23 and 24 under general anesthesia. The wound was opened to the oral cavity. Histopathological diagnosis was GOC. Nine months later, tooth extraction of 21, 22, 23 and 24 was performed because of their increased mobility. Two months later, reconstruction of the alveolar ridge using particulate cancellous bone and marrow （PCBM） was carried out. Nine months after the PCBM graft, 3 dental implants were placed into the reconstructed bone, and an implant-retained overdenture treatment was completed. Since then, the overdenture has uneventfully functioned for 4 years and 9 months, with no evidence of recurrence.
Spindle cell lipoma is a subtype of lipoma. It is characterized by a mixture of mature adipocytes and spindle cells. It usually occurs in the subcutaneous tissue of the neck, shoulders, and back, and is rare in the oral region. We report a rare case of spindle cell lipoma of the lip. A 57-year-old woman was referred to our department because of a painless mass of the upper lip. The mass was completely removed under local anesthesia, and was histopathologically diagnosed as spindle cell lipoma, because it consisted of mature adipocytes and CD34 positive-spindle cells. Two years have passed since the operation, and the healing progress has been good without recurrence.
An osteoma is a benign tumor with proliferation of mature bone tissue, often found in the facial-cranial bones. Patients with osteoma often complain of cosmetic disturbance. We report a case of a comparatively large osteoma found in the mandibular angle in a 45-year-old man. He was referred to our hospital by his dental clinic for examination of a swelling of the right cheek. His complexion was asymmetric because of the immobile, bone-like hard mass in his right mandibular angle. Facial CT showed a pedunculated mass about 35×21mm in size in the outer surface of the right mandibular angle. Diagnosed as an osteoma, the mass was resected by an extraoral approach under general anesthetic. The pathological diagnosis was peripheral osteoma with proliferation of mature lamellar bone. Postoperative esthetic appearance was satisfactory. Two years after the operation, there is no evidence of recurrence in this patient.
Botryoid odontogenic cyst is an extremely rare cyst that was first reported by Weathers and Waldron in 1973. This cyst most frequently occurs in the mandible and rarely in the maxilla. Herein, we report a case of botryoid odontogenic cyst in the right maxillary molar region in a 70-year-old woman.
The patient was referred to our department by a dental clinic for a cystic lesion near the right maxillary molar. Our pre-operative diagnosis was a radicular cyst. However, a post-operative histopathological analysis of a specimen of the surgically resected material confirmed the lesion to be a botryoid odontogenic cyst. The postoperative healing was normal and there were no signs of recurrence 1 year postoperatively.
Pleomorphic adenoma is the most common benign tumor of salivary glands. Pleomorphic adenoma derived from minor salivary glands most commonly occurs in the palate. However, to the best of our knowledge, reports of pleomorphic adenoma on the tongue are extremely rare, with only 24 cases including the present case. The patient, a male in his 40s, had an encapsulated mass, about 20mm in diameter, on the front part of his tongue. The mass was well-demarcated and movable. On magnetic resonance imaging （MRI） examination, T2 weighted imaging showed a lesion of moderate signal with clear border and low signal rim. For a clinical diagnosis of the tumor of the tongue, we performed an excisional biopsy under general anesthesia. The final diagnosis of the extirpated specimen was pleomorphic adenoma. Anterior lingual gland （Blandin Nuhn’s gland） and the posterior lingual gland exist in lingual glands. It was presumed to be a tumor derived from Blandin Nuhn’s gland. About 2 years after surgery, there has been no recurrence or malignancy in clinical or radiological findings.