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5/04 aadmd.la

American Academy of Developmental Medicine and Dentistry
Developmental Medicine &
Dentistry Reviews and Reports

This month’s issue of the AADMD Developmental X-rays in a 45-year-old woman with a neurodevelop- Medicine & Dentistry Reviews & Reports features an article by Horbelt and Fenton which demonstrates poliomyelitis and complicated by severe cognitive the value of dental radiography—and also good dysfunction, motor dysfunction, seizures, and history—in providing quality healthcare to patients impulsive destructive behaviors. She presented with developmental disabilities. Academy dentists with a mass in the left jaw which might have been such as Dr Henry Hood have repeatedly emphasized a neoplasm, but because of the appearance on X-ray the importance of dental radiography in providing quality and additional clinical history the correct diagnosis of a health services to patients with disabilities secondary to neurode- benign condition could be made. The authors make a velopmental disorders. Dr Hood has demonstrated in his previous compelling case for the routine use of dental radiography as a studies that when dental radiographs are obtained in patients with standard of care for patients with developmental disabilities.
developmental disabilities, pain-producing and other serious lesions are often discovered. The case reported here by Corbelt General Information about the American Academy of and Fenton underscores what Dr Hood has been saying for years. Developmental Medicine and Dentistry and how to join can be The authors were able to innovatively obtain panoramic dental obtained by visiting our website at http://www.aadmd.org. THE IMPORTANCE OF DENTAL RADIOGRAPHS:
A CASE REPORT
BY CARLTON V. HORBELT, DDS, FADPD & SANFORD J. FENTON, DDS, MDS, FDS RCSED, FADPD Anyone who has accepted the important, if not more, for the patient The subject of this case report is a 45- diagnostic dental radiographs as it is for who currently resides at a state institution for the care of persons with developmental that one of the most difficult procedures pose of this case report is to underscore disabilities. She has been seen in the facil- to successfully complete is the taking of ity dental clinic an average of five times a factors, such as the patient’s heightened opmental disabilities whenever possible.
With such exams, potentially serious, life keeping still, combine to create signifi- oral tissues are in good condition at this cant obstacles to the taking of X-rays in this population. Regardless of the inher- before it is too late or ruled out as a pos- unit on a daily basis. Upon her arrival at the facility, she did have an asymptomatic 6 6 May 2004 • EP MAGAZINE/www.eparent.com With the panoramic X-ray as a diagnostic tool,
mandible causing a slight facial asymmetry.
Her primary care physician was consulted what could have been a potentially life
and he felt that no definitive treatmentintervention was necessary. Due to the threatening condition was correctly diagnosed
existing equipment in the dental clinicand her marginal behavior level, the and ruled out as a serious health threat.
dental staff had been unable to take apanoramic X-ray.
treated in this clinic. After much begging and pleading with the facility administra- tors, the dental clinic had the very good allowed the removal of the chair and as a diagnosed epilepsy, and it has controlled 2. Bilateral flaccid paralysis of the lower bility, panoramic X-rays were finally suc- individuals treated in this dental clinic, including the subject of this case report. Note: Both her mental retardation and This individual visited the dental clinic for lower extremity paralysis were attributed her regular recall dental prophylaxis and to poliomyelitis contracted at the age of to the infirmary, and her seizure activity exam. After the dental cleaning and exam, the dental staff was able to successfully take a panoramic X-ray using the new machine.
ming appears to be good at this time.
disorder – this was demonstrated during This individual has been seen in the facili- unknown origin present in the left posterior ty dental clinic on a regular and continuing basis. When she is in the dental clinic, she is radiopacity approximately 4 cm. in diame- a moderately cooperative patient, allowing ramus. It was fairly well delineated and had would never allow the dental staff to suc- 5. Congenital dislocation of her right hip the lesion consisted of fine granular flecks many of the individuals at this facilitybecause of the older model Panorex machine required that a patient sit in the move suddenly during the X-ray process.
www.eparent.com/EP MAGAZINE • May 2004 6 7 As a result of this finding in her past medical history, it was tumor is associated with an impacted tooth and it normally clear that the oral pathologist had been correct concerning the involves the mandibular bicuspid or molar area.
possible existence of hydroxyapatite paste, and no further treat- Radiographically, this will appear as an impacted tooth with a ment was deemed necessary. With the panoramic X-ray as a radiolucency around the crown. The radiolucency will contain diagnostic tool, what could have been a potentially life threat- small or large areas of radiopacity. It usually develops during or ening condition was correctly diagnosed and ruled out as a seri- after the third decade of life. This rare condition requires only ous health threat. Also, the panoramic X-ray led to the discov- ery of an interesting treatment decision that was made becausethis individual had developmental disabilities, and as a result, difficulty with tolerating dental care. This asymptomatic bony This is an irregular disorganized mass of hard dental tissues that enlargement of the left posterior mandible could have proven to appears radiographically as an irregular radiopacity of limited be a very serious health problem. Fortunately, this patient growth with the teeth remaining vital. It can occur in either jaw ended up having a positive outcome. However, without the ben- at any age and in either sex. This condition requires excision efit of the panoramic X-ray, a definitive diagnosis would have unless there is a danger of fracture during the removal.
been impossible. This case report illustrates the need for routineradiographs whenever possible on dental patients with develop- 3. Cemento-ossifying fibroma, mature stage: mental disabilities. It is the only way that “hidden” dental prob- This is a combination of fibrous tissue and bone that appears lems with potentially serious health implications can be discov- radiographically as a single radiopacity of long duration. It is ered, diagnosed, and properly treated if necessary. Dental and painless and it can be expansile. This can occur in the jaw, and medical professionals who treat special needs patients have a develops in children as well as in adults of either sex. This con- clear responsibility to use all available diagnostic tools to ensure that they deliver the highest quality of care. EP
4. Localized chronic sclerosing osteomyelitis and foreign Carlton V. Horbelt, DDS, FADPD is an Associate Professor in the Division material consistent with hydroxyapatite used to fill a large surgi- of Pediatric Dentistry and Community Oral Health at the University of cal defect associated with a bony impacted third molar, cystic Tennessee College of Dentistry in Memphis, and Dental Director at the Arlington Developmental Center in Arlington, TN. Dr. Horbelt is a Fellowof the Academy of Dentistry for Persons with Disabilities and a Fellow ofthe American College of Dentists. He is the Immediate Past-President of the Academy of Dentistry for Persons with Disabilities and a Past- President of the Southern Association of Institutional Dentists. Dr.
Horbelt has been providing dental care to persons with developmental 1. If previous history supports hydroxyapatite material to fill a surgical defect, no treatment is necessary.
2. If the history is not available or negative, then an incisional Sanford J. Fenton, DDS, MDS, FDS RCSED, FADPD, is Professor and biopsy is recommended in order to rule out a neoplastic dis- Chair of the Department of Pediatric Dentistry & Community Oral ease. However, all of the neoplastic lesions that are this large Health at the University of Tennessee College of Dentistry. Dr.
should cause significant expansion of the mandible.
Fenton is also the UTHSC Chief of Dental Services at ArlingtonDevelopmental Center, President-Elect of the American Academy of After receiving these recommendations, the treating dentist Developmental Medicine and Dentistry, and a Past President of the went to the medical records department at this facility to see if Academy of Dentistry for Persons with Disabilities. He is a fellow of there was any old pertinent medical information, which had the American College of Dentists, International College of Dentists, been deleted from her active chart, that might address this situa- Academy of Dentistry for Persons with Disabilities, and Royal College tion. After searching through a great deal of deleted material on of Surgeons of Edinburgh. Dr. Fenton also served as Chairman of theHealth Promotions: Providers Work Group during the Surgeon microfiche, records were located indicating that she had been General’s Conference on Health Disparities and Mental Retardation.
treated by an oral surgeon at a local hospital in June of 1987. Theoral surgeon removed a lower left impacted third molar and adentigerous cyst. This procedure resulted in a considerable bonydefect into which he placed hydroxyapatite paste. In his notes hemade mention that part of the reason he decided to place thehydroxyapatite paste was to help insure that this individualwould not require any further care as a result of this surgical pro-cedure. He noted her lack of compliance to dental treatmentbecause of her developmental disabilities and his desire that shenot be subjected to further traumatic procedures if at all possible. 6 8 May 2004 • EP MAGAZINE/www.eparent.com

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The New Testament Greek term for “church” is ekklesia, which means an assembly of believers, called out by God (1Pet. 2:9-10). The Bible speaks of the church in two distinct ways: the universal church and the local church, with the majority of references to local churches. Grudem simply defines the church as, “the community of all true believers for all time.” The church consists of

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