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Chronic exposure to endogenous and exogenous glucocorticoids will cause CS. Endogenous CS is uncommon, with an annual incidence of 0.2-5 individuals per million. Endogenous causes could be 1. adrenocorticotropic hormone (ACTH) dependent or 2. ACTH independent. The use of exogenous glucocorticoids to manage chronic autoimmune or inflammatory diseases is the most common cause of CS and results in iatrogenic CS. Cushing disease is caused by excess ACTH production by a pituitary tumor. CS's clinical manifestations in the head and neck region include a moon-shaped face, acne flares, and hirsutism.

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The local prevalence of primary adrenal insufficiency (PAI) depends on various factors such as genetics, environment, and timely disease diagnosis. PAI is uncommon, and the prevalence is reported to be 2 per 10,000 population. PAI is commonly caused by an autoimmune process that destroys the adrenal gland, resulting in the loss of glucocorticoid and mineralocorticoid secretion from the adrenal cortex. The lack of cortisol results in impaired glucose/fat/protein metabolism, hypotension, increased adrenocorticotropic hormone secretion, impaired fluid excretion, and hyperpigmentation. PAI has a female predominance and is commonly seen in ages 20 to 50 years but can occur at any age.

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Thyroid gland dysfunctions can adversely affect patients' systemic health and well-being. Thyroid disease is the most common endocrine disorder. Recognizing early signs and symptoms of hypothyroidism is crucial in the early diagnosis of hypothyroidism. Oral health care providers must obtain comprehensive medical records from patients with hypothyroidism before dental treatments.

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Oral health care providers should obtain comprehensive medical records from patients with hyperthyroidism before dental treatments. Graves disease is the most common cause of hyperthyroidism. Untreated hyperthyroidism can lead to dangerous adverse effects, such as coma or death. Recognizing early signs and symptoms of hyperthyroidism is crucial in reducing complications.

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Most of the primary hyperparathyroidism is due to adenomas in the parathyroid glands. Hypercalcemia is more common in primary hyperparathyroidism. Hyperparathyroidism may be asymptomatic and detected incidentally as part of a routine serological evaluation. Oral health care providers should recognize distinct changes in the jawbone associated with primary and secondary hyperparathyroidism.

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Invisalign has improved periodontal health in comparison to traditional metal wire braces. Due to a growing interest in attaining better teeth esthetics, there are more adults seeking Invisalign treatment. Ten percent carbamide peroxide (CP) breaks down to 6.5% urea and 3.5% hydrogen peroxide, which elevates oral pH, removes stains, and diminishes caries by inhibiting plaque formation. The aim of this study is to investigate whether 10% CP use during Invisalign treatment can enhance tooth shade esthetics while decreasing plaque levels and improving gingival health indices. Twenty-eight patients at Western University dental center undergoing Invisalign were assigned to two groups where the experimental group applied daily bleaching material (10% CP, Ultradent Inc., South Jordan, UT, USA), while the control group did not for 4 weeks. Tooth shade, plaque index (PI), and gingival index (GI) were assessed at baseline and in 2-week intervals for 6 weeks. Results showed that 10% CP had significant change in tooth shade over the 2- and 4-weeks periods (p < 0.05) and significantly reduced plaque and gingival indices (p < 0.05), with minimal to no relapse after 2 weeks post-op. Thus, applying CP at 10% may be a useful application during Invisalign treatment in improving teeth shade and overall gingival health.

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Oral mucosal lesions are frequently encountered in a variety of healthcare settings and often present as a diagnostic and management challenge. Several immune-mediated disorders present with overlapping oral and/or cutaneous manifestations. Healthcare providers must establish a specific diagnosis to guide effective disease management. This article describes the case of a patient previously diagnosed with Behçet's disease who presented with recalcitrant gingival lesions. The case report underscores the need for healthcare providers to have a fundamental knowledge of mucocutaneous disorders.

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In this article, we discuss several common abnormal signs and symptoms that may be present in the oral cavity initially with or without any systemic symptoms at a typical dental practice. The purpose of this discussion is to increase clinical awareness for establishing differential diagnoses so that patients may obtain appropriate referrals for appropriate medical treatment.

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INTRODUCTION: The purpose of this study was to assess canal preparation outcomes in vitro by novice clinicians after standardized teaching sessions. METHODS: All students received a training session. In experiment 1, twenty canals of mandibular molars were prepared with GT and ProTaper rotaries by 10 students. Standardized radiographs were exposed before and after canal preparation, and canal curvature was measured; canals were assessed for patency and preparation time. In experiment 2, mandibular molars (20 canals) were submitted to microcomputed tomography before and after canal preparation with ProTaper and GT rotaries by 2 dental students. Canals were metrically assessed for changes (volume, surface, cross-sectional shape, transportation) during canal preparation by using software. RESULTS: In experiment 1, canal curvature decreased by 7.6 degrees and 7.8 degrees for GT and ProTaper preparations; there were no broken instruments, and 2 canals lost patency. The time for GT preparation was longer than for ProTaper (29.7 +/- 6.8 vs 19.4 +/- 8.1 minutes, P <.05). In experiment 2, canal volumes and surface areas increased (P < .001), and prepared canals were rounder in cross-section and more tapered. Mean canal transportation ranged between 0.14 +/- 0.05 mm and 0.23 +/- 0.09 mm for apical and coronal canal thirds. There were no significant differences between the instruments or the operators regarding center of mass shifts; qualitative and quantitative data for canal transportation were similar to earlier studies with experienced operators. CONCLUSIONS: Both rotary instruments performed adequately with inexperienced operators who received a brief structured training session.

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