An unusual white lesion in a 10 month old child

Introduction: Oral lesions commonly diagnosed in neonatesinclude Epstein’s pearls, Bohn’s nodules, dental lamina cysts,natal teeth and congenital epulis. Nevertheless, intriguing caseswhich have rarely been reported in the literature are sometimesencountered by clinicians. We report a case of an unusual whitelesion in a 10-month old male infant. Clinical management: The infant’s mother had noticed a smallwhite swelling in the anterior region of the maxilla in the morningwhich increased in size by the late afternoon. Hence, she wasurged by the paediatrician to seek dental advice. Intra-oralexamination revealed a white mass (approximately 5 mm indiameter) in the maxillary right central incisor region, firm inconsistency and adherent to the mucosa. Radiographic examina-tion indicated that the white mass was radiolucent. The parentswere reassured and advised to monitor the lesion. The parentsreturned 3 weeks later reporting that the white mass had, thatday, shed spontaneously. It had a uniform hemispherical outlineand measured 10 mm · 5 mm in diameter. Histopathologicalexamination reported the mass to be acellular and amorphous;as it did not resemble any known bodily tissues, it was diagnosedas a Ôforeign bodyÕ.Conclusion: Infants tend to explore things with their mouths; hencethey put anything they can hold into their oral cavity to determinethe size and texture. This case serves to illustrate that theunexpected can occur and that in children the differential diagnosisshould include a Ôforeign bodyÕ.link_to_OA_fulltex

The importance of the primary dentition to children - Part 1: Consequences of not treating carious teeth

Humans are diphyodonts, which means that they have two successive sets of teeth: primary and permanent. The primary teeth are important in a child's life as they help in mastication, in speech, contribute to aesthetics and preserve the integrity of the dental arches, finally guiding permanent teeth into their correct positions. Dental caries (decay) which is avoidable, remains a common chronic disease of early childhood with an occurrence rate five times higher than that of asthma and seven times higher than that of allergic rhinitis. Untreated carious teeth in young children frequently lead to pain and infection, necessitating emergency visits to the dentist. Carious teeth in early childhood are not only indicative of future dental problems, they also adversely affect growth and cognitive development by interfering with nutrition, sleep and concentration at school. In addition, they may have a significant impact on an individual's quality of life. Primary teeth are not always given a high priority although physicians and health policy-makers have an interest in playing an active role in children's oral health, owing possibly to lack of simple well-defined practical guidelines to follow when performing dental screenings and other activities relating to the infant's oral health. Also, many parents are unaware of the importance of primary teeth; consequently, dental attendances before the age of two years are uncommon. They consider primary teeth to be only temporary and think that related problems are rarely life-threatening. Intervention to prevent or arrest dental caries should focus on reducing the availability of refined carbohydrates (substrate), reducing the microbial burden (causative organism), increasing the resistance of the teeth (host) to caries, or a combination of these approaches. Nevertheless, dental caries can be effectively treated using various restorative materials with suitable pain control measures. This is possible if proper advice and referral is made by medical practitioners who have early and often frequent contact with young children. There seems to be no logical reason for leaving carious primary teeth untreated in a child's mouth. Early recognition and timely referral of infants and young children with dental caries is critical in preventing the unpleasant complications. Primary care providers who have contact with children are well placed to offer anticipatory advice to reduce the consequences of dental caries.link_to_subscribed_fulltex

Determination of the optimum time for surgical removal of unerupted anterior supernumerary teeth

Purpose: The purpose of this study was to determine the optimum time for surgical removal of unerupted maxillary anterior supernumerary teeth. Methods: The study population consisted of 126 children. Stages C to H of the Demirjian classification were used to classify the dental development of the adjacent incisors. Associations were sought between the complications and the developmental stage of the adjacent maxillary incisors at the time of surgical removal. Tests of association were carried out using Fisher's exact test with a probability level of P=.05 for statistical significance. Results: Significant differences were evident: for mature maxillary central incisors (N=170); between all the proportions for root resorption, with the greotest difference being between stages E and H (P<.001); for arrested root development between stages D and E (P=.013), and D and H (P=.02); and for persistent malocclusion between stages E and G (P=.004), E and H (P=.02), F and G (P=.005), and F and H (P=.OI). Conclusion: Early removal of unerupted maxillary supernumerary teeth seems to be advantageous with a cutoff point of approximately 6 to 7 years old, after which more complications are expected.link_to_subscribed_fulltex

Agenesis of maxillary permanent first molars: literature review and two case reports

Congenital absence of teeth is the most commonly known developmental dental anomaly in humans. Agenesis of the permanent first molars has the least frequency of all the tooth types and when present, usually occurs in association with oligodontia or anodontia. Generally, it is easy to diagnose agenesis of the permanent first molars retrospectively, based on the clinical morphology and x-ray photographic features of the permanent second molars; while it is often debatable when made prospectively. Several hypotheses have been promulgated to explain the etiology of hypodontia with evolutionary and anatomic models. Nevertheless, clinical epidemiology does not completely support these hypotheses and therefore clinicians should be cautious; while speculating the missing tooth type based on these hypotheses. We encompass a comprehensive review of the literature on missing permanent first molars and illustrate two cases of missing maxillary permanent first molars to emphasize the complexity involved in their diagnosis.published_or_final_versio

The genetic basis of a dentigerous cyst associated with a supernumerary tooth?

Oral Sessions - O12/Syndromes and Genetics 2INTRODUCTION: Supernumerary teeth are teeth additional to the normal complement and the frequent clinical indicators are noneruption or delayed eruption of teeth, crowding, displacement and dentigerous cyst (DC) formation. Approximately, 95% of DCs involve the permanent dentition and only 5% are associated with supernumerary teeth. The objectives of this study were to: (i) report a pair of siblings with supernumeraries of whom, one developed a dentigerous cyst and (ii) analyze fragile histidine triad (FHIT) and p53 gene status in DC associated with supernumerary teeth. CLINICAL MANAGEMENT: This six-year-old Chinese boy complained of swelling in the maxillary right incisor region. Radiographs revealed the presence of two supernumeraries in the premaxillary region, one of which had evidence of an enlarged follicle. Histopathology confirmed that the cystic lining was consistent with a DC. The patients elder sister also exhibited two supernumeraries in the premaxilla which was subsequently surgically removed. Blood samples were collected and the DNA extracted using the Qiagen_ mini blood kit. The DNA yield was quantified using 260 nm/280 nm ratio. After isolation, aliquots of the DNA samples were prepared for analyzing the status of the FHIT and p53 gene. CONCLUSION: Occurrence of supernumerary teeth in siblings indicates that inheritance is a major contributory factor in their development. Although DCs are uncommon in the first decade of life, regular inspections of radiographs are important. It is hypothesized that aberrations of FHIT and p53 genes could be considered as markers responsible for the development of DCs associated with supernumerary teeth.link_to_OA_fulltextThe 22nd Congress of the International Association of Paediatric Dentistry, Munich, Germany, 17-20 June, 2009. In International Journal of Paediatric Dentistry, 2009, v. 19, suppl. s1, p. 32, abstract no: O12-8

A novel combination of dens evaginatus and dens invaginatus in a single tooth - Review of the literature and a case report

Dens evaginatus (DE) and dens invaginatus (DI) are rare developmental dental anomalies affecting both the primary and permanent dentitions. Concurrence of DE and DI within the same tooth is extremely rare. We report a case of DE and DI in a maxillary right lateral incisor tooth. Comprehensive clinical and radiographic examinations are essential to identify such dejects; the early diagnosis can then result in the appropriate prophylactic treatment being performed, thus preventing undesirable pulpal complications.link_to_subscribed_fulltex

Characteristics of 283 supernumerary teeth in southern Chinese children

Objectives: This was a retrospective study to determine the characteristics and distribution of supernumerary teeth in southern Chinese children. Methods: The study population consisted of 208 children aged from 2 to 16 years. Results: Males were more frequently affected than females in the ratio 3.1:1. Of the 283 supernumerary teeth, 95.0% were located in the premaxilla, 71.5% were conical, 70.7% were unilateral, 29.3% were bilateral, 47.7% were inverted, and 16.9% were erupted. The mean age at the time of diagnosis and removal of the supernumerary teeth was 7.3 ± 2.7 years (the minimum age was 2.1 years) and 8.1± 2.7 years (the minimum age was 4.1 years), respectively. Seventy percent of the children were in the mixed dentition and 81.3% of the supernumeraries were removed under general anesthesia. Conclusion: In accordance with previous studies, the majority of the supernumerary teeth were located in the premaxillary region, were conical shaped, and remained unerupted. © 2008 Mosby, Inc. All rights reserved.link_to_subscribed_fulltex