Mostrando entradas con la etiqueta Clinical Case. Mostrar todas las entradas
Mostrando entradas con la etiqueta Clinical Case. Mostrar todas las entradas


CLINICAL CASE : Brain abscess secondary to a dental infection in an 11 year old child

Clinical Case

A primary molar dental abscess was implicated as the cause of a brain abscess in an 11-year-old boy.

This case report describes the neurological signs and symptoms, and acute management of a brain abscess in a child.

A brain abscess is provisionally diagnosed from the patient’s medical history, as well as the presence of signs and symptoms such as fever, headache, nausea, vomiting, focal neurological deficit, altered mentation, speech alterations, papillary edema, and neck stiffness or seizures.

A definitive diagnosis of brain abscess is confirmed through imaging.

The dental source of infection is identified by the exclusion of more probable foci such as the ears, heart, lungs, eyes or sinuses.

Read Also: EMERGENCY : Multidisciplinary approach in the immediate replantation of a maxillary central incisor

Introduction : Dental abscesses and facial cellulitis put dentists on alert for potentially life-threatening conditions such as sepsis or airway obstruction, but the risk of a brain abscess is a complication of odontogenic infection that dentists rarely consider.

This report describes the case of an 11-year-old boy whose brain abscess and associated neurological signs were most likely attributable to an abscessed primary molar.

The description of the neurological signs and symptoms, and the history and management of this case will inform dentists about the real possibility of a brain abscess of dental origin.


°Canadian Dental Association
°Dr. Hibberd / Dr. Nguyen


ORAL PATHOLOGY : Congenital epulis with auto-resolution: case report

Congenital epulis

Congenital epulis is an uncommon benign lesion that affects the oral cavity of newborns, and presents histological features which are similar to those of granular cell tumor.

The origin of this lesion has not been fully elucidated, and many hypotheses are considered due to the large variety of cell types observed in histological sections.

Epulis development occurs further in the prenatal period, and is more common in newborn females, frequently in the maxilla.

This lesion usually is presentend as a nodule covered by normal oral mucosa, which in some cases, interferes with baby's breathing and feeding.

This report describes the case of a two-month-old male baby who presented a pedunculated intraoral lesion in the mandibular alveolar ridge.

Read Also: Reimplantation of avulsed dry permanent teeth after three days

Histological sections revealed presence of mucosal fragments with atrophic squamous stratified epithelium, and fibrous connective tissue composed of cells with granular and eosinophilic cytoplasm.

A few days after initial exam, the lesion detached from alveolar ridge, and healed spontaneously.


° Adriane Sousa de SIQUEIRA, Márcia Regina Dias de CARVALHO, Ana Celina Dourado MONTEIRO, Maria das Graças Rodrigues PINHEIRO, Lucas Rodrigues PINHEIRO, João de Jesus Viana PINHEIRO


ORAL MEDICINE : Clinical Management of Regional Odontodysplasia. Clinical Case

Oral Medicine

Regional odontodysplasia (ROD) is a relatively rare localized developmental anomaly of the dental tissues with specific clinical, radiographic, and histologic characteristics.

Crawford ascribed the first report of ROD to Hitchin in 1934, while others suggested that McCall and Wald were the first to describe this condition in 1947.

It was not until 1963, however, that Zegarelli et al coined the term “odontodysplasia” and Pindborg added the prefix “regional” in 1970.

In an extensive review of ROD in 1989, Crawford and Aldred stated females are more often affected than males (1.4:1) and that there was no association with race.

These authors listed several etiological factors such as local circulatory disorders, viral infections, pharmacotherapy during pregnancy, facial asymmetry, local trauma, metabolic disturbances, somatic and neural mutations, and syndromal involvement.

They also suggested that a combination of factors might be involved. In spite of this, ROD’s etiology remains undetermined.

Read Also: ORAL MEDICINE : How to treat oral thrush in newborns

The criteria for ROD diagnosis are based on clinical, radiographic, and histologic findings. The maxilla is typically affected twice as often as the mandible.

Clinically, the condition is usually unilateral and rarely crosses the midline; exceptions are, however, occasionally found. In most cases in which the damage crosses the midline, only the central incisor on the opposite side is affected.

The teeth are likely to be small, brown, grooved, and hypoplastic. Eruption failure or delay is frequently seen as well as abscesses or fistulae in the absence of caries.

Radiographically, there is a lack of contrast between the enamel and dentin, both of which are less radiopaque than unaffected counterparts.

Moreover, enamel and dentin layers are thin, giving the teeth a “ghost like” appearance. The pulp chambers are large, and usually present areas of relatively radiodense tissue (pulp stones or denticles). The follicles of unerupted teeth are enlarged.


° Abel Cahuana, PhD, MD, DDS Yndira González, DDS Camila Palma, DDS


CLINICAL CASE : 26 Month old child with severe child hood caries

Dental Caries

Dental caries (decay) is an international public health challenge, especially amongst young children.

Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries.

ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated.

Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well.

ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition.

Read Also: ORAL PATHOLOGY : Residual Neonatal Teeth: A Case Report

Youtube / Ahmed ElNassry
Image : NZ Herald


EMERGENCY : Reimplantation of avulsed dry permanent teeth after three days


Avulsion is a traumatic injury which results in loss of the tooth from the alveolus, while reimplantation is the technique of reinserting an avulsed tooth into the alveolus or tooth socket after its loss.

The success of reimplantation depends on many factors among which are the time lapse before the tooth is reimplanted in the socket and the storage medium of the avulsed tooth.

Other factors which may affect the success of reimplantation include the condition of the tooth, particularly the periodontal ligament tissue remaining on the root surface, sex, age, type of tooth reimplanted, stage of root formation, type of cleansing procedure following contamination of the root surface, duration of splinting, and the use of antibiotics.

With favorable conditions such as the periodontal ligament remaining on the root surface, the tooth stored in adequate storage medium for not more than 60 minutes, and immediate reimplantation after the accident, the tooth may be retained for as long as 5 to 10 years and few for a lifetime, but some fail soon after reimplantation.

Read Also: ORAL SURGERY : Guideline on Pediatric Oral Surgery

Unfavorable conditions include teeth out of the mouth for more than 6 hours in no storage media and without periodontal ligament on the root surface.

In such cases, the reimplanted tooth fails with subsequent loss of the tooth.

This is because dry storage affects pulp revascularization and survival of the periodontal ligament cells along the root surface resulting in either replacement resorption or loss of the tooth.


°Nigerian Journal of Clinical Practice
°IN Ize-Iyamu, BDO Saheeb


ORAL SURGERY : Conservative treatment of the dentigerous cyst: report of two cases in childrens

Dentigerous Cyst

The purpose of this paper is to present two cases of dentigerous cyst associated to permanent teeth in children treated by conservative techniques.

Dentigerous cyst is the most common developmental cysts of the jaws.

Conservative treatment is very effective to this entity and aims at eliminating the cystic tissue and preserving the permanent tooth involved in the pathology.

Two techniques are described as conservative treatment for these cysts, marsupialization and the decompression. Two children presented with dentigerous cysts.

A female child was affected by a large lesion at the right side of the mandible associated to tooth 45. The other lesion arose at the left maxilla associated to tooth 21 of a male child. Each dentigerous cyst promoted severe tooth displacement.

The first patient was treated with decompression and the second with marsupialization.

Read Also: ORAL SURGERY : Guideline on Pediatric Oral Surgery


Dentigerous cyst is the most common odontogenic development cyst. It can involve any included tooth, although molars and canines are the most affected ones. Cystic formation involving the crown of premolars and incisives is rare.


°Brazilian Journal of Oral Sciences
°Manoela Carrera; Danilo Borges Dantas; Antônio Mareio Marchionni; Marília Gerhardt de Oliveira; Miguel Gustavo Setúbal Andrade

PERIODONTICS : Generalized Aggressive Periodontitis in Preschoolers: Report of a case in a 3-1/2 Year Old


The importance of a prompt diagnosis and treatment of periodontitis in children is emphasized by the association between the presence of periodontitis in primary dentition and periodontitis at older ages in the same individual.

The 1999 International Workshop for a Classification of Periodontal Diseases and Conditions classified periodontal disease in children as follows:

°Dental plaque-induced gingival diseases; aggressive periodontitis (previously known as “prepubertal” or “early onset periodontitis”); chronic periodontitis; periodontitis as a manifestation of a systemic disease; and necrotizing periodontal diseases.

Aggressive and chronic periodontitis is subdivided into localized or generalized, depending on the size of the area affected. Most of the literature reports of severe periodontal destruction in children are associated with systemic diseases such as hypophosphatasia, cyclic neutropenia, agranulocytosis, histiocytosis X, leukocyte adhesion deficiency, Papillon-Lefèvre syndrome and leukemia.

Although destructive forms of periodontal disease in infants are relatively uncommon, children and adolescents may manifest any form of periodontitis. However, it has been shown that aggressive periodontitis may be more common in children and adolescents, while chronic periodontitis is more frequent in adults.

The etiology of aggressive periodontitis may be broadly divided into two categories: bacterial plaque with highly pathogenic bacteria, and impaired host defense mechanism.

Read Also: EMERGENCY : Managing Patients With Primary Incisor Root Fracture

As far as pathological microflora is concerned, the most important bacteria appear to be highly virulent strains of Aggregatibacter actinomycetemcomitans previously known as Actinobacillus actinomycetemcomitans in combination with Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola, however other bacteria may be present.

Although there seems to be a genetic predisposition for periodontal diseases, it has also been shown that periodontopathic bacteria are transmissible among family members or between children and their caregivers.

Camila Palma Portaro / Yndira Gonzalez Chópite / Abel Cahuana Cárdenas


Aesthetic Rehabilitation of Maxillary Primary Anterior Teeth with Early Child Hood Caries – Report of Three Different Cases

Oral Rehabilitation

It is a great challenge for Pediatric Dentists to restore and to aesthetically rehabilitate a pre-schooler, who has lost their anterior teeth subsequent to early childhood caries or extensive dental trauma.

This paper discusses case reports of anterior aesthetic rehabilitation of upper primary incisors in three different methods taking into account the different aspects of the treatment modalities.

The different methods employed were post and core restoration with direct resin composite build up, restoration with strip crowns and rehabilitation with fixed functional space maintainers replacing the crowns of upper primary central and lateral incisors.

1. Introduction : Dental caries has been reported since prehistoric times and the present dietary course has contributed substantially to the increased prevalence of this disease worldwide.

The most common cause of the structural damage of the anterior teeth is the early childhood caries and dental trauma. ECC is defined as “the presence of one or more decayed (non-cavitated or cavitated lesions), missing teeth (due to caries), or filled tooth surfaces in any primary tooth in a child 72 of months age or younger.

Read Also: EMERGENCY : Multidisciplinary approach in the immediate replantation of a maxillary central incisor

In the initial phase it is found on either the labial or lingual surfaces of the teeth and the primary maxillary incisors are generally affected earlier.

ECC starts as a dull, white demineralized enamel that quickly advances to obvious decay along the gingival margin. S. mutans and Streptococcus sobrinus are the main cariogenic micro-organisms responsible for the ECC.


° Rena Ephraim, Rajamani. T, Ambili Ayilliath, Arifa. M.K
° International Journal of Dental Sciences and Research. 2017, 5(6), 159-162. DOI: 10.12691/ijdsr-5-6-5 Published online: January 05, 2018


Double mesiodens in mixed dentition period: Report of 3 cases


Mesiodens is a supernumerary tooth present in the midline of maxilla, between central incisors, occurring in 0.15%–1.9% of populations.

Mesiodens is the most commonly found supernumerary teeth on many occasions. Mesiodens is paired, single, unerupted, and sometimes impacted.

These mesiodens cause many complications, such as midline diastema, displacement, rotation, root resorption, unpleasing esthetics, and cyst formation.

In the present cases, mesiodens is found bilaterally in the anterior maxilla. In these cases, both mesiodens are prophylactically extracted to prevent its adverse effects on permanent dentition.

Introduction : A mesiodens is a supernumerary tooth located in the maxillary central incisor region; the overall prevalence of mesiodentes is between 0.15% and 1.9%.

Read Also: Clinical Management of Regional Odontodysplasia. Clinical Case

Mesiodens can occur individually or as multiples (mesiodentes), may appear unilaterally or bilaterally, and often do not erupt. Mesiodentes can significantly alter both occlusion and appearance by altering the eruption path and the position of the permanent incisors.

Primosch classified supernumeraries into two types according to their shape: supplemental and rudimentary. Supplemental refers to supernumerary teeth of normal shape and size and may also be termed incisiform.


° Rana SS, Ohri N. Double mesiodens in mixed dentition period: Report of 3 cases. SRM J Res Dent Sci 2018;9:125-9


ORAL SURGERY : Inverted mesiodens: case report


Mesiodens is the term used for describing the supernumerary tooth that occurs in the maxilla, between the central incisors, in the midline region.

These may erupt in the oral cavity or keep themselves impacted. Their presence causes cleaning inadequate, impossibility or difficult of the eruption of the regular teeth and having the aesthetic compromised.

This paper aims at showing that early identification of supernumerary teeth, planning and correct approach, allow the preservation of the teeth and adjacent structures.

This article presents the clinical case of a seven-year-old child, male, who sought for treatment complaining that teeth 11 didn't appear in the buccal cavity. Clinical and radiographic exams were done and they demonstrated the presence of the supernumerary tooth.

Read Also: ORAL SURGERY : Guideline on Pediatric Oral Surgery

The plan of treatment aimed at the correct localization, extraction of this supernumerary tooth and continuous follow up of the case.

INTRODUCTION : "Mesiodens" is the term used to describe the supernumerary tooth that occurs in the maxilla, between the central incisors, in the midline region.


° RGO - Revista Gaúcha de Odontologia
° Eneane MIRANDA, Luciene Dornas MENDES, Sérgio Milton Martins de Oliveira PENIDO, Cláudia Valéria de Sousa Resende PENIDO


Map on tongue: An enigmatic oral lesion - Rare Case Report of 2 pediatric patients

Map on tongue

It is truly said that the tongue is a mirror of the body. Very often, the manifestations of diseases or systemic conditions of body are reflected on the tongue.

There are a variety of different lesions present on the tongue out of which geographic tongue (GT) is the second most common, but its frequency of occurrence in the pediatric population is very rare.

This condition is most commonly asymptomatic and is usually discovered on routine clinical examination. This case report describes symptomatic GT, an uncommon occurrence reported in the pediatric literature.

Introduction : Benign migratory glossitis was first reported as a wandering rash of the tongue, in 1831, by Rayer.

This constantly changing pattern of serpiginous white lines surrounding areas of depapillated mucosa resembles land masses and oceans on a map.

Read Also: ORTHODONTIC : Dental disorders are linked to mouth breathing

A number of synonyms are used in literature may refer to this condition such as geographic tongue (GT), erythema migrans, annulus migrans, wandering rash.

Sapiro and Shklar also called it as "stomatisis areta migrans." The term "migratory" is used to denote apparent migration due to simultaneous epithelial desquamation at one site and proliferation at another.


° Swati Phore / Rahul Singh Panchal


Management of Facial Space Infection in a 9-Year-Old Child - A Case Report

Oral Medicine

Fascial space infections of the head and neck region are usually odontogenic in origin.

An untreated or rapidly spreading odontogenic infections can be potentially life threatening.

The present case report describes a patient with orofacial infections who required emergent incision and drainage in the oral and maxillofacial surgery OPD at our hospital.

Conclusion: Fascial space infections of the head and neck region, though potentially life threatening, can be prevented by regular dental visits.

Early recognition and treatment of the infections are necessary to prevent considerable morbidity and mortality, especially in younger patients where more care should be given for oral health.

Read Also: ORAL MEDICINE : How to treat oral thrush in newborns

Successful results can be achieved for pediatric patients who can be treated with Incision and Drainage, removal of etiologic factor followed by a combo of three antibiotics.

Introduction : Dental disease is the underlying cause of most of inflammatory swellings which occurs either in or around the jaws.

Inflammation may commence either at the root apices or gingival margins of erupted teeth, or in the soft tissues which surround and overlie the crown of an unerupted or partially erupted tooth.


°International Journal of Clinical Oral and Maxillofacial Surgery
°Khaja Khalid Nawaz M.


ORAL SURGERY : Central Giant Cell Granuloma in a Child - Case Report

Oral Surgery

Central giant cell granuloma (CGCG) is a non-neoplasic lesion of unknown etiology.

This lesion was initially described by Jaffe in 1953 as a "reparative" reaction, but this term was abandoned when it was proven to be more destructive than reparative in nature.

The World Health Organization has defined it as an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasionally trabeculae of woven bone. CGCG accounts for less than 7 % of all benign lesions of jaws.

There is predilection in patients younger than 30 years and it occurs more frequently in females, in the anterior region of mandible.

Giant cell lesions of jaws demonstrate variable clinical behavior and radiological changes.

Read Also: DENTAL EMERGENCY : Primary Tooth Injury and Emergency Extraction

The lesions varies from a slow growing painless swelling to a rapidly aggressive lesion that presents with pain, cortical perforation, root displacement or root resorption.

Radiographic findings are diverse, ranging from small apical lesions to large multilocular lesions, with varying degrees of expansion. This radiographic appearance is not pathognomonic and may be confused with several other lesions of jaws.


°International journal of odontostomatology
°Central Giant Cell Granuloma in a Child - Case Report
°Soukayna Bahbah / Saloua Dghoughi / Hakima Chhoul / Wafaa El Wady


ORAL REHABILITATION : The advent of the primary prefabricated zirconia crown. Clincal Case

If you are a general dentist who cares for children, you are the rule rather than the exception.

In 2016, the number of dentists in the United States was 196,441.1 Of these, 155,102 were general practitioners and 7,337 were pediatric dentists.

Given that the majority of children are treated in family practices, it is imperative that general dentists remain current with advancing pediatric dental technology.

From preventive modalities to restorative materials, pediatric dentistry has seen significant innovations in recent years. In my opinion, one of the most revolutionary changes is the advent of the primary prefabricated zirconia crown.

Read Also : CLINICAL CASE : Brain abscess secondary to a dental infection in an 11 year old child

Increasingly, parents and children are demanding better esthetic restorations. These demands are described in a study by Peretz and Ram, while another study by Zimmerman et al. documents changing parental attitudes toward pediatric restorative materials.

As these studies and clinical experience have shown, the demand for improved esthetic restorative dentistry for children is here. General dentists have the ability to supply that demand with the latest esthetic materials such as primary prefabricated zirconia crowns.

These crowns are made of excellent material, and when combined with proper technique, they give dentists the ability to restore anterior and posterior carious dentition both functionally and esthetically.


°The advent of the primary prefabricated zirconia crown
°Carla Cohn, DMD


ORAL REHABILITATION : Fixed Orthodontic Appliances in the Management of Severe Dental Trauma

Dental trauma is common in the pediatric population, affecting approximately 1 in 3 children. 

Trauma to the mixed dentition can be complicated because of the varying stages of tooth eruption and root development. 


Luxation injuries to the dentition are classified according to resulting tooth mobility and displacement. These injuries include concussion, subluxation, lateral luxation, extrusion, intrusion and avulsion. 

Potential complications include pulp necrosis, pulp canal obliteration, internal and external root resorption, cessation of root development, ankylosis and loss of marginal bone. 

The goal of management is to mitigate these complications and prevent tooth loss. Splinting is the principle method for treating dental trauma, as splinting stabilizes the traumatized teeth, maintaining them within the periodontium, precluding further trauma and facilitating periodontal healing. 

Splinting is indicated when a tooth is displaced, avulsed or excessively mobile or for the comfort of the patient. 

Ideally, the splinting procedure should be simple, fast and atraumatic. The splint should provide adequate stabilization and fixation; be esthetic, hygienic, passive and non-irritating; not interfere with occlusion; and allow for endodontic access, physiological mobility and easy assessment of teeth on follow-up visits. 

Many splinting methods and materials have been described, including suture splints, direct resin splints, wire-composite splints, nylon-monofilament-composite splints, polyethylene fibre-reinforced splints, orthodontic splints and titanium trauma splints.

Canadian Dental Association 
Fouad-Hassan Ebrahim, Gajanan Kulkarni


ORAL PATHOLOGY : Dentinogenesis imperfecta type II: approach for dental treatment

Dentin is a major structural component of tooth and serves as the framework upon which enamel and cementum form. 

Dentin supports enamel via mechanical stress distribution through well‑organized dentinoenamel junctions. 

Heritable dentin defects are rare diseases that affect primarily the organic dentin matrix. They have been classified into three types of dentinogenesis imperfecta (DI-I, DI-II and DI-III), and two types of dentin dysplasia (DD-I and DD-II) both of which present autosomal dominant transmission that affects the primary and permanent dentition.

According to Shields et al. (1973), the DI type I is associate with osteogenesis imperfecta.


DI type II is found in patients with dentition abnormalities alone and no bone disease. DI type III is the Brandywine form, named for the city Brandywine, Maryland, where there was a large population of patients with this disorder. 

DI has a reported incidence range from 1:6000 to 1:8000 (for all types of DI) in the United States2. Clinically, the color of affected teeth ranges from gray to brownish-blue with a translucent opalescence. 

Radiographically, the teeth show bulbous crowns, cervical constriction and short roots. In DI type II the pulp chambers and root canals are partial or completely obliterated, while in DI type III the teeth present viable pulp chambers leading to what is referred to as "shell teeth". 

Due to the lack of support of the poorly mineralized underlying dentin, the enamel frequently fractures leading to rapid wear and attrition of the teeth.

In general, patients with DI require complex treatment that should take into account the degree of tooth destruction, age and cooperation of the patient. 

°Revista de Odontologia da UNESP 

°Raquel Mantuaneli Scarel-Caminaga, Lícia Bezerra Cavalcante; Livia Sertori Finoti; Maria Cristina Leme Godoy dos Santos; Maria Flávia Konishi; Lourdes Aparecida Martins dos Santos-Pinto