Expansive Oral Giant Cell Granuloma in a Pediatric Patient.

Aim: This article describes a peripheral oral giant cell granuloma (POGCG) in a pediatric patient and its surgical management and histological characteristics. Background: Peripheral oral giant cell granuloma (POGCG) is a hyperplastic reactive lesion formed by a proliferation of mononuclear cells and osteoclast-type giant cells in vascular tissue, occasionally with bone formation. Generally found in women and adults, POGCG has rarely been described in children. Case description: An 8-year-old girl was consulted for an exophytic lesion in the anterior area of the upper jaw, which had increased in volume in the preceding weeks. An excisional biopsy of the tumor was performed with an electrosurgical pencil. The pathological diagnosis was POGCG. Conclusion: Excision followed by additional therapy, such as scaling and curettage, should be the first option in the treatment of POGCG. Clinical significance: Early detection of these lesions involving the periodontium is important in order to reduce bone loss and avoid pathological dental migration. How to cite this article: Cahuana-Bartra P, Brunet-Llobet L, Suñol-Capella M, et al. Expansive Oral Giant cell Granuloma in a Pediatric Patient. Int J Clin Pediatr Dent 2023;16(2):405-408.

Woolly hair in tricho-dento-osseous syndrome.

Tricho-dento-osseous syndrome (TDOS) is a rare ectodermal dysplasia caused by mutations in the DLX3 gene and it is not usually included as a cause of syndromic woolly hair. We present a new case of TDOS with a novel DLX3 variant and woolly hair.

Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis.

AIM: To investigate microbial profiles in placentas from a population of East African mothers with and without adverse pregnancy outcomes and with regard to their periodontal status. MATERIAL AND METHODS: Thirty-six placentas from pregnant women from Tanzania were classified into three groups according to both pregnancy outcome and the mother's periodontal health. The microbial composition in each group was then compared using 16S rRNA metagenomics. Additionally, placenta specimens were analyzed histologically for chorioamnionitis by a single pathologist blinded to the clinical data. RESULTS: The greatest differences were observed in the group of mothers with periodontitis. The microbial load was low in all three groups of mothers. Periodontitis had a notable influence on the structure of the placental microbiota. Three phyla and 44 genera were associated with periodontitis, whereas only the Tenericutes phylum was associated with the adverse pregnancy variable. Streptococcaceae and Mycoplasmataceae families were associated with both periodontitis and adverse pregnancy outcomes. Finally, although the differences for chorioamnionitis were not significant, this intra-amniotic infection was more frequent in the placentas from mothers with periodontitis. CONCLUSIONS: Our findings suggest that bacteria from the oral cavity may involve the feto-placental unit, and that periodontitis may be a modulating factor of the microbial community present in this niche.

Prevalence of, and risk factors for, dental sequelae in adolescents who underwent cancer therapy during childhood.

INTRODUCTION: The increase in survival rates in children treated for cancer has been accompanied by a rise in sequelae in permanent teeth. The aim of the study was to correlate the type of cancer therapy administered to patients during early childhood and the dental sequelae recorded in survivors. MATERIAL AND METHODS: Single-center retrospective cohort study carried out at the Children's University Hospital of Sant Joan de Déu in Barcelona, Spain. Hundred and nine patients who had received cancer treatment during early childhood were randomly examined and grouped according to diagnosis and cancer therapy received. The type of therapy was correlated with the number and severity of dental lesions that patients presented in adolescence. RESULTS: Dental sequelae of some kind were present in 85.3% of patients. Microdontia was the most prevalent (52.3%). Treatment with alkylating agents had a relative risk of presenting moderate lesions of 3.36 (1.18-9.60), and one of 2.29 (1.07-4.91) of presenting severe lesions. Topoisomerase inhibitors and cytotoxic antibiotics presented relative risks of 1.6 (1.07-2.38) and 2.08 (1.02-4.26) of root alterations and agenesis, respectively. CONCLUSIONS: Treatment with alkylating agents together with cytotoxic antibiotics and topoisomerase inhibitors was associated with a higher relative risk of microdontia, agenesis, and root shortening.

The use of silver diamine fluoride in a children's hospital: Critical analysis and action protocol.

OBJECTIVES: The present critical analysis aims to propose an action protocol for the use of silver diamine fluoride (SDF) in pediatric patients in a hospital setting, especially for those who are currently awaiting hospital dental treatment under general anesthesia. MATERIAL AND METHODS: A literature search was performed in the PubMed/MEDLINE from 2009 to 2021 using the search terms "silver diamine fluoride", "pediatrics silver diamine fluoride", "application silver diamine fluoride", and "AND" - combined with terms: "potassium iodide", "properties", "adverse effects", "early childhood caries", "patient with disability", "management", "special health care needs patient". Articles that recorded the type of teeth, application protocol, the concentration of the product, and possible complications of the treatment were selected. RESULTS: Four hundred and sixteen related articles were obtained, of which 13 were finally chosen on the basis of the search criteria. The age at which the use of SDF was recommended ranged from the first year of life to 12 years, in most cases in primary teeth. The study populations varied in size from 53 to 799 patients. An analysis of the characteristics of SDF and its use in pediatric patients with dental caries was performed. The recommended concentration was 38% SDF, applied twice yearly. The main complication reported was staining. A decision algorithm was designed including SDF as an agent for caries control in patients attending the specific population of our hospital (divided into two groups: healthy children aged 0-4 years and patients with special health care needs (SHCNs) aged 0-18 years). CONCLUSIONS: SDF therapy appears to be effective in the control of caries in pediatric patients. We propose an action protocol for patients with early childhood caries to reduce risk, complications, and the progression of lesions. The protocol is aimed especially at pediatric patients who also have some systemic pathology, disability, SHCNs, and/or behavioral difficulties.

Oral irritation fibroma associated with the pathological migration of a primary tooth.

We report the case of a 3-year-old girl referred to our hospital dentistry service, from a public health centre, due to a 4-week-old swelling in the area of the hard palate, causing displacement of the deciduous tooth and the appearance of an interincisal diastema. The clinical characteristics suggested the possibility of a reactive fibroma and we decided to intervene surgically by means of an excisional biopsy. Histology confirmed the presumptive diagnosis. Prompt referral and early surgical care spontaneously favoured both repositioning of the displaced primary tooth and closure of the diastema. This is an infrequent lesion in paediatric patients.

Do the clinical criteria used to diagnose periodontitis affect the association with prematurity?

In recent years, several studies have examined the possible relationship between periodontal disease in pregnant women and preterm birth. One of the difficulties facing these studies is the heterogeneity of the clinical criteria used to define periodontitis. The aim of this cross-sectional study was to determine the degree of association between maternal periodontitis and preterm birth according to different consensus definitions of periodontal disease. In a study of 146 mothers (60 with preterm births and 86 with term deliveries) at the Sant Joan de Déu Maternal and Children's Hospital in Barcelona, a periodontal examination was carried out within 2 days of birth and the presence of periodontal disease was evaluated using the main clinical classifications published in the literature. The prevalence of periodontitis ranged from 25.4 to 52.1%, depending on the criteria used for its definition. Using the most restrictive criteria, pregnant women with periodontitis had a higher risk of preterm birth (OR: 7.49; p < 0.001) and premature rupture of membranes (OR: 2.49; p = 0.017). Premature infants born to mothers with periodontitis presented a tendency toward low weight, adjusted for gestational age (OR: 3.32; p = 0.065). Our findings suggest that the association between periodontitis and preterm birth is influenced by the definitions of periodontitis used.

The use of 3D additive manufacturing technology in autogenous dental transplantation.

BACKGROUND: In medicine and dentistry, 3D technology allows the virtual planning and printing of surgical replicas of anatomical structures that can facilitate certain transplant procedures. In dentistry, 3D technology is useful in autogenous tooth transplantation. CASE PRESENTATION: We present a clinical case of an ectopic mandibular second premolar, describing the preoperative planning with dental replicas and the autotransplantation surgery. 3D prints of the surgical replica of the tooth to be transplanted was made using an Objet30 Prime® Printer, PolyJet. Clinical controls performed at 3, 6 and 12 months indicated the satisfactory evolution of the transplanted tooth. CONCLUSION: 3D additive manufacturing technology allows the preparation of a new recipient socket with the aid of a surgical replica of the tooth to be transplanted, thus minimizing handling and extraoral time.

Oral disorders in children with Prader-Willi syndrome: a case control study.

INTRODUCTION: Prader-Willi Syndrome (PWS) is a genetic disorder caused by the lack of expression of certain paternal genes located on chromosome 15q11-q13. This anomaly causes cognitive, neurological and endocrine abnormalities, among which one of the most important is hyperphagia. The aim of this study was to assess the oral health of children with PWA and to establish preventive criteria. RESULTS: Thirty patients with PWS (mean age 10.2 years) and 30 age- and gender-matched controls were included in the study. Twenty-six patients with PWS(86.6%) followed dietary treatment prescribed by their endocrinologist. Individuals with PWS had a mean caries index of 53.3% and Decayed Missing Filled teeth (DMFT) index 2.5, and 53.3% had gingivitis, in the control group the respective figures were 43.3%, 0.93, and 60%. Only the DMFT index (p 0.017) presented significant differences. Regarding stimulated salivary secretion, patients with PWS presented a mean of 0.475 ml/min with a pH of 6.15, while controls presented a mean of 0.848 ml/min with a pH of 7.53; the differences between the groups were statistically significant in both cases (p 0.032 and p 0.0001 respectively). The population with PWS presented a higher plaque index (> 2) than their healthy peers, but the differences were not significant. CONCLUSION: Pediatric patients with Prader-Willi syndrome have an increased risk of caries and gingivitis. The children with this syndrome have a decreased salivary flow and a more acidic salivary pH. In these patients, dental care is an essential part of their multidisciplinary medical treatment.

Periodontal and dental conditions of a school population in a volcanic region of Tanzania with highly fluoridated community drinking water.

INTRODUCTION: Dental fluorosis is endemic in the Rift Valley in Africa, especially around volcanic areas, due to the high fluoride content in daily drinking water. OBJECTIVE: This study evaluates the oral health status and types of occlusion in a school population, and to assess the possible association between dental fluorosis and other pathologies such as decay, gingivitis and periodontitis. MATERIAL AND METHODS: An observational study of 581 individuals recruited from a public secondary school in Arusha, Northern Tanzania was undertaken. The indices used were: the Silness & Löe Plaque Index, the Community Periodontal Index and the Decayed/Missing/Filled index. Descriptive statistical analyses were performed and a chi-square test was used to assess the associations between independent variables. RESULTS: Almost all the school children evaluated (96.73%) presented Angle class I dental occlusion, and 75.22% presented some degree of dental fluorosis. Most of the population (511, 87.95%) showed bleeding on probing. A moderate/high degree of some dental pathology (DMF score) was recorded in 14.46%. The association between dental fluorosis, gingival bleeding and tooth decay indicated a higher concentration of pathology in groups with more severe fluorosis (p<0.05). CONCLUSION: In this large population sample, both tooth decay and gingivitis were significantly associated with moderate or severe dental fluorosis.

Oral health status in pediatric patients with cerebral palsy fed by oral versus enteral route.

AIMS: Cerebral palsy (CP) is a chronic, nonprogressive disorder affecting movement, posture, and tone, caused by injuries in the central nervous system during the early stages of life. Patients with CP have swallowing disorders, which make oral feeding difficult and necessitate the use of external feeding devices. The objective of this research was to study the oral health status of pediatric patients affected with CP fed by either oral or enteral route. METHODS: A cross-sectional observational clinical study of the oral health of two groups of patients with CP, fed either orally or enterally (via percutaneous endoscopic gastrostomy, PEG). RESULTS: Patients fed by enteral route via PEG presented lower caries scores (DMFT: PEG: 1.09, non-PEG: 2.81) and higher percentages of supragingival dental calculus than the oral feeding group (PEG: 86%, non-PEG: 57.6%). CONCLUSION: Oral health status differed in pediatric patients with CP fed enterally via PEG and those fed orally. Specific preventive measures in both groups will be required to minimize the risk of complications.

Continuous Surgical Decompression for Solitary Bone Cyst of the Jaw in a Teenage Patient.

BACKGROUND: A solitary bone cyst or simple bone cyst is a nonneoplastic osseous lesion, with no epithelial lining, also considered as a pseudocyst. These lesions, with an intact bony wall and fluid-filled, are frequently discovered by chance in radiological studies. The etiopathogenesis has not been studied in depth, and the management remains controversial. CASE PRESENTATION: We present a clinical case of a 15-year-old boy who underwent an orthopantomography to assess the development and position of the third molars during a routine postorthodontic check-up. By chance, the X-ray identified an asymptomatic radiolucent image in the left jaw, measuring 12.0 mm × 17.8 mm and compatible with a solitary bone cyst involving teeth 35 and 36. We describe our technique for performing minimally invasive decompression of the lesion using a microperforated catheter. We describe the entire course of the follow-up, both clinical and radiological, until complete cure. CONCLUSIONS: This straightforward continuous decompression technique poses no problems for the patient, has a low risk of sequelae, and is clearly cost-effective. In view of the highly satisfactory evolution, whenever possible, we favor this minimally invasive technique for the treatment of solitary bone cysts in the jaw.

The Periodontium as a Potential Cause of Orofacial Pain: A Comprehensive Review.

INTRODUCTION: Orofacial pain of periodontal origin has a wide range of causes, and its high prevalence and negative effect on patients' quality of life make intervention mandatory. This review provides a periodontological overview of the field of orofacial pain, focusing on the entities which involve the periodontal tissues and may be the cause of this pain or discomfort. METHODS: The study comprised a literature search of these pathologies conducted in the MEDLINE/PubMed Database. Acute infectious entities such as gingival and periodontal abscesses are emergencies that require a rapid response. Periodontitis associated with endodontic processes, necrotizing periodontal disorders, desquamative gingivitis, gingival recession, and mucogingival herpetic lesions, cause mild to severe pain due to tissue destruction and loss. Other lesions that lead to periodontal discomfort include gingival enlargement and periodontal ligament strains associated with occlusal trauma, parafunctional habit and the impaction of food or foreign bodies. CONCLUSION: A range of therapeutic, pharmacological and surgical alternatives are available for the management of these injuries. However, the wide variety of causes of orofacial pain or periodontal discomfort may confuse the clinician during diagnosis and may lead to the wrong choice of treatment.

In-vivo compatibility between pacemakers and dental equipment.

In-vitro studies suggest that electromagnetic interference can occur under specific conditions involving proximity between electronic dental equipment and pacemakers. At present, in-vivo investigations to verify the effect of using electronic dental equipment in clinical conditions on patients with pacemakers are scarce. This study aimed to evaluate, in vivo, the effect of three commonly used electronic dental instruments - ultrasonic dental scaler, electric pulp tester, and electronic apex locator - on patients with different pacemaker brands and configurations. Sixty-six consecutive non-pacemaker-dependent patients were enrolled during regular electrophysiology follow-up visits. Electronic dental tools were operated while the pacemaker was interrogated, and the intracardiac electrogram and electrocardiogram were recorded. No interferences were detected in the intracardiac electrogram of any patient during the tests with dental equipment. No abnormalities in pacemaker pacing and sensing function were observed, and no differences were found with respect to the variables, pacemaker brands, pacemaker configuration, or mode of application of the dental equipment. Electromagnetic interferences affecting the surface electrocardiogram, but not the intracardiac electrogram, were found in 25 (37.9%) patients, especially while using the ultrasonic dental scaler; the intrinsic function of the pacemakers was not affected. Under real clinical conditions, none of the electronic dental instruments tested interfered with pacemaker function.

The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study.

BACKGROUND: For the past two decades, studies have investigated the relationship between periodontal disease and adverse pregnancy outcomes such as pre-eclampsia, preterm birth, low birth weight and preterm premature rupture of membranes. OBJECTIVES: To determine the prevalence of periodontal disease and associated adverse pregnancy outcomes among women delivering at the Kilimanjaro Christian Medical Centre (KCMC). METHODS: This cross-sectional study was based on the use of patients' files, clinical examinations and oral interviews with mothers who delivered at the KCMC. Pregnant women with singleton babies (N=1117) who delivered at the KCMC were recruited for the study. Intra-oral examination was performed within five days of birth. The Community Periodontal Index was used to assess periodontal disease. RESULTS: The prevalence of periodontal disease was 14.2%. Periodontal disease was significantly associated with higher odds of pre-eclampsia [adjusted Odds Ratio 95% Confidence Interval (aOR=4.12;95%CI:2.20-7.90)], low birth weight (aOR=2.41;95%-CI:1.34-4.33) and preterm birth (aOR=2.32;95%CI:1.33-4.27). There was no significant association between periodontal disease and preterm premature rupture of membranes (aORs 1.83;95%CI:0.75-4.21) and eclampsia (3.71;95%CI:0.80-17.13). CONCLUSION: Maternal periodontal disease is a potential independent risk indicator for pre-eclampsia, low birth weight, and preterm birth. Periodontal assessment and therapy should form part of the preventive antenatal care provided to women in developing countries.

Replantation of an avulsed tooth after one day of storage in adverse extraoral dry conditions: Acceptable outcome after a 10-year follow-up.

This article reports a clinical case of a 10-year-old boy who sustained an avulsion of the maxillary right central incisor. The avulsed tooth was kept in adverse extraoral dry conditions for 26 hours from the moment of trauma until its replantation. Treatment guidelines for avulsed mature permanent teeth with closed apex were only partially followed. However, the clinical and radiographic findings after 10 years revealed acceptable functional outcome, in spite of ankylosis and root resorption of the replanted tooth, which was eventually treated cosmetically.

On the Cellular and Molecular Mechanisms of Drug-Induced Gingival Overgrowth.

INTRODUCTION: Gingival overgrowth has been linked to multiple factors such as adverse drug effects, inflammation, neoplastic processes, and hereditary gingival fibromatosis. Drug-induced gingival overgrowth is a well-established adverse event. In early stages, this gingival enlargement is usually located in the area of the interdental papilla. Histologically, there is an increase in the different components of the extracellular matrix. OBJECTIVE: The aim of this manuscript is to describe and analyze the different cellular and molecular agents involved in the pathogenesis of Drug-induced gingival overgrowth. METHOD: A literature search of the MEDLINE/PubMed database was conducted to identify the mechanisms involved in the process of drug-induced gingival overgrowth, with the assistance of a research librarian. We present several causal hypotheses and discuss the advances in the understanding of the mechanisms that trigger this gingival alteration. RESULTS: In vitro studies have revealed phenotypic cellular changes in keratinocytes and fibroblasts and an increase of the extracellular matrix with collagen and glycosaminoglycans. Drug-induced gingival overgrowth confirms the key role of collagenase and integrins, membrane receptors present in the fibroblasts, due to their involvement in the catabolism of collagen. The three drug categories implicated: calcineuron inhibitors (immunosuppressant drugs), calcium channel blocking agents and anticonvulsant drugs appear to present a multifactorial pathogenesis with a common molecular action: the blockage of the cell membrane in the Ca2+/Na+ ion flow. The alteration of the uptake of cellular folic acid, which depends on the regulated channels of active cationic transport and on passive diffusion, results in a dysfunctional degradation of the connective tissue. Certain intermediate molecules such as cytokines and prostaglandins play a role in this pathological mechanism. The concomitant inflammatory factor encourages the appearance of fibroblasts, which leads to gingival fibrosis. Susceptibility to gingival overgrowth in some fibroblast subpopulations is due to phenotypic variability and genetic polymorphism, as shown by the increase in the synthesis of molecules related to the response of the gingival tissue to inducing drugs. The authors present a diagram depicting various mechanisms involved in the pathogenesis of drug-induced gingival overgrowth. CONCLUSION: Individual predisposition, tissue inflammation, and molecular changes in response to the inducing drug favor the clinical manifestation of gingival overgrowth.

GH-secreting pituitary macroadenoma (acromegaly) associated with progressive dental malocclusion and refractory CPAP treatment.

BACKGROUND: A link between progressive dental malocclusion, the use of a continuous positive airway pressure mask and GH-secreting pituitary macroadenoma (acromegaly) has not been previously reported. The present clinicopathological analysis stresses that tooth malposition should not be seen exclusively as a local process. CASE PRESENTATION: A 62-year-old caucasian man with no relevant medical history reported difficulty chewing food and perceived voice alteration during his annual periodontal check-up. He also referred stiffness of the tongue, face, and submandibular area. The patient had been diagnosed with obstructive sleep apnea syndrome two years previously, since when he had worn a continuous positive airway pressure device during sleep. Exploration of the occlusion revealed significant changes: an atypical left lateral and anterior open bite with major buccoversion of teeth 33, 34, 35, 36. Inspection of the soft tissue revealed only macroglossia, although external palpation indicated a subcutaneous stiffness of the submandibular area. General analytical tests, including hormone profiles, and magnetic resonance imaging confirmed the diagnosis of acromegaly induced by a pituitary adenoma. Intrasellar tumor resection via transsphenoidal approach was performed. After surgery, the patient already noted a marked improvement of all symptoms associated with the acromegaly. Desaturation data also evolved favourably and the pulmonologist advised the patient to abandon the continuous positive airway pressure treatment. CONCLUSION: Progressive dental malocclusion may be associated with a systemic disease and the use of a nasal mask with premaxillary support may distort the diagnosis of acromegaly.

Risk of electromagnetic interference induced by dental equipment on cardiac implantable electrical devices.

Patients with cardiac implantable electrical devices should take special precautions when exposed to electromagnetic fields. Proximity to equipment used in clinical dentistry may cause interference. This study evaluated in vitro the risks associated with different types/makes of cardiac devices and types of dental equipment. Six electronic dental tools were tested on three implantable cardioverter defibrillators and three pacemakers made by different manufacturers. Overall, the risk of interference with the pacemakers was 37% lower than with the implantable cardioverter defibrillators. Regarding the types/makes of cardiac devices analysed, that from Boston Scientific had a five-fold greater risk of interference than did that from Biotronik [prevalence ratio (PR) = 5.58]; there was no difference between that from Biotronik and that from Medtronic. Among the dental equipment, the electric pulp tester had the greatest risk of inducing interference and therefore this device was used as the benchmark. The electronic apex locator (PR = 0.29), Periotest M (PR = 0.47), and the ultrasonic dental scaler (PR = 0.59) were less likely to induce interference than the electric pulp tester. The risk was lowest with the electronic apex locator. Pacemakers presented a lower risk of light to moderate interference (PR = 0.63). However, the risk of severe electromagnetic interference was 3.5 times higher with pacemakers than with implantable cardioverter defibrillators (PR = 3.47).

Salivary Secretory Disorders, Inducing Drugs, and Clinical Management.

BACKGROUND: Salivary secretory disorders can be the result of a wide range of factors. Their prevalence and negative effects on the patient's quality of life oblige the clinician to confront the issue. AIM: To review the salivary secretory disorders, inducing drugs and their clinical management. METHODS: In this article, a literature search of these dysfunctions was conducted with the assistance of a research librarian in the MEDLINE/PubMed Database. RESULTS: Xerostomia, or dry mouth syndrome, can be caused by medication, systemic diseases such as Sjögren's Syndrome, glandular pathologies, and radiotherapy of the head and neck. Treatment of dry mouth is aimed at both minimizing its symptoms and preventing oral complications with the employment of sialogogues and topical acting substances. Sialorrhea and drooling, are mainly due to medication or neurological systemic disease. There are various therapeutic, pharmacologic, and surgical alternatives for its management. The pharmacology of most of the substances employed for the treatment of salivary disorders is well-known. Nevertheless, in some cases a significant improvement in salivary function has not been observed after their administration. CONCLUSION: At present, there are numerous frequently prescribed drugs whose unwanted effects include some kind of salivary disorder. In addition, the differing pathologic mechanisms, and the great variety of existing treatments hinder the clinical management of these patients. The authors have designed an algorithm to facilitate the decision making process when physicians, oral surgeons, or dentists face these salivary dysfunctions.