Salvaging a Periodontally Compromised and Endodontically Involved Three-Rooted Mandibular First Molar With Cervical Enamel Projection.

This case report describes the management of a mandibular first molar with an additional distolingual root (radix entomolaris) and grade III cervical enamel projection through a multidisciplinary approach. Diagnosis for the case was endodontic-periodontal lesion due to non-vitality and associated advanced periodontal destruction. The patient was treated with drainage of the periodontal abscess with adjunct antibiotics, phase I periodontal therapy, endodontic therapy, radiculoplasty, regenerative periodontal therapy, replacement of the missing right mandibular second molar, and long-term maintenance. Follow-up of the patient up to 9 months has been uneventful. Cases of advanced periodontal destruction typically show some degree of tooth mobility, which was absent in this case. The article discusses the tripod effect as well as the increased surface area for periodontal attachment provided by the additional root contributing to the non-mobility of the involved tooth.

Oral manifestations of lipoid proteinosis in a 10-year-old female: A case report and literature update.

Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. Here, we present a case of LP with significant oral, dermatologic, and neurologic manifestations occurring in a 10 year-old female of Asian descent. In addition to the more typical oral findings of restricted tongue movement and labial and buccal mucosal involvement, this case highlights an unusual pattern of gingival enlargement infrequently reported in the literature. As LP almost always involves the oral cavity, often before the onset of cutaneous lesions, it is important for dental providers to be familiar with the oral manifestations of this disease. Early detection and diagnosis of LP by the dental practitioner can help expedite proper multidisciplinary care and lead to significant reductions in patient morbidity and mortality.

A novel small deletion in the NHS gene associated with Nance-Horan syndrome.

Nance-Horan syndrome is a rare X-linked recessive inherited disease with clinical features including severe bilateral congenital cataracts, characteristic facial and dental abnormalities. Data from Chinese Nance-Horan syndrome patients are limited. We assessed the clinical manifestations of a Chinese Nance-Horan syndrome pedigree and identified the genetic defect. Genetic analysis showed that 3 affected males carried a novel small deletion in NHS gene, c.263_266delCGTC (p.Ala89TrpfsTer106), and 2 female carriers were heterozygous for the same variant. All 3 affected males presented with typical Nance-Horan syndrome features. One female carrier displayed lens opacities centered on the posterior Y-suture in both eyes, as well as mild dental abnormalities. We recorded the clinical features of a Chinese Nance-Horan syndrome family and broadened the spectrum of mutations in the NHS gene.

NHS Gene Mutations in Ashkenazi Jewish Families with Nance-Horan Syndrome.

PURPOSE: To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. METHODS: Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. RESULTS: An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. CONCLUSIONS: Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.

The prevalence of dental anomalies in an Australian population.

BACKGROUND: The aim of this study was to determine the prevalence of dental anomalies within an Australian paediatric population using panoramic radiographs. METHODS: This was a prospective review of 1050 panoramic radiographs obtained as part of a school dental screening program in suburban and rural New South Wales, Australia. RESULTS: Fifty-four (5.14%) patients had a dental anomaly present. Agenesis was noted to have occurred 69 times across 45 patients (4.28%), along with seven cases of impaction (0.6%) and three cases of supernumerary teeth (0.28%). CONCLUSIONS: Dental anomalies rarely occur in the Australian population, which possesses a wide-ranging multiethnic cohort. Despite their rarity, they can be incidentally discovered so identification and management by dental practitioners are important.

Manejo clínico de la mancha negra en odontología / Clinical Management of black stains in dentistry

El propósito del presente artículo es realizar una revisión bibliográfica y presentación de casos de una entidad clínica poco conocida que se presenta con mucha frecuencia en la práctica clínica odontopediátrica llamada mancha negra. La mancha negra es un tipo de tinción cromógena que se observa en la cavidad oral como pigmentaciones negras sobre los dientes, causando una gran preocupación en los pacientes y en los padres de família. Estas pigmentaciones son de origen extrínseco, cuya causa se debe a la presencia de bacterias cromógenas en la saliva del sujeto y son eliminadas mediante una limpieza profesional; luego de ser eliminadas de las superfícies de los dientes estas manchas vuelven a reaparecer. Así mismo presentamos 2 casos clínicos de pacientes con mancha negra donde se puede observar la secuencia cómo estas manchas, después de un período de tiempo tienden reaparecer.

The purpose of this article is to conduct a literature review of a little known clinical entity that occurs frequently in the clinical practice of pediatric dentistry called black stain. The black stain is a type of chromogenic staining observed in the oral cavity as black pigmentation on the teeth, causing great concern for patients and parents. These pigmentations are of extrinsic origin, the cause is due to the presence of chromogenic bacteria in the saliva of the subject and can be removed by a professional cleaning, which after being removed from the surfaces of these teeth stains reappear. We present 2 cases of patients with black stains where you can see the sequence of how these stains after being removed after a period of time tend to reappear.

Carabelli's trait in Croatian populations over 1800 years.

Examination and comparison of the morphological features of tooth crown in archaeological and recent samples can be difficult due to the different levels of tooth wear seen both within and between populations. These differences make the comparison of frequency data for Carabelli trait problematic. The aim of the present study is to detect the frequency and degree of expression of Carabelli's trait in Croatian populations from late antiquity to recent times and to use these data as supplementary evidence of complex population migration. A total of 1287 individuals from the late antiquity, medieval, early modern and modern periods were examined. Correlation between the presence of Carabelli's trait and tooth crown size was tested. The results of our analyses show that the frequency of Carabelli's trait is significantly greater in the early modern period (51.3%) and in the 21st century (43.1%) than in the late antiquity (20.4%) and medieval periods (23.4%). These results are consistent with historical evidence of migration and population change in the territory of present-day Croatia throughout the almost 1800 years covered by this study. The results also provide additional evidence for the complex nature of population change in the transition from the late antiquity to the early medieval period.

Attitude and beliefs of traditional birth attendants to prematurely erupted teeth of infants in urban local government areas in Ibadan, Nigeria.

Traditional birth attendants (TBAs) can be invaluable in assisting to dispel myths commonly associated with natal/neonatal teeth. To ensure correct delivery of the message, baseline data of their beliefs is important. To assess the attitude and beliefs of some Nigerian TBAs to prematurely erupted teeth in infants, a total enumeration of the TBAs in the five urban Local Government Areas in Ibadan was conducted and 163 consenting TBAs were recruited using an interviewer-administered questionnaire. The attitude of the TBAs was that of fear and shock (35.6%) while 30 (18.4%) will consider the child weird. Perceived causes of the variation include evil spirits (31.9%), contravening cultural taboos (9.2%), and prolonged gestation (4.9%). Beliefs on the effect of natal/neonatal teeth on the child include strange behavior (31.3%), child developing evil spiritual powers (41.1%), and mental retardation (3.1%). Practices included advising parents to get rid of/or hide the child (4.9%) and immediate extraction of the teeth with/without sacrifices (35.6%). There is an urgent need to address knowledge gaps by giving health education to TBAs.

An audit of concomitant dental anomalies with maxillary talon cusps in a group of children from Hong Kong.

AIM: To investigate the prevalence of various concomitant dental anomalies in Hong Kong children with true talon cusps on the permanent maxillary incisors. METHODS: Dental records and radiographs of a group of Hong Kong Chinese primary schoolchildren with true talon cusps (half crown height or more) on one or more permanent maxillary incisors were selected and studied retrospectively. The prevalence of various dental anomalies in this group of children was compared with that of the general population of Hong Kong Chinese children of similar age. RESULTS: A total of 11,537 records were reviewed and 58 children with true talon cusps on one or more permanent maxillary incisors were identified. A total of 69 permanent maxillary incisors were affected, of which all except one were lateral incisors. Dens evaginatus on premolars, supernumerary teeth in the anterior maxilla, and hypodontia were found in 5 (8.6%), 5 (8.6%), and 5 (8.6%) cases respectively. The prevalence of supernumerary teeth was significantly higher in children with true talon cusps as compared with the results of two previous general studies of Chinese children of similar age (P<0.05, Fisher's exact test). CONCLUSION: Children with true talon cusps on the permanent maxillary incisors were more frequently affected by supernumerary teeth in the anterior maxilla. Further studies with a larger sample are needed to confirm a true association.

Survey of talon cusps in the permanent dentition of a Turkish population.

AIM: Talon cusp is the name given to the accessory tubercles located on the lingual faces of anterior teeth. The occurrence of talon cusps has been reported among Europeans and Asians. However, there are few reports of this anomaly in Caucasians as well as a paucity of literature on its characteristics. Today there are seven million Turkish citizens of Caucasian origin that have settled in the Marmara, Central-Anatolia, East-Anatolia, and Black Sea regions of Turkey. The aim of this study is to present 27 Caucasian cases with 33 taloned teeth. This study is the first that was undertaken to investigate the characteristics of talon cusps in a group of Turkish people. METHODS AND MATERIALS: A survey of 27 patients examined in the Department of Oral Diagnosis and Radiology at Ondokuz Mayis University in Samsun, Turkey between January, 2003 and June, 2006 was conducted. Their ages ranged from seven to 33 years. A total of 33 talon cusps were diagnosed in the 27 patients. The patients' records and radiographs were evaluated and the following variables were studied: age, sex distribution, affected tooth, type of talon cusp, radiographic evidence of pulp extension, and associated dental anomalies and complications. RESULTS: There were 13 male and 14 female patients with a gender ratio of approximately 1:1. Ten of 33 talon cusps (30%) were seen in maxillary right central incisors while four cases (12%) were in maxillary left central incisors and nine cases (27%) were in maxillary right lateral incisors. Eight cases (24%) were seen in maxillary left lateral incisors, one case (3%) was in a mandibular right central incisor, and one case (3%) was in a mandibular left canine. Fifteen (15) of the 33 talon cusps were Type 1 talons (45%), while eight cases (24%) were Type 2 talons and ten cases (30%) were Type 3 talons. Twelve of the 33 talon cusps (36%) showed radiographic evidence of pulpal extension into the tubercule on periapical radiographs. One patient had gemination (3%) on the maxillary permanent incisors and two patients had mesiodens (6%) in the maxillary anterior region. CONCLUSION: The talon cusp remains as one of the more uncommon dental anomalies worldwide and in Turkey and presents with different clinical features. CLINICAL SIGNIFICANCE: The talon cusp may be more likely to be associated with other odontogenic anomalies and some systemic conditions; early recognition of this anomaly is essential to provide proper treatment.

A catalogue of anomalies and traits of the primary dentition of southern Chinese.

Variation in size, form and morphology of the teeth result in anomalies such as macrodontia, microdontia, hyperdontia, hypodontia, double tooth, taurodontism and dens in dente. While traits that may occur more commonly in certain ethnic groups may be considered to be specific to that population. The characteristics of these anomalies and traits are presented along with the prevalence figures for their occurrence in primary dentition of southern Chinese.

Dental anatomical anomalies in Asians and Pacific Islanders.

Dental anatomical anomalies having a significant impact on endodontic diagnosis and treatment are the talon cusp, tuberculated premolars, three-rooted mandibular molars, and C-shaped molars. Asian and Pacific Islander ethnic groups have the highest percentage of these dental anatomical anomalies compared to the general population. As the population of Asians and Pacific Islanders continues to grow in California and other western states, dentists should be aware of the diagnostic and treatment complexities associated with specific patient groups.

Taurodoncia múltiple: presentación de un caso / Multiple taurodontism: report of a case

La taurodoncia es una alteración morfológica de la anatomía dental que trae como consecuencia un cambio en la forma de la pieza dentaria, usualmente en las piezas multirradiculares. Consiste en un alargamiento de la cámara pulpar a expensas de los conductos radiculares, desplazando el piso pulpar hacia apical. El diagnóstico temprano y el seguimiento radiográfico son importantes. La mayoraía de las veces es un hallazgo radiográfico, dado que a la inspección clínica las piezas dentarias suelen verse normales. Puede presentarse aislado o asociado a otras anomalías dentarias. El propósito de este artículo es presentar un caso de taurodoncia múltiple que fue también un hallazgo radiográfico en un paciente de raza negra oriundo de Senegal y comunicar la alta incidencia de esta patología en dicho país.

The root and root canal morphology of the human mandibular first premolar: a literature review.

The purpose of this study was to undertake a comprehensive literature review of the root and root canal morphology of the mandibular first premolar. Published studies citing the anatomy and morphology of mandibular premolars report data for over 6,700 teeth. These studies were divided into anatomical studies reporting number of roots, number of canals, and apical morphology. Variations because of sex and ethnic background have also been reported, along with case reports of anomalies. Approximately 98% of the teeth in these studies were single-rooted. The incidence of two roots was 1.8%. Three roots when reported were found in 0.2% of the teeth studied. Four roots were rare and were found in less than 0.1% of the teeth studied. Studies of the internal canal morphology revealed that a single canal was present in 75.8% of the teeth. Two or more canals were found in 24.2% of the teeth studied. A single apical foramen was found in 78.9% of the teeth, whereas 21.1% had two or more apical foramina. The role of genetics and racial variation may result in differences of incidence of root number and canal number in human populations. The dental literature is not unique in studying ethnicity and sex variations. Higher incidences of teeth with additional canals and roots have been reported in Chinese, Australian, and sub-Sahara African populations. Physical anthropology studies seem to show the lowest incidence in Western Eurasian, Japanese and American Arctic populations. The root and root canal morphology of this tooth can be complex and requires careful evaluation prior to root canal therapy.

Dental abnormalities in children preparing for pediatric bone marrow transplantation.

The purpose of our study was to describe the types and frequencies of altered dental development in pediatric patients preparing for bone marrow transplantation (BMT). Retrospective review of the medical records and panoramic radiographs of all patients who underwent BMT at St Jude Children's Research Hospital between 1990 and 2000 for whom pre-BMT dental examination and panoramic radiography records were available. All patients were treated on institutional protocols. We recorded patient demographics and radiographic evidence of microdontia, hypodontia, taurodontia, root stunting, caries, enamel pearls, and pulpal calcifications. The 259 patients identified (150 male and 109 female) had a median age of 12.82 years (range, 3.18-25.93 years) at the time of BMT. In total, 203 were Caucasian, 38 were African-American, and 18 were of other races. In all, 150 (57.9%) had abnormal dentition. The most common dental abnormalities were caries (n=84), pulpal calcifications (n = 34), and dental extractions (n = 33). Developmental abnormalities occurred less frequently: taurodontia (n = 8), hypodontia (n = 10), microdontia (n = 11), and root stunting (n = 11). Dental abnormalities are prevalent in children undergoing BMT. Pre-transplant oral hygiene and dental examination should be standard care in order to minimize potential sites of infection.

Congenital absence of permanent teeth in a six-generation Chinese kindred.

We report on rare, heritable, permanent tooth agenesis in a large Chinese kindred. The congenital absence of permanent teeth except the first and second accessory teeth was observed in 52 individuals through six successive generations in the kindred comprising 328 members. Clinical assessments were carried out, and inheritance mode and spousal influence of the anomaly on their offspring were analyzed. Consequently, the anomaly was transmitted in an autosomal dominant fashion with incomplete penetrance (P = 0.88), and no significant clinical manifestations other than the oligodontia were found. A geographical or environmental effect on the affected individuals was obviously eliminated, because any who are related to the kindred but live under the same conditions are fully healthy. The disorder we describe, therefore, differs from any previously reported oligodontia/anodontia syndromes. The oligodontia ranged from a few teeth to the whole set of teeth, and usually occurred at a period from age 7 or 8 years, the time when primary teeth are normally replaced by permanent teeth, to the forties. Roentgenography of the affected persons indicated that only the first and/or second accessory teeth with tooth buds developed as permanent teeth. In fact, the diphyodontic germination sometimes occurred in the oral cavity of the affected individuals.

A catalogue of anomalies and traits of the permanent dentition of southern Chinese.

Variations in size, form and morphology of the teeth can result in anomalies such as macrodontia, microdontia, hyperdontia, hypodontia, double tooth, dens evaginatus, dens invaginatus, and talon cusp. A trait may occur more commonly in certain ethnic groups. Among these traits are shovel-shaped incisors, lingual tubercle, Carabelli's trait and protostylid of the molars. Because people are traveling more frequently than ever before, and there are many migrants in different parts of the world, it is increasingly important for dental professionals to be aware of the characteristics and prevalence of the anomalies and traits that occur in the different ethnic groups, so as to be able to make valid clinical judgments and to provide the appropriate treatment. The characteristics of these anomalies and traits are presented along with the prevalence figures in the southern Chinese.

Dens evaginatus: review of the literature and report of several clinical cases.

Dens evaginatus (DE) presents as an innocuous looking tubercle of enamel on the occlusal surface of a tooth, most commonly a bicuspid. Problems can arise when the tubercle is either worn, ground, or fractured off, resulting in pulpal exposure and possible loss of vitality of the tooth. Dentists who perform orthodontic treatment should be aware of this dental anomaly, which occurs in at least two per cent of the Asian and Native Indian populations. Bicuspid extraction cases should involve the extraction of the anomalous premolars rather than the normal ones. In addition, the dentist should be mindful of occlusal changes that may occur during treatment or occlusal equilibration, both of which can jeopardize the vitality of teeth with DE. Pulp capping or partial pulpotomy has been postulated to be one of the most reliable forms of vital tooth treatment when pulp exposure is encountered following the sterile removal of the tubercle. When pulp exposure is not encountered, preventive resin composite sealing of the dentin or class I amalgam cavity preparation seems to be the treatment of choice.