Toxic posterior segment syndrome with retinal vasculitis likely caused by intraocular cotton fiber after vitreoretinal surgery - a case report.

BACKGROUND: Intraocular inflammation is common after anterior or posterior segment surgery. They typically manifest either as non-infectious inflammation of the anterior or posterior segment, known as toxic anterior or posterior segment syndrome (TPSS), or as sterile or infective endophthalmitis. In this report, we describe a rare case of TPSS following vitreoretinal surgery, presenting as hemorrhagic retinal vasculitis. CASE PRESENTATION: A 58-year-old male diagnosed with a left eye acute rhegmatogenous retinal detachment underwent an uneventful primary pars plana vitrectomy with silicone oil endotamponade on the same day of presentation. At presentation, there were no signs of intraocular inflammation, and his visual acuity in the affected eye was 20/200. RESULTS: The retina was well-attached with silicone oil in place on the first post-operative day. Along the inferior retinal periphery, a hemorrhagic occlusive vasculitis was observed. Clinical examination revealed retained intraocular cotton fiber along the inferotemporal quadrant over the retinal surface. In addition to the standard post-operative medications, a course of systemic steroids (40 mg per day of Prednisolone tablets) was started. At the end of the first post-operative week, clinical signs of hemorrhagic retinal vasculitis were beginning to resolve, and by the end of the fourth post-operative week, they had completely resolved. CONCLUSION: This report describes an unusual diagnosis of TPSS after vitreoretinal surgery, most likely due to the presence of an intraocular cotton fiber. This excessive inflammation of the posterior segment usually responds to a course of topical and systemic steroids.

Autocrine regulation of mesenchymal progenitor cell fates orchestrates tooth eruption.

Formation of functional skeletal tissues requires highly organized steps of mesenchymal progenitor cell differentiation. The dental follicle (DF) surrounding the developing tooth harbors mesenchymal progenitor cells for various differentiated cells constituting the tooth root-bone interface and coordinates tooth eruption in a manner dependent on signaling by parathyroid hormone-related peptide (PTHrP) and the PTH/PTHrP receptor (PPR). However, the identity of mesenchymal progenitor cells in the DF and how they are regulated by PTHrP-PPR signaling remain unknown. Here, we show that the PTHrP-PPR autocrine signal maintains physiological cell fates of DF mesenchymal progenitor cells to establish the functional periodontal attachment apparatus and orchestrates tooth eruption. A single-cell RNA-seq analysis revealed cellular heterogeneity of PTHrP+ cells, wherein PTHrP+ DF subpopulations abundantly express PPR. Cell lineage analysis using tamoxifen-inducible PTHrP-creER mice revealed that PTHrP+ DF cells differentiate into cementoblasts on the acellular cementum, periodontal ligament cells, and alveolar cryptal bone osteoblasts during tooth root formation. PPR deficiency induced a cell fate shift of PTHrP+ DF mesenchymal progenitor cells to nonphysiological cementoblast-like cells precociously forming the cellular cementum on the root surface associated with up-regulation of Mef2c and matrix proteins, resulting in loss of the proper periodontal attachment apparatus and primary failure of tooth eruption, closely resembling human genetic conditions caused by PPR mutations. These findings reveal a unique mechanism whereby proper cell fates of mesenchymal progenitor cells are tightly maintained by an autocrine system mediated by PTHrP-PPR signaling to achieve functional formation of skeletal tissues.

A three-dimensional analysis of primary failure of eruption in humans and mice.

OBJECTIVES: Primary failure of eruption (PFE) is a genetic disorder exhibiting the cessation of tooth eruption. Loss-of-function mutations in parathyroid hormone (PTH)/parathyroid hormone-related peptide (PTHrP) receptor (PTH/PTHrP receptor, PPR) were reported as the underlying cause of this disorder in humans. We showed in a PFE mouse model that PTHrP-PPR signaling is responsible for normal dental follicle cell differentiation and tooth eruption. However, the mechanism underlying the eruption defect in PFE remains undefined. In this descriptive study, we aim to chronologically observe tooth eruption and root formation of mouse PFE molars through 3D microCT analyses. SETTING AND SAMPLE POPULATION: Two individuals with PFE were recruited at Showa University. A mouse PFE model was generated by deleting PPR specifically in PTHrP-expressing dental follicle and divided into three groups, PPRfl/fl ;R26RtdTomato/+ (Control), PTHrP-creER;PPRfl/+ ;R26RtdTomato/+ (cHet), and PTHrP-creER;PRRfl/fl ;R26RtdTomato/+ (cKO). MATERIALS AND METHODS: Images from human PFE subjects were acquired by CBCT. All groups of mouse samples were studied at postnatal days 14, 25, 91, and 182 after a tamoxifen pulse at P3, and superimposition of 3D microCT images among three groups was rendered. RESULTS: Mouse and human PFE molars exhibited a similar presentation in the 3D CT analyses. The quantitative analysis in mice demonstrated a statistically significant decrease in the eruption height of cKO first and second molars compared to other groups after postnatal day 25. Additionally, cKO molars demonstrated significantly shortened roots with dilacerations associated with the reduced interradicular bone height. CONCLUSIONS: Mouse PFE molars erupt at a much slower rate compared to normal molars, associated with shortened and dilacerated roots and defective interradicular bones.

Functional Space Maintainer with Bilateral Early Loss of Primary Maxillary First Molars: NAFC.

The primary dentition plays a very important role not only in the child's growth and development but also in the guidance and eruption of permanent teeth. Premature loss of a deciduous tooth or a group of teeth will lead to a wide range of implications in the permanent dentition. The best way to avoid these problems is to preserve the primary teeth in the arch until their normal time of exfoliation. However, in cases where extraction of teeth is unavoidable due to extensive caries, the safest option to maintain arch space is by placing a space maintainer. The present case report is about a 4-year-old male patient with bilaterally decayed, nonrestorable primary maxillary first molars. After examination and radiographic investigations, it was decided to extract teeth 54 and 64. Since the permanent successors were still in Nolla's stage 4, a space maintainer was planned to prevent any migration and space loss. To encourage a positive outcome, it was decided to carry out prosthetic intervention using a Nance appliance with functional components. After the replacement of the missing teeth, a marked improvement in function, along with space maintenance, was seen. How to cite this article: Gupta A, Mohapatra A, Dutta B, et al. Functional Space Maintainer with Bilateral Early Loss of Primary Maxillary First Molars: NAFC. Int J Clin Pediatr Dent 2024;17(5):612-615.

A Leap Beyond Traditional Methods: A Case Report on the Horizontal Loop Distal Shoe.

This case report presents the successful management of a four-year-old male patient with pain in the lower right back tooth region. Clinical and radiographic examinations revealed the necessity for extraction of tooth 85 due to persistent infection and bone resorption, necessitating space maintenance. A modified distal shoe space maintainer, incorporating horizontal loops for enhanced adjustability, was utilized postextraction. The appliance was fabricated, cemented, and monitored through follow-up visits. At the 24-month recall, the permanent mandibular first molar (tooth 46) was clinically visible, indicating successful space maintenance. Incorporating horizontal loops into the distal shoe space maintainer represents an innovative approach in pediatric dentistry, offering clinicians a versatile tool for managing space loss and promoting optimal eruptive patterns.

Comparative evaluation of the osteogenic capacity of second-generation platelet concentrates on dental pulp stem cells - An ex vivo study.

Introduction: Clinical evidence of platelet-rich fibrin (PRF) benefits on bone repair is still emerging, prompting researchers to experiment with different PRF formulations as osteoconductive scaffolds. Aims: This study compared the osteoconductive effects of injectable PRF (i-PRF) and leukocyte-rich PRF (L-PRF) on the differentiation of dental pulp stem cells (DPSCs) into osteoblasts. Materials and Methods: Blood samples were collected from the volunteers to prepare L-PRF and i-PRF conditioned media (CM) by centrifugation. DPSCs were isolated from impacted third molars and cultured. Proliferation of DPSCs in response to L-PRF and i-PRF was assessed by MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Osteoinductive potential was evaluated through alkaline phosphatase (ALP) activity, alizarin red S (ARS) staining, growth factor levels (vascular endothelial growth factor [VEGF], transforming growth factor [TGF-beta]), and cytokine expression (interleukin 6 [IL-6], IL-8) after 7 days. Results: MTT assay results showed that both L-PRF and i-PRF increased DPSC proliferation relative to the control group. After 7 days in L-PRF and i-PRF CM, DPSCs exhibited increased ALP activity, higher red-colored calcium deposits with ARS staining, and elevated levels of VEGF and TGF-beta. In addition, higher concentrations of inflammatory cytokines IL-6 and IL-8 were observed in both L-PRF and i-PRF compared to the control. Conclusions: Using both L-PRF and i-PRF as scaffolds can enhance the osteoinductive ability of stem cells, offering a potential strategy for regenerative therapies.

Restoring Vitality: The Science and Practice of Pulp Revascularization in Endodontics.

Pulp revascularization is an emerging treatment modality in endodontics aimed at preserving the vitality and function of immature permanent teeth with necrotic pulp and apical periodontitis. This review provides a comprehensive examination of the current state of pulp revascularization, encompassing its rationale, clinical procedures, indications, contraindications, advantages, limitations, and potential future prospects. By critically analyzing the existing literature and clinical experiences, this review aims to offer insights into the efficacy, challenges, and potential advancements in the field of pulp revascularization.

Analysis of Annual Costs of Mobile Clinics in the Southern United States.

INTRODUCTION: Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. METHODS: The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. RESULTS: Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. CONCLUSION: The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

Therapeutic Potential of Phytomedicines and Novel Polymeric Strategies for Significant Management of Candidiasis.

BACKGROUND: Candidiasis is one of the most common opportunistic fungal infections caused by genus Candida. The genus is composed of around 200 species. The most virulent among all are, Candida albicans followed by various nonalbicans species. Despite various treatments available, the incidence of severe systemic fungal infections is increasing, and with it the related morbidity and mortality, in relation to the misuse of antimicrobials and the emergence of drug-resistant fungal species. Therefore, various novel therapeutic approaches need to be developed and explored to overcome these limitations and effective management of candidiasis. OBJECTIVE: In this review, we focused on natural herbal remedies and significance of novel formulation approaches for the treatment of candidiasis. CONCLUSION: The reported studies suggested the promising role of phytomedicines and novel polymeric drug delivery systems in therapeutic management of candidiasis. Phytomedicines are effective substitutes of synthetic drugs as they are inexpensive with lesser number of side effects. Various novel particulate approaches can be successfully used to reduce fungal burden at the target site.

Knowledge and Attitude of Parents/Caretakers toward Management of Avulsed Tooth in Maharashtrian Population: A Questionnaire Method.

BACKGROUND: Traumatic injuries to teeth and their supporting structures during childhood are one of the major problems faced by the dentist in day to day practice. Children usually encounter minor accidents in their routine activities and hence, it of utmost importance to provide emergency care to reduce such outcomes. Most of children with dental trauma present late for treatment due to lack of awareness and knowledge among parents/caretakers resulting in unfavorable long-term prognosis. This study was conducted to evaluate by means of a questionnaire, the knowledge, and usual attitude of the parents/caretakers about the management of avulsed tooth in children of age group 5-14 years. MATERIALS AND METHODS: The questionnaire containing 6 questions was distributed among 200 parents/caretakers who participated in the study. The questions assessed the knowledge and attitude of parents toward avulsed tooth and its management. Statistical analysis was performed using Statistical Package for Social Sciences version 17.0. RESULTS: A lack of technical information regarding the preservation and management of avulsed tooth was observed among the parents/caretakers. The education status of the study population when associated with the knowledge variables of avulsion showed that most of the variables had statistically significant association with P < 0.04. CONCLUSION: These data reinforce the need to provide the population with some important information regarding the emergency management of avulsed tooth. This warrants the need of effective communication between dental professionals and caretakers for better handling of dental emergencies.

Transcutaneous electric nerve stimulation (TENS) in dentistry- A review.

Transcutaneous electric nerve stimulation (TENS) is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions. Similarly, it can be utilized for the management of pain during various dental procedures as well as pain due to various conditions affecting maxillofacial region. This review aims to provide an insight into clinical research evidence available for the analgesic and non analgesic uses of TENS in pediatric as well as adult patients related to the field of dentistry. Also, an attempt is made to briefly discuss history of therapeutic electricity, mechanism of action of TENS, components of TENs equipment, types, techniques of administration, advantages and contradictions of TENS. With this we hope to raise awareness among dental fraternity regarding its dental applications thereby increasing its use in dentistry. Key words:Dentistry, pain, TENS.

Estimation of dental and facial proportions using height as criteria.

BACKGROUND: Ideal dental restoration is one which not only restores optimal functions but also confirm to standard dental and facial relations. This is important to achieve long term patient satisfaction both with regard to esthetics as well as functions. Objective was to find a credible relationship between dental and facial proportions using height of individuals as the criteria in a specific group of population. To determine a regression equation for determination of various dental and facial proportions using height. MATERIALS AND METHODS: One hundred and forty-four (n = 144) students, of which 91 were males (n = 91) and 53 were females (n = 53) of the dental college participated in this study. Height of the individual, the lower facial height, inter-incisal and inter-canine and inter-commissural width was measured as per protocol and resulting data was analyzed using SPSS 17 (SPSS Statistics for Windows, Version 17.0. Chicago SPSS Inc. Released 2008) version software regression equations were obtained. RESULTS: The study included 144 college students significant correlations were found between height of the individuals, inter-canine distance and lower facial height using Pearson correlation coefficient. The calculated values of t-test were significant. Regression equations were determined for determination of various parameters using height as the sole criteria. CONCLUSION: There exists a definite relationship between height of the individual and their dental and facial parameters in this group of population and values of maxillary anterior teeth can be determined using regression equations.