Cervical lymphocele: A rare complication following salvage surgery for ocular adnexal apocrine adenocarcinoma. A case report and review of the literature.

BACKGROUND: An ocular adnexal apocrine adenocarcinoma (OAAA) is an extremely rare, but potentially aggressive and life-threatening tumor with ill-defined management based only on recommendations from a limited number of reported cases. The development of cervical lymphocele following neck dissection is a very rare complication, but one with well established methods for prevention and treatment. Here we describe a previously unreported case of salvage surgery including neck dissection for OAAA in addition to an emergence of cervical lymphocele. A literature review of current knowledge on both pathological conditions is included. METHODS AND RESULTS: A 58-year-old man suffering from OAAA, previously treated with multiple eye-sparing excisions and adjuvant proton therapy, underwent salvage surgery for locoregional recurrence of the tumor. A partial orbitectomy with orbital exenteration, primary reconstruction and left-sided neck dissection was performed. The procedure was complicated by a cervical lymphocele resolved after the surgical therapy. The patient remained disease-free during the one-year follow-up. CONCLUSION: OAAA is a locally aggressive tumor with potential to local or distant metastatic spread. Whole-body staging, regular clinico-radiological follow-up and stage-dependent therapy with surgery as the first-choice treatment is required. A cervical lymphocele as a complication of especially left-sided neck dissection is managed with a conservative or surgical therapy according to the level of lymph leakage, extent and localization of lesions, presence of local or systemic disorders and the period from primary surgery.

Exogenous Intake of Fluorides in Caries Prevention: Benefits and Risks.

Caries incidence and prevalence have decreased significantly over the last few decades due to widespread use of fluoride. However, an increase in the prevalence of dental fluorosis has been reported in both fluoridated and non-fluoridated communities. Care must be taken to ensure that a balance between the optimal fluoride preventive effect at the individual and community level and minimal risk of dental fluorosis is maintained. This review describes the main sources of fluoride intake that have been identified: fluoridated drinking water, dietary fluoride supplement, and topical forms comprising toothpastes, rinses, gels and varnishes. The cited data were taken from meta-analytic studies and reports from Cochrane database systematic reviews up to December 2019. Efficiency, but safety, of topically applied fluorides in individual home care is dependent on the degree of compliance of individuals/parents and on the level of competence of providers of preventive counselling. The broad spectrum of these resources allows individualization of fluoride prevention based on risk analysis of caries attack and taking into consideration other preventive measures.

Evaluation of the risk factors of dental caries in children with very low birth weight and normal birth weight.

BACKGROUND: Health problems of premature infants can affect both general and oral health. The enamel defects, poor dietary and oral hygiene habits may predispose these children to dental caries. This study was conducted to assess the impact of very low birth weight and prematurity on caries risk in early childhood. METHODS: The study cohort consists of 189 of one year old infants. Anamnestic data were obtained from hospital records, feeding practice, bed-time sugar drinks and oral hygiene onset from questionnaires. Saliva samples of children and their mothers were collected for the detection of cariogenic pathogens. RESULTS: VLBW newborns had significantly shorter gestation age (29.6 vs. 38.8)) and lower mean birthweight (1124 g vs 3315 g) compared to NBW ones (p < 0.0001). Statistical significance has been found in the presence of early morbidity (p < 0.0001) and regular medication intake (p = 0.007). VLBW children got more frequently sweetened drinks during the day and night (p = 0.007). Regular oral hygiene practice was more frequent in full term group (p = 0.002). There was statistical difference in the presence of enamel hypoplasia in VLBW children (p = 0.033) but no statistical difference in the presence of hypomineralization (p = 0.0736) in comparison to NBW individuals. Proportional representation and count of S. mutans did not reveal statistical difference neither in both groups of children (p = 0.484) nor in both groups of mothers (p = 0.385). CONCLUSIONS: The study confirmed anamnestic and medical differences between both groups. The proportional representation and count of S. mutans did not reveal statistical difference neither in VLBW and NBW children, nor in their mothers.

General and oral health status of preterm one-year-old very low and extremely low birthweight infants (a cross - sectional study).

AIMS: The aim of the present study was to evaluate the general and oral health status of a group of preterm one-year-old very low (VLBW) and extremely low birthweight (ELBW) infants and make a comparison with full-term one-year-old normal birthweight infants (NBW). METHODS: A cross-sectional study was conducted in 102 one-year-old preterm VLBW and ELBW infants, and the data obtained were compared to 87 one-year-old full-term NBW infants. The infants' medical histories were obtained from hospital records and interviews with the mothers. The oral cavities of all infants were examined under the same conditions. The chi-square test, Pearson's chi-square test of independence and Mann-Whitney test were used for the statistical evaluation, with P < 0.05 considered statistically significant. Relative risk (RR) and 95% confidence interval (CI) estimates for variables significantly associated with oral findings were calculated. RESULTS: Both perinatal variables (gestational age, mode of delivery, birthweight, Apgar score, resuscitation, orotracheal intubation and presence of intraoral pathology) and neonatal variables (antibiotic treatment and infections) had a significant association with prematurity, VLBW and ELBW. The one-year-old preterm VLBW and ELBW infants frequently suffered from general diseases, frequently received regular medication and had fewer erupted primary teeth; they also had a higher prevalence of developmental defects of the enamel and deformations of the hard palate. CONCLUSION: This study confirmed anamnestic, medical and oral differences between one-year-old preterm VLBW and ELBW and full-term NBW infants.

Recurrent Aphthous Stomatitis in Children: A Practical Guideline for Paediatric Practitioners.

Recurrent aphthous stomatitis (RAS) is the most common chronic oral mucosal lesion affecting up to 25% of the population. The diagnosis is based on well-defined clinical characteristics, but the precise aetiology and pathogenesis remain unclear. The treatment of RAS should be based on the identification and control of possible predisposing factors. A wide range of topical medicaments is available as antiseptics, anti-inflammatory drugs and corticosteroids. The systemic treatment is indicated in patients with continuous and aggressive manifestation, which is extremely rare in children. The present article provides a review of the current concept and knowledge of the aetiology, pathogenesis, and management of RAS in the paediatric population.

Complete removal of dentigerous cysts with preservation of associated teeth as an alternative to marsupialization in children and preadolescents.

The aim of this study is to evaluate the results of dentigerous cysts enucleation with preservation of cyst-associated teeth as a single procedure in a group of children and preadolescents. A retrospective case series of seven patients with 15 unerupted developing teeth associated with or adjacent to dentigerous cysts was conducted. Patients were treated using the uniform surgical protocol (cystectomy, preservation of cyst-associated teeth, without use of orthodontic traction, primary wound closure). The metric analysis of the cysts and unerupted teeth on CBCT and an evaluation of the state of involved teeth after the treatment was performed. The mean age of patients was 9.0 ± 2.1 years (range 5-12 years, median = 9 years). All teeth erupted spontaneously. No serious postoperative complications or recurrences of lesions were detected. The mean follow-up was 53.1 ± 15.7 months (range 25-71 months, median = 52 months). The cystectomy of dentigerous cysts with preservation of associated teeth may be considered an alternative to marsupialization in children and preadolescents.

The Analysis of Dental Treatment under General Anaesthesia in Medically Compromised and Healthy Children.

Dental care under general anaesthesia (GA) is an option when normal treatment cannot be accomplished due to un-cooperation and systemic or cognitive/intellectual disabilities. The purpose of this retrospective cohort study was to analyse the dental treatment under GA in medically compromised and healthy children. The data were collected from the medical records of children who received their dental treatment under GA. The data regarding patient age, sex, general health, and type of treatment were analysed. This clinical trial included 229 study subjects (138 males, 91 females) with an average age of 8.34 (SD 3.78). Counts and relative counts were used for description of qualitative data. The association between the variables was analysed using contingency tables. The significance of the findings was tested by the chi-square test. Most of the children were older pre-school 63 (27.51%) and young school children 102 (44.54%). Medical disability (systemic or intellectual) was diagnosed in 142 children (62.01%); the remaining 87 (37.99%) were healthy children. Dental treatment of primary teeth was more commonly performed in healthy children (65.52%) compared to medically compromised children (58.45%) (p = 0.287). The total number of medically compromised children and the total number of healthy children were both considered to be 100% for the purpose of the following calculations. In terms of permanent dentition, medically compromised children required more extractions and fillings (38.03%, 57.04%) compared to healthy children (14.94%, 17.24%, respectively). The results of this study revealed that dental treatment under GA was more commonly performed in medically compromised children in permanent teeth only in comparison to healthy children. Based on these findings, both health professionals and state authorities should focus more on preventive care in medically compromised children in order to improve their oral health.

Early colonization of the oral cavity in 6- and 12-month-old infants by cariogenic and periodontal pathogens: a case-control study.

The colonization of the oral cavity by cariogenic and periodontal pathogens occurs earlier than previously thought. This study aimed to identify the presence and quantity of representative cariogenic and periodontal pathogens in the oral cavities of 6- and 12-month olds and to evaluate the influence of C-section delivery on early Streptococcus mutans (Sm) colonization of the oral cavity. The research cohort was composed of 59 infants (35 infants were delivered vaginally and 24 via C-section) and their mothers. At 6 months of age, the infants were examined, and unstimulated saliva samples were collected. Variables concerning mothers were DMF index and salivary levels of Sm. Repeated saliva samples were taken 6 months later. The representative cariogenic and periodontal microorganisms were identified, and their quantities were measured using a polymerase chain reaction-based method. The relationships between the presence of detected microbes, the mode of delivery, and maternal variables were evaluated using paired t tests, chi-squared test, and ANOVAs. High rates of cariogenic bacteria, Aggregatibacter actinomycetemcomitans (Aa) and Fusobacterium nucleatum (Fn), were found in both infant cohorts. An analysis of the differences between delivery methods revealed that the group of 6-month-old vaginally delivered infants had a significantly higher amount of Sm. We conclude that the cariogenic bacteria, Aa and Fn, are present in edentulous infants. This presence increases in the months following the eruption of the deciduous teeth. Results did not confirm the influence of C-section delivery on the early Sm colonization of the oral cavity.

The presence of cariogenic and periodontal pathogens in the oral cavity of one-year-old infants delivered pre-term with very low birthweights: a case control study.

BACKGROUND: Recently, the dental literature has focused mainly on the microbial colonization of healthy full-term infants and their mothers or caretakers. However, oral microbial acquisition by premature infants has not been adequately investigated, and the correlation between pre-term birth and the presence of cariogenic and periodontal pathogens has not been determined. The aim of this study was to identify the presence and quantities of representative cariogenic and periodontal pathogens in the oral cavities of 12-month-old infants and compare the occurrence of these microbes between a cohort of pre-term infants with very low birthweights and a control cohort comprising full-term infants. METHODS: The research cohort was composed of 69 one-year-old infants, of whom 24 were born prematurely with very low birthweights and 45 of whom were carried to full term. Information regarding the infants' gestational age, mode of delivery, general health status, birthweight and antibiotic use were obtained from hospital records and through oral interviews. At 12 months of age, both groups of infants were examined, and unstimulated saliva samples from the dorsum of the tongue and dental plaque samples were collected. The microorganisms (Streptococcus mutans, Lactobacillus spp., Actinomyces spp., Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Peptostreptococcus micros, Prevotella intermedia, Fusobacterium nucleatum) were identified and their quantities were evaluated using a PCR-based method. The chi-squared and Fisher's factorial tests were used for the statistical evaluations. RESULTS: The infants had a high prevalence of cariogenic microbes and of Fusosbacterium nucleatum and Aggregatibacter actinomycetemcomitans. Cariogenic microbes were detected in 91.7% of the very low birthweight infants and in all full-term infants. Periodontal pathogens were present in 83% of the pre-term infants and in 96% of the full-term infants. A significant difference was found between the cohorts in terms of the presence of S. mutans. Most of the very low birthweight infants had negative values of this microbe, while the full-term infants had positive values. CONCLUSIONS: This study confirms the early transmission of representative cariogenic and periodontal pathogens to the oral cavity of one-year-old infants and a higher prevalence of S. mutans in full-term infants than in premature infants.

Langerhans cell histiocytosis in childhood - review, symptoms in the oral cavity, differential diagnosis and report of two cases.

BACKGROUND: Langerhans cell histiocytosis is a rare disease characterized by monoclonal proliferation and migration of special dendritic cells. This disease primarily affects bones, but occurs less frequently in other organ systems or may manifest as a multisystem disease. CASE REPORTS: Extraoral and intraoral symptoms of Langerhans cell histiocytosis are described in a 13-month-old female and a 5-month-old male infant. Dermatitis was found on the scalp, abdomen, flexures and in intertrigineous areas in both patients. The intraoral examination of the 13-month-old infant showed premature eruption of all maxillary deciduous molars, loosening and significant damage of periodontal tissues (gingivitis with bleeding, swelling of palatal mucosa, periodontal pockets) resembling severe periodontitis. In the oral cavity of the 5-month-old predentate infant bilateral swellings of maxillary alveolar mucosa with deep ulcerations were seen. The oral and skin symptoms in both infants were indications for biopsy. Langerhans cell histiocytosis was confirmed histologically and immunohistochemically. CONCLUSION: Oral findings in Langerhans cell histiocytosis may be the only clinical symptom of the disease; therefore the role of dentists in establishing diagnosis is very important.

Oral health status of women with high-risk pregnancies.

AIM: The aim of this study was to investigate the oral health status of women with high-risk pregnancies. METHODS: A case-control study of 142 pregnant women was conducted. The case group included 81 pregnant women with high-risk pregnancies, while 61 women with normal pregnancies served as controls. The following variables were recorded for each woman: age, general health status, DMF, CPITN, and PBI index, amounts of Streptococcus mutans in the saliva and dental treatment needs. The Mann-Whitney test, Kruskal-Wallis test, t-test and chi-squared test were used for statistical analyses. RESULTS: Statistically significant differences were detected between the PBI indices and dental treatment needs of the two groups. Out of the entire study cohort, 77% of the women in the case group and 52% of the women in the control group required dental treatment. CONCLUSION: In this study, women with complications during pregnancy had severe gingivitis and needed more frequent dental treatment than those in the control group.

Congenital epulis.

Congenital epulis is a rare, soft-tissue benign condition that presents at birth. It arises from the alveolar mucosa and occurs more frequently in the maxilla, mainly in the frontal region. This condition may interfere with respiration, feeding or lip closure. Surgical excision is the only possible treatment, although spontaneous regression has been reported. This article presents the case of a female infant with a solid ovoid mass protruding from the oral cavity. Treatment of this lesion was surgical, and histopathological examination confirmed the clinical diagnosis of congenital epulis. Postsurgical follow-up was without complications; examination of the infant 5 months later has revealed only mild left frontal alveolar ridge hypoplasia without any sign of recurrence.

A retrospective study of 889 injured permanent teeth.

The aim of this study was to investigate pre-injury factors, causes of dental injuries and healing complications after traumatic injuries to permanent teeth. The analysed sample comprised 889 permanent teeth of 384 patients, who were treated in the Dentistry Department in Faculty Hospital in Pilsen. Enamel-dentin fractures [233 teeth (26.2%)] and lateral luxations [207 teeth (23.3%)] were the most frequent injuries. The age of the patients at the time of injury varied between 7 and 65 years. Predominantly, children were affected [587 injured teeth (66.0%)]. The most frequent causes of injuries in patients older than 11 years were various sport activities, predominantly bicycling. Pulp necrosis was observed in 239 teeth (26.9%). It was the most frequent post-traumatic complication in all types of dental traumas. Teeth with a completed root formation demonstrated a higher prevalence of pulp necrosis than teeth with an incomplete root formation in all types of luxation injuries. External root resorption was observed in 144 teeth. The rate of inflammatory resorption differed between the various types of luxation injuries (extrusive luxation 5.6%, lateral luxation 11.6%, intrusive luxation 33.3%). Following avulsion and replantation, active inflammatory resorptions were diagnosed in 13 (26.5%) of 49 replanted teeth and ankylosis/replacement resorptions were observed in 21 (42.9%) of 49 replanted teeth. After avulsion, primarily, immature teeth were affected by these complications. Within the observation period of 5 years, 39 teeth (4.4%) had to be removed (16 teeth with root fractures, 19 avulsed and replanted teeth, 3 luxated teeth, 1 tooth with crown-root fracture).

Retrospective clinical study of 90 avulsed permanent teeth in 58 children.

The aim of this study was to find out the causes that lead to dental avulsion in children, to analyze the effectiveness of our treatment and the response of the adults when such incidents occur and finally to determine the occurrence of posttraumatic complications some time after the injury, especially the resorption of the affected teeth root. We analyzed the documentations of a sample of patients containing 57 children who had a total of 90 avulsed teeth and were treated in Dentistry Department of Medical Faculty in Pilsen, Czech Republic, in the years between 1995 and 2005. We discovered that most frequently the children experience dental avulsion in the age between 8 and 11 years old, the most affected teeth are the upper central incisors and the most frequent causes are sports and games which are very common in these ages, in various environments, like schools, sport fields and home. The majority of the children were transferred to the Dentistry Department either quite long after the avulsion incident and without the avulsed teeth, or with the avulsed teeth which were carried in an inappropriate transport medium, indicating that there is insufficient knowledge of adult people, especially the ones who are in daily contact with children, on how to provide first aid in cases of dental avulsion.

Attitude of Pilsen primary school teachers in dental traumas.

Dental injuries are rather common during sport activities and at schools where children spend most of their time every day. The purpose of this study was to evaluate the knowledge of primary school teachers in Pilsen, Czech Republic, of how to provide first aid in cases of one of the most serious dental injuries, the tooth avulsion. To this end, a questionnaire which contained nine questions about avulsion of permanent teeth was prepared. The questionnaires were distributed in nine primary schools in Pilsen where almost 300 teachers are employed. Seventy-four percent of the teachers replied. Sixty-eight percent had never received any information about providing first aid in cases of dental injuries and 81% would place the avulsed tooth in a dry handkerchief until the transfer of the patient to dentist. Prevention of tooth injuries is very important, as they may result even in tooth loss. This demands an effort to properly inform and educate sport trainers and primary school teachers about providing first aid in dental trauma situations; this effort should be intensive and continuous.