Query: Dental caries case report, 2015

title: Dental root elevator embedded into a subgingival caries: a case report
abstract: BackgroundBreakage of surgical instruments is a rare complication. A mistake in operator technique or sub standard/aged tools could lead to this type of accident. A tooth elevator is an instrument used in minor oral surgical procedures to luxate the tooth or fractured root from its socket. The authors have not found any previously published cases reporting the breakage of a tooth elevator tip which then remained as a foreign body in a hidden caries cavity.Case presentationA 28 year old African black male was referred to a hospital in Tanzania for an intraoral radiography. The patient explained that six months previously his mandibular left third molar had been extracted. Whilst the healing process had been satisfactory, he had recently experienced acute oral pain in this region. The dental X ray showed an image consistent with a piece of broken metal embedded in a distal subgingival caries at the mandibular left second molar.ConclusionOral and dental surgeons should take particular care when employing metal instruments with strong force in poorly visible areas. A radiographic study should be carried out when instrument breakage occurs. If an unexpected accident takes place during a surgical procedure, the patient must be informed in accordance with ethical codes, and suitable measures adopted to resolve the issue.

title: Dental management of patient with Williams Syndrome A case report
abstract: Williams syndrome is a multisystemic rare genetic disorder caused by deletion of 26 28 genes in the long arm of chromosome 7. It is characterized by developmental and physical abnormalities including congenital cardiovascular abnormalities, mental retardation, neurological features, growth deficiency, genitourinary manifestations, gastrointestinal problems, musculoskeletal problems, unique behavioral characteristics, and dental problems. Dental abnormalities include malocclusion, hypodontia, malformed teeth, taurodontism, pulp stones, increased space between teeth, enamel hypoplasia, and high prevalence of dental caries. Authors report a 17 year old female patient with underlying Williams syndrome. Oral features and problems seen in the patient are listed. Malocclusion and screwdriver shaped teeth were noticed. Generalized widening of the periodontal ligament space with vital teeth was seen. This finding has not been reported in cases of Williams syndrome earlier. Precautions taken during dental treatment in patients with Williams syndrome are also discussed.

title: DENTAL TREATMENT IN A PRADER WILLI SYNDROME PATIENT A CASE REPORT
abstract: Prader will syndrome (PWS) is a genetic disorder displayed with short stature and behavioral problems. The major manifestation is hyperphagia and obesity but there is no known effective drug that can solve this problem. This article presents a case report of a 3 year 9 month old girl affected with PWS syndrome treated under general anesthesia due to lack of cooperation and multiple caries. The dentist should work as a member of the multidisciplinary medical team. Careful long term follow up is required to prevent dental caries and periodontal diseases as well as maintain good oral hygiene. A strict diet control should also be encouraged.

title: Detection of dental caries lesion at early stage based on image analysis technique
abstract: Dental caries is a bacterial disease of teeth caused by acid, carbohydrates and it destroys the enamel and dentine. This also causes dental pain. As per World Health Organization report, worldwide 60 90% children and 100% adult have dental caries  In near future it will be an epidemic. Unfortunately there is no highly sensitive technology for early caries detection. Besides that, no single method will allow detection of caries on all types of the tooth surfaces like enamel, dentin region etc. Hence periodic monitoring and treatment is essential for preventing the growth of the caries. It is difficult for doctor to monitor the progress of each dental caries lesion. That case, x ray images are helpful, but it is injurious to health. Hence optical image based caries monitoring system is advantageous for doctor to monitor the size of the caries. This method is not injurious to health. The proposed method describes a technique where optical images of teeth are filtered and caries lesions are extracted followed by tooth region segmentation. This system is able to segment each tooth, caries lesion and monitor the growth of lesion size. The main goal of this research work is to find the exact caries lesion of affected teeth which helps dentist for better follow up and diagnosis.

title: Vital Pulp Therapy of a Mature Molar with Concurrent Hyperplastic Pulpitis, Internal Root Resorption and Periradicular Periodontitis: A Case Report
abstract: Vital pulp therapy (VPT) of permanent mature teeth is continuously ascertaining to be a more reliable endodontic treatment. The purpose of this case report was to describe successful VPT of a mature mandibular left first molar with concurrent hyperplastic pulpitis, internal root resorption and periradicular periodontitis in a 35 year old male patient. After complete caries removal and access cavity preparation, the dental pulp was removed from the coronal third of the roots. To protect the remaining pulp, calcium enriched mixture (CEM) cement was placed and adapted into the cavities; the tooth was then restored with amalgam. Six months after VPT, radiographic examination showed evidence of periradicular healing. Clinically, the tooth was functional without signs and symptoms of infection/inflammation. The successful outcome of this case suggests that diseased dental pulp (i.e. irreversible pulpitis) has the potential to heal after pulp protection with CEM biocement.

title: Case report: A medieval case of molar incisor hypomineralisation
abstract: Molar incisor hypomineralisation (MIH) has been identified in recent years as a condition affecting the first permanent molars and, in some cases, the permanent incisors. Many factors have been suggested as to its aetiology. Examples of MIH have also been reported in skeletal remains in the past. These historical examples have, however, been for unknown individuals.Case report A skull that has become available for dental examination that is uncertainly attributed to be that of Lady Eleanor Talbot (c.1436 1468) who ended her life as a Carmelite nun in Norwich (England) The dental findings of the examination showed enamel defects of molar teeth 36 and 46, as well as small areas on other molars, and striations of the enamel of permanent anterior teeth consistent with MIH. There is exposure of the roots of some maxillary teeth with resultant root caries. The presence of areas of enamel decalcification commensurate with 'Turner teeth' on 43 and 44 indicates that there were likely to have been periapical abscesses secondary to dental caries of the primary teeth. In addition, there is occlusal wear of all of teeth with extensive calculus and periodontal exposure of the roots of the mandibular incisors. Failed development or very early ante mortem loss of premolars 15 and 25 is evident, as well as evidence in the same region of a large abscess cavity with extensive maxillary bone destruction. Healing cribra orbitalia, porosity, which is considered to be an indicator of nutritional stress, is visible on the superior aspect of the left orbit. A case of MIH is reported in a skull dating from the mid 15th century.

title: Freeman Sheldon syndrome: a case report.
abstract: Freeman Sheldon syndrome is a rare hereditary disorder characterised by three basic abnormalities, namely microstomia, camptodactyly with ulnar deviation of the fingers, and clubfoot. The majority of these patients have microstomia and dental crowding, making oral hygiene difficult and increasing the risk of caries. Treatment of these patients requires a coordinated effort by a team of specialists, including a paediatrician, an anaesthesiologist, a plastic surgeon, a paediatric dentist, and an orthodontist. Herein, we describe dental problems of a child with Freeman Sheldon syndrome and the treatment procedures performed.

title: Blaschko Linear Enamel Defects A Marker for Focal Dermal Hypoplasia: Case Report of Focal Dermal Hypoplasia
abstract: Focal dermal hypoplasia (FDH) is a rare genetic skin disorder. The inheritance of FDH or Goltz Gorlin syndrome is X linked dominant and the disease is associated with a PORCN gene mutation. This gene plays a key role in the Wnt pathway, which has an impact on embryonic development. Every tissue derived from meso and ectoderm can be affected. Patients suffer from cutaneous, ocular, osseous, oral and dental defects. The skin and dental alterations manifest along the Blaschko lines. We present a woman (born in 1962) suffering from FDH with congenital skin changes and Blaschko linear enamel defects. Typical symptoms (e.g. fat herniations, scoliosis, syndactyly, microphthalmia, caries and alopecia) plus vertical grooving of all teeth gave a first indication. Molecular genetic testing confirmed the definitive diagnosis of FDH. We hypothesize that, in the context of typical skin changes, visible Blaschko lines on the teeth in the form of vertical grooves are almost pathognomonic for FDH.

title: Bilateral Fusion of Primary Mandibular Incisors: A Rare Case Report.
abstract: A 32 month old boy accompanied by his parents reported with chief complaint of decayed teeth. The patient did not have any systemic disorder and his medical history was noncontributory. There was no family history of dental anomaly and no consanguinity was reported in the parents. On examining the patient intraorally, bilateral presence of unusually large teeth in the mandibular incisor region was seen. Both side lateral and central incisor were fused to form large tooth [Table/Fig 1]  Intraoral view of fused bilateral mandibular central and lateral incisors These bulbous teeth were not affected by dental caries and periodontal problems. Radiographic evaluation of the left and the right sides revealed two distinct roots and root canals and were evident of the fused 71,72 and 81,82 [Table/Fig 2] The underlying permanent successor tooth were also evident in both the intraoral and periapical and panoramic radiographs  So, a diagnosis of bilaterally fused mandibular primary central and lateral incisors was made. Now patient is on follow up.  IOPA showing bilateral fused mandibular central and lateral incisors  OPG showing bilaterally fused mandibular incisors and presence of permanent tooth germ The developmental anomaly of union of two deciduous or permanent teeth is called as fusion. There are certain problems associated with fusion namely aesthetic problems, space problems, occlusal disturbances and delayed eruption of permanent teeth. Therefore careful monitoring of the case is required. This case report highlights a rare case of bilateral fusion of primary mandibular incisors in a 32 month old boy. In the primary dentition various anomalies of number and form may occur  One of such anomaly is fusion which is identified as union of two distinct dental organs. In fusion the number of teeth in the dental arch is reduced. This anomaly is different from gemination because in gemination single tooth germ divides into two. The causes of fusion is still unknown but possible cause can be due to the pressure or physical forces, close contact between two developing teeth occurs  Other contributing factors include genetic predisposition and racial differences. Fused teeth may also present in some syndromes like chondroectodermal dysplasia or achondrodysplasia. In primary teeth, the incidence of bilateral fusion is 0.01 0.04% [2] In fused teeth, the clinical crown appears as a crown which is double the size of normal crown. On radiographic examination, fused teeth can show separate pulp chambers and root canals or a single common pulp chamber and root canal system. Fused teeth can predispose to caries due to presence of deep fissures and can also lead to periodontal, aesthetic and spacing problems  Fusion occurs when some physical force or pressure brings contact of the two normally separated tooth germs. It occurs during developmental stage of the teeth. When the contact occurs before calcification stage, a single large tooth is produced. When the contact and union of the teeth occurs after the formation of the crown, the incomplete fusion at the root level is formed. Several problems occurred in permanent dentition follow fused primary teeth such as repeated double teeth, hypodontia (missing teeth) supernumerary teeth and peg shaped teeth  Also, double primary teeth may cause delayed resorption of the root because of the big root mass, resulting in delayed or ectopic eruption of permanent teeth [4] Fused primary teeth are highly correlated with the absence of permanent teeth and the prevalence depends on the combination of fused primary teeth [5]

title: Strip Crowns Technique for Restoration of Primary Anterior Teeth: Case Report
abstract: Dental caries is the single most common chronic childhood disease affecting worldwide. In early childhood caries, there is early pulp involvement and gross destruction of maxillary anterior teeth as well as posterior teeth. Treatment of such caries represents a challenge to pediatric dentists especially, when teeth are badly destroyed. By the time the dentist sees the child, most of the coronal structure is lost. This case report describes challenging task of a Case of early childhood caries patients with mutilated maxillary incisors restored with a strip form composite restorations.  Early childhood caries, Resin composite, Strip crowns