Van der Woude syndrome with sensorineural hearing loss, large craniofacial sinuses, dental pulp stones, and minor limb anomalies: report of a four-generation Thai family

Correlation of Pulp Calcification and Cardiovascular Conditions: A Literature Review

The pathophysiology of calcified dental pulp is considered to be comparable to that of calcified atheroma in the artery. These calcified masses are small nodular which is seen more often in the coronal pulp region than in the radicular pulp. This is generally more common in the elderly population and usually corresponds to increasing age. Calcifications are also found in the brain, breast, arteries, and kidneys. There is a link between pulp calcification and cardiovascular problems. It is commonly assumed that individuals suffering from cardiovascular diseases have a higher risk of calcification in the pulp. The use of radiography as a quick means of detecting cardiovascular disease is possible. The pulp calcification process is usually triggered by the osteoblastic process. The process is identified by the presence of an osteoid matrix, which is built down by odontoblast cells in the pulp's peripheral portions, culminating in the production of tissue that is comparable to dentine. This review will look at pulp calcifications from all angles, including their mechanism, clinical considerations, radiographic features, and management, and also to determine if there is a link between pulp calcification and cardiovascular problems.

Association between the prevalence of pulp stones and calcified atherosclerotic plaques: a systematic review and meta-analysis

OBJECTIVE

To evaluate the association between the prevalence of pulp stones (PS) in permanent teeth and calcified atherosclerotic plaques (CAP).

METHODS

An electronic search was performed in 10 databases to locate observational studies that investigated the association between PS in permanent teeth and CAP, published until March 2022. Two reviewers performed the search, selection and extraction of data from eligible studies. The individual risk of bias of eligible studies was assessed using the JBI Critical Appraisal Tools. The meta-analysis was conducted using fixed and random effects and odds ratio (OR) as an effect measure with a 95% confidence interval (CI). The heterogeneity between the studies was quantified using the I² test. The certainty of evidence was evaluated using the GRADE approach.

RESULTS

The electronic search resulted in 2968 records, of which only 7 studies were considered eligible. The total sample consisted of 3770 participants from 5 countries. All studies showed biases of confounding factors and exposure assessment. Based on six studies and with very low certainty of evidence, the meta-analysis showed that patients with PS were more likely to also have CAP in carotid or coronary arteries (OR: 1.70; 95% CI: 1.21; 2.38, I² = 0%).

CONCLUSIONS

Limited evidence suggests that there is a positive association between the prevalence of PS in permanent teeth detected using panoramic radiography and CAP in the coronary or carotid arteries.

Correlation between Pulp Stones and Gall Bladder Stones: A Radiographic Retrospective Case-Control Study

Background

Calcifications can occur in the dental pulp as discrete bodies known as pulp stones. Their etiology remains obscure. They were believed to be formed as a result of local irritating factors within the pulp; however, a few authors now suggest that they may be a part of systemic biomineralization process that affects many body parts such as kidneys, gall bladder, joints, arteries as well as pulp leading to formation of stones.

Aim

This retrospective case-control study was taken up to (i) determine the prevalence of pulp stones as well as pulp chamber narrowing in patients with gallbladder stones as well as the controls (ii) whether any correlation exists between the prevalence of pulp stones and gallbladder stones so as to test the hypothesis that pulp stones and gallbladder stones may be a part of a common systemic calcification process.

Setting and Design

This retrospective case-control study was conducted in the Department of Gastroenterology and Department of Radiodiagnosis, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. A total of 200 individuals were taken up for the study. Group I consisted of 100 patients (cases) with confirmed diagnosis of gallbladder stones. Group II included the control group in which individuals who were the close relatives of the patients with gall bladder stones were taken (n = 100), so as to eliminate the common confounding factors in these two groups such as diet, air, water, environment, genes, and age, which could affect the formation of pulp stones could not be the reason for the formation of pulp stones.

Materials and Methods

Standard bitewing radiographs were taken for all the patients in each group and presence or absence of pulp chamber narrowing and pulp stones were observed.

Statistical Analysis Used

McNemar's statistical test was used to find the difference between the two groups, and the P value was determined. Coefficient of association using the Phi coefficient was used to determine if there was any association between the two groups.

Results

In Group I, 37% of the patients with gallbladder stones showed the presence of pulp stones; whereas in the Group II which was the control, 57% of individuals showed the presence of pulp stones. McNemar's test of significance calculated with one-degree freedom (1-df) showed that P = 0.01, thereby showing that there was a significant difference between these two groups.

Conclusion

According to the study, a negative correlation between pulp stones and gallbladder stones was found and they are not related to each other.

Clinical, pathological, and genetic evaluations of Chinese patient with otodental syndrome and multiple complex odontoma: Case report

Otodental syndrome is a rare autosomal-dominant disease characterized by globodontia, associated with sensorineural, high-frequency hearing loss. Here, we describe the clinical, pathological, and genetic evaluations of a 9-year-old girl with otodental syndrome and multiple complex odontoma.The patient presented with a draining sinus tract in her left cheek, globodontia, and hearing loss. The odontomas which caused the cutaneous sinus tracts were extracted because of the odontogenic infection. The extracted odontoma and primary tooth was studied by micro-CT and further observed histopathologically. The micro-CT findings revealed that the primary tooth had three crowns with two separated pulp chambers, and their root canals were partially fused. The histological findings showed abnormal morphologies of odontoblasts and dentin, hyperplasia of enamel, and malformation of odontogenic epithelium. Furthermore, DNA sequencing and analyze of deafness associated gene GJB2, GJB3, and PDS had not revealed any SNP or mutation; but exon 3 of the causative gene FGF3 could not be amplified, which may be associated with the microdeletion at chromosome 11q13.3. Three month after surgery, the patient was found to be asymptomatic and even the evidence of the extra-oral sinus had disappeared.The dental abnormality of otodental syndrome included congenital missing teeth, globodontia, and multiple complex odontoma. Globodontia exhibited characteristic features of fusion teeth. In addition, gene FGF3 haploinsufficiency was likely to be the cause of otodental syndrome. The report provides some new information in the field of otodental syndrome, which would make dentists more familiar with this disease.

Odontoblasts: Specialized hard-tissue-forming cells in the dentin-pulp complex

Odontoblasts are specialized cells that produce dentin and exhibit unique morphological characteristics; i.e., they extend cytoplasmic processes into dentinal tubules. While osteoblasts, which are typical hard-tissue-forming cells, are generated from mesenchymal stem cells during normal and pathological bone metabolism, the induction of odontoblasts only occurs once during tooth development, and odontoblasts survive throughout the lives of healthy teeth. During the differentiation of odontoblasts, signaling molecules from the inner enamel epithelium are considered necessary for the differentiation of odontoblast precursors, i.e., peripheral dental papilla cells. If odontoblasts are destroyed by severe external stimuli, such as deep caries, the differentiation of dental pulp stem cells into odontoblast-like cells is induced. Various bioactive molecules, such as non-collagenous proteins, might be involved in this process, although the precise mechanisms responsible for odontoblast differentiation have not been fully elucidated. Recently, our knowledge about the other functional activities of odontoblasts (apart from dentin formation) has increased. For example, it has been suggested that odontoblasts might act as nociceptive receptors, and surveillance cells that detect the invasion of exogenous pathogens. The regeneration of the dentin-pulp complex has recently gained much attention as a promising future treatment modality that could increase the longevity of pulpless teeth. Finally, congenital dentin anomalies, which are concerned with the disturbance of odontoblast functions, are summarized.

Complex intrachromosomal rearrangement in 1q leading to 1q32.2 microdeletion: a potential role of SRGAP2 in the gyrification of cerebral cortex

Background

Van der Woude syndrome (MIM: 119300, VWS) is a dominantly inherited and the most common orofacial clefting syndrome; it accounts for ~2 % of all cleft lip and palate cases. Intellectual disability (ID) is characterized by significant limitations, both in intellectual functioning (cognitive deficit) and in adaptive behavior as expressed in conceptual, social and practical adaptive skills. Karyotyping has been the first standard test for the detection of genetic imbalance in patients with ID for more than 35 years. Advances in genetic diagnosis have laid chromosomal microarrays (CMA) as a new standard and first first-line test for diagnosis of patients with ID, as well as other conditions, such as autism spectrum disorders or multiple congenital anomalies.

Case Presentation

The present case was initially studied due to unexplained cognitive deficit. Physical examination at the age of 18 years revealed cleft palate, lower lip pits and hypodontia, accompanied with other dysmorphic features and absence of speech. Brain MRI uncovered significantly reduced overall volume of gray matter and cortical gyrification. Banding cytogenetics revealed an indistinct intrachromosomal rearrangement in the long arm of one chromosome 1, and subsequent microarray analyses identified a 5.56 Mb deletion in 1q32.1-1q32.3, encompassing 52 genes; included were the entire IRF6 gene (whose mutations/deletions underlay VWS) and SRGAP2, a gene with an important role in neuronal migration during development of cerebral cortex. Besides, a duplication in 3q26.32 (1.9 Mb in size) comprising TBL1XR1 gene was identified. Multicolor banding for chromosome 1 and molecular cytogenetics applying a battery of locus-specific probes covering 1q32.1 to 1q44 characterized a four breakpoint-insertional-rearrangement-event, resulting in 1q32.1-1q32.3 deletion.

Conclusions

Considering that the human-specific three-fold segmental duplication of SRGAP2 gene evolutionary corresponds to the beginning of neocortical expansion, we hypothesize that aberrations in SRGAP2 are strong candidates underlying specific brain abnormalities, namely reduced volume of grey matter and reduced gyrification.

Electronic supplementary material

The online version of this article (doi:10.1186/s13039-016-0221-4) contains supplementary material, which is available to authorized users.

Prevalence of and relationship between pulp and renal stones: A radiographic study

AIM

The aim of the present study was to determine the prevalence of and the relationship between pulp and renal in affected patients and in healthy adults.

MATERIALS AND METHODS

A total of 240 patients participated in the study. Group A consisted of 120 patients who had renal calculi and Group B had 120 randomly selected controls for the study. The periapical radiographs for all patients were evaluated for the presence or absence of the narrowing of dental pulp chambers and pulp canals. The radiographs were also evaluated to determine the presence or absence of pulp stones. The results were compared and analyzed using the Chi-square test (p < 0.001).

RESULTS

A total of 164 patients had pulp narrowing and 112 patients had pulp stones, which included 55 controls and 57 renal calculi patients. There was no statistical correlation between pulp narrowing and renal stones (p > 0.001) and also between pulp stones and renal stones (p > 0.001).

CONCLUSION

However, there was no significant correlation between the presence of pulp stones and renal stones, and the incidental findings of pulp stones on periapical radiographs can provide useful information in the early diagnosis of the systemic calcifications.

The relationship between pulp calcifications and salivary gland calcifications

Aim: Pulp stones are discrete calcified bodies found in the dental pulp. Sialolithasis is the most common salivary gland disease. The aim of the present study was to determine the relationship between the pulp stones and salivary gland stones. Material and Methods: 196 patients were randomly selected from the out patient department for the study. The periapical radiographs for all patients were evaluated for the presence or absence of the narrowing of dental pulp chambers and pulp canals. The intra oral occlusal radiographs were also evaluated to determine the presence or absence of salivary stones. The results were compared and analyzed using the Chi-square test (p<0.001). Results: Salivary gland calcifications were detected in 5 patients. 191 patients had pulp narrowing and 118 patients had pulp stones. There was no statistical correlation between pulp narrowing and salivary stones (p>0.001) and also between pulp stones and salivary gland stones (p>0.001). Conclusions: However, the incidental findings of salivary gland stones on intra oral occlusal radiographs can provide useful information in the early diagnosis of the condition, but in the present study no significant relationship was found between the presence of pulp stones and salivary gland stones.

Key words:Pulp stone, salivary gland stone, periapical radiograph, occlusal radiograph.

Radiographic assessment of the prevalence of pulp stones in Malaysians

INTRODUCTION

The aim of this study was to determine the prevalence of pulp stones in the Malaysian population using radiographs, and to assess the association of pulp stones with gender, age, tooth type, dental arch and tooth status. Occurrence of pulp stones among the three races in Malaysia (Malay, Chinese and Indians) was also studied.

METHODS

A retrospective study was performed from a random sample of 361 dental records in AIMST Dental Centre, Faculty of Dentistry, AIMST University, Kedah, Malaysia. Data were collected from patient files and 507 intraoral periapical radiographs. All radiographs were examined by an oral radiologist to identify pulp stones and associated factors. Statistical analysis was performed using the Pearson chi-square test.

RESULTS

Of the 361 patients, 205 were female and 156 were male. Pulp stones were identified in 162 (44.9%) subjects in 1 or more teeth and in 280 (15.7%) teeth of the total 1779 teeth examined. Pulp stones were found significantly more in molars and teeth that were not intact (carious/restored/both carious and restored). There was no significant correlation with sex, increasing age, dental arches, and ethnic races.

CONCLUSIONS

The prevalence of pulp stones in the Malaysian population studied was 44.9%. Pulp stones were more often seen in teeth that were restored or affected with caries. These findings require further investigation.

A study on pulp stones in a group of the population in Andhra Pradesh, India: An institutional study

Aim:

The aim of this study was to determine the occurrence of pulp stones in a group of the population of Andhra Pradesh. This study also aims to determine the association of pulp stones in different sexes, tooth type, dental arches and sides and with systemic diseases.

Materials and Methods:

A total of 4449 teeth of 2000 patients were examined, comprising of patients with C.V.S. disorders; Type II diabetes mellitus and gastritis were examined. Patients were selected from the radiology department who came for diagnostic radiograph of posterior teeth. The presence or absences of pulp stones were recorded.

Statistical Analysis Used:

Statistical analysis of the data was done using the statistical package for the social sciences (SPSS 15.0-SPSS Inc., 233 South Waker Drive, 11^th floor, Chicago, IL 60606-6412.) using Chi-square analysis. Differences were considered as significant when P ≤ 0.05.

Results:

Pulp stones were found in 799 (17.9%) of 4449 teeth detected. Significantly, higher numbers of pulp stones were recorded in patients with systemic diseases. The occurrences of pulp stones were significantly higher in maxillary first and second molars. No significant difference was found between sexes and sides.

Conclusions:

Positive correlation was found between systemic disorder and occurrence of pulp stones.

Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis

OBJECTIVES

The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis.

METHODS

A total of 112 End Stage Renal Disease (ESRD) patients on who were haemodialysis participated in this study. The periapical and the panoramic radiographs for all the patients were evaluated for the presence or absence of the narrowing of the dental pulps and for pulp stones in the pulp chambers and the pulp canals. The panoramic radiographs were also evaluated to determine the carotid calcification.

RESULTS

Carotid calcifications were detected in none of the patients. 84 (74.99%) patients had dental pulp narrowing, and 38 (33.92%) patients had pulp stones. There was no statistical correlation between pulp narrowing and Carotid Artery Calcification (CAC) in the haemodialysis patient group. There was also no statistical correlation between pulp stones and CAC in the haemodialysis patients.

CONCLUSION

However, the incidental finding of CAC on a panoramic radiograph can provide life-saving information for the vascular disease patients, but in the present study, no significant relationship was found between the presence of the pulpal calcification and CAC in the ESRD patients who were on haemodialysis. Therefore, the presence of pulp calcification does not seem to serve as a diagnostic marker for carotid atherosclerosis.

The role of Irf6 in tooth epithelial invagination

Thickening and the subsequent invagination of the epithelium are an important initial step in ectodermal organ development. Ikkα has been shown to play a critical role in controlling epithelial growth, since Ikkα mutant mice show protrusions (evaginations) of incisor tooth, whisker and hair follicle epithelium rather than invagination. We show here that mutation of the Interferon regulatory factor (Irf) family, Irf6 also results in evagination of incisor epithelium. In common with Ikkα mutants, Irf6 mutant evagination occurs in a NF-κB-independent manner and shows the same molecular changes as those in Ikkα mutants. Irf6 thus also plays a critical role in regulating epithelial invagination. In addition, we also found that canonical Wnt signaling is upregulated in evaginated incisor epithelium of both Ikkα and Irf6 mutant embryos.

Craniofacial and dental features in kabuki syndrome patients

Objective : To describe oral manifestations in Brazilian individuals with Kabuki syndrome, a multiple congenital anomaly/mental retardation syndrome. Study Design : A total of 16 Kabuki syndrome individuals, aged between 8 to 24 years and of both sexes, were referred by the Department of Clinical Genetics for oral treatment and follow-up to the Oral Care Center for Inherited Diseases, University Hospital of Brasília, Brasília, Brazil. Each individual underwent complete physical examination, as well as intraoral and radiographic examinations. Results : Craniofacial and dental alterations were observed in all Kabuki syndrome patients examined. In addition, atypical shape of the molars' crowns, occlusal convergence of the premolars' crowns, and root dilaceration were also observed. Enamel diffuse opacities were observed in permanent dentition (n  =  10). Conclusion : A great clinical heterogeneity was observed in Kabuki syndrome individuals in line with previous studies in the literature. Further clinical and molecular studies are necessary in order to better understand the presence of dental anomalies in this syndrome.

TBX22 mutation associated with cleft lip/palate, hypodontia, and limb anomaly

Mutations in TBX22 are known causes of cleft palate with/without ankyloglossia. We identified a hemizygous missense c.452G>T (p.Arg151Leu) mutation in a Thai boy who had unilateral complete cleft lip and palate, agenesis of a maxillary second premolar, ankyloglossia, hypoplastic carpal bones, and hypoplastic right thumb. Our study has demonstrated that TBX22 mutation is associated not only with cleft palate and ankyloglossia, but also cleft lip and palate and tooth agenesis. Phenotypic variability caused by a single nucleotide substitution is clearly demonstrated.

Pulp stones: a review

Pulp stones are a frequent finding on bitewing and periapical radiographs but receive relatively little attention in textbooks. A review of the literature was therefore performed, initially using the PubMed database and beginning the search with 'pulp calcifications' and 'pulp stones'. Each term provided more than 400 references, many of which related to pulp calcification in general rather than pulp stones, and focussed largely on the problems these changes presented to clinicians. A manual search using references from this source was carried out. Contemporary textbooks in endodontology were also consulted, and an historic perspective gained from a number of older books and references. The factors involved in the development of the pulp stones are largely unknown. Further research may determine the reasons for their formation, but with current endodontic instruments and techniques this is unlikely to alter their relevance to clinicians.

Cognitive dysfunction in adults with Van der Woude syndrome

PURPOSE

Van der Woude syndrome is an autosomal dominant disorder manifested in clefts of the lip and/or palate and lip pits. There is phenotypic and genotypic overlap between Van der Woude syndrome and isolated cleft of the lip and/or palate. Subjects with isolated cleft of the lip and/or palate have been shown to have cognitive dysfunction. Given the similarities between Van der Woude syndrome and isolated cleft of the lip and/or palate, the current study was designed to evaluate the pattern of cognitive function in adults with Van der Woude syndrome.

METHODS

Fourteen adults with Van der Woude syndrome were compared with age- and gender-matched controls. A battery of cognitive tests was administered to determine general IQ as well as more specific cognitive performance measures.

RESULTS

All subjects with Van der Woude syndrome showed deficits in performance on an executive function task. In addition, males with Van der Woude syndrome had significantly lower scores on intelligence measures and on a verbal fluency task compared with controls.

CONCLUSION

The pattern of cognitive function in Van der Woude syndrome is very similar to that seen in isolated cleft of the lip and/or palate. In addition, the findings have a significant gender effect in which males are more severely affected than females. This pattern is common to other conditions with a neurodevelopmental etiology, supporting the notion that the cognitive deficits of Van der Woude syndrome and isolated cleft of the lip and/or palate are due to abnormal brain development.

Genomic, cDNA and embryonic expression analysis of zebrafish IRF6, the gene mutated in the human oral clefting disorders Van der Woude and popliteal pterygium syndromes

Van der Woude syndrome (VWS) and popliteal pterygium syndrome (PPS) are autosomal dominant clefting disorders recently discovered to be caused by mutations in the IRF6 (Interferon Regulatory Factor 6) gene. The IRF gene family consists of nine members encoding transcription factors that share a highly conserved helix-turn-helix DNA-binding domain and a less conserved protein-binding domain. Most IRFs regulate the expression of interferon-alpha and -beta after viral infection, but the function of IRF6 remains unknown. We have isolated a full-length zebrafish irf6 cDNA, which encodes a 492 amino acid protein that contains a Smad-IRF interaction motif and a DNA-binding domain. The zebrafish irf6 gene consists of eight exons and maps to linkage group 22 closest to marker unp1375. By in situ hybridization analysis of embryo whole-mounts and cryosections, we demonstrate that irf6 is first expressed as a maternal transcript. During gastrulation, irf6 expression was concentrated in the forerunner cells. From the bud stage to the 3-somite stage, irf6 expression was observed in the Kupffer's vesicle. No expression could be detected at the 6-somite and 10-somite stages. At the 14-somite stage, expression was detected in the otic placode. At the 17-somite stage, strong expression was also observed in the cloaca. During the pharyngula, hatch and larva periods up to 5 days post-fertilization, irf6 was expressed in the pharyngeal arches, olfactory and otic placodes, and in the epithelial cells of endoderm derived tissues. The latter tissues include the mouth, pharynx, esophagus, endodermal lining of swim bladder, liver, exocrine pancreas, and associated ducts. Overall, the zebrafish expression data are consistent with the observations of lip pits in VWS patients, as well as more recent reports of alae nasi, otitis media and sensorineural hearing loss documented in some patients.

[Morphologic disequilibrium of the lips]

The aetiologies of the labial desequilibrium are multiple. They respond to the anomalies of the position and the dimension. The authors will enumerate the different variety and their etiology.