Pulp polyp in traumatized primary teeth--a case-control study

Clinical, radiographic and histological findings of seven teeth from two California sea lions (Zalophus californianus) housed under professional care

Seven teeth extracted from two adult California sea lions (Zalophus californianus) due to pulp exposure and/or to gain access to the mandibular canine teeth were histologically evaluated, and the findings were compared with clinical and radiographic findings. Three teeth were diagnosed with pulp exposure, and two of these showed no radiographic signs of endodontic disease and were histologically vital with prominent coronal pulpitis and a pulp polyp. Another tooth with pulp exposure was showing clinical and radiographic signs of endodontic disease and was histologically confirmed with pulp necrosis. A discoloured incisor tooth was showing radiographic signs of endodontic disease and was also histologically non-vital. Two clinically and radiographically healthy mandibular first premolar teeth and one second incisor tooth had no evidence of pulpitis or pulp necrosis but had pulp canal obliteration. Regular clinical and radiographic follow-up for 5 months to 3 years after the procedures confirmed uneventful healing of the extraction sites, despite initial flap's dehiscence. Although extractions of affected teeth in California sea lions are considered the most practical and beneficial therapy, these are associated with the risks of extensive trauma and anaesthesia and the need to perform these surgical procedures on-site under variable conditions. As California sea lions can be trained to allow conscious dental radiographic re-checks, monitoring teeth with clinical signs of pulp polyp formation and without radiographic signs of endodontic disease warrant further evaluation/reconsideration from previous recommendations. Endodontic treatment of abscessed teeth in California sea lions is reportedly unsuccessful and is discouraged. However, vital pulpectomy could be an alternative treatment to extraction in teeth with pulp polyps as it was found to be highly successful in humans, but the possibility of endodontic failure and need for further treatments should be weighted in the treatment choice.

[Clinical radiological evaluation of teeth-part 2 : Caries, inflammatory dental changes and important differential diagnoses]

Inflammatory diseases of the teeth and periodontium are widespread and are frequent secondary diagnoses in head and neck examinations. Periapical inflammation can be the cause of sinusitis or abscess formation in the oral and maxillofacial region. Early detection is important for the patient's course of treatment. For further diagnostics, a dental presentation should be carried out. Dental radiological examinations, such as panoramic radiographs and dental films are used for specific diagnostics. This article is intended to provide an overview of the different stages of caries, the most important inflammatory dental changes and their most frequent differential diagnoses.

Peripheral Exophytic Oral Lesions: A Clinical Decision Tree

Diagnosis of peripheral oral exophytic lesions might be quite challenging. This review article aimed to introduce a decision tree for oral exophytic lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of keywords such as “oral soft tissue lesion,” “oral tumor like lesion,” “oral mucosal enlargement,” and “oral exophytic lesion.” Related English-language articles published since 1988 to 2016 in both medical and dental journals were appraised. Upon compilation of data, peripheral oral exophytic lesions were categorized into two major groups according to their surface texture: smooth (mesenchymal or nonsquamous epithelium-originated) and rough (squamous epithelium-originated). Lesions with smooth surface were also categorized into three subgroups according to their general frequency: reactive hyperplastic lesions/inflammatory hyperplasia, salivary gland lesions (nonneoplastic and neoplastic), and mesenchymal lesions (benign and malignant neoplasms). In addition, lesions with rough surface were summarized in six more common lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.

Delayed Treatment of Traumatized Primary Teeth with Distinct Pulp Response: Follow-Up until Permanent Successors Eruption

Complicated crown fracture and crown-root fracture with pulp involvement expose dental pulp to the oral environment. The pulp outcome is often unpredictable because the patient and injury which are related to variables can influence the treatment of choice and the prognosis of the case. This report presents the case of a 4-year-old boy with complicated crown fracture with pulp polyp in the primary right maxillary central incisor (51) and crown-root fracture with pulp involvement in the primary left maxillary central incisor (61), which was treated only 3 months after the tooth injuries. The treatment of choice was extraction of tooth (61) due to a periapical lesion with disruption of the dental follicle of the permanent successor and pulpotomy (MTA) of the tooth (51), because the pulp presented signs of vitality. At the follow-up visits, no clinical, symptomalogical, and radiographic changes were observed until the primary tooth's exfoliation. However, at 3-year follow-up, the permanent successors showed hypocalcification and the position of the permanent right maxillary central incisors (11) was altered. Besides the conservative and adequate delayed treatment, the sequelae on the permanent successors could not be avoided.

Osseo-gingival pathology as sequelae of dental trauma to the primary upper incisor: a case series

BACKGROUND

Osseo-gingival pathology (OGP) may be observed in traumatized primary teeth, and its knowledge is essential for treatment decision.

AIM

To describe the occurrence and treatment of OGP in traumatized primary upper incisors.

DESIGN

One examiner collected data from patients' charts of the Clinic of Trauma in Primary Teeth of the University of Sao Paulo. OGP was divided into apical fenestration (AF), total gingival recession (TGR), and partial gingival recession (PGR).

RESULTS

From 2516 charts, 61 patients (2.4%) presented 73 teeth with OGP (9.6% AF, 19.2% TGR and 71.2% PGR). OGP was observed in 63% of male and 43.8% of children aged 4-5 years old. Mean time between trauma and diagnosis was 15 months AF, 23.5 months TGR, and 7.5 months PGR. Periodontal trauma occurred in 86.3% of teeth with OGP. Pulp necrosis was observed in all cases of AF and 92.9% of TGR; however, 76.9% of PGR were vital. All teeth with AF and 85.7% of TGR were extracted, and 44.2% of PGR were monitored.

CONCLUSIONS

Osseo-gingival pathology has low occurrence in traumatized primary upper incisors. The treatment for AF and TGR is tooth extraction, and for PGR is tooth monitoring or extraction depending on the case severity.