Nitesh Tewari

Multiple abnormalities in permanent maxillary incisors following trauma to the primary dentition.

Diverse consequences to the trauma to primary dentition are sometimes difficult to explain. This report describes a rare case of sequelae to primary tooth trauma. The traumatic episode which occurred at the age of 3 years resulted in abnormally large crowns of 11 and 21 with yellowish-brown discoloration and enamel hyperplasia. It also led to dilaceration in the root of 21 and enamel hypoplasia with discoloration in 12 and 22.

Root hypoplasia: an unusual sequela to primary tooth trauma

The traumatic injury to primary teeth has been associated with diverse consequences in permanent dentition. The root abnormalities in permanent teeth are relatively rare. An unusual and rare case of sequelae to primary tooth trauma has been presented here. The complexity of the impact which occurred at the age of 4 years and 8 months resulted in root hypoplasia in 11, 21, root duplication in 12 and avulsion of 22 tooth bud.

Bilateral fusion in primary mandibular teeth: A report of two cases

The rare anomaly of fusion in primary dentition has very little documentation in Indian population. Two rare cases of bilateral fusion between primary mandibular lateral incisors and canines and primary mandibular central incisors and lateral incisors have been presented in this report. A minimal intervention approach, preventive procedures, and a long-term follow-up have been discussed.

Leukocyte adhesion defect-I: rare primary immune deficiency: LEUKOCYTE ADHESION DEFECT-I

Leukocyte adhesion defect I is a rare disorder (1:1,000,000) caused by diminished expression of CD-18 β2 integrins on leukocytes leading to abnormal adhesion, migration, and chemotaxis. Clinical manifestations include delayed separation of umbilical cord, omphalitis, recurrent severe infections, impaired wound healing, persistent oral ulcers, and severe periodontitis in primary and permanent dentition. A 5-year-old girl, second-born child to parents with consanguinity, presented with pain and mobility of lower teeth. There was history of recurrent infections and multiple hospital admissions with CD18 level-3% and frame shift mutation in ITGB2, on 21q22.3. There were scars on hands and feet. Oral examination revealed multiple missing teeth and periodontitis in primary dentition. Oral prophylaxis and palliative treatments were performed with periodic follow-ups. Interdisciplinary care is ubiquitous for patients with immune deficiencies. Early consultation with pediatric dentists and exploration of medical history is essential for diagnosis and treatment of rare diseases.

Concomitant hypodontia and hyperdontia: A report of two cases

“Concomitant hypodontia and hyperdontia” is a very rare dental anomaly of number, having a prevalence rate of 0.002%–3.1%. It describes the simultaneous presence of hypodontia or missing teeth and supernumerary teeth in the same individual. It represents the opposite forces of nature acting simultaneously. Two rare cases of this anomaly involving different jaws and a classification based on the literature review have been presented here.

Lesch-Nyhan syndrome: The saga of metabolic abnormalities and self-injurious behavior

Lesch-Nyhan syndrome (LNS) is an X-linked recessive disorder of purine metabolism caused by a mutation in Xq26.2-q26.3 (OMIM 308000.0004). The presence of the diagnostic triad, i.e. signs of self-injurious behavior (SIB) and results of pedigree analysis and novel molecular biology & genetic testing, confirms the diagnosis of LNS. With a level of hypoxanthine guanine phosphoribosyl-transferase 1 (HPRT1) enzyme activity < 2%, patients develop neurological, neurocognitive, and neuromotor symptoms along with SIB. Described here is a case of 4-year-old boy who was diagnosed with LNS. The boy displayed SIB, i.e. biting of the lips and fingers, and he had cerebral venous sinus thrombosis caused by LNS.

Corpus alienum on hard palate - An unusual "misdiagnosis" of foreign body: A case report.

Corpus alienum or foreign body on hard palate is a rare presentation and often associated with a scare secondary to misdiagnosis. The potential dangers of respiratory obstruction, mucosal tear, nasopharyngeal inflammation and gastro-intestinal bleeding make these non-invasive foreign bodies, life threatening. A case report of a three year old girl with a 2.5cm×2cm plastic sticker lodged on hard palate for four months and misdiagnosed as salivary gland tumor has been reported along with a literature review.

940 nm Diode Laser assisted excision of Peripheral Ossifying Fibroma in a neonate

BACKGROUND Peripheral ossifying fibroma associated with neonatal tooth extraction is a rare, benign reactive lesion, but its nature and location often scares the patient & parents for possibility of neoplasm. A high recurrence rate makes its histopathological examination and long term follow up important. CASE REPORT A 2 months old boy presented with enlarging soft tissue growth on the anterior mandibular ridge. The history revealed extraction of two neonatal teeth at 2 weeks of age. Lesion was excised using 940 nm diode laser and histopathological examination revealed hypercellularity and prominent dystrophic calcification, confirming it to be Peripheral Ossifying Fibroma. There was no recurrence after 18 months follow up. CONCLUSION Paediatric dentists should be aware of possible outcomes of natal and neonatal teeth extraction and histopathological features of soft tissue lesions in neonates and infants. This report also highlights that 940 nm diode laser can be safely used for minor oral soft tissue surgeries in neonates and infants.

Cryotherapy as a conservative treatment modality for gingival enlargement in a patient with Sturge-Weber Syndrome

This case report describes a case of Sturge-Weber syndrome reported for unilateral gingival enlargement and bleeding from gingiva in maxillary left region. Initial treatment in the form of scaling and root planing was done but recurrence was observed after one year of follow up. Instead of performing conventional surgery, an alternative conservative treatment was planned in the form of cryotherapy with the help of closed nitrous oxide probe. Seeing the satisfactory results obtained, cryotherapy can be suggested as an atraumatic, bloodless and effective chair side procedure for treating vascular gingival enlargement.

Clinical performance of ICDAS II, radiovisiography, and alternating current impedance spectroscopy device for the detection and assessment of occlusal caries in primary molars

Objective: To investigate the clinical performance of International Caries Detection and Assessment System II (ICDAS II) (a ranked visual scale), radiovisiography (RVG) (a digital radiography device), and an alternating current impedance spectroscopy (ACIS) device for the detection and assessment of occlusal caries in primary teeth. Materials and Methods: Twenty-five molars were assessed using all three systems under standardized in vivo conditions. They were then extracted and also assessed by examiners in vitro. Downer′s histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operator curves were calculated for enamel caries and dentine caries. Repeatability was analyzed using intraclass correlation coefficient (ICC). The performances of the systems between in vivo and in vitro settings by the same examiner were also compared. Statistical Analysis: SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Comparison of the performance of all three systems for all caries and dentine caries using receiver operating characteristic curves was calculated using a range of cutoffs. Reliability was assessed using ICC method. Results: ICDAS II system showed the highest validity and repeatability for assessing occlusal caries in the primary molars. RVG was less accurate than the ICDAS II for detecting caries lesions confined to enamel. However, when dentine was involved, RVG was found to be as effective as ICDAS II. Conclusion: Within the limitations of the study, the in vivo results of ICDAS II and RVG were satisfactory and comparable to those obtained in vitro, with ICDAS II performing better. The ACIS device was least accurate among the three systems for caries assessment.