Dens in Dente

Dens invaginatus, dens in dente or tooth with in a tooth is a rare developmental anomaly. In it, the lingual pit is extended deep in to the crown or root, in later instance causing pulpitis. It is mostly seen in the maxillary lateral incisors but may be found in any anterior tooth.

Dens in Dente-lateral incisors

The cause of dens in dente in not known but role of genetic factor can not be established. In early stage, it can be treated by filling or endodontic treatment, if pulp is involved.

A. showing Type I Dens Invaginatus in lateral incisors. Note- periapical cyst. B. Type II dens invaginatus in second premolar and C. Type III dens invaginatus in mandibular canine. [1]

Ref: 
  1. https://www.omicsonline.org/scientific-reports/srep147.php

Journey of Dentist to Australia: Part 2

Saudi Arabia Riyadh landscape at Morning – Riyadh Tower Kingdom Centre, Kingdom Tower, Riyadh Skyline – Burj Al-Mamlaka, AlMamlakah – Riyadh at Daylight – Tower View-Getty Images

Click to read part 1 of the story at the link given below

....... Continues

With the passage of time,  Ganesh became aware of the situation of his family. He started to understand the pain of his wife and the thought process of his father. He, who always cared for him, was worried about his future; the future ahead of his family life as well as financials, as it has to have a long lasting effect on his Son too.

Both Ganesh and his wife dropped the idea of ADC as it was clear, no matter how hard they try it, it was not meant for them. Moreover, they were out of funds, rather, better word was, in negative funds. So, to regain their lost finances, they modified their plan. 

The plan was to try for a gulf job and regain the lost finance. They consulted with their friend who had the experience of the gulf job. Ganesh and his wife got a decent job in Saudi Arabia. It was a job in a remote area of the Kingdom, but since they had their own circumstance, they adjusted themselves in a few months.

In this world there is no end of issues, no matter where a person lives. This soon started being applied to them too. A recently came new dentist in their workplace had Arab origin and the staff started giving him preferential treatment. The distribution of work started skewing, putting Ganesh in a difficult situation. His wife was cool as being a female, she was spared or the person involved had no guts to disturb her and be caught in a situation that might have backfired.

Ganesh contacted his friend for solace. He understood his situation and the options available. He decided, as long as I am getting my salary, I have to stay here and refill my coffer. There was no second choice.

His wife and he stayed for five years in Saudi Arabia and then started thinking of  coming back to India. They have earned sufficient, filled their coffer and most importantly regained the lost self esteem and self worth. Their family life has again come back on the smooth track.

Before coming back to India, Ganesh refurbished his old clinic when he had visited India last time. It was ready to start the work. Ganesh started working  in his own clinical practice the next day of arrival to India. His wife got her old tutoring job back in the same college she was teaching in. Within a year, they decided to open a second clinic. Soon it was booming by the hard working ethics of his wife, who decided to go take the clinical practice as full time work.

The couple decided to buy a house near their old home and were happy ever after. Ganesh remained obliged to his friends who supported him during his bad time. 

Hypertension

The 2017 ACC/AHA guideline for high BP in adults provides four BP categories based on the average of two or more in-office readings on 2 or more occasions:

  • Normal: Lower than 120 mm Hg systolic BP (SBP) and 80 mm Hg diastolic BP (DBP).
  • Elevated: 120–129 mm Hg SBP and lower than 80 mm Hg DBP.
  • Stage 1 hypertension: 130–139 mm Hg SBP or 80–89 mm Hg DBP.
  • Stage 2 hypertension: Higher than or equal to 140 mm Hg SBP or 90 mm Hg DBP.

Ameloblastoma

Ameloblastoma is a rare head and neck tumor with an estimated annual incidence of 0.5 per million population. They constitute 1% of tumors and cysts involving the jaws and accounts for approximately 10% of the odontogenic tumors. Ameloblastomas are originated from the epithelial lining of odontogenic cysts, enamel organ or dental lamina, stratified epithelium of oral cavity or displaced epithelial remnants. They are primarily seen in adults during the third and fourth decade of life with no gender preference and more frequently located in the mandible (80%), especially in the angle and ascending ramus [1].

Even though they are benign and slow-growing lesions, ameloblastomas exhibit locally destructive behavior with a high recurrence rate. Thus, most relapses (50% and even over 80%) occur during the first 5 years after the primary surgery. The major contributing factor for recurrence seems to be the inadequate initial surgical procedure rather than the histological type [1].

Radiographic Features

Radiographically, ameloblastoma typically forms round, cyst-like, radiolucent area with well-defined margins. The smallest lesions appear unilocular; whereas larger ameloblastoma may comprise a few large clustered cysts, giving 'soap-bubble’ or 'multilocular appearance' or  ‘honeycomb’ appearance (Fig 1) Expansion of the lesion may be on both, lingual and buccal side.
Fig. 1. Ameloblastoma: multilocular appearance


Differential Diagnosis

Other multilocular lesions that may mimic ameloblastoma radiologically include odontogenic keratocyst, giant-cell granuloma and odontogenic myxoma. Ameloblastoma with a single bony cavity simulate many types of cyst and tumour radiographically.

Treatment

The surgical options for ameloblastoma vary from simple enucleation (with or without bony curettage) to radical excision.


Ref: 
  1. Medina A, Velasco Martinez I, McIntyre B, Chandran R. Ameloblastoma: clinical presentation, multidisciplinary management and outcome. Case Reports Plast Surg Hand Surg. 2021;8(1):27-36. Published 2021 Feb 22. doi:10.1080/23320885.2021.1886854

Supernumerary Teeth

Extra numbers of teeth are known as supernumerary teeth. When they are present in the anterior maxilla in midline, they are known as mesiodens. When the extra teeth are present in the molar region as fourth molar, they are known as paramolar teeth. The anterior midline of the maxilla is the most common site whereas the maxillary molar area is the second most common site for supernumerary teeth.

Supernumerary tooth-mesiodens in anterior mandible in midline [1]


Radiograph showing mesiodens in anterior maxilla [1]


The investigation involves routine blood examination and IOPA or OPG radiographs. Depending on the anticipated level of difficulty of the surgery, additional investigations may be advised.

Treatment involves surgical extraction.





Ref:
  1. Oral pathology clinical pathologic correlation, Regezi, Sciubba, Jordan 4th Ed Saunders

Oral Candidiasis

Oral candidiasis is a fungal disease that is caused by Candida albicans. It looks like a white  or creamy plaque or patch that can be wiped off with the help of a cotton swab or a tooth brush leaving a red base.

Gingival thrush

It occurs due to disturbance in the oral microflora due to antibiotics, corticosteroid, Xerostomia , immune defects especially in HIV infection, immunosuppressant, leukaemia or lymphomas and diabetes. It rarely occurs in a healthy individuals except in neonates.

Chronic mucocutaneous candidosis: note the wide adherent plaque.

Gram stain smear shows the Candida albicans hyphae. It should be differentiated from Koplik's spot or Fordyce's granules.

The treatment involves treating the cause. Antifungal agents, for example, nystatin oral suspension or pastilles, amphotericin lozenges, or miconazole gel or tablets or fluconazole tablets can be given.



Ref:

1. Oral diseases 2nd Ed. Crispian Scully, Roderick A. Cawson Churchill Livingstone

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