lecture viii.pdfpedo

8/14/2019 Lecture VIII.pdfpedo

1/13


2/13

10/8/2013

Ectopic Eruption

Exfoliation (Contd.) Exfoliation is symmetrical on either side of

arches Girls tend to shed teeth earlier than Boys Resorption process has period of rest & period

of repair- explain for intermittent mobility ofprimary teeth

Premature exfoliation leads to either earlyeruption / delayed eruption


3/13

10/8/2013

Premature exfoliation : Primary teeth(Causes)

Toxicities (Acrodynia & Radiation) Metabolic disorders (Acatalasia, Chediak-Higashi

disease, Hypophosphatasia) Malignancies (Langerhans cell histiocytosis, leukemia,

cyclic neutropenia, agranulocytosis) Dental causes (Caries related infections, trauma,

periodontitis, Papillon Lefevre syndrome, Cherubism) Miscellaneous causes (Tumors of jaw, self mutilation,,

extreme bruxism)

Acrodynia Also known as Pink Disease Chronic exposure to mercury, ointments or medications Amalgam restorations do not cause Acrodynia Primarily affects young children Often occurs in infants, age of onset being between 4

months and 8 years Symptoms : Fever, irritability, photophobia, pinkdiscoloration of hands & feet, polyneuritis & painfulextremities

Orally : Excessive salivation, swelling, loss of alveolarbone, focal gum erosion with subsequent loss of teeth


4/13


5/13

10/8/2013

Chediak-Higashi disease

Abnormal platelets causes spont. bleeding & easy bruising 85% of children with CHD develop unusual lymphoma-like

condition generally leading to death Remaining 15% presents less severe clinical manifestations The oral lesions are consequence of repeated infections Consist of ulcers, markedly hypertrophic gingivitis and

severe periodontal destruction Due to recurrent intraoral infections, extensive alveolar

bone loss occurs which in most patients leads to toothexfoliation

Hypophosphatasia

Characterized by diminished serum levels of alkalinephosphatase and phosphoethanolamine in urine

4 groups: perinatal (lethal), infantile, childhood & adult Phenotype range from premature loss of decidious teeth

to severe bone abnormality leading to neonatal death. Abnormal cementum or lack of cementum may lead to

spontaneous shedding of primary teeth, affectingincisors more than molars

Pulp chambers unusually large Dentinal dysplasia is seen Higher incidence of uni-radicular primary teeth is shed


6/13

10/8/2013

Histiocytosis

3 variants :Lettere-Siwe disease (most severe form)Hand schuller Christian disease (affects children above 3

yrs & involves mostly bones)Eosinophilic granuloma (affects older children & is benign

in nature) Neoplastic proliferation of Langerhans' histiocytes C.M: Scaly erythematous skin rashes : scalp &

extremities, fever, anemia, hepatosplenomegaly O.M: Swelling, ulceration, gingival necrosis, radiolucent

lesion of mandible & skull. Management: Chemotherapy, radiotherapy, surgical

curettage

Leukemia

Immature neoplastic white blood cells in circulation Hyperplastic gingivitis with cyanotic bluish-red discolor. Oral tissues are friable and bleed easily Hyperplastic gingivae may completely cover the teeth In severe cases, purpuric lesions and necrotic ulcers Alveolar bone destruction & necrosis of PDL may

occasionally lead to loosening & exfoliation of teeth Treatment : systemic & palliative - chemotherapy,

radiation, bone marrow transplant Oral cavity - free of local irritants Child instructed to maintain a high level of oral hygiene


7/13

10/8/2013

Cyclic neutropenia Can occur at any age Rythemic reduction in PMN in 21 day cycle Risk for opportunistic infection (affected during the

interval of neutropenia, in a 21 day cycle, concomitantwith oscillation of bone marrow blood cell production)

Fever, malaise, sore throat, stomatitis, regionallymphadenopathy, headache, cutaneous infection,conjunctivitis

Gingivitis, ulceration, loosening of teeth, loss of

supporting bone Repeated insult as gingiva return to normal during the

cycle, when neutrophil count is normal

Cyclic neutropenia


8/13


9/13

10/8/2013

Papillon Lefevre syndrome

Marked destruction of periodontium (periodontoclasia) Unknown cause Depressed peripheral blood neutrophil chemotaxis. Palmar and plantar hyperkeratosis Horizontal bone loss, infected periodontal pockets Loosening of primary teeth leading to premature loss Possible organism: Actinobacillus actinomycetemcomitans,

Fusebacterium nucleatum Management : Specific antibiotic therapy, extraction,

denture fabrication

Papillon Lefevre syndrome


10/13

10/8/2013

1

Cherubism

Fibro-osseous lesion of jaws involving more than onequadrant

Stabilizes after growth period Usually leaving some facial deformity and malocclusion Ground glass appearance RG : Unilocular/multilocular bilateral expansive

radiolucenices Faint radiopacities resembling residual bones sometime

present at puberty

Self mutilation Purposeful traumatizing ones own oral structures Local cause, Emotional cause Finger Nails, Bobby pins, Pacifier Lower anterior teeth , Cheeks, lower lip Necrosis of tissue, loosening of teethLesch-Nyhan Syndrome : Spastic cerebral palsy, mental retardation, severe

motor disability, cognition, ocular motility andbehavioral control

Self mutilating aggressive behavior - mutilation of lipsby constant chewing on them

Teeth are lost due to prophylactic extractions


11/13

10/8/2013

1

Lesch-Nyhan Syndrome

Odontodysplasia

Also k/n as Ghost teeth Affected teeth are poorly mineralized Lack of proper calcification of E, D & C Abnormal pulp chamber & root shape

Radiographically appear abnormal in size & shape Permanent teeth affected more frequently then primaryteeth

Generally fail to erupt but if they do; have consistency ofgelatin

Often need to be extracted


12/13


13/13

10/8/2013

Diagnosis of early exfoliation(Contd /-)

Medical History Family history of loss of teeth, systemic disease History of skin infections/lesions, otitis media, or

other recurrent infection Hyperkeratosis of palms or soles of feet Exophthalmia Pale mucosa or petechiae Neurologic disorders

Implications of early exfoliation of primary teeth : Change may be necessary, for example : caries, diet,

hygiene Precautions may be necessary : radiation, salivary

stimulant or substitute If part of a syndrome, need to determine what other

issues ariseConcerns : Esthetics Speech Eating, nutrition, diet Self-esteem, psyche Health of succedaneous teeth

lecture viii.pdfpedo

Documents