Simultaneous presentation of dual pathologies within the oral cavity: an unusual and diagnostically challenging presentation.

Necrotising sialometaplasia (NS) is a rare condition, with a limited scientific evidence base regarding its aetiology and pathophysiology. Diagnosing NS demands extensive investigatory tests. Their accuracy is vital in order to exclude oral malignancy and prevent unwarranted, invasive management.Within Birmingham Dental Hospital, a 22-year-old, South Asian woman presented with generalised pain from the lower right third molar extending to involve the palate, to which the patient's general medical practitioner previously attributed to a viral upper respiratory infection. Clinical examination revealed bilateral erythematous: non-ulcerated, palatal swellings (10 mm x 5 mm) at the greater palatine foramina. Following extensive investigations, the challenging definitive diagnoses of two distinct pathologies were made: non-ulcerative NS and pericoronitis.This case report describes the successful diagnosis and management of non-ulcerating NS, an 'atypical' presentation of a rare condition, that was confounded by a simultaneous episode of pericoronitis - a presentation not previously documented within scientific literature.

Multiple external root resorptions in a patient with Stage IV, Grade C periodontitis and autoimmune diseases: A case report.

BACKGROUND: Pathological root resorption affects permanent teeth and is usually triggered by infectious-inflammatory stimuli and/or dental trauma. Periodontitis and traumatic occlusion have been reported as possible causative factors of root resorptions, whilst the impact of systemic diseases is less well understood. This case highlights the need for consideration of multiple risk factors, especially when presenting in combination. METHODS AND RESULTS: A 62-year-old South Asian female presented with unstable Stage IV Grade C periodontitis, poor oral hygiene and multiple autoimmune conditions including oral lichen planus. Clinical and radiographic examination revealed multiple advanced apical and external root resorptions of the patient's molars associated with periapical bone loss, despite of a minimally restored dental status. CONCLUSION: A likely etiology of this patient's multiple root resorptions is the presence of unstable periodontitis with periodontal-endodontic lesions, exacerbated by a dysbalanced immune response to infectious agents. Appropriate monitoring and managing of such patients can prevent or limit the pathological process of inflammatory root resorption. KEY POINTS: Why is this case new information? This is the first report documenting advanced multiple external inflammatory root resorptions in a periodontitis patient with oral and systemic co-morbidities. What are the keys to successful management of this case? Early diagnosis, prevention and intervention to limit periodontal inflammation, endodontic infection and occlusal trauma. What are the primary limitations to success in this case? Late diagnosis of multiple root resorptions, palliative periodontal treatment due to poor oral hygiene compliance, and poorly controlled systemic inflammation favoring the persistence of a dysregulated immune response to the oral microbiota.