Case report: premature exfoliation of primary teeth in a 4-year-old child, a diagnostic dilemma.

BACKGROUND: Premature exfoliation of primary teeth is an important diagnostic event warranting urgent investigation. The majority of conditions presenting with early loss of teeth are serious and in some cases fatal. CASE REPORT: This is a case of premature exfoliation of primary teeth in a 4-yr-old female. On presentation her teeth were mobile and there was a history of gingival bleeding when biting into food. Hair loss and fatigue were also reported. Her medical history revealed she had dry skin but was otherwise fit and healthy. Extra-oral examination was unremarkable. Dental examination revealed she had a full complement of primary teeth with unusual spacing, generalised tooth mobility, halitosis and an orange extrinsic dicolouration. Her gingivae were inflamed in the 84 region. Radiographic examination revealed severe generalised bone loss. TREATMENT: She received periodontal care including regular scaling, a short course of metronidazole, preventative advice and continued monitoring. She was also sequentially referred to the departments of Dermatology, Paediatric Haematology, Immunology, Oral Microbiology and Oral Pathology for further investigation. Underlying disorders known to cause premature tooth loss were ruled out. FOLLOW-UP: Two years on, there has been early exfoliation of her 54, 51, 61, 62, 64, 71, 84 and 81 with no new progressive mobility of her remaining primary teeth. CONCLUSION: The commonest causes of premature tooth loss have been eliminated including Papillion-Lefevre syndrome, Chediak-Higashi syndrome, hypophosphatasia, Langerhans' cell histiocytosis, neutropenia and leukemia. Therefore, this fit and healthy 4-yr-old has an aggressive early onset periodontal condition with associated fatigue and hair loss. Diagnosis of associated systemic conditions is not straightforward in these cases and requires multi-disciplinary input.

The structure of bovine periodontal ligament with special reference to the epithelial cell rests.

The aim of this study was to determine the structure of the bovine periodontal ligament, with special reference to epithelial cell rests (ECR) and their cytokeratin content. Periodontal ligament was obtained from bovine molar teeth and studied at both the light microscopic and electron microscopic levels. Cytokeratin content was determined using immunohistochemistry against a number of cytokeratin antibodies and specificity tested against bovine and human oral mucosa. Collagen fibril diameters and the area of a fiber bundle occupied by collagen were determined using a digital planimeter with a digitizing tablet. The majority of periodontal fibroblasts possessed considerable quantities of roughened endoplasmic reticulum, indicating rapid synthesis and secretion of collagen, but no intracellular collagen profiles were present. Endothelial cells showed Weibel-Palade bodies. Collagen fibril diameters showed a unimodal distribution with a mean collagen fibril diameter of 55.3 nm. The mean percentage area of the extracellular matrix occupied by collagen was 42%. Structurally, ECR were unusual in exhibiting large numbers of microvilli and conspicuous amounts of cytokeratin filaments. Bovine ECR showed a positive reaction to the pancytokeratin MNF116 (which reacts with the cytokeratins 5, 6, 8, 17, and probably 19), to PCK-26 (which reacts with the type II cytokeratins 1, 5, 6, and 8) and to cytokeratin 13. There was no reaction for cytokeratins 1, 4, 10, 11 and 18. Structurally, bovine periodontal ligament showed features common to other species. However, ECR in terms of both structure and cytokeratin content showed features indicative of important species differences which may have relevance when considering the etiology of radicular cysts.