Ultrasonography as a diagnostic aid for a neonate with gingival swelling in a COVID-19 neonatal intensive care unit.

COVID-19 pandemic has impacted all the aspects of life and has emerged as the biggest challenge to the health-care sector. Dental fraternity has also taken its significant impact since the transmission of disease is primarily through aerosol droplets. Management of infants with orofacial anomalies such as natal and neonatal teeth born to COVID-19-positive mothers is another challenge due to unavailability of dental facilities in the isolation wards. In such unforeseen circumstances, out-of-routine approaches such as extraoral mandibular ultrasonography were performed for the management of a congenital intraoral swelling in an infant and are being described in this case report.

Gingival Swelling as the Initial Manifestation of Granulomatosis with Polyangiitis.

We describe a case of granulomatosis with polyangiitis (GPA; formerly named Wegener granulomatosis) that presented initially as florid areas of gingival swelling. The patient also had upper respiratory symptoms that included sinus congestion and cough of recent onset. Clinical-pathologic correlation aided the interpretation of non-specific biopsy findings and immediate referral to an appropriate medical specialist. Treatment was rendered at an early stage of disease with a good response to date. Review of the literature indicates that gingival swelling, often with the characteristic appearance of "strawberry gingivitis" may represent the initial sign of disease in 2% of patients with GPA. Biopsy of gingival lesions often shows a non-specific histologic appearance that should be interpreted in the context of the clinical appearance and pertinent medical history. The clinical investigations that lead to definitive diagnosis and treatment are presented to facilitate the management of this uncommon but potentially fatal condition.

Oral juvenile xanthogranuloma in a child: Clinical, histological and immunohistochemical profile of a rare entity.

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis (non-LCH) affecting normolipemic infants and children most frequently in the first year of life, often showing spontaneous regression within 3 to 6 years. Classic JXG is characterized by a yellowish asymptomatic papule or nodule, often located in the skin of the head, neck and upper trunk. Oral JXG has been reported, but is rare. Histologically, JXG is composed mainly of an infiltrate of macrophages with a variable degree of lipidization (foamy macrophages), and (most of the time) scattered Touton-type giant cells. Because of the rarity of oral lesions and possible variations in the clinical and histological presentation, the correct diagnosis can be challenging, requiring a careful clinical and histopathological evaluation with adjuvant immunohistochemical studies. Our review of the English-language literature disclosed 33 cases of oral JXG, including this case report. The purpose of this study is to present a new case of this uncommon entity as well as to review and discuss its main clinicopathologic features and immunohistochemical findings.

Prevalence of referral reasons and clinical symptoms for endodontic referrals.

OBJECTIVES: To investigate the prevalence of different primary reasons for endodontic referrals and the clinical symptoms of the referred cases. MATERIALS AND METHODS: Clinical data of total endodontic treatment cases (1,014 teeth) including endodontic referral cases (224 teeth) between January 1, 2010 and December 31, 2012, at Kangdong Sacred Heart Hospital, were investigated retrospectively. The one major reason for referral, the clinical symptoms, and the resulting treatment procedures of referral cases were recorded. The percentages of clinical symptoms of the endodontic referral cases and the total endodontic treatment cases were compared by χ(2) test for each symptom. RESULTS: Persistent pain was the most frequent reason for endodontic referral (29.5%), followed by presence of gingival swelling and sinus tract (24.1%), and apical radiolucency (12.9%). Referrals in cases involving endodontic difficulties such as canal calcification, broken instruments, post, perforation, and resorption were less than 5.0%, respectively. The percentages of four major clinical symptoms of pain, apical radiolucency, previous endodontic treatment, and gingival swelling and sinus tract were significantly higher in the endodontic referral cases than those in the total endodontic cases (p = 0.001). Among the included referral cases, 72.8% were treated with nonsurgical endodontic treatment only. Teeth other than the referred teeth were diagnosed as the origin of the problem in 5.8% of the referrals. CONCLUSIONS: The high prevalence of pain, apical radiolucency, previous treatment, and gingival swelling and sinus tract in endodontic referral cases suggest that these symptoms may be what general practitioners consider to be difficult and refer to endodontists.

Prevalence of referral reasons and clinical symptoms for endodontic referrals

OBJECTIVES: To investigate the prevalence of different primary reasons for endodontic referrals and the clinical symptoms of the referred cases. MATERIALS AND METHODS: Clinical data of total endodontic treatment cases (1,014 teeth) including endodontic referral cases (224 teeth) between January 1, 2010 and December 31, 2012, at Kangdong Sacred Heart Hospital, were investigated retrospectively. The one major reason for referral, the clinical symptoms, and the resulting treatment procedures of referral cases were recorded. The percentages of clinical symptoms of the endodontic referral cases and the total endodontic treatment cases were compared by chi2 test for each symptom. RESULTS: Persistent pain was the most frequent reason for endodontic referral (29.5%), followed by presence of gingival swelling and sinus tract (24.1%), and apical radiolucency (12.9%). Referrals in cases involving endodontic difficulties such as canal calcification, broken instruments, post, perforation, and resorption were less than 5.0%, respectively. The percentages of four major clinical symptoms of pain, apical radiolucency, previous endodontic treatment, and gingival swelling and sinus tract were significantly higher in the endodontic referral cases than those in the total endodontic cases (p = 0.001). Among the included referral cases, 72.8% were treated with nonsurgical endodontic treatment only. Teeth other than the referred teeth were diagnosed as the origin of the problem in 5.8% of the referrals. CONCLUSIONS: The high prevalence of pain, apical radiolucency, previous treatment, and gingival swelling and sinus tract in endodontic referral cases suggest that these symptoms may be what general practitioners consider to be difficult and refer to endodontists.