Inferior alveolar nerve paraestheia and cutaneous sinus on the face associated with periapical infection of lower molar teeth in a 14-year-old girl: A rare and unusual case report.

BACKGROUND: Paresthesia is defined as a burning or prickling sensation or partial numbness caused by neural injury. OBJECTIVE: The purpose of this paper is to present a rare and unusual case report of odontogenic infection-induced inferior alveolar nerve (IAN) paresthesia along with cutaneous draining sinus on the face of a pediatric patient and to discuss the possible pathophysiologic mechanism of nerve injury. METHODS: A 14-year-old female patient with cutaneous sinus and paresthesia associated with inferior alveolar nerve was enrolled in the study and the clinical and radiological manifestations of sinus lesion were carefully evaluated. RESULTS: The most appropriate treatment was carried out not only to resolve extraoral sinus but also to ensure progressive healing for the complete resolution of neurological disturbance. CONCLUSION: The simultaneous occurrence of infection and paresthesia strongly suggested a definitive relationship. Therefore, there seems to be a correlation between duration, origin, significance of the injury and the prognosis of paresthesia.

Evaluation of the efficacy of the modified bluegrass appliance in cessation of thumb-sucking habit: an in vivo study with 12 months follow-up.

BACKGROUND AND AIMS: Blue grass appliance, also known as habit correction roller has gained universal attention and acceptance to correct thumb sucking habit. The present study utilizes the modified bluegrass appliance that was fabricated with an inexpensive acrylic roller to lower the cost of treatment and make it more affordable for the patients in developing countries. The purpose of this study was to evaluate the efficacy of the modified bluegrass appliance in cessation of thumb-sucking habit. METHODS: Forty children aged 4-14 years visiting our department for the treatment of thumb sucking habit were selected. A modified bluegrass appliance having an acrylic roller was used along with the positive reinforcement. The patients were followed-up after two weeks of appliance placement and then monthly for twelve months. The various factors like need of reinsertion, discomfort caused due to improper placement or distortion, and/or breakages of the appliance following insertion were evaluated. The cessation of the thumb sucking habit was determined by the patient and/or parental/legal guardian confirmation and disappearance of the callous formation on the thumb. However, the total treatment time was determined when the appliance was removed. RESULTS: Of the total 33 patients included in the final analysis, the treatment was successful in 32 (97%) of the patients. The treatment time for the cessation of habit was ≤ 4 weeks in 13 (40.6 %) patients and 5-20 weeks in 50% of the subjects. Conversely, in 2 (6.3%) of the patients the habit ceased after 21-24 weeks and in 1 (3.1%) patients it took 25-28 weeks for the habit to cease. The appliance had to be reinserted during the treatment in 5 (15.7%) out of the total 32 patients. The total treatment time for the cessation of thumb-sucking habit with modified bluegrass appliance was ≤24 weeks in 17 (53.1%) patients, 25-36 weeks in 34.4% and 37-48 weeks for the 12.5% subjects. CONCLUSION: The modified bluegrass appliance was found to be highly comfortable and cost saving for the patients and very much successful in eliminating the habit within a short period of time without any complications.

Overdenture Prostheses with Metal Copings: A Retrospective Analysis of Survival and Prosthodontic Complications.

PURPOSE: To retrospectively evaluate complications associated with overdentures and abutment teeth restored with metal copings, including post-procedural and prosthetic problems; also to analyze the frequency and influencing factors associated with these problems. MATERIALS AND METHODS: A total of 80 subjects (48 females, 32 males, mean age 62 years) wearing root-supported overdentures were enrolled in the study. All participants were thoroughly examined by a single examiner, and appropriate maintenance care was performed. The 80 subjects had 270 abutments, which were endodontically treated teeth. All 80 subjects were carefully interviewed, inspected, and evaluated for post-procedural and clinical problems with their overdentures for an observation period of up to 5 years. RESULTS: Of the post-procedural problems evaluated, the most common problems were gingival inflammation (69%) and root caries (36%) because of poor oral hygiene (41%) and loss of metal copings (34%), followed by overdenture base fracture over abutment teeth (34%). Other post-procedural problems reported were loss of overdenture stability (23%), incidence of overdenture repair (20%), poor retention (18%), incidental finding of root fragments (unplanned) in the jaws (15%), and up to two grade net change in the mobility of overdenture abutments (8%). All prostheses were in use at the time of data collection and observation up to 5 years. CONCLUSIONS: Overdenture therapy was satisfactory; however, post-procedural and prosthetic complications and aftercare maintenance must not be underestimated.

Dental Infection Mimicking Dermatological Lesion: Three Case Reports of Cutaneous Fistulae and Sinus Tracts on Face.

Cutaneous odontogenic fistulae or sinus tracts are commonly misdiagnosed and incorrectly treated, leading to unnecessary and excessive medications attributing to patient agony. An understanding of cutaneous sinus tracts and their drainage will guide to more appropriate treatment. The following clinical case reports present three patients with cutaneous sinus tracts on chin and jaw line, secondary to chronic periapical dental infection, which was misdiagnosed initially as dermatological lesion and was submitted to inappropriate dermatological treatment and antimicrobial therapy. Diagnosis, etiopathogenesis, and treatment in relation to patient history, clinical findings, and radiographic imaging are elaborated.

Kinetics and Characterization of Non-enzymatic Fragmentation of Monoclonal Antibody Therapeutics.

PURPOSE: To understand non-enzymatic hydrolytic fragmentation of a monoclonal antibody therapeutic under temperature stressed conditions and investigating possible mechanism for the same. METHODS: The mAb therapeutic was incubated at 50°C in phosphate buffer at pH 6.5 and fragmentation was monitored at different ionic strengths under stressed conditions. The incubated mAb was sampled at regular time intervals by analytical Size Exclusion Chromatography (SEC). RESULTS: It was observed that 57% of the mAb product fragmented over 4 days into two fragment species - Fc-Fab and Fab with molecular weights of 97 KDa and 47 KDa, respectively, as measured by mass spectrometry (MS) and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). The fragmentation rate was slow initially and then accelerated with time. No change in % aggregate level was observed in this duration, implying that degradation was primarily via fragmentation at high temperature. Kinetics of hydrolytic fragmentation was hypothesized and SEC data was fitted to estimate the kinetic rate constants. While degradation of the monomer into fragment species was non-Arrhenius with a negative activation energy, further degradation of Fab-Fc fragments into Fab or Fc fragments followed Arrhenius Law with an activation energy of 2.1 and 15.38 kcal/mol, respectively. CONCLUSION: High temperature (50°C) causes mAb to cleave at the hinge region to form Fab-Fc and Fab/Fc, as confirmed by dynamic light scattering, SDS-PAGE, SEC, and MS. A kinetic model for hydrolytic fragmentation has been proposed. The results are expected to assist end users in formulation development as well as in monitoring stability of biotherapeutic products.

Assessment of structural and functional similarity of biosimilar products: Rituximab as a case study.

Biosimilars are products that are similar in terms of quality, safety, and efficacy to an already licensed reference/ innovator product and are expected to offer improved affordability. The most significant source of reduction in the cost of development of a biosimilar is the reduced clinical examination that it is expected to undergo as compared to the innovator product. However, this clinical relief is predicated on the assumption that there is analytical similarity between the biosimilar and the innovator product. As a result, establishing analytical similarity is arguably the most important step towards successful development of a biosimilar. Here, we present results from an analytical similarity exercise that was performed with five biosimilars of rituximab (Ristova®, Roche), a chimeric mouse/ human monoclonal antibody biotherapeutic, that are available on the Indian market. The results show that, while the biosimilars exhibited similarity with respect to protein structure and function, there were significant differences with respect to size heterogeneity, charge heterogeneity and glycosylation pattern.

Hemifacial Microsomia : Clinicoradiological Insight and Report of a Case.

BACKGROUND: Hemifacial microsomia is a congenital malformation characterized by deficiency in the amount of hard and soft tissue on one side of the face. It is primarily a syndrome of the first branchial arch, involving underdevelopment of the temporomandibular joint, masticatory muscles, mandibular ramus, ear and, occasionally, defects in facial nerve and muscles. CASE DETAILS: The clinical and radiological manifestations of a 14-year-old male patient having hemifacial microsomia is highlighted in this article to enhance our knowledge and diagnostic skill of this rare entity. CONCLUSION: This case illustrates that early diagnosis and intervention in a patient with hemifacial microsomia is quintessential for proper functioning and esthetics of the orofacial structures, which will lead to a better prognosis.

Intraradicular reinforcement for traumatized immature teeth.

Immature necrotic teeth after trauma pose both endodontic and restorative challenges because of incomplete closure of the apex, and thin and weakened dentinal walls that make them prone to fracture. The use of light-transmitting plastic posts, in combination with adhesive materials, enable intraradicular reinforcement of flared canals, helping to rehabilitate fractured immature teeth and maintain a functional unit within the dental arch. The purpose of this paper is to present the case of a nine-year-old patient who had a complicated fracture of an immature anterior tooth, which was endodontically treated with mineral trioxide aggregate in the apical third. The dentinal root walls were successfully reinforced with composite resin and a light-transmitting glass fiber post, followed by the placement of a glass fiber composite post and a metal ceramic crown.

Genetic basis of dental agenesis - molecular genetics patterning clinical dentistry

Tooth agenesis is one of the most common congenital malformations in humans. Hypodontia can either occur as an isolated condition (non-syndromic hypodontia) or can be associated with a syndrome (syndromic hypodontia), highlighting the heterogeneity of the condition. Though much progress has been made to identify the developmental basis of tooth formation, knowledge of the etiological basis of inherited tooth loss is still lacking. To date, the mutation spectra of non-syndromic form of familial and sporadic tooth agenesis in humans have revealed defects in various such genes that encode transcription factors, MSX1 and PAX9 or genes that code for a protein involved in canonical Wnt signaling (AXIN2), and a transmembrane receptor of fibroblast growth factors (FGFR1). The aim of this paper is to review the current literature on the molecular mechanisms responsible for selective hypodontia in humans and to present a detailed overview of causative genes and syndromes associated with hypodontia

Sodium hypochlorite dental accidents.

Sodium hypochlorite is widely used in dentistry as an intra-canal irrigant, for debridement and to disinfect root canals. Although it is considered to be safe, serious mishap can result from its inappropriate use, and this has been reported infrequently in the literature. Two unusual cases of sodium hypochlorite toxicity and their successful non-surgical management are described in a 14-year-old girl and a 13-year-old boy.

Understanding dental status and treatment need of geriatric patients: oral health trends in an Indian population.

BACKGROUND: Comprehensive data on the oral health status and dental treatment needs of the elderly population in India is deficient. AIM: To understand and assess the dental status and treatment needs of a geriatric population in Northern India. METHODS: A cross-sectional study was undertaken in National capital of India, New Delhi, and 412 subjects aged 60 years and above was involved in this study (259 females and 153 males). An intraoral clinical examination and a questionnaire performa were performed. The treatment needs were evaluated independently of the patient's request based on their dental and prosthetic status. RESULTS: he prevalence of edentulism was 75%, with gender difference (69% of the men and 81% of the women). Eighty percent wore removable dentures, 10% had natural teeth only, and 10% had neither prostheses nor natural teeth. Most of the subjects needed to redo the prostheses (50%), 60% extractions and 25% conservative treatments. The treatment needs were extensive and mainly accumulated due to lack of awareness, neglected care and economic barriers. CONCLUSION: high unmet need for perceived oral care and dental treatment existed among the sample elderly population studied.

An innovative approach to cessation of thumb-sucking in a child with epilepsy: a case report.

The thumb-sucking habit is acquired in infancy, but if it persists beyond preschool age, it can have deleterious effects on facial growth, oral function, occlusal relationship, and aesthetics, leading to dental and skeletal deformities. This paper presents a clinical case history of using nonpunitive reminder therapy to intercept the thumb-sucking habits of an 8-year-old child with epilepsy. A modified Bluegrass appliance was used along with the positive reinforcement. The modified Bluegrass appliance utilized an acrylic roller and was very comfortable for the patient; it was also successful in eliminating the habit within a short period of time.