Maxillary Osteonecrosis Related with Herpes Zoster: A Case Report and Review of the Literature.

Osteonecrosis of the jaw (ONJ) can occur through various mechanisms including radiation, medication, and viral infections such as herpes zoster. Although herpes zoster is a varicella-zoster virus infection that can affect the trigeminal nerve, it rarely causes oral complications. The author reports a rare case of herpes zoster-related ONJ, followed by a review of the relevant literature pertaining to herpes zoster-related oral complications, including ONJ. A 73-year-old woman presented with a scarred skin lesion on her left midface with an exposed alveolar bone of the left maxilla. Based on her medical records, she received a diagnosis and treatment for herpes zoster six months prior and experienced a few teeth loss in the left maxilla following a fall preceding the onset of herpes zoster. Sequestrectomy of the left maxilla was performed and ONJ was diagnosed. The operative site recovered favorably. Although unusual, several cases of localized extensive ONJ in herpes zoster-infected patients have been reported. This case illustrates the possibility of a rare occurrence of unilateral widespread osteonecrosis of the jaw (ONJ) even in the maxilla associated with herpes zoster. The exact mechanism has not been elucidated; nevertheless, surgeons should consider the possibility of oral and dental complications, including ONJ, related to a history of herpes zoster.

Infection may play an important role in the pathogenesis of alveolar osteonecrosis following facial herpes zoster: a case report and literature review.

BACKGROUND: Herpes zoster (HZ) is one of the most common skin diseases caused by viruses. Facial HZ develops when the varicella-zoster virus affects the trigeminal nerve, and alveolar osteonecrosis is a rare complication. However, the exact pathogenesis of postherpetic alveolar osteonecrosis remains unclear. CASE DESCRIPTION: We encountered a patient who presented to the dermatology clinic with facial HZ and tooth exfoliation in the upper right jaw, and panoramic radiography revealed decreased bone density and poor alveolar socket healing in his right maxilla. Biopsy of the alveolar process revealed fragments of nonvital lamellar bone, which were devoid of osteoblasts and osteocytes and were surrounded by numerous neutrophils and bacterial aggregates. Thus, the diagnosis of alveolar osteonecrosis following facial HZ was confirmed. He then underwent resection of the osteonecrotic tissue. The pathological findings of postoperative tissue were similar to those of previous biopsies. Varicella-zoster virus and multiple types of bacteria were detected through next-generation sequencing, and the species of bacteria were consistent with the results of bacterial culture. Antibiotics and valaciclovir were administered during the perioperative period. The patient showed good recovery at the 9-month follow-up. CONCLUSIONS: The coexistence of bacterial and viral infection may play an important role in the pathogenesis of alveolar osteonecrosis following HZ. To our knowledge, we are the first to directly explore microbial pathogens in a case of postherpetic alveolar osteonecrosis through next-generation sequencing and bacterial culture. We recommend that oral examinations be carefully conducted for patients who are diagnosed with facial HZ, even if their facial rashes have faded away. We suggest that a prolonged and full-dose antiviral therapy course may be beneficial for the treatment of facial HZ with intraoral lesions. The implementation of dental preventive measures should be considered for patients with facial HZ. The application of antibiotics and excision of necrotic bone may reduce the abundance of bacteria in lesions and improve wound healing.

Delayed Presentation of Mandibular Osteonecrosis Following Herpes Zoster Infection - A Case Report.

Rationale: Apart from the usual presentation of herpes zoster (HZ) infection (HZI), reports of spontaneous teeth exfoliation and osteonecrosis are infrequent and sporadic. Patient Concerns: A 51-year-old male patient presented with spontaneous exfoliation of multiple teeth and subsequent pathological fracture on the right side of the lower jaw after three months of HZI. Diagnosis: Biopsy was taken from the alveolar bone of the oedematous region, which revealed the presence of trabeculae of dead bone with empty lacunae. Intervention: Necrosed part of the alveolar bone was excised under local anaesthesia and antibiotic coverage, which was followed by open reduction and internal fixation of the pathological fracture under general anaesthesia. Outcomes: The patient was followed up for one year without any evidence of recurrences. Take-away Lessons: Presentation of osteonecrosis following HZI is unique but rare and should be diagnosed at the earliest.

Alveolar Osteonecrosis and Tooth Exfoliation in Herpes Zoster: A Rare Pediatric Case Report and Review of Literature.

Varicella-zoster virus (VZV) is an envelope, spherical, 150-200 nm in diameter virus, with the single, linear, double-stranded DNA molecule, 125,000 nt long. It belongs to the genus Varicellovirus, family. How to cite this article: Singh G, Mehrotra A, Garg K, et al. Alveolar Osteonecrosis and Tooth Exfoliation in Herpes Zoster: A Rare Pediatric Case Report and Review of Literature. Int J Clin Pediatr Dent 2020;13(S-1):S106-S109.

Alveolar Fracture Caused by Tooth Extraction at Home.

Injuries to the teeth and surrounding structures are relatively common. Although traumatic injuries caused by falls or activities related to sports are widely discussed, the same cannot be said regarding accidents arising from non-professional extraction of primary teeth. The present study reports a 6-year-old male child who underwent mandibular alveolar bone fracture during non-professional extraction of his central lower left incisor at home, performed by his 30-year-old aunt. The root of the tooth was with an irregular physiological resorption, which acted as a lever component for the mechanical force applied, leading to bone fracture. Although not common, the possibility that dental roots with irregular resorption can act as a possible risk factor for accidents if the parents or guardians of children during the period of transitional dentition try to perform intentional extraction of primary teeth should be highlighted. Parents should always consult a professional, preferably a pediatric dentist, for monitoring this period of transitional dentition.

Herpes Zoster Induced Alveolar Bone Necrosis in Immunocompromised Patients; Two Case Reports.

INTRODUCTION: Herpes zoster Infection (HZI) is a viral disease with painful skin rashes and blisters in a limited area on one side of the body, often in a strip. Osteonecrosis with spontaneous exfoliation of teeth in association with HZI of the mandibular nerve is a rare phenomenon. In this report, such an unusual complication of HZI is presented. CASE REPORT: The clinical course of a 53-year-old woman and a 54-year-old man with HZI associated with alveolar bone necrosis and tooth exfoliation were reviewed in order to develop a patient profile for this rare combination of physical findings. CONCLUSION: In immunocompromised patients, the clinicians should consider HZI as a possible cause of tooth mobility, exfoliation, and alveolar osteonecrosis, which needs early intervention to prevent secondary complications.

Presencia de anomalías dentomaxilofaciales en niños con pérdida prematura de caninos temporales / Dental and Maxillofacial Abnormalities in Children with Premature Loss of Primary Canines

Fundamento: Los caninos temporales, por ser de los últimos en hacer el recambio a permanentes, son de gran importancia en el mantenimiento del espacio en el arco y la adecuada oclusión. Su pérdida prematura tiene mayor repercusión sobre el sector anterior, aunque también puede afectar el sector posterior.Objetivo: describir la presencia de anomalías dentomaxilofaciales en niños con pérdida prematura de caninos temporales.Métodos: se realizó un estudio descriptivo, transversal, en niños de 5 a 9 años de edad, pertenecientes a la Escuela Primaria Guerrillero Heroico del Área II del municipio de Cienfuegos, en el período comprendido de noviembre de 2014 hasta abril de 2015. Las variables analizadas fueron: edad, sexo, causa de la pérdida de los caninos temporales y anomalías dentomaxilofaciales (linguoversión de los incisivos inferiores o superiores, mesoclusión, apiñamiento dentario, sobrepase, resalte).Resultados: la pérdida prematura de los caninos temporales fue más frecuente en niños de 5 y 6 años de edad; en la mayoría de los casos a causa de extracciones indicadas (66,7 %). La linguoversión de incisivos inferiores y el sobrepase aumentado, fueron identificados como las anomalías más frecuentes.Conclusión: todos los niños presentaron anomalías dentomaxilofaciales, en correspondencia con la pérdida prematura de los caninos temporales. Ello evidencia la importancia de evitarlas siempre que sea posible, pues son un precedente clave para el desarrollo de maloclusión.

Background: since primary canines are among the last teeth to be replaced by permanent ones, they are critical to maintain the space in the dental arch and proper occlusion. Their premature loss has a greater impact on the anterior region, but it can also affect the posterior region. Objective: to describe dental and maxillofacial abnormalities in children who prematurely lost the primary canines. Methods: a cross-sectional study was conducted in children aged 5 to 9 years attending the Guerrillero Heroico Elementary School located within the health area number 2 of Cienfuegos municipality, from November 2014 through April 2015. Variables analyzed were: age, sex, cause of tooth loss, dental and maxillofacial abnormalities (linguoversion of lower or upper incisors, mesial occlusion, crowding, hyperocclusion, and increased or decreased overjet). Results: the premature loss of primary canines was more frequently observed in children aged 5 and 6 years and in most cases, it resulted from indicated extractions (66.7%). Linguoversion of lower incisors and increased overjet were the most common abnormalities. Conclusion: all children showed dental and maxillofacial abnormalities related to the premature loss of primary canines. This demonstrates the importance of avoiding their early loss whenever possible, as it is a key factor for the development of malocclusion.

A rare case report and appraisal of the literature on spontaneous tooth exfoliation associated with trigeminal herpes zoster.

BACKGROUND: Reports of post herpetic maxillofacial complications have been very rarely documented in the literature that includes periapical lesions, calcified and devitalized pulps, resorption of roots, osteonecrosis, and spontaneous exfoliation of teeth. The atypical feature of the case of concern to the dental surgeon is the rare complication of spontaneous tooth exfoliation following herpes zoster. CASE REPORT: This case reports a male patient of age 47 years who reported to the Department of Periodontology with the chief complaint of mobility in the left upper central incisor. Patient history revealed herpes zoster infection that began 11 days earlier along with underlying diabetes mellitus condition. We hereby report a known diabetic patient with history of herpes zoster infection who presented with rare complication of spontaneous tooth exfoliation involving the maxillary division of the trigeminal nerve. DISCUSSION: Limited number of cases has been reported in the literature regarding spontaneous teeth exfoliation secondary to herpes zoster. The exact pathogenesis regarding the spontaneous exfoliation of teeth in herpes zoster patient is still controversial. Thus, an oral health care provider should be aware of this rare complication while managing a case of tooth mobility with the previous history of herpes zoster of trigeminal nerve.

Exfoliation rates of primary molars submitted to three treatment protocols after 3.5 years.

OBJECTIVE: The aim of the study was to evaluate the exfoliation pattern of primary molars treated according to three treatment protocols. The hypothesis tested was that there is no difference in the exfoliation pattern of primary molars treated according to conventional restorative treatment using amalgam (CRT), atraumatic restorative treatment using high­viscosity glass­ionomer (ART), and ultraconservative treatment (UCT). The latter consisted of restoring small cavities with ART and cleaning medium/large nonrestored cavities daily with toothpaste/toothbrush under supervision. METHODS: A sample of 302 children aged 6­7 years from a suburban area of Brasilia was followed up for 3.5 years. The numbers of treated molars were 341 (CRT), 244 (ART), and 275 (UCT). Exfoliation rates were obtained using the PHREG procedure. Differences between the three treatment protocol groups were tested using the Wald test. RESULTS: After 3.5 years, there was no difference over the exfoliation rates of all primary molars as 51.0% (CRT), 48.7% (ART), and 59.3% (UCT) had exfoliated at the overall period (P = 0.34). CONCLUSION: The three treatment protocols led to similar exfoliation patterns of all primary molars after 3.5 years.

Dynamic expression of Runx2 gene profile during osteogenesis in stem cells from human exfoliated deciduous teeth / 中国组织工程研究

BACKGROUND:Runx2 is considered to the main regulatory factor of osteogenic gene expression and be necessary for osteoblast differentiation, it plays an extremely important role in the osteoblast development, differentiation, regulation, bone calcification formation and bone repair. OBJECTIVE:To observe the biological properties of mesenchymal stem cells from human exfoliated deciduous teeth, explore the osteogenic differentiation potential of deciduous teeth stem cells, and observe the dynamic expression of Runx2 gene at varying time points. METHODS:The stem cells from human exfoliated deciduous teeth were isolated and cultured in vitro. The cellsurface antigen was detected with flow cytometry. The third passage cells were cultured in the adipogenic medium for 4 weeks, and oil red O staining was conducted to test lipid droplets formation. The third passage cells were cultured in the osteogenic medium for 21 days, and mineralized nodules were detected by alizarin red staining. Runx2 mRNA dynamic expression was detected with semi-quantitative RT-PCR at different time points. RESULTS AND CONCLUSION:The stem cells from human exfoliated deciduous teeth were obtained by enzyme digestion and limited dilution methods. Flow cytometry results showed that, CD146 and STRO-1 were expressed to varying degrees. Oil red O staining revealed salmon pink positive particles. Alizarin red staining showed positive expression. RT-PCR results showed that, Runx2 expression was found at day 0, up-regulated from day 0 to day 6, and subsequently dropped with an expression bottom at day 12, after that a second expression peak occurred at day 18, fol owed by a stably regulation. The stem cells from human exfoliated deciduous teeth can be isolated and cultured in vitro, express surface antigen of mesenchymal stem cells, and have the potentials of differentiating into adipocytes and ostetoblasts. Runx2 gene profiles are dynamical y expressed during osteoblastic differentiation. Runx2 express throughout every stage of osteoblastic differentiation. The expression is up-regulated during early and later stages, and down-regulated in metaphase.

Alveolar bone necrosis and spontaneous tooth exfoliation associated with trigeminal herpes zoster: a report of three cases

Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus, an infection most commonly affecting the thoracolumbar trunk. Herpes Zoster Infection (HZI) may affect the cranial nerves, most frequently the trigeminal. HZI of the trigeminal nerve distribution network manifests as multiple, painful vesicular eruptions of the skin and mucosa which are innervated by the infected nerves. Oral vesicles usually appear after the skin manifestations. The vesicles rupture and coalesce, leaving mucosal erosions without subsequent scarring in most cases. The worst complication of HZI is post-herpetic neuralgia; other complications include facial scarring, motor nerve palsy and optic neuropathy. Osteonecrosis with spontaneous exfoliation of the teeth is an uncommon complication associated with HZI of the trigeminal nerve. We report several cases of osteomyelitis appearing on the mandible, caused by HZI, and triggering osteonecrosis or spontaneous tooth exfoliation.

Prevalência e severidade de gengivite em escolares de 7 a 14 anos: condições locais associadas ao sangramento à sondagem / Prevalence and severity of gingivitis among scholars (7-14 years): local conditions associated to bleeding on probing

O objetivo deste estudo foi coletar dados sobre a prevalência e severidade de gengivite em uma amostra de crianças em idade escolar, bem como sua relação com possíveis fatores de risco locais. Duzentos e seis indivíduos foram examinados, sendo 107 meninos e 99 meninas, com idades entre 7 e 14 anos; foram coletados dados referentes ao índice de placa (IP), índice gengival (IG) e profundidade clínica de sondagem (PCS). Entre os parâmetros clínicos observados, as médias referentes a PCS, IP e IG encontradas foram de 1,58 + 0,46, 1,12 + 0,49 e 0,89 + 0,32, respectivamente. Noventa e cinco indivíduos (46,1 por cento) apresentaram um quadro de gengivite leve e 111 (53,9 por cento), de gengivite moderada. No geral, os indivíduos do sexo masculino apresentaram estatisticamente maior quantidade de placa bacteriana e maior inflamação do tecido gengival que indivíduos do sexo feminino. A presença de inflamação gengival foi encontrada em todos os indivíduos examinados. A severidade de inflamação nos dentes permanentes esteve diretamente relacionada à quantidade de placa e ao sangramento à sondagem.

The objective of this study was to collect data about the prevalence and severity of gingivitis in a sample of scholars, as well as its relationship with possible local risk factors. Two hundred and six subjects were examined, 107 male and 99 female, with age ranging from 7 to 14 years, where data from their Plaque Index (IP), Gingival Index (IG), and Clinical Probing Depth (PCS) were collected. Among all the clinical parameters observed, the mean values found referent to PCS, IP and IG were 1.58 + 0.46, 1.12 + 0.49 and 0.89 + 0.32, respectively. Ninety five subjects (46.1 percent) presented a diagnostic of slight gingivitis and 111 (53.9 percent) of moderate gingivitis. Overall, male subjects presented statistically more dental plaque and more gingival inflammation than female subjects. Clinical signs of gingival inflammation were found in all the examined subjects. Gingivitis severity around permanent teeth was directly linked to the amount of dental plaque deposits and to the presence of bleeding on probing.