Multiple Caries Research Articles

Mucosal leishmaniasis of the lips and cheeks: a first concomitant presentation of visceral and mucosal leishmaniasis in a patient living with HIV/AIDS in Monastir, Tunisia

BackgroundVisceral Leishmaniasis (VL) is the most severe and fatal disease if left untreated. In people living with HIV/AIDS (PLHA), VL is considered an emerging opportunistic infection. The aim of this manuscript was to report a first case in Tunisia of a concomitant presentation of visceral and oral leishmaniasis in a patient LHA. A systematic review of the literature was performed according to PRISMA guidelines, as well.Case presentationThe patient, a 43-year-old heterosexual man, treated for HIV/AIDS was referred for macrocheilitis of the upper and lower lips. A noticeable nodular and painless swelling extending to the cheeks’ mucosa was noted. The patient's poor oral hygiene was evident due to the presence of multiple dental caries. Histological analysis of the biopsied lower lip sample revealed the presence of numerous Leishmania amastigotes. The diagnosis of VL was clinically confirmed by the presence of a mild splenomegaly and pancytopenia and biologically by the identification of the parasite using PCR Lei and the species L. infantum involved using RFLP-PCR and culture. The treatment consisted of an intravenous administration of liposomal Amphotericin B (Ambisome®, 40 mg/kg/weight) for a period of 6 weeks. A favorable outcome was noted after one year with the resolution of clinical symptoms and a negative Leishmania blood PCR test. After 2 years, the patient remained asymptomatic but showed a positive Leishmania blood PCR test. Dolutegravir® was introduced in the patient’s ART regimen.ConclusionsTo the best of our knowledge, this is the first case report in Tunisia of atypical VL diagnosed through an uncommon oral location in an HIV/AIDS co-infected patient . Since VL is a severe and potentially fatal disease, it is essential for dentists to perform a thorough clinical examination and adopt a multidisciplinary approach in order to ensure an early diagnosis and an effective treatment outcome.

Overhauling dental implications in a child with rare craniofrontonasal syndrome: a case report

Craniofrontonasal syndrome is an extremely rare X-linked dominant genetic disorder characterized by features such as hypertelorism, craniosynostosis, ocular anomalies, a bifid nasal tip, and longitudinal ridging with splitting of the nails. Heterozygous females are more severely affected, presenting frontonasal dysplasia and coronal craniosynostosis (fusion of the coronal sutures), while males typically only exhibit hypertelorism. This case report describes the dental management of a 9-year-old female with craniofrontonasal syndrome who was referred to the department of paediatric and preventive dentistry for pain in the lower right and left back tooth region. The patient exhibited a clinical spectrum including microcephaly, short neck, axillary pterygium, clinodactyly of the toes, longitudinal ridging with split nails, pectus excavatum, and underdeveloped female genitalia. Extraoral examination revealed hypertelorism, flat nasal bridge, low-set ears, strabismus, antimongoloid slant, and an indistinct philtrum. Intraoral examination showed a high palatal vault, crowding of the upper and lower arches during the mixed dentition period, multiple dental caries, and poor oral hygiene. An orthopantomogram confirmed delayed dental development. Dental treatment was carried out on a dental chair system using adequate behaviour management techniques with short appointments, keeping in mind the reduced cooperative ability of the child. The importance of this report stems from the limited dental literature available on the syndrome. Preventive measures along with home care instructions were emphasized to support professional care.

Replantation After Dental Avulsion: A Scoping Review and Proposal of a Flow Chart.

Dental avulsion, the complete displacement of a tooth from its socket, is a severe dental trauma with a prevalence of 0.5% to 16% of all dental injuries. Replantation of avulsed teeth is common, yet recent studies show high failure rates and unpredictable long-term outcomes. This review examines clinical variables influencing intentional dental replantation decisions and proposes a treatment flow chart. A comprehensive literature search was conducted in PubMed-Medline, Scopus, WoS, and Cochrane databases using the keywords "tooth avulsion," "tooth replantation," and "tooth ankylosis." Inclusion criteria encompassed studies from January 2018 to February 2024. From 752 identified articles, 9 systematic reviews including 3 meta-analyses were selected for this scoping review. Immediate replantation is the gold standard for avulsed teeth, yet delayed replantation is more common in practice, impacting survival rates. Adherence to guidelines from the International Association on Dental Traumatology improves outcomes, especially in paediatric patients. Factors such as multiple caries, severe periodontal disease, advanced age, psychological conditions, immunodeficiency, and lack of cooperation are contraindications for replantation. Despite the high failure rate, replantation remains recommended in literature due to its potential advantages over prosthetic implants. This review highlights the complexities in decision-making for dental replantation, emphasising the need for a comprehensive approach considering individual clinical cases. A proposed treatment flow chart aims to support clinicians in predicting prognosis and making informed decisions. The review also underscores the link between dental trauma, poor oral health, and potential neglect in children, highlighting the importance of preventive measures and parental awareness.

Pediatric Patient with Chronic Hyperplastic Pulpitis: Case Report and Pathology Overview

Pulp polyp (PP) is a type of irreversible pulpitis that occurs more frequently in young teeth, also referred to as chronic hyperplastic pulpitis or proliferative pulpitis, refers to a tissue condition characterized by excessive tissue growth in the pulp chamber. This process is often activated by an open cavity (traditionally induced by caries) and a chronic stimulus. This clinical case aimed to present a surgical traditional approach to extract a tooth diagnosed with a pulp pathology which is classified as a pulp polyp (PP) in a primary first molar. This article has been elaborated following the guidelines for case reports. A 7-year-old pediatric male patient with no systemic complications and no history of dental follow-up was referred to undergo care at the supervised internship clinic at the Maurício de Nassau University Center to assess his oral health condition in the year 2024 and to evaluate multiple caries lesions and sensitivity in some teeth. The patient didn’t show any painful symptoms or signs of secondary infection and did not respond positively to pulp tests. The extraction of unit 74 was performed with minor local anesthesia and atraumatic technique. The removal was successful and the child did not have any complications, the recovery went well, respectively. Pulp polyps can be treated by removing the pulp polyp followed by pulpectomy or root canal therapy, which removes the diseased pulp and seals the canals, or, in extreme situations, by teeth extraction.

Activated phosphoinositide 3-kinase delta syndrome: report of seven cases

To summarize the clinical data of 7 children with activated phosphoinositide 3-kinase delta syndrome (APDS) and enhance understanding of the disease. A retrospective analysis was conducted on clinical data of 7 APDS children admitted to Hunan Provincial People's Hospital from January 2019 to August 2023. Among the 7 children (4 males, 3 females), the median age of onset was 30 months, and the median age at diagnosis was 101 months. Recurrent respiratory tract infections, hepatosplenomegaly, and multiple lymphadenopathy were observed in all 7 cases. Sepsis was observed in 5 cases, otitis media and multiple caries were observed in 3 cases, and diarrhea and joint pain were observed in 2 cases. Lymphoma and systemic lupus erythematosus were observed in 1 case each. Fiberoptic bronchoscopy was performed in 4 cases, revealing scattered nodular protrusions in the bronchial lumen. The most common respiratory pathogen was Streptococcus pneumoniae (4 cases). Six patients had a p.E1021K missense mutation, and one had a p.434-475del splice site mutation. p.E1021K is the most common mutation site in APDS children. Children who present with one or more of the following symptoms: recurrent respiratory tract infections, hepatosplenomegaly, multiple lymphadenopathy, otitis media, and caries, and exhibit scattered nodular protrusions on fiberoptic bronchoscopy, should be vigilant for APDS. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(5): 499-505.

Full-mouth rehabilitation in a patient with multiple caries: A case report

Background: Full-mouth rehabilitation of multiple caries can improve the quality of life. The selection of appropriate restorations on caries and teeth that have undergone post-endodontic treatment is critical to treatment success and enhances the quality of life. Purpose: This case report presents a full-mouth rehabilitation of a patient with multiple caries. Case: A 30-year-old man complained of multiple caries and pain in the posterior mandibular tooth, especially when eating and drinking (cold and hot), which interfered with his activities. The clinical examination found caries in teeth 16, 22, 24, 25, 26, 27, 36, 37, and 38 and a retained root of tooth 46. The percussion and biting tests were negative, while the sensibility test was positive. Case Management: Severe caries found in tooth 37 was managed with endodontic treatment and an indirect onlay restoration with lithium disilicate-based material. The retained tooth of 46 was extracted and restored with a partial denture. The other teeth, 16, 22, 24, 25, 26, 27, 36, 37, and 38, were treated by direct composite restoration. Holistic treatment was performed on all the problem teeth to support oral hygiene and was followed by dental health education. Conclusion: Full-mouth rehabilitation is essential for oral hygiene and can improve the quality of life. Education on maintaining oral hygiene is a must for protecting oral health.

General anesthesia as one visit dental management for down syndrome child with hypothyroidism and post closure of heart valves

Introduction: Several studies have stated that the prevalence of dental caries in children with Down Syndrome (DS) is quite high (89%), as is the prevalence of periodontitis (59%). Several systemic conditions with DS always hamper their dental management. Thus, appropriate management behavior is needed to improve oral health care. Case History: An 8-year-old boy, with DS, complaining that his teeth often experienced spontaneous pain and swelling. Medical history revealed that the patient had hypothyroidism and post-closure of heart valves. During intraoral examination, multiple caries and multiple gangrene radix were found. The patient was uncooperative (Frankl scale number 1). One-visit dental management by GA was performed on the patient, resulting in the patient never experiencing toothache again and having a good appetite. Discussion: Uncooperative DS children with several accompanying systemic conditions make dental examination and treatment difficult to do in regular dental office. Because of these conditions require appropriate behavioral management to carry out dental treatment. Based on aspects of safety and effectiveness, GA is one of the behavioral management that can be done. Related to it, GA requires a multidisciplinary team, to consider each stage of the procedure. This method makes the dental treatment can be done in one-visit, helps decrease the child’s anxiety, and makes the dental experience safe and less painful. Conclusion: For patients with several systemic conditions, behavioral management with GA as one-visit dental management is a good option.

ORAL HEALTH STATUS OF CHALDREN WITH INFECTIOUS MONONUCLEOSIS IN THE PAST MEDICAL HISTORY

Dental caries and periodontal tissue diseases remain one of the most actual problems in pediatric dentistry. There is also a trend towards an increase in the prevalence of malocclusion. Dental morbidity in children in most cases develops under the influence of both local and general factors. Somatic pathology has a particularly significant impact on the development of dental morbidity in children, caused by metabolic disorders, which serves as the pathogenetic basis for the development of diseases. Viral infection, which is widespread among children and adults, plays a significant role in the development of dental diseases. In recent years, there has been an increase in the incidence of children with infectious mononucleosis caused by Epstein-Barr virus. Therefore, the assessment of oral health status in children with infectious mononucleosis will allow the development of effective means of preventing and treating diseases.
 Purpose. The purpose of the study is to assess the oral health status of children with infectious mononucleosis in the past medical history.
 Methods and Material. 240 children aged 6-15 years, including 112 children with infectious mononucleosis in the past medical history of (the main group) and 128 children of the comparison group, have been examined. The prevalence of dental caries, malocclusion and the condition of periodontal tissues were assessed in the examined children. The oral health status of children was determined in accordance with the recommendations of P.A. Leus (1991).
 Results. It has been found that in children with infectious mononucleosis in the past medical history, the prevalence of caries of permanent teeth, on average, was 73.68±3.04% with an intensity of 3.41±0.24 teeth, which was significantly higher than in children in the comparison group (65.06±2.98%; 2.53±0.22 teeth). Diseases of periodontal tissues were diagnosed in 69.8% of children in the main group and 48.7% in the comparison group. Among the periodontal diseases, chronic catarrhal gingivitis was the most common (62.7%). In children with infectious mononucleosis, malocclusion was detected, on average, in 86.36±4.22%, which is significantly higher than in the comparison group (69.23±4.27%). The oral health status of children with infectious mononucleosis aged 9 years was 70%, and 12 years 65%, and in the comparison group it was 80% and 76%, respectively.
 Conclusions. Thus, a decreased oral health status of children with infectious mononucleosis in the past medical history was found, especially in 12-year-old children, mainly due to the development of multiple dental caries and periodontal diseases. The identified dependencies indicate significant disorders of the protective mechanisms of the oral cavity, insufficiently effective oral hygiene and lack of preventive measures in children with infectious mononucleosis in the past medical history.

Partial penetrance and phenotypic variability of aplasia of lacrimal and salivary glands caused by a novel FGF10 donor splice-site mutation.

Thirteen affected individuals of six generations of a single kindred presented with epiphora evident from infancy. Physical exam and Schirmer test revealed variable expression of tear deficiency, congenital punctal atresia, and dry mouth with multiple caries, without concomitant abnormalities of the ears or digits, commensurate with a diagnosis of aplasia of the lacrimal and salivary glands (ALSG). Reconstruction of the upper lacrimal drainage system was performed in some of the affected individuals. Genetic analysis, testing six affected individuals and three non-affected family members, identified a single novel heterozygous splice-site variant, c.429 + 1, G > T in fibroblast growth factor 10 (FGF10) (NM_004465.1), segregating throughout the family as expected for dominant heredity. RT-PCR assays of HEK-293 cells transfected with wild type or mutant FGF10 demonstrated that the variant causes skipping of Exon 2. Notably, individuals sharing the same variant exhibited phenotypic variability, with unilateral or bilateral epiphora, as well as variable expression of dry mouth and caries. Moreover, one of the variant carriers had no ALSG-related clinical findings, demonstrating incomplete penetrance. While coding mutations in FGF10 are known to cause malformations in the nasolacrimal system, this is the second FGF10 splice-site variant and the first donor-site variant reported to cause ALSG. Thus, our study of a unique large kindred with multiple affected individuals heterozygous for the same FGF10 variant highlights intronic splice-site mutations and phenotypic variability/partial penetrance in ALSG.

Features of the molecular composition of dental biofilm in patients depending on the degree of caries and the method of its prevention: synchrotron FTIR spectroscopic studies

The article studies the molecular composition of dental biofilm in healthy people and patients with multiple caries lesions during several stages of exogenous and endogenous preventive measures. The observed changes in the IR spectra registered during different stages of the experiment indicate a lack of balance between demineralisation and mineralisation of hard tissues resulting from different absorption mechanisms of agents applied exogenously and endogenously. All the observed changes result from the difference in the microbiota in healthy patients and patients with caries, as well as the difference in the microbiota caused by the impact of preventive agents on biofilm

Профілактика захворювань порожнини рота в дітей з бульозним епідермолізом: опис клінічного випадку та огляд стану проблеми

Today, more than 300 million people worldwide suffer from one or more rare diseases. Epidermolysis bullosa (EB) is a heterogeneous group of hereditary diseases characterized by a genetic predisposition to a hypersensitive body reaction to minor skin damage, characterized by the formation of blisters and erosions on the skin and mucous membranes, followed by scarring. It is one of the most severe hereditary dermatoses. In EB, pathological conditions also occur in the oral cavity. Thus, patients with EB require a special “atraumatic” approach to medical procedures, hygienic care, professional oral hygiene, etc. Purpose - to systematize clinical recommendations for oral care for patients with BE on the basis of a clinical case. Clinical case. We present a clinical case of a patient with a dystrophic EB and a diagnosis of acute chronic granulating periodontitis. Examination of the oral cavity revealed microstomia, multiple caries, erosions and ulcers on the oral mucosa, signs of chronic catarrhal gingivitis, as well as dentoalveolar anomalies. After achieving a satisfactory degree of mouth opening using a set of exercises for the maxillofacial muscles, treatment of the acute chronic granulating periodontitis of the tooth 23 was performed. As a result of the clinical observation and analysis of the literature, we systematized practical recommendations aimed at facilitating the treatment of oral diseases in patients with EB. Conclusions. Treatment of oral diseases in patients with EB is primarily aimed at preventing pain and preventing secondary infection of affected areas. Treatment of dental caries contributes to the correct position of the tongue, improved swallowing and phonetics, as well as to improvement in nutritional status and aesthetic appearance. Oral hygiene reduces the risk of injury to the oral and pharyngeal mucosa. In the treatment of patients with EB, it is important to use a multidisciplinary approach with the involvement of specialists of different specialties. Implementation of simple but effective recommendations made by pediatric dentists will increase the effectiveness of prevention of oral diseases in these children. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent of parents and child was obtained for the study. No conflict of interests was declared by the authors.

The effectiveness of dental caries treatment in children of prepubertal and pubertal age with juvenile rheumatoid arthritis

Annotation. Despite the modern achievements in dentistry, multiple teeth decay in children with juvenile rheumatoid arthritis (JRA) is a widespread problem. The search for new methods of treatment and prevention of these lesions is an actual task for scientists. Therefore, the aim of the research was to study the effectiveness of the developed comprehensive treatment and prevention of multiple dental caries in children with JRA. We carried out a study of 53 children with JRA aged 8-16 years: 14 children of the second childhood and 12 – adolescence, who made up the main group and, respectively, 14 and 13 children of the comparative group. Evaluation of the efficiency of treatment and preventive measures was studied according to the values of dental caries intensity, and data of content of the main electrolytes and their regulators in the blood: total and ionized calcium, inorganic phosphorus, magnesium, potassium, sodium, chlorine, parathyroid hormone, alkaline and acid phosphatase activity. For statistical analysis, the program “Statistica 6.1” was used. Carrying out treatment and prevention measures of dental caries in children of the main and comparative groups with JRA contributed to the elimination of relative hypophosphatemia and hypocalcemia and the normalization of other indicators of calcium and phosphorus metabolism (content and activity of biological catalysts), which were detected before treatment. At the same time, in two years of observation of pre-pubertal children in the comparison group, the DMF+df index was three times higher than in the main group. In the pubertal age period, the DMF index in children of the comparison group exceeded the same index of the main group by 3.4 times. Performing only basic therapy with correction of mineral metabolism and vitamin balance in the body of children with JRA is insufficient for effective prevention of carious lesions of the teeth. The results of a dental examination show high clinical efficiency of the proposed method for the treatment and prevention of dental caries. This indicated the expediency of its implementation in practical health care.

Xerostomia in patients with diabetes mellitus (pilot study)

Relevance. Saliva performs some essential functions indispensable for oral health. Patients with diabetes mellitus (DM) often complain of xerostomia. Long-term dry oral mucosa in diabetic patients adversely affects the quality of life and causes speech. chewing. swallowing. and taste problems; it leads to multiple caries and inflammatory periodontal diseases.Aim. To evaluate the detection rate and determine the x erostomia nature in patients with DM.Materials and methods. The interview and survey included 251 patients aged 18-82 y.o. with Type 1 DM. latent auto-immune diabetes in adults and Type 2 DM. The patients informed the study of DM duration. current therapy duration. xerostomia presence and nature. The patients’ records provided information about the established diagnosis. age. glycohemoglobin (HbA1c). body mass index (BMI). and prescribed DM therapeutic regimen. The data were statistically analysed using the StatTech v. 2.4.8 software. Results. 134 (53.4%) patients complained of a transient dry mouth associated with blood sugar levels increase; 6 (2.4%) patients noted dry mouth if blood sugar levels decreased; 30 subjects (12.0 %) and 10 subjects (4.0 %) reported constant and stress-associated dry mouth. respectively (р > 0.05). Patients over 80 declared dry mouth associated with blood sugar decrease more often than patients aged 45-64 and 65-80 y.o. (р = 0.002*; р45-64 – over 80 = 0.012; рover 65 – over 80 < 0.001); 21.1% of patients aged 65-80 noted permanently dry mouth (р = 0.028). Patients with persisting xerostomia (permanent dry mouth and stress-associated dry mouth) had statistically significant. higher BMI of 33 (31-37) kg/m2 (р = 0.019) and 36 (34-41) kg/m2 (р = 0.002). respectively. The higher glycohemoglobin level increase was more statistically significant in patients with DM. who reported dry mouth associated with glucose increase. The evaluation of xerostomia nature vs to diagnosis. sex. DM duration. drug therapy scheme. and smoking did not reveal any statistically significant differences.Conclusion. Xerostomia presents an additional problem for patients with DM. Patient education and the selection of individual products for oral care by dentists may improve oral health parameters in the long run.

Rehabilitation of Anterior Teeth Trough Endorestoration

Background: Nowadays, people has considered the importance of dental health, both in terms of functional and aesthetic improvements. Complex caries lesion of anterior teeth are a major problems that require aesthetic management due to patient’s confidence. Purpose : The aim is to present a case of anterior maxillary teeth with complex caries treated with endodontic and restoration treatment to recover its optimal function aesthetically. Case A 18-year-old female patient with multiple caries on anterior maxillary teeth. She felt unconfidence about her performance. 13 class IV black caries lesion, 12 radicular tooth, 11 and 21 previously endodontic treated with metal post. 22 class V Black carieus lesion, 23 class III Black caries lesion. Case management:. 13, 12 and 22 were managed with root canal treatment and followed by fiber post insertion. 11 and 21 were previously endodontic treated and retreated with prefabricated fiber post. 23 with moderate caries was managed with crown. All anterior maxillary teeth had crown lengthening before. And all crown materials were made with Lithium Disilicate. Conslussion : Anterior maxillary teeth with severed multiple caries, successfully managed with optimal result. Restoring its function, form aesthetically and improve her quality of life.

The impact of Er:YAG laser combined with fluoride treatment on the supragingival plaque microbiome in children with multiple caries: a dynamic study

BackgroundAs a minimally invasive tool for caries prevention tool, the pulsed erbium:yttrium-aluminum-garnet (Er:YAG) laser is being used in a large number of studies. Microorganisms are extremely vital in the occurrence and development of dental caries. However, the impact of Er:YAG laser irradiation combined with fluoride on the dynamic microbial changes that occur in dental plaques is still uncertain. In this study, we examined the effect of an Er:YAG laser combined with fluorine on supragingival microbial composition and diversity in children with multiple caries.MethodsIn this study, dental plaque samples (n = 48) were collected from 12 children with over 8 filled teeth. Supragingival plaques from left mandibular molars before (CB) and after fluoride treatment (CA) and right mandibular molars before (EB) and after fluoride+Er:YAG laser treatment (EA) were collected from each patient. In CB and EB groups, the samples were collected just before the treatments. In CA and EA groups, the samples were collected 1 month after treatments. Then, all specimens were subjected to 16S rRNA high-throughput sequencing to investigate the changes in microbial composition and diversity in mandibular molar supragingival plaques before and after fluoride or fluoride+Er:YAG laser treatment.ResultsThe dental plaque microbial diversity was higher in the EA group than in the EB group (baseline levels), and the microbial composition changed in EA group compared with EB group (P < 0.05). The levels of microorganisms associated with caries occurrence, including Proteobacteria, Fusobacteria, and Bacteroidetes, declined, while the levels of Faecacterium, Fastidiosipila, Vibrio, and Shewanella increased in EA group compared with EB group. The declines in Firmicutes, Streptococcus, Fusobacterium, and Veillonella levels were significantly lower in the EA group than in the CA group.ConclusionThe combined application of the Er:YAG laser and fluoride may be more effective than using fluoride alone in reducing the proportion of cariogenic bacteria, increasing the diversity of plaque microorganisms, and further promoting the microecological balance.

The clinical and laboratory features of patients with triple A syndrome: a single-center experience in Turkey.

Triple-A Syndrome (TAS) is a rare autosomal recessive disorder characterized by adrenal insufficiency, achalasia, and alacrimia. This disorder is caused by mutations in the AAAS gene. The aim of this study is to discuss the clinical, laboratory and molecular genetic analysis results of 12 patients with TAS. We evaluated 12 patients from 8 families. Clinical and laboratory data were retrospectively collected from the medical records of the patients in the database for the period 2015-2020. All exons and exon-intron junctions of the AAAS gene were evaluated by next-generation sequencing method. Detected variants were classified according to American Collage of Medical Genetics criteria. Alacrimia was found in all patients (100%); achalasia was found in 10 patients (83.3%) and adrenal insufficiency was found in 10 patients (83.3%). In addition, hyperreflexia(6/12), learning disability(5/12), hypernasal speech(5/12), muscle weakness(8/12), delayed walking(7/12), delayed speech(6/12), excessive sweating(7/12), optic atrophy(1/12), epilepsy(1/12), palmoplantar hyperkeratosis(5/12), multiple dental caries(9/12), atrophy of the thenar/hypothenar muscles(4/12) and short stature(4/12) were detected. The DHEA-S levels were measured in 10 patients and were found to be low in 8 of them. In all patients, the sodium and potassium levels were found to be normal. AAAS gene sequencing revealed four previously reported c.1066_1067del (p.Leu356fs*8), c.1432 C > T (p.Arg478*), c.688 C > T (p.Arg230*), and c.1368_1372del (p.Gln456fs*38) variants and two novel homozygous c.1250-1 G > A and c.398_399 + 2del variants in the AAAS gene. We detected two novel variants in the AAAS gene. While the classic triad is present in 66.7% of the cases, neurological dysfunction, skin and dental pathologies also occur quite frequently. The earliest and most common finding of TAS is alacrimia. Therefore, adrenal insufficiency should be investigated in all patients with alacrimia and if necessary, genetic analysis should be performed for TAS. In addition, TAS should be followed up with a multidisciplinary approach since it involves many systems.

Прогностическая значимость определения фторид-ионов в ротовой жидкости при остром перикороните

Oral fluid is a valuable substrate for assessing dental health and other aspects of physical status. New methods for early diagnosis and prognosis of dental diseases on the basis of oral fluid composition are in constant demand. Excessive fluoride concentrations, often oversighted by dental therapists, negatively affect organs and tissues of the oral cavity. This study aimed at development and approbation of a method for reliable measurement of fluoride ions in oral fluid by capillary electrophoresis to be used in patients with dental diseases. The fluoride ion concentrations were measured in health (2.16 ± 0.48 mg/L), in isolated acute pericoronitis (15.2 ± 2.7 mg/L) and in acute pericoronitis combined to multiple caries (18.9 ± 4.2 mg/L). By post-operative day 3, fluoride levels in the group with isolated acute pericoronitis dropped to normal values (2.28 ± 0.52 mg/L), whereas in the group with acute pericoronitis combined to multiple caries fluoride levels remained high (8.7 ± 1.9 mg/L; р &lt; 0.0001). The developed protocol is efficient for studying fluoride ion concentrations in isolated and combined dental diseases.

Odontogenic Optic Neuropathy, Clinic, Treatment Dynamics: A Case Report

Optic nerve neuropathy due to dental lesions is rare but causes complex persistent functional disorders that are difficult to diagnose. The aim of this case report is to show odontogenic optic neuropathy through treatment tactics and observation of structural dynamics and functional changes of the optic nerve with the help of a clinical case. The consultation of the patient was done as per the Department of Ophthalmology, Ivano-Frankivsk National University, Ukraine. Tests such as computed perimetry, Optically Coherent Tomography (OCT) of the optic nerve, Magnetic Resonance Imaging (MRI) of the brain, Computed Tomography (CT) of the paranasal sinuses and immunological blood tests were performed. The patient gave informed consent to access personal data and use it for scientific purposes. In the case of patient S., the combination of neuritis with lesions of the anterior part of the vascular tract is attributed to the background of multiple caries and prolapse of the teeth of the upper jaw in the sinus. Treatment includes a regimen by a dentist for caries and pulse therapy with corticosteroids. From the result, it was possible to reduce the swelling in the nerve fibers of the right eye by 35% and the left eye by 19%. The average sensitivity threshold in the right eye increased by 79% and in the left eye by 90%. In conclusion, we confirm that odontogenic optic neuropathy is a rare form of optic nerve damage. Two-stage treatment (dental and corticosteroids) reduces the nerve fibers swelling and increases retinal ganglion cells sensitivity.

Treatment of Fissure Caries of Children with Severe Rheumatic Diseases with Difficulty in Opening the Mouth.

Background:Pediatric dentists face difficulties in treating tooth decay of children with difficulty in opening the mouth. This is especially true, as the main disease is accompanied by such symptoms as arthritis, osteoarthritis, myositis, myalgia, sclerosis, and oral atrophy.Aim:The aim was to increase the level of treatment of fissure tooth decay for children with rheumatic diseases, using the silicone key method (SKM).Materials and Methods:A dental examination of 82 children was carried out, with diagnoses: systemic lupus erythematosus, juvenile systemic scleroderma, juvenile dermatomyositis, and juvenile rheumatoid arthritis. Evaluation of the intensity of caries using indices: decayed, missing, and filled teeth (DMFT)(average). Assessment and measurement of the degree of mouth opening (MMO) by Sh. M. Batashvili. The SKM was used to treat fissure tooth decay.Results:During the dental examination of the oral cavity of all children with RD, multiple caries lesions were found. In the first age group of index indicators (DMFT) (on average) - 4.88, in the second age group DMFT (on average) - 7.58 - these values corresponded to high scores for the degree of dental caries, which requires frequent appointment to the dentist. Oral hygiene of children with difficult opening of the mouth is unsatisfactory, which leads to a rapid increase of caries. Restriction of moth opening <4 mm was found in 57 children with RD (69, 51%) that made it difficult to treat caries.Conclusion:Using SKM will improve the quality of caries treatment and provide a stable result of treatment in patients with difficulty opening the mouth in severe somatic pathologies.

Complex Aesthetic Treatment of Patients with Multiple Caries

Background: The need for dental esthetics is very important in recent years. Fulfilling aesthetic demands with both non-invasive and minimally invasive techniques can maintain tissue continuity. A 38 year old female patient came to the clinic with an esthetic complaint of maxillary anterior teeth. The following case report describes a step by step complex aesthetic treatment of a patient with multiple caries. Appealing aesthetic results will restore the patient's smile through restorative treatment in dentistry. Purpose: The purpose of this case report is to explain the management of complex aesthetic treatment of patients with multiple caries Case: A 38-year-old female patient complained her upper front teeth is turning black. The patient complained that her teeth had hurt ± 3 months ago and sometimes felt sore. The patient wants her teeth to be treated because she feels less confident when she smiles and wants to fix these teeth. The history of treatment on the tooth in question have had root canal treatment and been filled since 8 years ago. The tooth has had braces (orthodontic) treatment and was removed ± 7 years ago. The patient stated that she had no systemic health disorder. Case management : The treatment of this complex case were done using root canal treatment, endodontic retreatment, direct and indirect veneer, dowel, and crown. Conclusion: complex aesthetic treatment of patients with multiple were done aiming for good aesthetic result