Multiple Caries Research Articles

Analysis of changes in biochemical parameters of oral liquid under the influence of lecithin-calcium complex in young patients with multiple caries

Given the high prevalence of dental caries, it is important to find new means and methods of prevention. At present preparations of natural origin, such as lecithin and calcium citrate, are widely used. The aim was to study the lecithin-calcium complex effect on the oral fluid biochemical parameters of individuals with multiple dental caries. Materials and methods. 85 KhNMU Dental Faculty students-volunteers were examined. Groups of participants were formed depending on the dental caries intensity level index value for the oral fluid biochemical parameters determination (degree of oral dysbiosis, antioxidant-prooxidant index) in patients before and after the start of the lecithin-calcium complex treatment course. Results. In persons with multiple dental caries the degree of dysbiosis is 3 times higher than normal, the concentration of calcium decreases by 1.5 times and the antioxidant-prooxidant index reduces by 2 times. After lecithin-calcium complex treatment course the dysbiosis degree decreases almost by 8 times, the concentration of calcium and API return to normal. This indicates the ability of the lecithin-calcium complex to regulate the oral cavity microbiocenosis and restore antioxidant-prooxidant indices. Conclusions. In patients with multiple dental caries the phenomena of the oral cavity dysbiosis, a decrease in the protective antioxidant system level and a decrease in the oral fluid calcium concentration are observed. The lecithin-calcium complex intake during the month completely eliminated the phenomenon of dysbiosis in the oral cavity, increased the antioxidant-prooxidant system level and the oral fluid calcium concentration to normal.

Pathology-specific molecular profiles of saliva in patients with multiple dental caries-potential application for predictive, preventive and personalised medical services.

Improving the quality of life is part of the global agenda. The focus is predominantly on prevention of socially significant diseases. Combating dental caries-related diseases is a top priority as it has a huge impact on people's social lives. Therefore, the purpose of the work was to study the changes in the molecular composition of saliva from subjects with multiple caries lesions using spectroscopic methods of analysis to identify potential tissue markers of caries development for predictive, preventive and personalised medical services. The molecular composition of mixed saliva (oral fluid) from subjects with and without multiple caries was analysed with the use of spectroscopic techniques, FTIR with synchrotron radiation for the excitation. The IR spectra of the oral fluid as well as the calculated mineral-organic, carbon-phosphate, Amide II/Amide I and protein/thiocyanate ratios were compared between subjects with and without multiple caries. This complex analysis of the obtained experimental data determined that the molecular composition of the oral fluid from those with multiple caries differed from those without caries; the organic-mineral balance in the oral fluid of those with multiple caries shifted towards a reduction in the mineral complexes, accompanied by an increase in the organic component. The thiocyanate content increased more than twofold, accompanied by increased carboxyl groups of esters, lipids and carbohydrates. The detected features in the IR spectra of mixed saliva as well as the calculated changes in the ratios between organic and inorganic components can be used as biomarkers of cariogenesis in the oral cavity, as a diagnostic criterion in the analysis of the oral fluid samples.

How Are Ocular Signs and Symptoms of Dry Eye Associated With Depression in Women With and Without Sjögren Syndrome?

To determine whether ocular phenotypic features of keratoconjunctivitis sicca (KCS) and/or participant-reported symptoms of dry eye disease are associated with depression in women participants enrolled in the Sjögren's International Collaborative Clinical Alliance (SICCA). Cross-sectional study. Women enrolled in the SICCA registry from 9 international research sites. Participants met at least 1 of 5 inclusion criteria for registry enrollment (including complaints of dry eyes or dry mouth, a previous diagnosis of Sjögren syndrome (SS), abnormal serology (positive anti-Sjögren syndrome antigen A and/or B [anti-SSA and/or anti-SSB]), or elevated antinuclear antibody and rheumatoid factor), bilateral parotid gland enlargement, or multiple dental caries). At baseline, participants had oral, ocular, and rheumatologic examination; blood and saliva collection; and a labial salivary gland biopsy (LSGB). They also completed an interview and questionnaires including assessment of depression with the Patient Health Questionnaire 9 (PHQ-9). Univariate logistic regression was used to assess the association between depression and demographic characteristics, participant-reported health, phenotypic features of Sjögren syndrome, and participant-reported symptoms. Mixed-effects modeling was performed to determine if phenotypic features of KCS and/or participant-reported symptoms of dry eye disease were associated with depression, controlling for health, age, country or residence, and sex and allowing for nonindependence within geographic site. Dry eye complaints produced a 1.82-fold (95% confidence interval [CI] 1.38-2.40) higher odds of having depression compared to being symptom-free (P < .001). Additionally, complaints of specific ocular sensations were associated with a higher odds of depression including burning sensation (odds ratio 2.25, 95% CI 1.87-2.72, P < .001) compared to those without complaints. In both women with and without SS, the presence of symptoms of dry eyes and/or dry mouth rather than SS itself resulted in higher odds of depression. One particular ocular phenotypic feature of SS, a positive ocular staining score, was inversely correlated with depression. Participant-reported eye symptoms, particularly specific ocular sensations such as burning, were found to be positively associated with individual American College of Rheumatology/EUropean League Against Rheumatism (ACR/EULAR) SS criteria items.

Sialagogic Effect of a New Mouthwash for Relieving Oral Dryness

Background/purpose: Oral dryness is known to cause several oral disorders, including candidiasis, glossitis, atrophy of the oral mucosa, dysgeusia and multiple caries. Recently, it has been noted that not only older people, but an increasing number of younger people are suffering from oral dryness as they become less able to accommodate to the range of emotional and physical environment changes, becoming overstressed and developing symptoms of depression as a result. Oral dryness is thus now a condition that affects people across the generations. The authors have previously developed an agent that is both simple and capable of providing not only hydration, but also total oral dryness care, and they have reported its potential effect. In this study, whether this newly developed oral dryness care agent increased the amount of saliva produced and contributed to moisture retention was investigated in individuals of different generations. Materials and methods: The young subjects (45 men) and the geriatric subjects (19 men, 27 women) washed their mouth with each mouthwash. Unstimulated salivary and stimulated salivary secretions were measured before mouth washing and immediately after (0 min) and 30 min and 60 min after mouth washing. Results: The present results showed that, with the exception of saliva secreted by young subjects with stimulation, the test mouthwash significantly increased the amount of saliva secreted by all age groups, both at rest and with stimulation, compared with the control mouthwash, and this effect was persistent. Conclusion: The present results suggest that the agent tested may be useful as a new mouthwash for relieving oral dryness, and it promoted saliva secretion in different age groups.

Dental Management of a Young Child Affected by Galactosialidosis and a Gigantic Abdominal Growth

Galactosialidosis (GS) is a rare form of lysosomal storage disease that involves a broad spectrum of skeletal and soft tissue abnormalities. We report here on a 4-year 7-month-old boy with mild mental retardation, exhibiting multiple caries cavities and associated infectious foci and macroglossia. A huge abdominal enlargement due to peritoneal ascites was evident. Behavioral management and patient positioning on the dental chair represented a true challenge. The patient was treated under general anesthesia. However, life-threatening postoperative complications occurred because of the impossibility of extubating the patient. A very careful preanesthetic assessment is crucial in children affected by general conditions associated with airway anomalies, such as GS.

Multiple Socioeconomic Factors and Dental Caries in Swedish Children and Adolescents

The study aimed to explore associations between multiple socioeconomic factors and dental caries experience in Swedish children and adolescents (3-19 years old). Electronic dental records from 300,988, in a Swedish region (97.3% coverage) were collected using the DMFT indices (decayed, missing, filled teeth: dependent variables). Socioeconomic status (SES) data (ethnicity, wealth, parental education, and employment) for individuals, parents, and families were obtained from official registers. Principal component analysis was used to explore SES data. Scores based on the first factor were used as an independent aggregated socioeconomic variable in logistic regression analyses. Dental caries experience was low in the participants: 16% in 3- to 6-year-olds (deft index: decayed, extracted, filled teeth) and 47% in 7- to 19-year-olds (DFT index). Both separate and aggregated socioeconomic variables were consistently associated with the dental caries experience irrespective of the caries index used: the crude odds ratio (OR) for having at least 1 caries lesion in 3- to 6-year-olds (deft index) in the lowest SES quintile was 3.26 (95% confidence interval [CI] 3.09-3.43) and in ≥7-year-olds (DFT index) OR 1.80 (95% CI 1.75-1.84) compared with children in the 4 higher SES quintiles. Overall, associations were stronger in the primary dentition than in the permanent dentition. Large SES models contributed more to explaining the caries experience than slim models including fewer SES indicators. In conclusion, socioeconomic factors were consistently associated with dental caries experience in the children and adolescents both as single factors and as multiple factors combined in an index. Socioeconomic inequalities had stronger associations to caries experience in young children than in older children and adolescents.

Oral Manifestations in Pediatric Patients with Coeliac Disease - A Review Article.

Background:Coeliac disease is a chronic enteropathy that remains a challenge for the clinician, due to its atypical manifestations and etiopathogenic complexity.Objective:This article intends to describe the oral characteristics of Coeliac Disease in children in order to facilitate their management in the dental office.Methods:A review of the literature was performed electronically in PubMed (PubMed Central, and MEDLINE) for articles published in English from 2000 to April of 2017. The article is also based on the authors' clinical experience with children with coeliac disease. The searched keywords were “coeliac disease “,”oral manifestations “, “dental enamel defects”, “recurrent aphthous stomatitis” and “oral aphthous ulcers”.Results:There are some oral manifestations which are strictly related to coeliac disease: dental enamel defects, recurrent aphthous stomatitis, delayed tooth eruption, multiple caries, angular cheilitis, atrophic glossitis, dry mouth and burning tongue.Conclusion:The complete knowledge of the oral manifestations of coeliac disease can trigger an effective change in the quality of life of the patients with this disease.

Management of a patient with osteogenesis imperfecta and trisomy 18

Trisomy 18 and osteogenesis imperfecta are serious diseases with multiple systemic complications. Osteogenesis imperfecta is usually associated with dentinogenesis imperfecta. Observation : A young woman consulted for dental care, with the family suspecting multiple caries because of yellow spots on her teeth. Medical history revealed trisomy 18 associated with osteogenesis imperfecta. The patient was quite uncooperative, even with tooth brushing at home. We provided care after the completion of clinical and radiographic examinations. The colorations were due to amelogenesis imperfecta. Discussion : The association between osteogenesis imperfecta and amelogenesis imperfecta has not been described in the literature. Moreover, the presence of an extra abnormality in tooth structure was a delicate situation for the family. This case suggests the link between amelogenesis imperfecta and osteogenesis imperfecta. Conclusion : This case is the first description of the association of amelogenesis imperfecta and osteogenesis imperfecta.

Дослідження динаміки показників імунного статусу у дітей з множинним карієсом на фоні захворювань шлунково-кишкового тракту у різні терміни лікування

The level of immunoglobulins and lysozyme in the oral fluid deviates from the norm at presence of the diseases of the gastrointestinal tract (GI), which is likely to be a trigger in the development of rampant caries in children. A detailed study of this aspect has made it possible to directly influence the inhibition of the pathological process.The aim of the study – to evaluate the effectiveness of the use of a complex of therapeutic and prophylactic measures aimed at increasing the resistance of the oral cavity in children with rampant caries on the background of diseases of the gastrointestinal tract in 12–14 days and 6 months after treatment; compare the data with these before treatment.Materials and Methods. The article presents the results of the study of the dynamics of immunological parameters in children with rampant caries on the background of diseases of the gastrointestinal tract. The increase of the indexes of immunoglobulins A, G, secretory immunoglobulin A, lysozyme in the oral liquid of the children of the main, comparative and control groups was determined by the method of radial immunodiffusion in Mancini agar and agar diffusion method containing 0.05 % biomass powder Micrococcus lysodeikticus.Results and Discussion. As a result of the proposed treatment and prophylactic complex, we managed to achieve a significant improvement in the immunological status of oral fluid in children with rampant caries on the background of GI tract diseases. Thus, after treatment (12–14 days), the content of IgA in the oral liquid of the children of the main group increased by 80.0 % higher in relation to the data before treatment. At the same time, in children of the main group, the decrease in the IgG concentration, which was lower than the data before treatment, was studied at 26.32 %. At 12–14 days after treatment in children with multiple caries, against the background of gastrointestinal lesions of the main group, an increase in sIgA and lysozyme was observed, which was 39.13 % and 23.85 % higher, respectively, for the data before treatment.Conclusions. The complex of therapeutic and prophylactic measures introduced and implemented in clinical practice causes a pronounced caries prophylactic effect and improves the state of hygiene, increases the acidity of the enamel and mineralizing properties of the oral liquid, normalizes microbiocenosis and immunological status, which in general optimizes the processes of remineralization.

A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital

BackgroundGeneral anesthesia (GA) as a pediatric dental procedure is a well-established method of behavior management. However, studies of pediatric dentistry under GA have mostly focused on handicapped patients, and various retrospective studies in Taiwan have mainly reviewed only a limited number of years. The purpose of the present study was to report trends in pediatric dental treatment performed under GA over the past 10 years. MethodsA retrospective review of the hospital records of patients receiving dental treatment under GA from 2006 until 2015 was performed. The patients were divided into three age groups: < 3 years, 3–6 years, and > 6 years. A range of information including basic patient characteristics and types of dental treatment was identified and then analyzed. ResultsA total of 791 cases (< 3 years old: 65 cases, 3–6 years old: 492, > 6 years old: 235; 549 male, 242 female) were treated under GA. The case number was found to have increased from 94 during 2006–2007 to 238 during 2014–2015, with the increase being especially pronounced among those aged 3–6 years (2006–2007: 49, 2014–2015: 165). The most common treatments (extraction, restoration, and pulp therapy) were associated with multiple dental caries (684, 86.4%). The < 3-years-old group was characterized by the highest decayed, extracted, and filled surface and decayed, missing, and filled surface indices; the highest mean number of treated teeth; and the highest mean number of treated teeth by composite resin fillings. The 3–6-years-old group had the highest number of primary teeth extractions. The > 6-years-old group had the lowest mean number of treated teeth by stainless-steel crowns (SSCs) and fewest cases treated with pulp therapy. From 2011 onwards, the number of primary tooth extractions significantly increased, while in 2013, there was a crossover whereby the SSC count surpassed the composite resin filling count. ConclusionOver the past 10 years, there has been an increased use of GA for pediatric dental treatments, in particular, in cases with multiple dental caries. In addition, there has also been an increasing trend towards extraction of primary teeth and the use of SSCs.

피에르 로빈 증후군 환아의 전신마취 하 치아우식 치료 증례 보고

저자는 소하악증으로 인해 기도유지가 어려우며 섭식 장애로 인한 다발성 우식을 보이는 피에르 로빈 증후군 환아의 증례를 보고하는 바이다. 환자는 소하악증 및 구개열, 심방중격 결손, 새끼 손가락의 측만지증(clinodactyly), 외사시(exotropia) 등의 증상을 동반하고 있었으며, 신체 발육이 매우 저하된 상태로 섭식 장애로 인한 구강내 침식 및 다발성 우식의 소견을 보이고 있었다. 환아는 가벼운 자폐 증상을 가지고 있으며 어린 나이로 협조를 구하기가 어려웠고 광범위한 치료가 필요한 상황이었으며 의식하 진정법시 하악의 발육 저하로 인한 기도 확보의 어려움이 예상되었기에 전신마취하 치과치료를 시행하였다. 피에르 로빈 증후군은 기도유지의 어려움과 섭식 장애로 구강위생 관리에 불리한 조건을 가지고 있지만 나이가 듦에 따라 점차 정상적인 하악의 성장이 이루어지므로 행동조절에 의한 일상적인 치과 처치도 가능할 것이다. Pierre Robin syndrome (PRS) is characterized by the triad of congenital mandibular hypoplasia, glossoptosis and cleft palate. Infant PRS patients are frequently suffering from upper airway obstruction, gastroesophageal reflux and growth retardation caused by above mentioned problems. We report a dental caries treatment of 3-year old girl with Pierre Robin syndrome with multiple caries. The cause of multiple caries was mainly presumed as patient's eating habit caused by her general condition. She had some feeding problems and had history of gastric tube. She was still using milk bottle and took more than an hour to finish a meal. The treatment was performed under general anesthesia considering patient's condition; mild autism, poor cooperation and respiratory problem due to micrognathia. Severely affected upper incisors were treated with pulp treatment and restored with zirconia crown for esthetic purpose. Lower incisors were treated with pulp treatment and restored with composite resin. Upper right first primary molar was restored with stainless steel crown and other primary molars were treated with composite resin. There were no postoperative complications. According to her parents, the patient's compliance to oral hygiene management was greatly improved after the treatment since she was very pleased with the esthetic result and highly motivated by her looks. The treatment without sedation or general anesthesia would be possible once the airway is improved as the mandible grows.

Результати дослідження показників мінерального обміну в крові пацієнтів з ураженням зубів каріозним процесом на фоні ювенільного ревматоїдного артриту

&lt;p&gt;We have defined the main macroelements (Ca, Ca +, P, Mg, K, Na, Cl) in blood plasma of 29 children of the second childhood and 26-children of juvenile age with multiple caries on the background of JRA and in comparison with respectively 25 and 27 children born in the same year from a control group. It was established that the state of mineral metabolism in the blood of sick children is characterized by a significant decrease in total calcium and its ionized faction, and inorganic phosphorus in regard to healthy population of the same age, but within the physiological norm. This went to prove a possible negative impact of accompanying pathology on the state of hard tooth tissues and the role of JRA in the development of multiple cariosity.&lt;/p&gt;

Clinical, hormonal, biochemical and genetic characteristics of 75 patients with hypophosphatemic rickets

Aim — the present research was aimed at identifying the genetic causes for hr in patients, as well as evaluating the clinical, hormonal and biochemical characteristics of the disease in this group of patients.Material and methods. 75 patients (aged, of 3 months to 57 years; females, n=38; males, n=37) with clinical and radiological findings of rickets, low serum phosphate and low tubular reabsorption of phosphate were included. ‘rickets panel’ genes were sequenced using a custom Ion Ampliseq gene panel and PGM semiconductor sequencer (Ion Torrent). The panel included primers for multiplex amplification of 22 genes associated with genetic calcium metabolism dysfunctions. Bioinformatic analysis was performed using torrent suite (Ion Torrent) and ANNOVAR software packages.Results. Out of the 75 patients 36 were diagnosed with familial form of hr, and 39 probands had sporadic cases. Out clinical characteristics the most widespread symptoms of the disease included: lower limbs malformations since the patients started to walk (94.5%), hypotonia in the first 12 months of life (70.2%), multiple caries (58%). Mutations were identified in 100% of familial and 88,5% of sporadic cases. In 68 probands (90,5%) mutations were detected in PHEX, 40 of which were novel. For familial forms of the disease mutations were discovered in 100% cases, for sporadic — in 82% cases. One subject had both DMP1 and PHEX mutations. No mutations were detected in FGF23, SLC34A1, SLC34A3, SLC9A3R1, ENPP1, CLClCN5 and SLC2A2 genes.Conclusion. The study confirmed predominance of PHEX mutations among the patients with HR. The identification of causative agent is very important for antenatal diagnostics for familial forms of disease and enables well-timed conservative treatment.

Evaluation of Possible Associated Factors for Early Childhood Caries and Severe Early Childhood Caries: A Multicenter Cross-Sectional Survey.

The present study evaluated associated factors for developing early childhood caries (ECC) and Severe-ECC (S-ECC) in a group of children aged 24-71 months. Potential positive effects of early dental visit on formation of ECC is investigated as well. This was a multicenter, cross-sectional study conducted at three governmental and university pediatric dentistry clinics in 408 preschool children who were randomly selected from a total of 4116 children. The questionnaires administered to the mothers by interview and intraoral examination performed by calibrated pediatric dentists. The children were evaluated in three groups according to their caries experience as who had caries free, ECC and S-ECC. The following factors were significantly associated with caries formation: 1. Prolonged (i.e., >18 months) breastfeeding in preterm babies (OR=2.4) 2. Prolonged breastfeeding in children who started tooth brushing after 1.5 years of age (OR=3.7), 3. Sugar (p<0.001) and fruit-juice consumption (p<0.0001), and 4. Lack of periodic dental examination (p<0.05). Parental smoking habit does not significantly affect ECC development. Nocturnal bottle feeding and nocturnal feeding also affected S-ECC formation significantly (p=0.043 and p=0.005, respectively). There is a significant difference between the children with caries and caries-free associated with the brushing initiation age started before or after 18 months. If a child is under the risk of multiple caries factors, it is very difficult to evaluate which habits affect the caries formation or increase the severity of the caries lesions.

Congenital Sideroblastic Anaemia- Classic Presentation.

An eight-year-old girl child came to our hospital with high grade fever since four days associated with generalised weakness and lethargy. Past history was suggestive of multiple similar episodes each of 4 to 5 days duration since two years of age often accompanied with severe anaemia requiring packed cell transfusion. Symptoms used to subside with antipyretics and broad spectrum antibiotics within seven days. She was started on colchicine one year back with no significant improvement based on the diagnosis of periodic fever syndrome. Then her frequency of febrile attacks increased up to once every week. Differential diagnosis like haemolytic anaemia due to various aetiologies including autoimmune were considered. Also, anaemia due to bone marrow failure was considered as differential. Subsequently she was started on prednisolone 5mg daily after which frequency of attacks were reduced to once monthly. Child was born out of 3rd degree consanguineous marriage. Multiple male relatives including elder and younger sister had died at an early age with similar symptoms. Antenatal history of mother was suggestive of oligohydramnios. Child was born of full term normal delivery with a birth weight of 1 kg. She required packed cell transfusion immediately after birth due to severe anaemia. On examination vitals were normal but there was pallor with multiple dental caries and mild prominence of jaw. Haematological examination revealed haemoglobin of 7.9 with haematocrit 25.5, White Blood Corpuscle (WBC) 5260, platelets 269, Mean Corpuscular Volume (MCV) 57.3 and Red Blood Cell Distribution Width (RDW) 34.1. Her peripheral smear examination revealed Anisopoikilocytosis, Tear Drop cells, Basophilic stippling, Microcytosis, Hypochromatic red cells and stomatocytes [Table/Fig-1a]. Serum Lactate dehydrogenase (LDH) was 216, serum ferritin was 634, Total iron-binding capacity (TIBC) 47.8 to 51.6, serum haptoglobin 58, Erythrocyte Sedimentation Rate (ESR) 6, serum fibrinogen 248, C-reactive protein (CRP) 1.5, serum folate and vitamin B12 were 4.645 and 392 respectively. Serum copper was 27.4 and serum lead was 0.07. Ultrasonography of abdomen showed splenomegaly. Patient was evaluated for haemolytic disorder. Glucose-6-phosphate dehydrogenase (G6PD), haemoglobin electrophoresis and osmotic fragility tests were normal. Bone marrow examination revealed a hypercellular marrow with erythroid majority with maturing myelopoiesis and some evidence of dysplasia [Table/Fig-1b,c]. When stained with Prussian blue, bone marrow showed ring sideroblasts [Table/Fig-1d]. Enzyme levels of aminolevulinic acid synthase could not be estimated. A diagnosis of congenital sideroblastic anaemia was made. The patient was started on 40 mg oral pyridoxine per day. There was a rise in haemoglobin level from 7.9 to 9 in first three weeks of treatment and the patient is still under follow-up and is 10 years old now.

Multidisciplinary approach to full mouth rehabilitation

A 25-year-old Saudi male reported with pain, swelling in gums, multiple caries, and loss of teeth as a result of caries. A thorough workup and multidisciplinary approach helped to deliver patient with good smile, relief from pain, and gum swellings. Use of radiographs which included orthopantomogram, full mouth series of X-rays, and 4R system for complete analysis of patient gave satisfactory result and brought a smile back to patients face.

프라더윌리증후군 환자에서의 치과 치료 : 증례보고

본 논문에서 소개된 환자는 전형적인 PWS 증상인 섭식 장애, 타액분비감소, 지적장애, 비만과 같은 특성이 관찰되었다. 전신마취 하에서 적극적인 치과 치료를 시행하였고 보호자에게 비만 및 치아 우식을 예방하기 위해 탄수화물과 당분 섭취를 제한하는 식습관에 대한 교육을 시행하였다. 환자의 내원 횟수를 늘려 치과 치료를 위한 전신마취까지 발전하지 않도록 정기적인 관리가 필요하다. Prader-will syndrome (PWS) is a genetic disorder displayed with short stature and behavioral problems. The major manifestation is hyperphagia and obesity but there is no known effective drug that can solve this problem. This article presents a case report of a 3-year 9-month old girl affected with PWS syndrome treated under general anesthesia due to lack of cooperation and multiple caries. The dentist should work as a member of the multidisciplinary medical team. Careful long term follow up is required to prevent dental caries and periodontal diseases as well as maintain good oral hygiene. A strict diet control should also be encouraged.

Culture Negative Abscesses at Multiple Sites: A Diagnostic and Management Dilemma in a District Hospital

Background: Culture negative abscesses at multiple sites are a common phenomenon. It is an important source of sepsis and septic shock in many developed and developing countries worldwide. Case Presentation: This case describes a 42 year-old Malay gentleman who presented to us with high grade fever associated with cough, foul-smelling sputum and pleurisy. He has underlying chronic Type 2 Diabetes Mellitus. He works as a rubber tapper, a smoker with a 40 pack years history, and a teetotaler. On physical examination, he had notable pyrexia with stable vital signs. He was septic looking and had obvious rigors. His dental hygiene was poor with multiple caries. Lungs were clear on auscultation. Examination of the abdomen revealed tender hepatosplenomegaly. Chest radiograph showed multiple cavitating lesions suggestive of lung abscesses. A subsequent Contrast Enhanced Computed Tomography (CECT) of the thorax, abdomen and pelvis revealed multiple lung, liver, splenic and adrenal abscesses of different sizes. A 2D transthoracic echocardiogram did not reveal any vegetation. Tuberculosis and viral screening were negative. His melioidosis serology titer was not significant. Multiple sets of blood, sputum and urine cultures did not grow any organism. He was treated for culture negative abscesses with a six week course of parenteral third generation cephalosporin antibiotics and metronidazole. Repeated imaging showed significant improvement of all abscesses and he responded well clinically. Conclusion: Effective and early management of culture negative abscesses with broad spectrum antibiotics is vital in reducing overall mortality and morbidity.

Prosthetic rehabilitation for a patient with CO-MI discrepancy

Centric occlusion-maximum intercuspation (CO-MI) discrepancy is one of main causes of evoking premature contact and resultant mandibular shift. These non-physiological conditions can induce temporomandibular disease, periodontitis, and non-carious cervical lesion. Therefore, if CO-MI discrepancy exists in patients who need extensive prosthetic rehabilitation, it must be corrected and then physiological occlusion must be restored. This report describes the treatment procedure of removing CO-MI discrepancy and prosthetic rehabilitation in a patient with 3.5 mm discrepancy, multiple caries and periodontitis. Proper mandibular position and modified opening & closing movement were confirmed by ARCUSdigma II and transcranial radiograph.

A rare association of Pierre Robins sequence with bilateral developmental dysplasia of hip—A case report

Four year old female child brought by her mother with history of difficulty in swallowing with frequent leaks of fluids through nose on feeding, speech difficulties, poor growth and abnormal gait. Intelligence was normal. No other members in her family had similar problems. Thorough clinical examination revealed Pierre Robin sequence like facial features, like micrognathia, U shaped cleft palate, glossoptosis with multiple caries in teeth and hypoplastic midface. Hearing and vision were normal. Child also showed hypoplastic thumb, exaggerated lumbar lardosis and bilateral developmental dysplasia of hips. Radiological examination showed bilateral dysplastic hips with acetabular index around 45̊°on both sides. Skeletal survey radiography ruled out features of spondyloepiphyseal dysplasia. Such a combination of Pierre Robins sequence with bilateral dysplastic hips are rare association and have been described only few times in literature.