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Premature exfoliation of primary teeth

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Premature exfoliation of primary teeth

  1. 1. Etiologies of PrematureExfoliation of Primary Teeth Amin Abusallamah
  2. 2. Exfoliation of Primary TeethUsually begin with the lower anteriorteethUsually around the age 6.5 years.
  3. 3. Premature Exfoliation of PrimaryTeeth can be due to: Toxicities Metabolic disorders Malignancies Dental causes Miscellaneous causes
  4. 4. ToxicitiesAcrodyniaRadiation
  5. 5. Acrodynia“Painful extremities”Attributed to chronic exposure to mercuryPrimarily affects young children. Oftenoccurs in infants and young children, withage of onset being between 4 months and8 years.Symptoms: irritability, photophobia, pinkdiscoloration of the hands and feet, andpolyneuritis.Dental: Inflammation, swelling, and focalgum erosion can been seen withsubsequent loss of teeth.
  6. 6. RadiationXerostomiaIncreased caries rateOsteoradionecrosis, leading tochanges in trabeculation, bone loss,radiolucency.May lead to increased tooth mobilityand subsequent tooth loss
  7. 7. MetabolicAcatalasiaChediak-Higashi diseaseGaucher’s diseaseHypophosphatasia (and vit. Dresistant rickets)PseudohypophosphatasiaJuvenile diabetes (diabetes mellitus)Scurvy
  8. 8. AcatalasiaAKA Acatalasemia or Takaharas disease. Thissyndrome is inherited as an autosomal recessive.Acatalasia is characterized by absence of theenzyme catalase.Poor oral hygiene or mouth injury can lead tobacterial infection. Certain bacteria producehydrogen peroxide. The peroxide destroyshemoglobin due to lack of catalase thus deprivingthe infected area of oxygen and causing necrosis.Patients may present progressive gangrenousgingivitis and periodontal disease withdestruction of alveolar bone and loss of teeth.
  9. 9. Chediak-Higashi SyndromeAutosomal recessive traitAbnormal platelets in these patients result in spontaneousbleeding and easy bruising.Eighty five percent of children with CHS develop the acceleratedphase of the syndrome, characterized by a lymphoproliferativereaction. This leads to unusual lymphoma-like condition generallyleading to death.The remaining 15% of patients present less severe clinicalmanifestations of the syndrome. The accelerated phase can betriggered by infections with lymphoproliferative viruses or theEpstein Barr virus.The oral lesions are a consequence of repeated infections andthey consist of ulcers, markedly hypertrophic gingivitis and severeperiodontal destruction. Periodontal treatment of these patients isoften unsuccessful.Due to recurrent intraoral infections there is extensive alveolarbone loss which in most patients leads to tooth exfoliation.
  10. 10. HypophosphatasiaAutosomal recessive4 groups: perinatal (lethal), infantile,childhood, and adultPhenotype can range from premature lossof decidious teeth to severe boneabnormality leading to neonatal death.Characterized by diminished serum levelsof alkaline phosphatase andphosphoethanolamine in the urine
  11. 11. HypophosphatasiaAbnormalcementum or lackof cementum maylead tospontaneousshedding ofprimary teeth.Pulp chambersmay be unusuallylarge.
  12. 12. HypophosphatasiaInfantile varietycharacterized bysevere rickets,hypercalcemia, andfailure to thrive.Fatal.Anterior primaryuniradicular teethare shed.
  13. 13. MalignanciesLangerhans’ Cell HistiocytosisLeukemiaNeutropeniasCyclic NeutropeniaAgranulocytosis
  14. 14. Langerhans’ Cell Histiocytosis
  15. 15. Langerhans’ Cell Histiocytosis Acute Disseminated (Lettere-Siwe) when it affects infants. Manifests clinically hepatosplenomegay and diffuse radiolucent bone lesions, “floating teeth” This type usually fatal.
  16. 16. Leukemia Oral lesions characterized by hyperplastic gingivitis with cyanotic bluish- red discoloration. Diffuse enlargement of gingiva. Poor oral hygiene in can lead to premature loss of teeth.
  17. 17. Dental CausesAnomalous dental treatmentCaries related infectionsPeriodontitisPapillon-Lefevre syndromeCherubism
  18. 18. Periodontitis Localized aggressive periodontitis (also known as prepubertal periodontitis)
  19. 19. PeriodontitisIn Localized Juvenile Periodontitis,there is not much accumulation ofsupragingival plaque and/or calculus.Gingiva is almost normal inappearance. Minimal subgingivalplaque deposition.
  20. 20. Periodontitis Radiographs show marked destruction of alveolar bone with vertical pocket formation. Advanced cases present tooth mobility and malposition which may lead to teeth loss.
  21. 21. Papillon-Lefevre syndrome Key features are palmar and plantar hyperkeratosis. Dentally: attachment and bone loss result in premature loss of primary and permanent teeth.
  22. 22. Papillon-Lefevre syndrome
  23. 23. Miscellaneous CausesDentin DysplasiaTumors of the jawAplastic anemiaSclerodermaFacial hemihypertrophyCherubism (familial fibrous dysplasia)Systemic infections, i.e. tuberculosisOdontodysplasia
  24. 24. Dentin DysplasiaAutosomal dominantTwo types. Type 1 known as radiculardentis dysplasia, and affects bothdentitions. Characteristics are markedlyshort and pyramidal roots.Type 1 is associated with premature loosof teeth.Teeth lost generally due to trauma sincethe short roots lead to easy avulsion.
  25. 25. Dentin DysplasiaNote the characteristically short andpyramidal roots.
  26. 26. Aplastic AnemiaAnemia is a common blood disorder,which is caused when there is a dropin hemoglobin or hematocrit in theblood.
  27. 27. Aplastic Anemia Sore or swollen tongue (glossitis) Oral thrush Bleeding gingiva Impaired wound and tissue healing
  28. 28. Cherubism
  29. 29. CherubismAutosomal dominant fibro-osseouslesion of the jaws involving morethan one quadrant that stabilizesafter the growth period, usuallyleaving some facial deformity andmalocclusion.
  30. 30. Cherubism
  31. 31. Cherubism“Ground glass" appearanceUnilocular or multilocularbilateral expansiveradiolucenicesRandomly distributed teethand multiple uneruptedteethFaint radiopacitiesresembling residual bonessometime present atpubertyRadiographic appearancebecomes moreradiopaque after stabilizationperiod
  32. 32. OdontoplasiaAlso known as “ghost teeth”Affected teeth are poorly mineralized andradiographically appear evanescentThey generally fail to erupt but if they do theyhave the consistency of gelatin. Often need to beextracted.
  33. 33. Misc. Causes (con’t.)Natal and neonatal teethTraumaExtreme bruxismFinger habit
  34. 34. Diagnostic Test for premature exfolioation of primary teethCBC–Hematrocrit, hemoglobin,platelets, RBC, WBCDifferential leukocyte countCell morphologySerum levels- Phosphate, calcium,alkaline phosphatase, blood glucoseErythrocyte sedimentation rate
  35. 35. (con’t.)Urinalysis- glucose,phosphoethenolamineSkull surveyCulture for anaerobic bacteriaGingival biopsyTooth biopsyNeutrophil chemotaxisCD11b/CD18 assays
  36. 36. Referenceshttp://www.dent.ohio-state.edu/postdocgd/Oncology/OralOncology06RadiationComphandoutdfwww.dent.ucla.edu/ftp/pic/visitors/teethlosshttp://www.dental.mu.edu/oralpath/lesions/cherubism/cherubism.htmE.medicine.comJordan, RC. Diagnosis of periodontal manifestations ofsystemicVolume 34 Periodontology 2000diseases. Issue 1 Page 217 - February 2004.Pictures from Dr. Casamassimo’s collectionDr. Eileen Cunnane, Eastman Dental Center, Rochester, NY