Experimental oral foreign body reactions. Commonly employed dental materials

Unravelling the Oral-Gut Axis: Interconnection Between Periodontitis and Inflammatory Bowel Disease, Current Challenges, and Future Perspective

As the opposite ends of the orodigestive tract, the oral cavity and the intestine share anatomical, microbial, and immunological ties that have bidirectional health implications. A growing body of evidence suggests an interconnection between oral pathologies and inflammatory bowel disease [IBD], implying a shift from the traditional concept of independent diseases to a complex, reciprocal cycle. This review outlines the evidence supporting an 'oral-gut' axis, marked by a higher prevalence of periodontitis and other oral conditions in IBD patients and vice versa. We present an in-depth examination of the interconnection between oral pathologies and IBD, highlighting the shared microbiological and immunological pathways, and proposing a 'multi-hit' hypothesis in the pathogenesis of periodontitis-mediated intestinal inflammation. Furthermore, the review underscores the critical need for a collaborative approach between dentists and gastroenterologists to provide holistic oral-systemic healthcare.

Be Qui Vive: Unravel the Mystery of Undiagnosed for Better Prognosis

Foreign bodies may access the oral cavity by trauma or iatrogenically. Iatrogenic foreign bodies that are frequently encountered include amalgam, obturation materials, shattered equipment, needles, broken teeth, and so on. Impaction of a tooth or bone fragment in the soft tissues is one type of dental trauma. When foreign bodies are found in the teeth, it's a highly grave scenario that requires prompt diagnosis. Thorough case histories, clinical assessments, and radiographic analyses are required to draw conclusions regarding the type, dimensions, location, and challenge of the foreign body retrieval. Due to the well-known tendency of children to put foreign objects in their mouths, it is more frequently observed in them. From time to time, children get strange items lodged in their teeth, which they are afraid to tell their parents about. These foreign objects might store possible infections, which could eventually result in a painful condition. This paper discusses the presence of unusual foreign bodies-a broken pencil and tooth fragment-and their management.

How to cite this article

Kaul B, Gulbar S, Gupta A, et al. Be Qui Vive: Unravel the Mystery of Undiagnosed for Better Prognosis. Int J Clin Pediatr Dent 2024;17(4):501-509.

Multilocular Myospherulosis of the Mandible: A Case Report

Myospherulosis in the jaw is a rare, foreign body reaction that typically follows tooth extraction and the use of petrolatum-based medicaments. It appears as a radiolucency and can be mistaken for endodontic pathosis or other lesions without thorough clinical and radiographic evaluation as well as biopsy submission. Treatment is surgical removal and the recurrence is rare. This case report presents a unique finding of a posterior mandible multilocular radiolucency appearing as an apical lesion on two-dimensional panoramic imaging until visualized with three-dimensional imaging. Clinical testing and patient referral led to a biopsy and diagnosis of myospherulosis. This is the first case report of myospherulosis presented in the endodontic literature.

Granulomatous diseases: Oral manifestations and recommendations

Granulomatous diseases may present with oral manifestations that are detectable by dental care providers. In certain cases, oral manifestations may precede systemic signs and symptoms. Dentists managing patients with these conditions may modify the dental treatment plan and possibly retain the support of other health professionals. This review gives an update on granulomatous diseases that can be faced by the dental practitioner.

Foreign body granuloma

Foreign bodies can penetrate soft tissues through open wounds, lacerations or through accidents iatrogenically. Among the commonly encountered foreign bodies encountered due to trauma are of glass, metal and wood in nature. We report a case of a 32 year old male who reported to our clinic, complaining of a small wound in the right upper cheek region intraorally since 1 month. Patient had a history of road traffic accident (RTA) 6 months back.

Impression Material Mass Retained in the Mucobuccal Fold

Trapped foreign bodies and tissue reactions to foreign materials are commonly encountered in the oral cavity. Traumatically introduced dental materials, instruments, or needles are the most common materials referred to in the dental literature. This paper describes an iatrogenic foreign body encapsulation in the oral mucosa, clinically appearing as5×10 mm tumor-like swelling with an intact overlying epithelium and diagnosed as a polymeric impression material. Detailed case history and, clinical and radiographic examinations including CBCT and spectrometric analysis of the retrieved sample were necessary to determine accurately the nature, size, and location of the foreign body. It is suggested that the origin of the material relates to an impression made 2 years ago, leaving a mass trapped in a traumatized mucosal tissue.

Oral manifestation in inflammatory bowel disease: a review

Inflammatory bowel diseases (IBDs), including Crohn's disease (CD) and ulcerative colitis, not only affect the intestinal tract but also have an extraintestinal involvement within the oral cavity. These oral manifestations may assist in the diagnosis and the monitoring of disease activity, whilst ignoring them may lead to an inaccurate diagnosis and useless and expensive workups. Indurated tag-like lesions, cobblestoning, and mucogingivitis are the most common specific oral findings encountered in CD cases. Aphthous stomatitis and pyostomatitis vegetans are among non-specific oral manifestations of IBD. In differential diagnosis, side effects of drugs, infections, nutritional deficiencies, and other inflammatory conditions should also be considered. Treatment usually involves managing the underlying intestinal disease. In severe cases with local symptoms, topical and/or systemic steroids and immunosuppressive drugs might be used.

An update on granulomatous diseases of the oral tissues

With new insights into the pathogenesis of specific granulomatous diseases, and with the advent of high-throughput genetic screening and availability of next-generation biological therapies, clinicians have several options at their disposal to help ensure accurate diagnosis and effective treatment. This article highlights some of the current knowledge about the more common granulomatous systemic diseases that may be encountered in clinical practice.

Unusual foreign bodies in the orofacial region

Foreign bodies may be deposited in the oral cavity either by traumatic injury or iatrogenically. Among the commonly encountered iatrogenic foreign bodies are restorative materials like amalgam, obturation materials, broken instruments, needles, and so forth. The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body, and the difficulty involved in its retrieval. It is more common to find this situation in children as it is a well-known fact that children often tend to have the habit of placing foreign objects in the mouth. Sometimes the foreign objects get stuck in the root canals of the teeth, which the children do not reveal to their parents due to fear. These foreign objects may act as a potential source of infection and may later lead to a painful condition. This paper discusses the presence of unusual foreign bodies—a tip of the metallic compass, stapler pin, copper strip, and a broken sewing needle impregnated in the gingiva and their management.

Oral Crohn's disease: is it a separable disease from orofacial granulomatosis? A review

Symptomatic oral Crohn's disease is comparatively rare. The relationship between orofacial granulomatosis, (where there is granulomatous inflammation and ulceration of the mouth in the absence of gastrointestinal disease) and true oral Crohn's disease is discussed along with the plethora of clinical oral disease presentations associated with both disorders and the differential diagnosis of oral ulceration in patients presenting to a gastroenterological clinic. Specific oral syndromes are outlined including the association between oral manifestations in Crohn's disease and the pattern of intestinal disease and their relationship to other recorded extraintestinal manifestations. The histological and immunological features of oral biopsies are considered as well as the principles of management of symptomatic oral disease. At present, it is suggested that both orofacial granulomatosis and oral Crohn's disease appear to be distinct clinical disorders.

A foreign body in the floor of the mouth

A case of unusual presentation of foreign body in the floor of mouth is reported. The patient presented with a history and clinical findings of sublingual ranula. Marsupialisation and sublingual sialadenectomy was planned. After marsupialisation, a foreign body (spray cover) was found between the lumen of the submandibular duct and the ranula.

Granulomatous diseases of the oral tissues: differential diagnosis and update

Because of the relatively nonspecific clinical findings associated with a variety of granulomatous diseases, a microscopic diagnosis of granulomatous inflammation often presents a diagnostic dilemma for the clinician. The most common differential diagnosis includes foreign body reactions, infection, Crohn's disease, sarcoidosis, and orofacial granulomatosis. However, a variety of other conditions may be associated with granuloma formation. Often an extensive clinical, microscopic, and laboratory evaluation may be required to identify the source of the granulomatous inflammation. This article highlights the origin, clinical manifestations, current diagnostic modalities, and treatment of specific granulomatous diseases that may be encountered in clinical practice.

Rheological properties and biocompatibility of endodontic sealers

AIM

To determine the flow characteristics and subcutaneous tissue reactions to five endodontic sealers.

METHODOLOGY

The materials used were Procosol, AH26, Endomethasone, Sealapex and Endion. The sealers were prepared following the manufacturers' instructions, and 0.075 mL of each material was placed on a glass surface, which was then rotated 90 degrees. The samples were stored at 37 degrees C and 95% humidity. The displacement of the sealer was recorded by measuring the difference between its original position and the position recorded at 15 and 60 min. Three samples of each material were used. Two pockets were created in the back of Wistar rats, and one silicone tube, 1 mm in diameter and 1 cm in length, was implanted in each. One was filled with one of the materials under study, and the other empty tube was implanted as a control. Fourteen days after implantation, the animals were sacrificed, and samples of the skin containing the tubes were histologically processed. Histological and histomorphometric evaluations of the tissues adjacent to the open end of the tube were carried out the volume of tissue reaction was measured histomorphometrically according to standard stereological principles. Results were statistically analysed using analysis of variance and Duncan's test.

RESULTS

The highest flow values were obtained with Sealapex and AH26. Time significantly affected the flow and the material (P < (1001). Procosol and Endion produced the most severe histological reactions: these were outlined by fibrous tissue; AH26. Endomethasone and Sealapex produced reactions of smaller size and with more moderately defined limits.

CONCLUSIONS

The flow did not correlate with the degree of inflammatory response. Procosol and Endion produced the most severe tissue reactions, whereas Endomethasone, Sealapex and AH26 produced only minimum reactions.

Relation of dental composite formulations to their degradation and the release of hydrolyzed polymeric-resin-derived products

This article reviews the principal modes of dental composite material degradation and relates them to the specific components of the composites themselves. Particular emphasis is placed on the selection of the monomer resins, the filler content, and the degree of monomer conversion after the clinical materials are cured. Loss of mechanical function and leaching of components from the composites are briefly described, while a more detailed description is provided of studies that have considered the chemical breakdown of materials by agents that are present in the oral cavity, or model the latter. Specific attention will be given to the hydrolysis process of monomer and composite components, i.e., the scission of condensation-type bonds (esters, ethers, amides, etc.) that make up the monomer resins, following reaction of the resins with water and salivary enzymes. A synopsis of enzyme types and their sources is outlined, along with a description of the work that supports their ability to attack and degrade specific types of monomer systems. The methods for the study of biodegradation effects are compared in terms of sensitivity and the information that they provide. The impact of biodegradation on the ultimate biocompatibility of current materials is discussed from the perspective of what is known to date and what remains to be studied. The findings of the past decade clearly indicate that there are many reasons to probe the issue of biochemical stability of composite resins in the oral cavity. The challenge will now be to have both industry and government agencies take a pro-active approach to fund research in this area, with the expectation that these studies will lead to a more concise definition of biocompatibility issues related to dental composites. In addition, the acquired information from such studies will generate the development of alternate polymeric chemistries and composite formulations that will require further investigation for use as the next generation of restorative materials with enhanced biostability.

Histological evaluation of the response of apical tissues to glass ionomer and zinc oxide-eugenol based sealers in dog teeth after root canal treatment

The object of the study was to compare two commercial root canal sealers: Ketac-Endo (a glass ionomer cement) and Fill Canal (a zinc oxide-eugenol cement). A total of 34 root canals from dog premolars with vital pulps were used. After instrumentation, the root canals were sealed with Ketac-Endo and Fill Canal cements using gutta-percha and a lateral condensation technique. After 270 days the animals were sacrificed with an anesthetic overdose and the maxillae and mandibles were removed and fixed in formalin for 48 h. After routine histological processing the sections were stained with hematoxylin-eosin and Mallory trichrome stains. Microscopic analysis revealed that Ketac-Endo cement presented better results than Fill Canal cement.

Cellular inflammatory responses to implanted dental materials

Cellular inflammatory responses to subcutaneous implantation of amalgam and composite resins were assessed in rats by use of histologic and immunocytochemical methods 2 days to 8 weeks after implantation. Frozen and paraffin sections were obtained from subcutaneous tissues associated with amalgam and composite resin suspensions. The amalgam induced mild inflammation with proliferation of few resident macrophages, but implantation of composite resins was associated with an influx of monocytes, increased numbers of resident connective tissue macrophages, and abnormal major histocompatibility antigen class II (Ia antigen) expression. The data suggest that composite resins may produce a a more pronounced inflammatory response than dental amalgams do when incorporated in soft tissues.

Cellular inflammatory responses to direct restorative composite resins

As a result of shaping, finishing, or removal of dental composite resin restorations, resin particles may become trapped and embedded in oral tissues. However, tissue reactions induced by entrapped composite resin particles have not been thoroughly examined. To assess the soft tissue inflammatory response to composite restorative materials, three commercial dental composite resin suspensions were implanted subcutaneously in rats. Implantation resulted in a granulomatous inflammatory reaction that persisted 8 weeks after placement. The lesion was characterized by an influx of lymphocytes and the presence of fibroblasts and epithelioid cells. Composite resin particles have the potential to cause persistent inflammation if they are entrapped in oral tissues.