Fusion of a Tooth with a Supernumerary Tooth: A Case Report and Literature Review of 35 Cases

A Case of Severe Early Childhood Caries Occurring in a Childhood Cancer Patient

BACKGROUND/OBJECTIVES

Childhood cancer is the leading cause of death among children, although medical advances are improving the prognosis. During cancer treatment, nausea or vomiting may occur and eating habits may become irregular; therefore, it is important to prevent the development of oral diseases. We encountered a childhood cancer patient with rapidly progressive multiple dental caries, and this report describes the progress.

METHODS

A boy aged 2 years 9 months was referred for perioperative oral management. No caries were detected in the oral cavity at the initial visit.

RESULTS

As the patient had difficulty eating because of nausea and vomiting during cancer treatment, he began to consume probiotic drinks frequently. At 8-month follow-up, dental caries localized to the primary molars was detected. However, caries had occurred in all erupted teeth by 9 months later, confirming the diagnosis of severe early childhood caries. Dental treatment and long-term oral management contributed to good oral health except for dental abnormalities caused by chemotherapy.

CONCLUSIONS

Childhood cancer patients, particularly at an early age, are at risk of rapid deterioration of oral disease even over a short time period. It is important to cooperate with medical or dental professionals from other hospitals to provide dietary and oral health instruction and continue long-term oral management to improve patients' quality of life.

Case Study of a Broken Instrument in a Primary Tooth and Literature Review

BACKGROUND

Root canal treatment is an important element of dental treatment, and broken instruments are one cause of endodontic treatment failure. Broken instruments are rarely reported in primary teeth because of their inherently wider and relatively straighter root canals. We describe a case of a patient with a broken instrument in a primary tooth and reviewed the literature across three databases.

CASE PRESENTATION

A boy aged 7 years and 2 months was referred to our hospital because of pain persisting despite multiple dental treatments. Radiographic examination revealed a broken instrument in the maxillary right primary second molar. The patient experienced dental fear, so the treatment proceeded with the use of behavioral management and nitrous oxide, after which his pain disappeared. At the age of 9 years and 2 months, eruption of the successive permanent teeth was confirmed, and no pathological findings were observed except enamel hypoplasia. We undertook a literature review across three databases and found only two articles about broken instruments in primary teeth, neither of which described the eruption of the permanent teeth. All three cases involved primary molars.

CONCLUSIONS

We removed a broken instrument from the root of a primary molar and performed root canal treatment, resulting in a good outcome for the primary molar until it was replaced with successive permanent teeth. Although rare, broken instruments in the roots of primary molars do occur, and care should be taken during root canal treatment of primary molars.

Management of a pediatric patient with dental anomalies and its effect on psychosocial status: a case report

Managing multiple dental anomalies in the anterior region of the dental arch presents unique and complex challenges. This case report describes using a multidisciplinary approach to manage a child with not only a fused tooth with a supernumerary but also the presence of other supernumerary teeth in the same place. In this case, deviation from the standard management of a fused permanent anterior tooth, an anchor for aesthetics, by extracting it because of crown root complexity and allowing a supernumerary to erupt into its place made the difference in the successful outcome. However, this condition required multidisciplinary management that necessitated the involvement of the psychiatric department. Continuous assessment of the patient's psychosocial function using the Social Avoidance and Distress Scale (SADS) allowed appropriate guidance to manage the patient's behavior. This case report added a different perspective on managing a fused tooth with a supernumerary to the literature. It showed how dental aesthetics can have an adverse effect on children's psychology.

A Case of Hypophosphatasia Started Enzyme Replacement Therapy Since Babyhood Stage

BACKGROUND

Hypophosphatasia (HPP) is an inherited disease caused by low activity of tissue-nonspecific alkaline phosphatase. Dental characteristics include premature loss of primary teeth, enlarged pulp chambers, and enamel hypoplasia. Although enzyme replacement therapy with asfotase alfa was approved in 2015, there are few reports about the dental outcomes of this treatment.

CASE PRESENTATION

A 1-year-old girl referred to our hospital had already lost two primary teeth at the time of her initial visit. She started enzyme replacement therapy 6 days after birth, and genetic analysis later confirmed the diagnosis of HPP. At the age of 4 years and 7 months, 11 primary teeth had been lost, and some of the exfoliated teeth showed inflammatory root resorption or root fracture. There was also a history of abscess formation in a non-carious primary molar.

CONCLUSIONS

This report suggests that early enzyme replacement therapy may prevent traditional tooth loss in patients with HPP. It also highlights the new challenges posed for dental professionals in providing infection control in large pulp cavities and receding periodontal tissue.

Usefulness of Generative Artificial Intelligence (AI) Tools in Pediatric Dentistry

Background/Objectives: Generative artificial intelligence (AI) such as ChatGPT has developed rapidly in recent years, and in the medical field, its usefulness for diagnostic assistance has been reported. However, there are few reports of AI use in dental fields. Methods: We created 20 questions that we had encountered in clinical pediatric dentistry, and collected the responses to these questions from three types of generative AI. The responses were evaluated on a 5-point scale by six pediatric dental specialists using the Global Quality Scale. Results: The average scores were >3 for the three types of generated AI tools that we tested; the overall average was 3.34. Although the responses for questions related to "consultations from guardians" or "systemic diseases" had high scores (>3.5), the score for questions related to "dental abnormalities" was 2.99, which was the lowest among the four categories. Conclusions: Our results show the usefulness of generative AI tools in clinical pediatric dentistry, indicating that these tools will be useful assistants in the dental field.

Eruption Disturbance in Children Receiving Bisphosphonates: Two Case Reports

BACKGROUND

Bisphosphonates used for the treatment of osteoporosis, hypercalcemia, or heterotopic calcifications can cause serious adverse dental events such as osteonecrosis of the maxillary and mandibular bones. However, the effects in childhood remain scarcely explored.

CASE PRESENTATIONS

We encountered two children who had started bisphosphonate therapy before completion of the primary dentition. No systemic disease causing congenital delayed tooth eruption was diagnosed. Although the children's height and weight increased with age, their tooth eruption was significantly delayed compared with the mean. The primary teeth gradually erupted in the follow-up period; however, some teeth did not completely erupt and needed to be extracted to allow for permanent tooth eruption.

CONCLUSIONS

We report a case of children with early use of bisphosphonates and eruption disturbance, highlighting the need for further investigation into the relationship between these factors.

Dental Abnormalities in Pediatric Patients Receiving Chemotherapy

Background: Chemotherapy is a common treatment for pediatric cancer. Although life prognosis is improving because of advances in medical science, it is important to deal with late effects such as dental abnormalities. We investigated the association between dental abnormalities and chemotherapy by age and tooth type. Methods: Among the 568 patients referred to the pediatric dentistry department of our hospital, we selected 32 patients (21 male and 11 female) who received chemotherapy between the ages of 0 and 6 and underwent panoramic examination after the age of 7. We recorded the age of chemotherapy commencement, diagnosis of systemic disease, and dental abnormalities such as congenital absence, microdonts, and short-rooted teeth. Results: Almost half of the patients had dental abnormalities such as congenital absence, microdonts, and short-rooted teeth, but there were no significant differences in the incidence of these abnormalities by age. When we analyzed the incidence of abnormal teeth by tooth type, the incidence of congenital absence was significantly higher in premolars (5.5%) and second molars (3.9%) than in incisor or canine or 1st molar (0.4%) (p < 0.01). The incidence of microdonts was significantly higher in premolars (3.9%) than in incisor or canine or 1st molar (0.2%) and second molars (0.0%) (p < 0.05). Conclusions: Patients who received chemotherapy had a high prevalence of dental abnormalities, and the incidence of abnormalities varied by tooth type. It is important to maintain long-term oral care for patients who have undergone chemotherapy even after the treatment is completed.

Dental Anomalies in Primary Dentition among Arabian Children: A Hospital-Based Study

An observational study was carried out in a teaching hospital in Saudi Arabia to determine the occurrence of dental anomalies among Arabian children. The study included children of Saudi nationality with primary teeth. The study assessed the prevalence of dental anomalies in their primary dentition. The assessment and data collection were conducted by a single examiner, utilizing clinical examination and intra-oral radiographs. A comparative analysis was conducted to examine dental anomalies in relation to gender (boys and girls) and arch type (maxillary and mandibular). In addition, the study explored the occurrence of gender-specific dental anomalies depending on arch type. The data analysis was conducted using IBM Statistics (version 21.0) with a significance level of p < 0.05. In total, there were 245 children included in the final analysis. The study population consisted of boys (66%) and girls (34%), with an average age of 4.87 ± 0.9 years. Taurodontism was the most prevalent dental abnormality, occurring in 2.8% of the individuals in the study sample. The study sample exhibited hypodontia in 2%, supernumerary teeth in 2.4%, double teeth in 2%, and microdontia in 1.2%. Talon cusp and macrodontia have a relatively low incidence of 0.4%. Boys exhibit supernumerary teeth, microdontia, macrodontia, talon cusp, and taurodontism, whereas hypodontia and double teeth were more frequent in girls.