Lichen Planus of the Eyelids: Case Report of a Rare Presentation of a Common Dermatosis

Lichen planus (LP) is a common T-cell-mediated autoimmune skin disease, and its exact etiology is unknown. Typically, it affects the trunk, flexural surfaces, and the mucosa.We report a rare finding of LP involving both eyelids in a 67-year-old female. A 67-year-old Saudi female with a medical history of diabetes mellitus, hypothyroidism and rheumatoid arthritis presented with a three-month history of pruritic skin eruptions in both eyelids. She had no associated musculoskeletal symptoms or fatigue and no medical or family history of atopy. The patient had violaceous, thin, scaly plaques confined to both eyelids. Oral mucosa, genitalia, scalp, and nails were not affected. Histopathology from the right lower eyelid confirmed the diagnosis of LP. Hepatitis C virus serology was negative. Patient was examined by ophthalmology to rule out conjunctival involvement of LP. She had dry eyes only. She was initially managed by topical tacrolimus 0.1% ointment and didn't tolerate it due to severe reaction. She tolerated mometasone propionate 0.1% cream, which relieved the itch and partially improved the lesions. Although rare, LP of the eyelids must be considered among differential diagnoses of eyelid dermatitis. It can be confined, or it may concomitantly involve other parts of the body. LP of the eyelid may also extend to the conjunctiva, so it's important to screen patients by ophthalmology to rule out possible ocular involvement. This is the first case report of a Saudi patient with LP confined to the eyelid. The management of LP involving the eyelids is challenging. Treatment options include topical steroids, tacrolimus ointment, phototherapy and oral retinoids (etretinate).

Phototherapy causing a purpuric eruption in a neonate

Neonatal jaundice is a frequent condition in newborns and is commonly treated with phototherapy. We describe the case of a neonate with hemolytic disease of the newborn who developed a rarely described purpuric eruption. Laboratory testing revealed elevated porphyrins.

Morphological variation of gubernacular tracts for permanent mandibular canines in eruption: a three-dimensional analysis

OBJECTIVES

This study aims to evaluate the morphological features of gubernacular tract (GT) for erupting permanent mandibular canines at different ages from 5 to 9 years old with a three-dimensional (3D) measurement method.

METHODS

The cone-beam CT images of 50 patients were divided into five age groups. The 3D models of the GT for mandibular canines were reconstructed and analysed. The characteristics of the GT, including length, diameter, ellipticity, tortuosity, superficial area, volume, and the angle between the canine and GT, were evaluated using a centreline fitting algorithm.

RESULTS

Among the 100 GTs that were examined, the length of the GT for mandibular canines decreased between the ages of 5 and 9 years, while the diameter increased until the age of 7 years. Additionally, the ellipticity and tortuosity of the GT decreased as age advanced. The superficial area and volume exhibited a trend of initially increasing and then decreasing. The morphological variations of the GT displayed heterogeneous changes during different periods.

CONCLUSIONS

The 3D measurement method effectively portrayed the morphological attributes of the GT for mandibular canines. The morphological characteristics of the GT during the eruption process exhibited significant variations. The variations in morphological changes may indicate different stages of mandibular canine eruption.

An outbreak of Gynanisa maja (Lepidoptera: Saturniidae) larvae in the south-eastern lowveld of Zimbabwe

The larvae of speckled emperor moths (Gynanisa maja) are important plant defoliators in savanna ecosystems of southern Africa and a valuable food resource for indigenous communities. Population explosions of G. maja larvae can negatively impact an area's primary productivity thereby altering herbivory patterns and associated ecosystem processes. Harvests of the larvae enhance socio-economic livelihoods of local people by providing a source of protein and improving household incomes. We report on a population outbreak of G. maja larvae that occurred in south-eastern Zimbabwe between December 2022 and January 2023 and discuss the ecological and social significance of the event. A total biomass weight of 5811 tons of G. maja larvae was estimated over the area of the outbreak and extensive defoliation was recorded in Colophospermum mopane trees. We could not associate the outbreak with any obvious environmental conditions and speculate that it may have been caused by subtle triggers that are not easily identified.

Ectopic Permanent Molars: A Review

Ectopic permanent molar is a condition in which the permanent tooth deviates from its normal path of eruption. The etiology of this eruption anomaly is multifactorial, with both general and local factors. The principal results suggest that a valid indicator of irreversible consequences is the degree of impaction of the first permanent molar. Self-correction is most common between the ages of 7 and 8, after which help may be required. Accordingly, early management can assist in preventing subsequent potential challenges that could interfere with maintaining a balanced occlusion. Several variables, including the degree of mesial tilting, the level of root resorption, and the condition of the second primary molar, may be crucial in choosing the most effective method of treatment. Interproximal wedging and distal tipping are the two basic therapeutic strategies for ectopic permanent molars. Additionally, the use of fixed or removable appliances might also be required. Delaying treatment until a later stage is not recommended because early diagnosis and treatment are essential for optimal management. This review aims to provide a comprehensive overview of ectopic permanent molars, including their prevalence, etiologic factors, self-correction rates, clinical implications for adjacent teeth, and various treatment techniques, that emphasizes the importance of early detection and intervention in the successful management of ectopic permanent molars. In addition, it highlights the importance of future research into the contributing variables of irreversible ectopic molar outcomes.

Infrared Spectroscopy to Analyze Sexual Dimorphism of Hard Dental Tissue Maturation at Eruption in Patients with Connective Tissue Dysplasia

The aim of this study was to research the biochemical changes in the hard tissues of the lower "wisdom" teeth, which are at the stage of eruption, with connective tissue dysplasia, depending on sex. The study involved 38 patients aged 17-25 years, who had the extraction of the lower third molars on the left and right for medical reasons. Twenty-one participants in the experiment (16 females, five males) were diagnosed with connective tissue dysplasia; the remaining 17 were healthy and made up the control group (11 females, six males). Samples of enamel, dentin, and enamel-dentin junction were dried to constant weight and examined in tablets pressed in a mixture with potassium bromide on an FT-801 Fourier transform infrared (FT-IR) spectrometer (NPF Simex, Russia) in the range of 500-4000 cm^-1. In the IR spectra of the enamel, enamel-dentin junction, and dentin, the absorbance ratio of amide I and II changed significantly and the absorbance of the absorption band of phosphate ions decreased from enamel to dentin. Differences between groups with and without connective tissue dysplasia increased in the following series: dentin, enamel-dentin junction, and enamel. With connective tissue dysplasia, a change in the ratio of the intensities of the absorption bands of amide I and phosphate ions was observed. Normally, the content of organic substances in the enamel of the teeth in the males group is lower than in the females group. Against the background of connective tissue dysplasia, the content of organic substances in the enamel in women decreased while in men it increased, which confirmed the presence of sexual dimorphism during the maturation of hard dental tissues at the eruption stage. The study confirms the opinion of many researchers about the significant role of collagen proteins, which, together with non-collagen proteins, are involved in the development and maturation of dental hard tissues, which are characterized by pronounced heterogeneity and sexual dimorphism in the group with connective tissue dysplasia.

Time and sequence of the replacement of the deciduous by the permanent dentition in dogs and its applicability for age estimation

This study investigated the influence of several covariates on the time and sequence of permanent dentition emergence following exfoliation of the deciduous teeth in puppies. The aim was to determine whether the emergence of permanent dentition can be used to assess whether a puppy that is traded across borders in the EU has reached the legally required minimum age of 15 weeks. The events were evaluated in a longitudinal study, with some cross-sectional observations, of 440 puppies belonging to 82 breeds. No significant differences were found between the left and right sides of a puppy's dentition nor between male and female puppies. Breed size and skull type had a significant impact: both the appearance and the completion of tooth eruption occurred considerably later in small or toy breeds and brachycephalic skull type breeds. The sequence of emergence differed little between maxillary or mandibular quadrants or between breeds. The first emerging elements were the maxillary first premolars or first incisors or the mandibular first incisors. The emergence of a permanent tooth usually occurred within 3 days before or after exfoliation of its precursor, except for the canines, which demonstrated a wider tooth replacement interval. This study presents standards for age assessment based on the emergence of permanent dentition for breeds of different sizes, using median ages or cumulative emergence percentages. However, the legal age determination of puppies with an assumed age of 15 weeks cannot be performed based on permanent dentition emergence, as this occurred at a later age in a large proportion of dogs (at least 95%) in our studied population. The probability of being at least 15 weeks old when at least one maxillary tooth has emerged was at least 72.25%, depending on breed size.

[General ideas about the stages, classifications, pathological conditions during the lower third molars eruption in humans. Literature review. Part 2]

The article is a review of literature data on the stages, classifications, pathological conditions during the eruption of the lower third molars in humans. The authors analyzed the established knowledge about clinical and morphological changes at various stages of eruption of the lower third molars, studied new data describing the pathogenetic, histological and biochemical features of their development, packaging, movement to the occlusal plane. The literature review helped to identify a series of current trends that define a number of key hypotheses that summarize the accumulated material and indicate different opinions on the topic under study, which confirms the prospects and relevance of continuing research.

[General ideas about the stages, classifications, pathological conditions during the lower third molars eruption in humans. Literature review. Part 1]

The article is a review of literature data on the stages, classifications, pathological conditions during the eruption of the lower third molars in humans. The authors analyzed the established knowledge about clinical and morphological changes at various stages of eruption of the lower third molars, studied new data describing the pathogenetic, histological and biochemical features of their development, packaging, movement to the occlusal plane. The literature review helped to identify a series of current trends that define a number of key hypotheses that summarize the accumulated material and indicate different opinions on the topic under study, which confirms the prospects and relevance of continuing research.

Health status of children's first permanent molars in Henan province from 2015 to 2020

OBJECTIVES

To investigate the eruption, caries, and pit and fissure sealing of the first permanent molars in children aged 6-9 years in Henan province.

METHODS

The data of oral health examination in Henan province from 2015 to 2020 were analyzed in the information management system of China Children Oral Disease Comprehensive Intervention Project.

RESULTS

Among 486 865 children in Henan province, the total eruption rate of the four first permanent molars was 73.44%, The prevalence rate of dental caries was 30.35%, DMFT was 0.67±1.18, the ratio of caries fil-ling was 4.45%, and the rate of pit and fissure sealing was 2.36%. From 2015 to 2020, the total eruption rates of the four first permanent molars in children aged 6, 7, and 8 showed a decreasing trend (χ2trend was 385.793, 964.142, and 71.964, respectively, all P<0.05). The prevalence rates of dental caries, DMFT caries filling ratio, and pit and fissure sealing rate in children aged 6-9 increased (χ2trend/Ftrend was 1 115.87, 1 270.53, 1 215.02, 763.48, respectively, all P<0.05). The total eruption rates of the four first permanent molars in suburban counties (75.41%) were higher than those in urban areas (71.90%) (χ2=756.44, P<0.05). The prevalence rates of dental caries, DMFT, filling ratio, and pit and fissure sealing rate in urban areas (34.23%, 0.76±1.24, 4.99%, and 3.75%, respectively) were higher than those in suburban areas (25.39%, 0.55±1.09, 3.50%, and 0.58%, respectively) (χ2 was 4 435.30, 3 922.56, 390.89, and 5 262.76, respectively, P<0.05). The first permanent molar eruption completely rate maxillary (84.96%) was higher than mandible (82.88%) (χ2=1 565.70, P<0.05), and the dental caries risk of the mandible (26.07%) was higher than that of the upper (13.88%) (χ2=38 112.53, P<0.05).

CONCLUSIONS

The health status of the first permanent molars of children aged 6-9 years in Henan province is not optimistic. The eruption rate decreased, the incidence of caries increased, and the rates of caries filling and pit and fissure sealing were low. We should pay attention to children's eating habits and oral health, strengthen oral health education, and improve oral health awareness.

DERMATOLOGY IN A MULTIDISCIPLINARY APPROACH WITH INFECTIOUS DISEASE AND OBSTETRIC MEDICINE AGAINST COVID-19

The care for patients infected with COVID-19 requires a team approach, and dermatologists may collaborate with other specialties, especially infectious disease (ID) medicine and obstetrics and gynecology (ObGyn), at every stage of the infection process. A broad spectrum of cutaneous manifestations may occur early in COVID-19 infection, making appropriate dermatologic identification critical for an early diagnosis. There is prognostic value in appropriately identifying different types of COVID-19–associated skin manifestations, which have been linked to disease severity. Such observations emanated from dermatology research, especially large series and international registries of cutaneous manifestations relating to COVID-19, and impact COVID-19 care provided by most health care providers. Also, research based on international registries of skin reactions from the COVID-19 vaccines has an impact across disciplines. An increased risk for severe illness from COVID-19 is encountered during pregnancy, and dermatologists’ role is to urge ObGyn and other clinicians to monitor and educate pregnant patients about the potential for eruptions as a manifestation of COVID-19. ID and ObGyn experts indicate that teledermatology enhanced the interaction among health care providers and improved COVID-19 care. More than 40% of all dermatology consultations at a tertiary care hospital were done via teledermatology. Future collaborative research involving dermatology and specialties, such as ID and ObGyn, could help delineate guidelines for dermatology consultations in patients infected with COVID-19 and determine cases appropriate for teledermatology.

Ectopic Eruption of Maxillary First Permanent Molars: Preliminary Results of Prevalence and Dentoskeletal Characteristics in Spanish Paediatric Population

The ectopic eruption of the maxillary first permanent molar (EEM) is a local alteration of dental eruption with a multifactorial aetiology. The aims of our study were to determine the prevalence of the EEM in children and to analyse whether there is a relationship between EEM and dento-skeletal characteristics. A total of 322 children were analysed with the Ricketts cephalometric study and descriptive and analytical statistical analysis was carried out. The prevalence of EEM was 8.7%, with no statistically significant differences regarding gender or location, but a higher prevalence in the 7-year-old age group (18.8%) and bilateral EEM was more prevalent than unilateral EEM (p < 0.05). The most frequent findings were a shortened anterior cranial base, a retroposition of the maxilla and a distal position of the upper permanent first molar in relation to the pterygoid vertical in children with EEM. No statistically significant differences were found regarding the cephalometric parameters except a decreased palatal plane in the bilateral EEM group and a distal upper incisor position in the EEM group (p < 0.05). In conclusion, the prevalence of the EEM was 8.7%, more frequently bilateral, and significantly in seven-year-old patients. Children with bilateral EEM have decreased palatal plane values and a more posterior position of the upper incisor.

SARS-CoV-2 and Skin: The Pathologist's Point of View

The SARS-CoV-2 pandemic has dramatically changed our lives and habits. In just a few months, the most advanced and efficient health systems in the world have been overwhelmed by an infectious disease that has caused 3.26 million deaths and more than 156 million cases worldwide. Although the lung is the most frequently affected organ, the skin has also resulted in being a target body district, so much so as to suggest it may be a real "sentinel" of COVID-19 disease. Here we present 17 cases of skin manifestations studied and analyzed in recent months in our Department; immunohistochemical investigations were carried out on samples for the S1 spike-protein of SARS-CoV-2, as well as electron microscopy investigations showing evidence of virions within the constituent cells of the eccrine sweat glands and the endothelium of small blood vessels. Finally, we conduct a brief review of the COVID-related skin manifestations, confirmed by immunohistochemistry and/or electron microscopy, described in the literature.

Ingrowth of Mineralized Tissue into the Root Canal of Immature Permanent Teeth after a Traumatic Injury: A Report of 3 Cases

The aim of this case series was to describe the endodontic management of 3 immature permanent teeth that sustained traumatic injuries and subsequently presented with complete ingrowth of mineralized tissue into the canal space. Ingrowth of bone/mineralized tissue into the canal has been considered a poor long-term outcome with an inherent risk of ankylosis. In cases 1 and 2, no endodontic treatment was undertaken, except for emergency management requiring splinting. The cases were followed for 36 and 23 months, respectively. No ankylosis was evident over the review period, and normal teeth eruption was apparent. In case 1, the tooth was treated orthodontically and was responsive to pulp sensibility testing. In both cases, there was an appearance of an internal periodontal ligament-like space on the inner root wall of the canal. In case 3, 2 years postinjury, pulp necrosis and apical periodontitis occurred, and the tooth was managed with regenerative endodontic treatment consistent with the European Society of Endodontology and the American Association of Endodontists guidelines/recommendations for a regenerative procedure. The case was followed for 8 years after regenerative endodontic treatment. No ankylosis was noted with normal eruption of the teeth. The tooth was responsive to pulp sensibility testing despite the ingrowth of mineralized tissue, which was confirmed clinically.

Biochemical evidence accumulates across neurons to drive a network-level eruption

Neural network computations are usually assumed to emerge from patterns of fast electrical activity. Challenging this view, we show that a male fly's decision to persist in mating hinges on a biochemical computation that enables processing over minutes to hours. Each neuron in a recurrent network contains slightly different internal molecular estimates of mating progress. Protein kinase A (PKA) activity contrasts this internal measurement with input from the other neurons to represent accumulated evidence that the goal of the network has been achieved. When consensus is reached, PKA pushes the network toward a large-scale and synchronized burst of calcium influx that we call an eruption. Eruptions transform continuous deliberation within the network into an all-or-nothing output, after which the male will no longer sacrifice his life to continue mating. Here, biochemical activity, invisible to most large-scale recording techniques, is the key computational currency directing behavior and motivational state.

Eruptions and related clinical course among 296 hospitalized adults with confirmed COVID-19

Background

Limited information exists on mucocutaneous disease and its relation to course of COVID-19.

Objective

To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19.

Methods

Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020.

Results

Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance.

Limitations

Skin biopsies were not performed.

Conclusions

Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.

Stokes settling and particle-laden plumes: implications for deep-sea mining and volcanic eruption plumes

Turbulent buoyant plumes moving through density stratified environments transport large volumes of fluid vertically. Eventually, the fluid reaches its neutral buoyancy level at which it intrudes into the environment. For single-phase plume, the well-known theory of Morton, Taylor and Turner (Morton BR, Taylor GI, Turner JS. 1956 Turbulent gravitational convection from maintained and instantaneous sources. Proc. R. Soc. A 234, 1-23. (doi:10.1098/rspa.1956.0011)) describes the height of the intrusion with great accuracy. However, in multiphase plumes, such as descending particle plumes formed from the surface vessel during deep-sea mining operations, or ascending volcanic plumes, consisting of hot gas and dense ash particles, the sedimentation of particles can change the buoyancy of the fluid very significantly. Even if the plume speed far exceeds the sedimentation speed, the ultimate intrusion height of the fluid may be significantly affected by particle sedimentation. We explore this process, illustrating the phenomena with a series of analogue experiments and some simple modelling, and we discuss the applications in helping to quantify some environmental impacts of deep-sea mining and in helping to assess the eruption conditions leading to the formation of large laterally spreading ash clouds in the atmosphere. This article is part of the theme issue 'Stokes at 200 (part 2)'.

Three cases of COVID-19 patients presenting with erythema

Individuals infected with the novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2 [SARS‐CoV‐2]) who develop coronavirus disease 2019 (COVID‐19) experience many symptoms; however, cutaneous manifestations are relatively rare. The authors encountered three patients with COVID‐19 who presented with erythema and suspected viral rash. In all cases, erythema appeared after the onset of the initial symptoms of COVID‐19. Erythema was considered to be caused by COVID‐19 and not a drug‐induced eruption because, in all cases, erythema was relieved merely by external medicine and oral antihistamines, without discontinuing the original medication. The authors’ hospital accepted 69 COVID‐19 patients between 22 February 2020 and 31 May 2020 and, of these, three (4.3%) exhibited eruptions, and all cases presented erythema. Except for seven patients who exhibited positive nasopharyngeal swab tests for SARS‐CoV‐2 RNA but no symptoms, three (4.8%) of the remaining 62 patients exhibited erythema. Although various types of eruptions have been reported in patients with COVID‐19, erythema was the only type in our patients. Erythema in the three patients exhibited many similarities to that previously reported in COVID‐19 patients, particularly in the manner it appeared and disappeared. For these reasons, these three cases were considered typical examples of erythema in patients with COVID‐19. Considering previous studies and the three cases reported here, there is a high probability that SARS‐CoV‐2 can cause erythema.

Efficacy of Operculectomy in the Treatment of 145 Cases with Unerupted Second Molars: A Retrospective Case-Control Study

The aim of this study is to assess whether operculectomy in patients with retained second molars eases spontaneous tooth eruption in respect to untreated controls. Two hundred and twenty-two patients with delayed eruption of at least one second molar were selected from the archives of the Department of Orthodontics, Milan, Italy. Eighty-eight patients, 40 males and 48 females (mean age 14.8 ± 1.3 years), met the inclusion criteria. Records were then divided into case and control groups. The case group consisted of patients that underwent removal of the overlaying mucosa over second molars (i.e., operculectomy) and the control group consisted of subjects who retained their operculum over an unerupted second molar and were followed for one year without performing any treatment. A total of 145 impacted second molars were considered (75 cases, 70 controls). A risk ratio with 95% confidence interval was used to compare the prevalence of eruption in the two groups. Spontaneous eruption occurred in 93.3% of cases in the operculectomy group (70/75), while in the control group, 10% teeth erupted spontaneously (7/70). Spontaneous eruption in the upper arch occurred in 95.2% of cases among treated patients (40 out of 42), while in the lower arch, spontaneous eruption occurred in 90.9% of cases (30 out of 33). Spontaneous eruption of the upper second molars in the control group occurred in 8.5% of cases (3 out of 35), while in the lower arch, it occurred in 8.5% (3 out of 35). Operculectomy can ease the spontaneous eruption of retained second molars and reduce the chances of inclusion.

Depth of Gingival Sulcus in Healthy Children with Erupting Permanent Teeth

INTRODUCTION

Measuring the gingival sulcus depth in children while their permanent teeth erupt is rather difficult especially if using reference norms for adults for a base.

AIM

Assessment of the depth of the gingival sulcus during the period of tooth eruption in healthy children.

MATERIALS AND METHODS

Thirty children were included in the study (age range 6 - 14 yrs). The children had good oral hygiene and no history of systemic disease. They were clinically examined - their dental statuses were taken, stages of permanent teeth eruption (up to 1/3 of the clinical crown, between 1/3 and 2/3, over 2/3, in occlusion contact), and their gingival sulcus depth was measured at 6 distovestibular, vestibular, mesiovestibular, mesiolingual, lingual, and distolingual sites using an electronic probe Parometer (Orange). It was concluded that the one with the highest value would be considered the maximum depth of the sulcus.

RESULTS

The gingival sulcus depth in fully erupted teeth is very similar to that in healthy adults (2.20 - 0.49 mm). The change of sulcus depth in incisors and canines has a variation of 1.5 mm, which at the end of eruption is close to those in adults. Maximum sulcus depth for molars, premolars and incisors was measured distovestibularly, and for canines - mesiovestibularly.

CONCLUSION

At the various stages of eruption, the depth of the gingival sulcus plausibly decreases in all tooth types, and by the end of eruption it reaches a depth similar to that of the adult standard. Most indicative in regard to depth are the vestibular probing point.

Bilateral Ectopic Eruption of a Maxillary Third Molar Tooth from the Infratemporal Surface of the Maxilla in a Dry Human Skull

Unilateral ectopic eruption in an infratemporal region (ITR) is rare and hardly documented a couple of times. However, the bilateral third molar in the ITR presented here is rarely described. ITR has a complex anatomy and is a house of many vital structures. Ectopic eruption of a tooth in this region may manifest in different ways depending on the effected anatomical structure. In this article, we report bilateral ectopic erupted third maxillary molar tooth that was found in a dry human skull. The tooth was partially erupted on both sides from the infratemporal surface of the maxilla, and the direction of the eruption was downward and laterally. The morphology and morphometric measurement of the ectopic tooth with the surrounding anatomical structures has been performed with the help of Vernier caliper. Knowledge of such rare anomalies may be helpful for the ear, nose, and throat and maxillofacial surgeon for the early diagnosis and treatment, hence avoiding the unnecessary hassle of the patient.

Atorvastatin-induced Lichenoid Drug Eruption: A Case Report and Review of Statin-associated Cutaneous Adverse Events

Statin medications [3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors] are generally used to treat hypercholesterolemia. Lichenoid drug eruptions are a potential cutaneous side effect of medications including antibiotics, antimalarials, and statins. This drug eruption can mimic features of idiopathic lichen planus in clinical presentation and pathology. We describe the case of a 73-year-old man who developed a lichenoid drug eruption secondary to atorvastatin. His clinical features, in addition to histological findings, helped to establish the diagnosis. The cutaneous eruption resolved one month after the cessation of atorvastatin and with corticosteroid therapy. Statins have been associated with adverse events including bullous dermatosis, eosinophilic fasciitis, lichenoid drug eruption, and phototoxicity. Lichenoid drug eruption associated with statin therapy requires discontinuation of the statin medication; an alternative class of medication for the treatment of hypercholesterolemia is usually necessary.

A Clinical, Radiographic and Histological Study of Unerupted Teeth in Dogs and Cats: 73 Cases (2001-2018)

Lack of dental eruption may be accompanied by development of dentigerous cysts and has also been rarely associated with neoplasia. However, little information is available on prevalence of unerupted teeth and associated lesions in dogs and cats. The main objective of this study was to describe the epidemiologic data of canine and feline dental patients with unerupted teeth, and assess the prevalence of associated dentigerous cysts and tumors. Secondary aims included the evaluation of possible factors implicated in cystic development, and description of the histological features of dentigerous cysts. Medical and dental records, intraoral photographs, intraoral radiographs of client-owned dogs and cats with clinically missing teeth examined between 2001 and March 2018 were reviewed. Collected data included signalment, reason for presentation, number, type, depth of inclusion and angulation of unerupted teeth, presence of cystic lesions or tumors, abnormalities affecting involved teeth, histopathological findings, performed treatment and outcome. Seventy-three animals (69 dogs and 4 cats) with 113 unerupted teeth were included. The most frequent unerupted tooth in dogs was the first premolar teeth (78%), followed by the canine and third molar teeth. Dentigerous cysts were diagnosed associated with 48 (44.4%) teeth in dogs and one out of five unerupted teeth in cats. The affected teeth in dogs were predominantly in horizontal inclination (40%) and in soft tissue inclusion (77%). Brachycephalic canine breeds were overrepresented. The only unerupted tooth in boxer dogs was the first premolar tooth (32 teeth). Ninety percentage of boxers with unerupted teeth developed associated lesions (25 dentigerous cysts and one tumor). Two ameloblastomas (one in a dog and one in a cat) and one osteosarcoma (in a dog) were diagnosed in association with three unerupted teeth. Histology was essential in diagnosing two odontogenic cysts not evident on radiographs. In all cases that were followed-up, treatment (i.e., extraction, extraction and surgical curettage, or operculectomy) appeared successful. Untreated dentigerous cysts showed progression at re-examination. None of the unerupted teeth without evidence of cyst at the time of diagnosis showed incipient cystic development. None of the evaluated factors were associated with lack of eruption and/or development of associated lesions.

Hidden Caries: A Case Report of a 17 Years Old Male with Two Affected Mandibular Premolars

Hidden caries is the term used to describe carious lesions that are not visualized clinically on erupted teeth but can be detected radiographically. The exact etiology remains an area of controversy. The purpose of the current case report was to discuss the diagnosis and treatment of two mandibular premolars with hidden caries. After diagnosis was established, both premolars were treated with indirect pulp caps and resin-based composite restorations. A one year follow up appointment revealed both teeth to be free from signs and symptoms of inflammation.

Follicular eruption with folliculotropic lymphocytic infiltrates associated with anti-tumor necrosis factor alpha therapy: Report and study of 3 cases

BACKGROUND

We have encountered three cases of follicular eruptions with folliculotropic infiltrates of non-atypical lymphocytes associated with anti-tumor necrosis factor alpha (TNF-α) therapy.

METHODS

Three patients aged 15 to 56 years treated with anti-TNF-α therapy (one with adalimumab, and two with infliximab) developed follicular eruptions characterized histopathologically by folliculotropic lymphocytic infiltrates. These were studied clinically, histopathologically, immunophenotypically, and molecularly.

RESULTS

All three cases were characterized histopathologically by folliculotropic cell infiltrates of non-atypical T (CD3+) lymphocytes with variable follicular exocytosis. Marked reduction in CD7 staining and marked predominance of CD4+ cells over CD8+ cells were observed in 1 and 2 cases, respectively. T-cell receptor (TCR) gene rearrangement studies were monoclonal in 1 case. Discontinuation of anti-TNF-α therapy in all three cases, with corticosteroid creams in 1 case, led to complete resolution. Rechallenge with adalimumab in 1 case resulted in exacerbation. Replacement of therapy with non-anti-TNF-α biologic agents in 2 cases was not associated with recurrence.

CONCLUSION

Follicular eruptions with folliculotropic lymphocytic infiltrates associated with anti-TNF-α therapy may show some immunophenotypical variations and/or monoclonal TCR gene rearrangements but lack sufficient cytomorphological features of folliculotropic MF. They may resolve with discontinuation of anti-TNF-α therapy.

Subgingival Microbiota during Formation of Permanent Dentition

BACKGROUND

Periodontal pathology in children has distinctive characteristics that can be accounted for by the peculiarities of the age, the dynamically changing oral environment, and the processes of formation and stabilization of periodontal structures during teeth eruption.

AIM

The aim of this study was to investigate the composition of the subgingival microbiota during permanent dentition formation in puberty.

MATERIALS AND METHODS

The study included 30 children aged between 10 and 15 years without gingivitis (up to 25% PBI), with good oral hygiene, with no systemic diseases or reception of antibiotics for 3 months. The clinical status of all children was assessed using a specially designed chart based on the periodontal examination chart of a child adopted by the Department of Pediatric Dentistry, FDM-Sofia. Gingival sulcus samples were taken with a paper pin from 6 teeth for a PCR - Real Time study of 9 control strains (a comprehensive sample). The samples were sent for investigation in standardized containers.

RESULTS

C. gingivalis (green complex) was found in almost all tested children and F. nucleatum (orange complex) - in more than half of them. The rest of the tested samples for microorganisms was isolated in just few of the children (6% - 17%). A. actinomycetemcomitans and P. gingivalis were not isolated in this study.

CONCLUSION

The results of the study suggest that a significant amount of the periodontal pathogens migrate to the subgingival zone relatively early, immediately after the permanent teeth eruption, and become a risk factor for the development of periodontal disease.

Continuous eruption of maxillary teeth and changes in clinical crown length: A 10-year longitudinal study in adult women

BACKGROUND

Continuous physiologic eruption of teeth may become a main aesthetic issue for implants inserted in the maxillary anterior region.

PURPOSE

To study maxillary tooth vertical changes during a 10 years period by 3-dimensional superimposition of digital dental casts.

MATERIAL AND METHODS

Alginate impressions were taken at both baseline and at the 10-year follow-up in a sample of 24 adult Swedish women (average age of 48 years at T0). The upper arch plaster casts were digitized with a 3-dimensional scanner and then superimposed on the palate and the palatal rugae. Occlusal and gingival anatomic structures were digitized for each upper tooth from first molar to first molar. The vertical changes of these structures gave an indication of tooth extrusion and apical or coronal displacement of the gingival margin.

RESULTS

A trend was found for eruption in the anterior region (+0.3 mm on average) while a slight extrusion if not any was found in the first molars and premolars area. Vertical displacement of the gingival margin showed also a positive trend from first molars to incisors. Negative average values, corresponding clinically to gingival recession, were found on first molars (-0.36 mm) and premolars (-0.15 mm), while no displacement was detected in the anteriors. Clinical crown lengths increased in all teeth and it is mainly due to gingival recession for first molars and premolars, while for the incisors the eruption is coupled to a slight equivalent gingival coronal migration.

CONCLUSIONS

During a 10-year period, continuous eruption takes place in female adult subjects, especially in the upper incisors area while gingival recession occurred in first molars and premolars area leading to crown length elongation. Implant placement in the anterior area of the maxilla may have an aesthetic impact even in mature adults due to the continuous eruption of the adjacent teeth.

Warm storage for arc magmas

Felsic magmatic systems represent the vast majority of volcanic activity that poses a threat to human life. The tempo and magnitude of these eruptions depends on the physical conditions under which magmas are retained within the crust. Recently the case has been made that volcanic reservoirs are rarely molten and only capable of eruption for durations as brief as 1,000 years following magma recharge. If the "cold storage" model is generally applicable, then geophysical detection of melt beneath volcanoes is likely a sign of imminent eruption. However, some arc volcanic centers have been active for tens of thousands of years and show evidence for the continual presence of melt. To address this seeming paradox, zircon geochronology and geochemistry from both the frozen lava and the cogenetic enclaves they host from the Soufrière Volcanic Center (SVC), a long-lived volcanic complex in the Lesser Antilles arc, were integrated to track the preeruptive thermal and chemical history of the magma reservoir. Our results show that the SVC reservoir was likely eruptible for periods of several tens of thousands of years or more with punctuated eruptions during these periods. These conclusions are consistent with results from other arc volcanic reservoirs and suggest that arc magmas are generally stored warm. Thus, the presence of intracrustal melt alone is insufficient as an indicator of imminent eruption, but instead represents the normal state of magma storage underneath dormant volcanoes.

Erupted complex odontoma of the posterior maxilla: A rarity

Complex odontomas, hamartomas of aborted tooth development, mainly occur in posterior part of the mandible and rarely erupt into the oral cavity. The spontaneous eruption may be associated with pain, inflammation of adjacent soft tissues or recurrent infection. The present case of complex odontoma is of particular interest due to its apparent eruption in the maxillary posterior segment, its association with agenesis of the second molar and impacted third molar; with the lesion being completely asymptomatic.

Microbiological characterization of post-eruption "snowblower" vents at Axial Seamount, Juan de Fuca Ridge

Microbial processes within the subseafloor can be examined during the ephemeral and uncommonly observed phenomena known as snowblower venting. Snowblowers are characterized by the large quantity of white floc that is expelled from the seafloor following mid-ocean ridge eruptions. During these eruptions, rapidly cooling lava entrains seawater and hydrothermal fluids enriched in geochemical reactants, creating a natural bioreactor that supports a subseafloor microbial “bloom.” Previous studies hypothesized that the eruption-associated floc was made by sulfide-oxidizing bacteria; however, the microbes involved were never identified. Here we present the first molecular analysis combined with microscopy of microbial communities in snowblower vents from samples collected shortly after the 2011 eruption at Axial Seamount, an active volcano on the Juan de Fuca Ridge. We obtained fluid samples and white flocculent material from active snowblower vents as well as orange flocculent material found on top of newly formed lava flows. Both flocculent types revealed diverse cell types and particulates when examined by phase contrast and scanning electron microscopy (SEM). Distinct archaeal and bacterial communities were detected in each sample type through Illumina tag sequencing of 16S rRNA genes and through sequencing of the sulfide oxidation gene, soxB. In fluids and white floc, the dominant bacteria were sulfur-oxidizing Epsilonproteobacteria and the dominant archaea were thermophilic Methanococcales. In contrast, the dominant organisms in the orange floc were Gammaproteobacteria and Thaumarchaeota Marine Group I. In all samples, bacteria greatly outnumbered archaea. The presence of anaerobic methanogens and microaerobic Epsilonproteobacteria in snowblower communities provides evidence that these blooms are seeded by subseafloor microbes, rather than from microbes in bottom seawater. These eruptive events thus provide a unique opportunity to observe subseafloor microbial communities.

Expression of Clu and Tgfb1 during murine tooth development: effects of in-vivo transfection with anti-miR-214

Expression of clusterin (Clu) in the murine first molar tooth germ was markedly increased at postnatal developmental stages. The time-course of expression of this gene paralleled those of other genes encoding proteins involved during the secretory phase of odontogenesis, as described previously. Immunohistochemical studies of clusterin in murine molar tooth germs suggested this protein to be located in outer enamel epithelium, regressing enamel organ, secretory ameloblasts, and the dental epithelium connecting the tooth to the oral epithelium at an early eruptive stage. Immunolabelling of transforming growth factor beta-1 (TGF-β1) revealed it to be located close to clusterin. The levels of expression of Clu and Tgfb1 were markedly decreased following in-vivo transfection with anti-miR-214. In contrast, the expression of several genes associated with regulation of growth and development were increased by this treatment. We suggest that clusterin has functions during secretory odontogenesis and the early eruptive phase. Bioinformatic analysis after treatment with anti-miR-214 suggested that, whilst cellular activities associated with tooth mineralization and eruption were inhibited, activities associated with an alternative developmental activity (i.e. biosynthesis of contractile proteins) appeared to be stimulated. These changes probably occur through regulation mediated by a common cluster of transcription factors and support suggestions that microRNAs (miRNAs) are highly significant as regulators of differentiation during odontogenesis.

ABCC2 Haplotype is Associated With Antituberculosis Drug-Induced Maculopapular Eruption

Genetic variants in ATP-binding cassette (ABC) transporter genes are associated with increased susceptibility to adverse drug reactions. We hypothesized that genetic variant ABC transporters (ABCB1 and ABCC2) may be candidate markers for predicting maculopapular eruption (MPE) induced by antituberculosis therapy. We compared the genotype distributions of single nucleotide polymorphisms and haplotypes in the ABCB1 and ABCC2 genes between 62 antituberculosis drug (ATD)-induced MPE cases and 159 ATD-tolerant controls using multivariate logistic regression analysis. There was no significant association between genetic polymorphisms in ABCB1 and ATD-induced MPE (P>0.05). Among seven selected SNPs of ABCC2, IVS3-49C>T in intron and I1324I were associated with ATD-induced MPE (P=0.029 and 0.036, respectively). In an analysis of the ABCC2 haplotypes (ht; -1549G>A_-24C>T_IVS3-49C>T_V417I), ht1[G-C-C-G] was significantly associated with ATD-induced MPE (P=0.032, OR=0.35, 95% CI: 0.16-0.95). No significant association between the other haplotypes and ATD-induced MPE was observed. An ABCC2 haplotype is associated with the presence of ATD-induced MPE in patients with tuberculosis and may be a genetic risk factor for the development of MPE induced by ATD.