Enamel hypoplasia associated with congenital hypoparathyroidism.
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Adolescent↗
Biomedical subjects
C M Flaitz
Publications and source records attributed to C M Flaitz.
Clear cell variant of calcifying epithelial odontogenic tumor: case report and review of the literature.
The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955 and accounts for less than 1% of all odontogenic lesions. Recently, a clear cell variant of CEOT has been identified with only eight well-documented cases in the literature. We present an additional case of clear cell CEOT of the mandible and review the salient clinical, radiologic, and histopathologic features of this entity and CEOTs in general. The differential diagnosis of clear cell tumors in the mandible includes: clear cell odontogenic tumor, clear cell ameloblastoma (odontogenic carcinoma), metastatic clear cell adenocarcinoma, primary intraosseous mucoepidermoid carcinoma, acinic cell carcinoma, epithelial-myoepithelial carcinoma, clear cell salivary gland tumors, and clear cell variant of squamous cell carcinoma. Because of the belief that clear cell odontogenic tumors are locally aggressive neoplasms, definitive resection of the entire mass with tumor-free surgical margins and long-term follow-up are recommended.
Diagnosis, Differential↗
Histocytologic grading of mucoepidermoid carcinoma of major salivary glands in prognosis and survival: a clinicopathologic and flow cytometric investigation.
BACKGROUND: Controversy exists regarding the role of a 3-tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3-tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades. METHODS: Forty-eight patients with 7 low-grade (LG), 23 intermediate-grade (IG), and 18 high-grade (HG) MECs of parotid (n = 43) and submandibular (n = 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal-Wallis and Chi-squared tests where appropriate). RESULTS: Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p = 0.02). Gender ratio (p < 0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 IG, and 3.6 HG (p < 0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p = 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p < 0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p < 0.001). DNA aneuploidy (DNA index < 0.9 or > 1.1) was present in 0% LG, 13% IG, and 28% HG (p = 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p = 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p = 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p = 0.009). Survival was decreased significantly (p < 0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG). CONCLUSION: Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3-tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals.
Adult↗
The immunoperoxidase method for the rapid diagnosis of intraoral herpes simplex virus infection in patients receiving bone marrow transplants.
Bone marrow transplant patients (N = 12) with oral lesions consistent with herpes simplex virus (HSV) infection were studied to compare the sensitivity of two rapid cytodiagnostic methods with viral cultures. Routine viral cultures and exfoliative cytology smears were prepared for microscopic evaluation using the Papanicolaou method and an immunoperoxidase staining technique for detection of HSV type 1. Patients with a positive viral culture (N = 10) showed positive staining for HSV, using the immunoperoxidase technique. Multinucleated giant epithelial cells were observed in only seven of the ten positive specimens, using the Papanicolaou method. The results from this preliminary study suggest that the immunoperoxidase method may provide the dentist with a reliable and rapid approach for the diagnosis of intraoral HSV.
Adolescent↗
Primary intraoral epithelioid hemangioendothelioma presenting in childhood: review of the literature and case report.
Epithelioid hemangioendothelioma (EH) is a recently described vascular neoplasm of borderline or intermediate malignant potential. This tumor arises from medium- to large-sized vessels, primarily involves the soft tissues of the extremities as well as the liver and lung, and rarely occurs in the head and neck region. Only eight well-documented cases of intraoral EH have been reported. We present an additional pediatric case of EH confined to the oral cavity and review the literature regarding EH presenting as an intraoral mass. EH is characterized histopathologically as an epithelioid lesion arranged in nests, strands, and trabecular patterns with infrequent vascular spaces. Occasional erythrocytes within intracytoplasmic lumina may be seen in tumor cells. Ultrastructural examination typically shows intracytoplasmic lumina with pseudopodial cellular membrane extensions. The cytoplasm usually contains intermediate filaments infrequently associated with Weibel-Palade bodies. Neoplastic cells are immunoreactive for factor VIIIR:Ag and Ulex europaeus. Histopathologic features, which may be associated with aggressive clinical behavior, include significant cellular atypia, one or more mitoses per 10 high-power fields, an increased proportion of spindled cells, focal necrosis, and metaplastic bone formation. Because of the intermediate malignant potential of epithelioid hemangioendothelioma, complete tumor resection is recommended for intraoral lesions.
Child↗
Recurrent intrapulmonary malignant small cell tumor of the thoracopulmonary region with metastasis to the oral cavity: review of literature and case report.
Malignant small cell tumor of the thoracopulmonary region (MSCT) was first described in 1979 and has been referred to as the Askin tumor. This malignant neoplasm is a member of the peripheral primitive neuroectodermal tumor (PPNET) family and typically involves the periosteum, soft tissue, and extrapulmonary tissue of the thoracic wall. MSCT may also involve the lung parenchyma by local extension or may arise de novo in peripheral lung tissue. Local recurrence, abdominal involvement by tumor extravasation across the diaphragm, and skeletal metastatic disease are relatively common. However, metastasis to the head and neck region and in particular to the oral cavity is extremely rare. We present a recurrent intrapulmonary MSCT with metastasis to the oral cavity in an adolescent Hispanic boy, and review the literature regarding this member of the PPNET family. Differentiation from neuroblastoma may be made based on immunoreactivity for beta 2 microglobulin and HBA71 and lack of immunoreactivity for chromogranin in PPNET and MSCT. Ultrastructural features commonly seen in MSCT and PPNET are round to ovoid tumor cells with occasional cytoplasmic processes with relatively few pleomorphic dense core granules. These tumors lack the gangliocytic and Schwann cell differentiation that is characteristic of neuroblastoma. MSCT and PPNET have a common reciprocal cytogenetic translocation [t(11;22)q(24;q12)], which is shared with Ewing's sarcoma. Prognosis in MSCT is quite dismal, with a 2-year survival of 38% and a 6-year survival of only 14%.
Adolescent↗
Oral candidiasis in children with immune suppression: clinical appearance and therapeutic considerations.
Children and adolescents with immune compromise and suppression are particularly susceptible to the development of oral candidiasis. In fact, oral candidiasis is the most common oral manifestation in HIV-infected children. Oral candidiasis has been linked to a depressed immune system, more rapid progression to AIDS, more advanced stage of disease in AIDS, and decreased survival. Several different forms of candidiasis may be recognized clinically. These forms are 1) pseudomembraneous candidiasis; 2) erythematous (atrophic) candidiasis; 3) papillary hyperplasia; 4) chronic hyperplastic candidiasis; 5) angular cheilitis; and 6) median rhomboid glossitis. Diagnosis of candidiasis is primarily based upon clinical appearance; in some cases, however, exfoliative cytology and/or biopsy of the lesion may be necessary. It is also possible to culture the lesion to determine the specific subtype of candidia and to evaluate the susceptibility of the fungus to specific antifungal agents. Both topical and systemic treatment by antifungal medications are readily available.
Antifungal Agents↗
Ectopic erythema migrans in an adolescent with a skin disorder.
Red and white circular lesions of the buccal and labial mucosa were observed in an adolescent. Periodically, these nontender patches would resolve and move to other oral sites. Detection of ectopic erythema migrans aided in the diagnosis of a bothersome skin condition.
Adolescent↗
Enamel caries formation and lesion progression with a fluoride dentifrice and a calcium-phosphate containing fluoride dentifrice: a polarized light microscopic study.
The effects of a fluoride dentifrice (Colgate Total) and a calcium-phosphate containing fluoride dentifrice (Enamelon) on caries-like enamel lesion formation and progression were evaluated in vitro. One quarter from each tooth (n = 12) was assigned to one of the study groups: 1) control group [artificial saliva only]; 2) Colgate Total; and 3) Enamelon. The dentifrices were applied to the enamel windows (3 minutes, 3 time per day for 14 days). Following treatment, enamel lesions were created with an acidified gel. After lesion initiation, sections were obtained for polarized light microscopy. To evaluate lesion progression, enamel windows with caries-like lesions in each test group were treated again for 14 days, returned to acidified gels for lesion progression, and then sections were obtained for polarized light microscopy. Mean lesion depths (polarized light, water imbibition) were as follows: 1) Lesion Initiation: Control 109 +/- 19 microns, Colgate Total 76 +/- 14 microns, Enamelon 63 +/- 17 microns; 2) First Lesion Progression: Control 164; +/- 24 microns, Colgate Total 124 +/- 22 microns, Enamelon 110 +/- 19 microns; 3) Second Lesion Progression: Control 235 +/- 23 microns; Colgate Total 172 +/- 27 microns, Enamelon 153 +/- 18 microns. Both Colgate Total and Enamelon enhanced the resistance of sound enamel and caries-like enamel lesions to a continuous in vitro cariogenic challenge when compared with matched controls (P < .05, ANOVA, DMR). Enamelon provided a further reduction in lesion depth for all periods when compared with Colgate Total (P > .05, ANOVA, DMR). Addition of bioavailable calcium and phosphate ions to a fluoride dentifrice may improve the ability of enamel to resist caries initiation and subsequent lesion progression.
Analysis of Variance↗
Focal epithelial hyperplasia: a multifocal oral human papillomavirus infection.
Widespread, slightly elevated and confluent nodules are observed throughout the oral mucosa in a young Hispanic girl. Repeated irritation of the soft tissues from a compromised occlusion is an aggravating factor for the spread of these lesions. A diagnosis of focal epithelial hyperplasia, a human papillomavirus infection, is made following histopathologic diagnosis and viral typing. Recognition of this specific type of warts is important in order to avoid the mistaken identification of condyloma acuminata, which may have significant repercussions in the life of a young child.
Child, Preschool↗
Peripheral giant cell granuloma: a potentially aggressive lesion in children.
A slowly enlarging gingival mass with a reddish-purple surface is observed in a school-age boy. The lesion was first noted 3 months ago during a routine oral examination but recently it has increased in size and interferes with eating. A periapical radiograph demonstrated focal loss of the alveolar crestal bone in the mandibular incisor region. The diagnosis of peripheral giant cell granuloma, a benign reactive gingival lesion, is confirmed by histopathologic examination. Early detection and excision of this hyperplastic nodule is important to minimize potential dentoalveolar complications.
Child↗
Surface topography and enamel-resin interface of pit and fissure sealants following visible light and argon laser polymerization: an in vitro study.
This in vitro study compared the effects of visible light and argon laser polymerization of pit and fissure sealants on surface topography and the enamel-sealant interface. Twenty caries-free human molars and premolars underwent soft tissue debridement and a fluoride-free prophylaxis. Fluoride-releasing sealant (UltraSeal XT Plus, South Jordan, UT 84095) was placed on the occlusal surfaces per the manufacturer's instructions, but underwent either visible-light polymerization for 30s (n = 10), or argon laser polymerization (0.231 J/cm2) for 10s (n = 10). The sealed teeth were thermocycled (500 cycles, 5 degrees to 50 degrees C) in artificial saliva. Surface morphology was evaluated by SEM. The teeth were sectioned for polarized light and SEM evaluation of the enamel-sealant interface, with two sections per tooth prepared for SEM. Phosphoric acid was used to unmask the enamel-sealant interface with one section; while the other section was not exposed to the phosphoric acid. Surface morphology of the sealant material was similar with both visible light and argon laser polymerization; however, there was a tendency for occasional areas of mild, focal cratering of the sealant surface with laser-curing. The junction between sealant and adjacent unsealed enamel was a relatively smooth transition without gaps, microspaces, crazing, exfoliative changes, or microfractures with both visible light and laser cured sealants. Acid treatment of the sections revealed resin tags which extended into the adjacent enamel for a considerable distance on SEM examination. The resin tas were similar in length and morphology with both visible light and argon laser curing. The enamel-sealant interface with visible light and laser curing showed intimate contact between the sealant and etched occlusal enamel with close apposition of the sealant. No microspaces were identified between the sealant and the occlusal enamel. An intact, interdigitating interface between a sealant and the adjacent etched enamel provides the first line of defense against a cariogenic challenge. Visible-light and argon laser curing allows for an intimate enamel-sealant interface without microspaces and protects sealed enamel from cariogenic challenges. The benefit of argon laser polymerization, fluoride release and mechanical protection of sealant material may provide improved caries resistance in sealed pits and fissures and adjacent nonsealed enamel surfaces.
Argon↗
Mucoepidermoid carcinoma of the palate in a child.
Salivary gland tumors are rare in children but when they involve the minor salivary glands, there is an increased risk that they will be malignant. The clinical and histopathologic features of a palatal mucoepidermoid carcinoma in an 8 year-old boy are presented. Differentiating this entity from common reactive and benign neoplastic lesions is discussed in order to prevent a delay in diagnosis and the potential for mismanagement.
Carcinoma, Mucoepidermoid↗
Dental caries in HIV-infected children: a longitudinal study.
PURPOSE: The purpose of this descriptive longitudinal clinical study was to determine primary and permanent dentition caries status in HIV-infected children, and to compare caries status with the CD4 percentage (CD4%) and immune suppression category. MATERIALS AND METHODS: 73 children up to 9 years of age with vertical HIV transmission were evaluated for caries in the primary dentition at baseline and at 6 month intervals over a 30 month period; while 19 HIV-infected children between 5 and 11 years of age had their permanent dentition evaluated for caries at baseline and at 6 month intervals over a 24 month period. Caries status was also compared with CDC CD4 percentage (> 25%, 15-24%, < 15%), and CDC immune suppression categories (immune suppression: none, moderate, severe). With primary dentition caries, comparisons were made among all children (2-9 yr-olds, N = 73), < 2 yr-olds (N = 28), 2 to 4 yr-olds (N = 20), and 5 to 9 yr-olds (N = 25), and compared with NHANES III data. Caries-free status was also determined. RESULTS: During the 30-month period, there was an almost two-fold increase in primary tooth surface caries for the 2 to 9 year-olds. Caries-free status in the primary dentition declined from 60% at baseline to 37% at the 30-month period. With 5 to 11 years-olds, DMFS and DMFT remained relatively stable, while the proportion of caries-free individuals declined from 72% at baseline to 50% at 18 months. Caries in the primary dentition was increased substantially for those in the low CDC CD4 percentage categories and CDC moderate to severe immune suppression categories. CONCLUSION: Primary dentition caries status in HIV-infected children is considerably greater than that for the US pediatric population, and increases with decreasing CD4 percentage and moderate to severe immune suppression. HIV-infected children with caries-free primary dentitions are less frequent than in the US pediatric population, and caries-free status decreases with age, lower CD4 percentage and moderate to severe immune suppression.
CD4 Lymphocyte Count↗
Oral lymphoepithelial cyst in a young child.
The oral lymphoepithelial cyst is an uncommon lesion in children with rather distinct clinical features. This case report describes the pertinent characteristics of this entity, involving the floor of the mouth in a 4 year-old boy.
Child, Preschool↗
Complications of an unrecognized cheek biting habit following a dental visit.
Cheek biting is a chronic, usually innocuous, self-inflicted injury that is occasionally seen in children. This case report describes the characteristic features of this entity in an 8 year-old girl, including an unfortunate complication following an inferior alveolar mandibular block for restorative dental care.
Anesthesia, Dental↗
Parotitis as the initial sign of juvenile Sjögren's syndrome.
Parotid swelling may be associated with a variety of glandular disorders in children. This case report describes the characteristic features of juvenile Sjögren's syndrome in an adolescent girl who presented with recurrent and bilateral parotid gland enlargement. Special emphasis is placed on an age-specific differential diagnosis for major salivary gland enlargements.
Adolescent↗
Delayed tooth eruption associated with an ameloblastic fibro-odontoma.
Delayed eruption of a single primary tooth is an uncommon event. Excluding a previous traumatic insult, the presence of a pericoronal odontogenic cyst or neoplasm is the primary cause for this abnormality. This case report describes the clinical and radiographic features of an ameloblastic fibro-odontoma in a young child, who presented with delayed eruption of the primary mandibular canine and prominent buccal expansion. A differential diagnosis for mixed, radiolucent and radiopaque lesions of the jaws will be discussed.
Child, Preschool↗