The aim of this study was to investigate new preschool patients with the chief complaint of dental caries at the Department of Pediatric Dentistry of Hiroshima University Hospital during fiscal 2018. A total of 118 patients (61 males, 57 females) were treated at our hospital. The age of the patients ranged from 1 to 6 years old, with the largest percentage being 5 years old (27.1%). The rate of dental caries was higher in primary molars and lower in lower incisors. Twelve patients (10.2%) had C4 or missing teeth.
We classified patients with dental cavities, and found that class III was the largest group. We created the class III category of “severe”, to which 72 patients were classified (61.0%). More than half of the patients had many dental caries, including C3 in many areas, C4, or missing teeth.
The patients who brushed their teeth did so at night. There was a significant difference in severity of dental cavities based on whether the patients flossed. We investigated their eating habits and preferred foods or drinks to determine which factors increase the risk of dental caries.
Congenital syphilis is an infection transmitted from a syphilitic mother to her fetus through the placenta. In infected neonates, manifestations of syphilis are classified as early congenital (birth to age 2 years) and late congenital (＞age 2 years). Although it is well known that congenital syphilis is associated with abnormalities of permanent teeth, those of primary teeth with early congenital syphilis are unknown. We experienced a case of early congenital syphilis at the age of 3 years 3 months at the first visit and performed a dental analysis.
The patient was born with a low birth weight and state of asphyxia, from an untreated mother with syphilis during pregnancy. The medical history of the child stated that antibiotic therapy with PCG was administered for 10 days after birth for neurosyphilis combined with congenital syphilis. The physical status was syphilitic pemphigus and hepatitis, but it became stable after the acute phase, and pediatric follow-up had ended at 1 year 4 months old.
Hellman's dental age was ⅡA stage, tooth number 81 was already missing, and tooth 82 was mesial tipping with the root exposed to the oral cavity, so it was extracted at the first oral examination. At the age of 4 years 0 months, teeth numbers 71 and 72 were extracted due to exposure of their roots to the oral cavity. It was also confirmed that tooth 61 was prematurely lost at 4 years 9 months old.
The mesiodistal widths of all primary teeth of this patient were extremely small, with an average value of －2SD to －7SD.
Oral pathological examination by undecalcified sections using extracted tooth 82 revealed enamel hypoplasia in the incisal edge and calcareous degeneration in pulp and root resorption.
This case report describes that microdonts and enamel hypoplasia, and premature loss of primary incisors due to apical periodontitis are related to early congenital syphilis.
In this patient, plaque control in the molar region was considered to be difficult due to bilateral supernumerary teeth based on X-ray imaging, CBCT imaging, and the eruption state of the supernumerary tooth on the left side at the initial visit. Since the presence of supernumerary teeth may affect the development of caries in adjacent teeth, extraction of the bilateral supernumerary teeth was indicated.
An impacted fourth molar was confirmed on the left side but not on the right side. CBCT revealed an impacted fourth molar buccodistal to the third molar. Therefore, we decided on a conservative treatment course of regularly examining this fourth molar as well as the molar region on the right side.
Extraction of the supernumerary teeth facilitated plaque control in the maxillary second molar region, reducing plaque deposits.
High IgE syndrome (HIES) is an immunodeficiency disease characterized by skin abscesses, pneumonia, atopic dermatitis, and high serum levels of IgE. In dentistry, prolonged retention of deciduous teeth is a characteristic finding in patients with HIES. In this paper, we report the case of a pediatric patient with prolonged retention of deciduous teeth caused by HIES. Under the remaining predecessor deciduous teeth, her successor permanent teeth were impacting her jawbone and were close to completing root formation.
In such cases, we generally choose towing to enable the eruption of the successor permanent teeth. However, in this case, we could guide the natural eruption of the successor permanent teeth only by extracting the remaining predecessor deciduous teeth. We considered that the successor permanent teeth would naturally erupt, only upon extracting the remaining predecessor deciduous teeth at an appropriate time.