NEET MDS Lessons
Pedodontics
Cherubism
Cherubism is a rare genetic disorder characterized by bilateral or asymmetric enlargement of the jaws, primarily affecting children. It is classified as a benign fibro-osseous condition and is often associated with distinctive radiographic and histological features.
Clinical Presentation
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Jaw Enlargement:
- Patients may present with symmetric or asymmetric enlargement of the mandible and/or maxilla, often noticeable at an early age.
- The enlargement can lead to facial deformities and may affect the child's appearance and dental alignment.
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Tooth Eruption and Loss:
- Teeth in the affected areas may exfoliate prematurely due to loss of support, root resorption, or interference with root development in permanent teeth.
- Spontaneous loss of teeth can occur, or children may extract teeth themselves from the soft tissue.
Radiographic Features
- Bone Destruction:
- Radiographs typically reveal numerous sharp, well-defined multilocular areas of bone destruction.
- There is often thinning of the cortical plate surrounding the affected areas.
- Cystic Involvement:
- The radiographic appearance is often described as "soap bubble" or "honeycomb" due to the multilocular nature of the lesions.
Case Report
- Example: McDonald and Shafer reported a case involving
a 5-year-old girl with symmetric enlargement of both the mandible and
maxilla.
- Radiographic Findings: Multilocular cystic involvement was observed in both the mandible and maxilla.
- Skeletal Survey: A complete skeletal survey did not reveal similar lesions in other bones, indicating the localized nature of cherubism.
Histological Features
- Microscopic Examination:
- A biopsy of the affected bone typically shows a large number of multinucleated giant cells scattered throughout a cellular stroma.
- The giant cells are large, irregularly shaped, and contain 30-40 nuclei, which is characteristic of cherubism.
Pathophysiology
- Genetic Basis: Cherubism is believed to have a genetic component, often inherited in an autosomal dominant pattern. Mutations in the SH3BP2 gene have been implicated in the condition.
- Bone Remodeling: The presence of giant cells suggests an active process of bone remodeling and resorption, contributing to the characteristic bone changes seen in cherubism.
Management
- Monitoring: Regular follow-up and monitoring of the condition are essential, especially during periods of growth.
- Surgical Intervention: In cases where the enlargement causes significant functional or aesthetic concerns, surgical intervention may be considered to remove the affected bone and restore normal contour.
- Dental Care: Management of dental issues, including premature tooth loss and alignment problems, is crucial for maintaining oral health.
Pit and Fissure Sealants
Pit and fissure sealants are preventive dental materials used to protect occlusal surfaces of teeth from caries by sealing the grooves and pits that are difficult to clean. According to Mitchell and Gordon (1990), sealants can be classified based on several criteria, including polymerization methods, resin systems, filler content, and color.
Classification of Pit and Fissure Sealants
1. Polymerization Methods
Sealants can be differentiated based on how they harden or polymerize:
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a) Self-Activation (Mixing Two Components)
- These sealants harden through a chemical reaction that occurs when two components are mixed together. This method does not require any external light source.
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b) Light Activation
- Sealants that require a light source to initiate the polymerization
process can be further categorized into generations:
- First Generation: Ultraviolet Light
- Utilizes UV light for curing, which can be less common due to safety concerns.
- Second Generation: Self-Cure
- These sealants harden through a chemical reaction without the need for light, similar to self-activating sealants.
- Third Generation: Visible Light
- Cured using visible light, which is more user-friendly and safer than UV light.
- Fourth Generation: Fluoride-Releasing
- These sealants not only provide a physical barrier but also release fluoride, which can help in remineralizing enamel and providing additional protection against caries.
- First Generation: Ultraviolet Light
- Sealants that require a light source to initiate the polymerization
process can be further categorized into generations:
2. Resin System
The type of resin used in sealants can also classify them:
- BIS-GMA (Bisphenol A Glycidyl Methacrylate)
- A commonly used resin that provides good mechanical properties and adhesion.
- Urethane Acrylate
- Offers enhanced flexibility and durability, making it suitable for areas subject to stress.
3. Filled and Unfilled
Sealants can be categorized based on the presence of fillers:
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Filled Sealants
- Contain added particles that enhance strength and wear resistance. They may provide better wear characteristics but can be more viscous and difficult to apply.
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Unfilled Sealants
- Typically have a smoother flow and are easier to apply, but may not be as durable as filled sealants.
4. Clear or Tinted
The color of the sealant can also influence its application:
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Clear Sealants
- Have better flow characteristics, allowing for easier penetration into pits and fissures. They are less visible, which can be a disadvantage in monitoring during follow-up visits.
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Tinted Sealants
- Easier for both patients and dentists to see, facilitating monitoring and assessment during recalls. However, they may have slightly different flow characteristics compared to clear sealants.
Application Process
- Sealants are applied in a viscous liquid state that enters the micropores of the tooth surface, which have been enlarged through acid conditioning.
- Once applied, the resin hardens due to either a self-hardening catalyst or the application of a light source.
- The extensions of the hardened resin that penetrate and fill the micropores are referred to as "tags," which help in retaining the sealant on the tooth surface.