Pediatric Sialolithiasis

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 07/24/2009

Article title: Pediatric Sialolithiasis

Author(s): Nahieli Oded, Eliav Eli, Hasson Oscar, Zagury Ami

Journal: Oral Surgery Oral Medicine Oral Pathology

Volume (number): Vol 90 Number 6

Month, Year: 2000

Major topic: Sialolithiasis

Minor topics:

Type of Article: Case Review

Main Purpose: Review of recent pediatric sialolithiasis cases and compare findings to previous literature.

Overview of method of research: Case Report

Findings:

Pediatric Sialolithiasis is relatively common in adults, but is rare in children. Still it must be considered in the differential diagnosis of facial swelling and intermittent pain in young patients.

Review was of 15 cases followed for 3 years in an OMS clinic in Israel. The endoscope was the primary instrument used to treat and evaluate the sialoliths.

Key points/Summary :

• The main complaint is usually unilateral swelling. Most are diagnosed by imaging.
• 33% of cases had a distinguishable cause: phytobezoar, hair follicle, intraductal evagination.
• Endoscopy is very important in the evaluation and elimination of sialolithiasis.
• Predominant in males.
• Usually affects the submandibular gland.

Assessment of article: I liked this article. It has some good images (although hard to see in a photocopy) of clinical findings as well as imaging and the stones themselves. Important to be able to recognize this stuff, because patients may come to us, when others have failed them.

Gingival Enlargement Associated With a Partially Erupted Mandibular Molar 7/24/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Ray Murphy Date: 7/24/09 Region: Providence
Article title: Gingival Enlargement Associated With a Partially Erupted Mandibular Molar
Author(s): Catherine Flaitz, DDS,MS
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 23:5, 3
Year: 2001
Major topic: Peripheral odontogenic fibroma (PodF)
Minor topic(s): -
Type of Article: Case Report
Main Purpose: Discuss the clinical and microscopic features of a PodF in a 13yo male.
Overview of method of research: 13yo male evaluated for soft tissue growth overlying his mandibular second molar.

Findings: A POdF is a rare tumor that exclusively exists in the soft tissues covering the tooth bearing areas of the jaws. It is described as a firm, sessile enlargement of the soft tissue with a pink, smooth, nonulcerated mucosal surface. They range in size from approx. .5cm-3.5cm. It is found throughout the dental arches with an affinity for the buccal gingival of the mandible. It typically presents as a solitary lesion. This 13 yo male patient presented with an asymptomatic fibrous overgrowth on his mandibular second molar. IOE revealed a 2cm x 1.5 cm firm, pinkish gray, smooth, dome shaped lesion arising from the posterior lingual gingival/retromolar pad. The lesion was delaying the second molar from fully erupting. Also, the maxillary second molar was displaced lingually into a cross-bite as a result of occluding on the lesion. Radiographically the second molar had normal root development and open apices. No bone involvement was noticed. EOE revealed multiple hypertrophic scars and keloids on the patients extremities. Treatment of the lesion was excisional biopsy to allow the second molar to completely erupt. Histologically, the lesion was comprised of well vascularized, fibrous connective tissue with multinucleated giant cells. There was no evidence of calcifications in the stroma. Ten months after the excision of the lesion there was no recurrence.

Key points in the article discussion: The POdF is an uncommon gingival tumor that is similar to the central odontogenic fibroma. Whether the lesion is a true neoplasm, or a reactive hyperplasia has not yet been decided. People of all ages are susceptible to PodF’s, with the largest occurrence being before the age of 20(although this may be underestimated b/c not an operculum are submitted for histological differentiation). Treatment of choice is surgical excision. While the prognosis of the lesion after excision is excellent, it’s behavior is not totally understood. Recurrence happens 38% of the time, usually within 1-4 years. It is suspected that recurrence following the first year after excision is due to incomplete removal of the entire lesion initially. Differential diagnosis is extensive, including reactive hyperplasias, hamartomas, neoplasms, irritation fibromas, POF, pericoronal hamartoma, etc. The most common gingival enlargement overylying a molar is focal fibrous hyperplasia of the operculum. The difference between an operculum and a PodF is that a PodF will hinder the complete eruption of the affected molar, an operculum does not.

Summary of conclusions: In conclusion, the PodF is a soft tissue lesion that can affect the eruption of whichever tooth it is associated with. The differential diagnosis are extensive, but a diagnosis can be narrowed down by thorough IOE and histological differentiation. Histologically, the PodF and the pericoronal hamartoma are extremely similar, which could possibly mean that they represent a clinical spectrum of the same disease, ESPECIALLY when it occurs in children. The treatment of choice is excisional biopsy to allow the affected molar to continue erupting. Following excision, normal eruption of the affected molar was noted in 95% of cases.

Assessment of article: Good article. Clinically relevant. Listed numerous differential diagnosis of PodF and why it was different. Overall a good case report.

Palatal Blue Nevus In Children 7/24/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Murphy Date:7/24/09 Region: Prov.
Article title: Palatal Blue Nevus In Children
Author(s): Flaitz, Catherine, DDS
Journal: Pediatric Dentistry
Volume #; Number; Page #s): 23:4, 2
Year: 2001
Major topic: Palatal Blue Nevus
Minor topic(s): Other soft tissue pigmentations
Type of Article: Case Report
Main Purpose: Review a case of blue nevus(BN) in a child
Overview of method of research: N/A

Findings: Except for vascular entities, blue lesions are relatively uncommon in a child’s oral cavity. They are mostly found on the skin. In this case, a 7 yo female presented with an asymptomatic, non-blanching, smooth, bright blue oval macule measuring 7mm x 4mm on her palate. There was no history of trauma. Treatment was excisional biopsy. Histologically, there was heavily pigmented spindle shaped cells with dendritic extensions aligned parallel to the epithelium.

Key points in the article discussion: Oral nevi are farely rare, with a prevalence of .1% in the general population. The BN is the second most common type of nevi, accounting for 36% of all nevi found. BN present as a solitary blue-gray macule that’s slightly raised, less than 6mm in size, regular margins, and a smooth surface. The most common site for a BN is the palate, accounting for 75% of the cases, followed by the labial mucosa. There’s a slight female predilection, but mostly in the third and forth decades. Only 2% of BN are seen in children. While the treatment of choice is surgical excision, this pratice is somewhat controversial. It’s recommended because the lesion is constantly subjected to trauma, which makes it hard to monitor changes in size and appearance, which may mimic melanoma. While malignant transformation of BN has been implicated in children, there are no intra oral examples of this. Some risk factors of malignant transformation include a new or changing nevus, the presence of multiple nevi, fair skin, family history of melanoma, congenital nevus, and immunosuppression. Differential diagnosis of BN includes amalgam tattoo, melanotic macule, and various vascular anomalies. In terms of amalgam tattoo, a good history of trauma and past dental procedures is important.

Summary of conclusions: In summary, the BN is an extremely rare lesion seen in the oral cavity of a child. Take a good medical history to rule out other possible causes and diagnosis, and when in doubt, excise the entire lesion. This is because should the lesion turn malignant, the overall 5 year survival rate for oral melanomas is less then 15%.

Assessment of article:Good article. It was quick to the point. Easy to read. Good summary.