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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2006  |  Volume : 24  |  Issue : 1  |  Page : 50-52
 

Loss of permanent mandibular lateral incisor and canine tooth buds through extraoral sinus: Report of a case


Department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai, India

Correspondence Address:
Ritesh R Kalaskar
Department of Pediatric Dentistry, Nair Hospital Dental College,Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.22838

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  Abstract 

Extraoral sinus tract may occur as a result of an inflammatory process associated with the necrotic pulp. Several non odontogenic disorders may also produce an extraoral sinus tract, the differential diagnosis of these clinical findings is of prime importance in providing appropriate clinical care. Presented here is a case report of 4 year old female child with extraoral sinus tract through which the tooth buds of mandibular permanent left lateral incisor and mandibular permanent left canine were lost. The extraoral sinus was due to mandibular left primary canine with class IX fracture (Ellis and Davey's classification).


Keywords: Mandibular permanent left lateral incisor, Mandibular permanent left canine, Mandibular left primary canine, Odontogenic sinus tract


How to cite this article:
Kalaskar RR, Damle S G. Loss of permanent mandibular lateral incisor and canine tooth buds through extraoral sinus: Report of a case. J Indian Soc Pedod Prev Dent 2006;24:50-2

How to cite this URL:
Kalaskar RR, Damle S G. Loss of permanent mandibular lateral incisor and canine tooth buds through extraoral sinus: Report of a case. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2020 Apr 4];24:50-2. Available from: http://www.jisppd.com/text.asp?2006/24/1/50/22838


Odontogenic extraoral sinus tract on the facial and cervical skin is known to develop as a result of dental pulpal necrosis and chronic periapical periodontitis.[1] Extraoral odontogenic sinus tract of dental origin have been well documented in literature.[2] The involved area is usually symptom free, the patients are usually healthy and in most of the cases patients are unaware of the associated dental problem[2], thus delaying the correct diagnosis and treatment plan of the extraoral sinus lesion with the primary odontogenic origin. Possible dental causes for odontogenic extraoral sinus include, trauma, retained roots, residual chronic infections of the jaws and pulp diseases. If the etiology is pulpal in origin, extraoral sinus usually responds to endodontic therapy. In the present case report tooth buds of mandibular permanent left lateral incisor and mandibular permanent left canine were lost post trauma, through odontogenic extraoral sinus tract.[3]


  Case Report Top


4 year old girl reported to the Dept. of Pediatric Dentistry, Nair Hospital Dental College, Mumbai, with the chief complaint of pus discharge and loss of tooth through extraoral sinus with which she reported to our department. Parent also complained of pain and slight swelling in lower left anterior region since 1 month. Detailed history revealed trauma to the mandible 9 months back while playing in school. She had not received any treatment for the trauma at that time as she was asymptomatic. 3 months after trauma she developed an extraoral sinus in mandibular left anterior region for which she had reported to our dept. OPG was advised which showed a radiolucent area extending from mandibular left primary canine to the inferior border of mandible [Figure - 1]. Patient was not treated at that time as she did not report back for the treatment. Later patient reported to our department after six months with the tooth bud which was lost through extraoral sinus. On eliciting the history from the mother, she revealed that one month back a tooth like hard structure came out through extraoral sinus, sighting something unusual, she got frightened and threw away the tooth. After 15 days another tooth like structure came out through extraoral sinus [Figure - 2], with which she reported to our department. On clinical examination the tooth bud appeared to be mandibular permanent left lateral incisor.

Intraoral examination revealed that all the primary mandibular and maxillary teeth were present in the oral cavity. Mandibular left primary canine showed grade III mobility, was slightly tender to percussion and palpation [Figure - 3] and failed to response to thermal [cold test (Pulpoflorane Pharma Dental Handelsges)] and electric pulp testing (Parkell Farmingdate). Adjacent teeth responded within normal limits. Extraoral examination showed sinus tract at the inferior border of the mandibular left canine region which was also associated with bony hard swelling [Figure - 4]. Lateral oblique radiograph of the left side of the mandible was taken which revealed absence of mandibular left permanent lateral incisor and canine tooth buds. Apart from this, lateral oblique radiograph also revealed a large radiolucent band extending from mandibular left primary canine region to inferior border of mandible [Figure - 5]. Mandibular left primary canine showed open apex [Figure - 5].

On the basis of clinical and radiographic findings extraction of the mandibular left primary canine was planned. Mandibular left primary canine was extracted using Lignocaine hydrochloride (Dentocaine 2% Pharma Health Care Product, Mumbai) under antibiotic cover. Patient was called for check up on the following day. Intra oral examination showed satisfactory healing at the extraction site. Extraoral examination revealed healing sinus tract. Patient was advised to continue medication for 4 days and called for check up after one week. Intra oral and extraoral examination after a week showed a healed extraction socket and healing extraoral sinus tract respectively [Figure - 6][Figure - 7]. OPG taken after one week showed no signs of spread of infection [Figure - 8].


  Discussion Top


Chronic extraoral sinus tract presents a diagnostic challenge to the clinician as they may be either odontogenic or non odontogenic origin. Spear et al (1983)[4] stated that obtaining a medical history from patients was most important for the differential diagnosis, this include traumatic lesion, fungal and bacterial lesion squamous cell carcinoma, osteomylites, pyogenic granuloma, foreign bodies and congenital fistula. In the present case report history of trauma to mandibular left anterior region, radiographic finding and clinical examination were suggestive of odontogenic extraoral sinus tract. Thoma,[5] Harrison,[6] Bender and Seltzer[1] stated that root canal treatment of the responsible tooth can cure the extraoral sinus tract rather than going for surgical treatment. But in the present case report extraction of mandibular left primary canine was carried out because the prognosis of mandibular left primary canine was very poor and the underlying infection may also affect the erupting permanent dentition.

The most interesting finding of this case report is that the mandibular permanent left lateral incisor tooth bud and mandibular permanent left canine tooth bud came out through extraoral sinus tract. We had not come across any such reference in the literature so the exact comment for the same is difficult. But it is assumed that as tooth buds of mandibular permanent left lateral incisor and mandibular permanent left canine were in the line of infection (the radiolucent band), body must have recognized this tooth buds as foreign bodies and hence the tooth buds were thrown out of the extraoral sinus tract.

 
  References Top

1.Bender IB, Seltzer S. The oral fistula:its diagnosis and treatment. Oral Medicine Oral pathology 1961;14:136-7.  Back to cited text no. 1    
2.Caliskan MK, Sen BH, Ozinel MA. Treatment of extracanal teeth with apical periodontitis. Endod Dent Traumatized 1995;11:115-20.  Back to cited text no. 2    
3.Tindel E, Jenkins JD, Elliss, Huston B. Cutaneous odontogenic sinus tract to the chin. A case report. International Endodontic Journal 1997;30:352-5.  Back to cited text no. 3    
4.Spear KL, Sheridan PJ. Sinus tract to the chin and jaw of dental origin. Journal of the American Academy of Dermatology 1983;8:486-92.  Back to cited text no. 4    
5.Thoma KH. Oral surgery. 4th edn. st louis USA mosby 1963. p. 733.  Back to cited text no. 5    
6.Harrison JW, Larson WJ. The epithelized oral sinus tract. Oral surgery Oral Medicine Oral Pathology 1976;42:511-7.  Back to cited text no. 6    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]


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