pink tooth.pptx BDS PEDODONTICS J .K .K N

PEDO

1. PINK TOOTH OF MUMMERY AJMAL KHAN KATTAK S THIRD YEAR B.D.S J.K.K.NATTRAJA DENTAL COLLEGE & HOSPITAL, KOMARAPALAYAM - A PARADIGM TO THE CAUSE OF DEATH

2. RESORPTION OF TEETH May occur when inflammation is present Occurs in deciduous teeth during exfoliation Can occur with excessive occlusal or orthodontic forces & with benign or malignant tumors A reimplanted tooth will tend to resorb. If seen within the root, it will be seen radiographically . May be classified as External or Internal

3. EXTERNAL RESORPTION Slight raggedness or blunting of the root apex Not reversible Progression can be avoided if the cause is identified and removed Impacted teeth > Erupted counterparts.

4. Presents with a “ moth-eaten ” loss of root structure. Most cases of external resorption involve apical or mid-portions of root

5. INTERNAL RESORPTION Chronic Perforating Hyperplasia of Pulp Internal Granuloma Odontoclastoma Pink Tooth of Mummery Inflammatory resorption - Dentin replaced by inflamed granulation tissue Replacement, or metaplastic resorption - Pulpal dentinal walls are replaced by bone or cementum-like bone

6. Internal resorption is a usually an asymptomatic condition. When it affects the coronal pulp, crown can display pink discoloration with b alloon like enlargement of the canal, known as Pink tooth of Mummery . Its called so after the Anatomist – James Howard Mummery.

7. ETIOPATHOGENESIS Idiopathic. Internal resorption is caused by cells located in dental pulp. Communication of the pulp and PDL. Recently evidence of the existence of three cytokine like proteins has become available.

8. RANK (Receptor activator of nuclear factor kappa) RANK signaling pathways are implicated in differentiation, resorption and survival responses of osteoclasts. 2 . RANKL (Receptor activator of nuclear factor kappa B ligand) PDL cells under mechanical stress unregulated osteoclastogenesis with increased expression of RANKL, m RNA and protein. 3. OPG (osteoprotegerin ) The inactivation of OPG plays an important role in the differentiation of osteoclasts. This helps to explain the mechanism of both inflammatory and non inflammatory resorption.

9. Internal resorption presents as a uniform, well-circumscribed symmetrical radiolucent enlargement of pulp chamber. May first appear as a pink-hued spot showing through the remaining overlying tooth substance. This is seen in deciduous teeth when the vascular resorptive process reaches the surface i.e the coronal pulp prior to exfoliation.

10. CLINICAL FINDINGS A 25-year-old female patient complains of mobility of tooth in right lower back tooth region since 2 months. Clinically, there was slight mobility in 48. Radiographically a resorptive area was seen in crown region of 48. The crown part was removed with gentle pressure using probe A hollow crown with resorbed dentin and intact thin enamel was seen in gross specimen. A final diagnosis of idiopathic internal resorption was given.

11. DIAGNOSIS RADIOGRAPHS

12. Round or ovoid radiolucent area in the central portion of the tooth, associated with pulp but not the external surface of the tooth. The margins are smooth & clearly defined. The walls of root canal system may appear to be balloon out. Their distribution of the pulp canal is symmetrical but can be eccentrical. The radiolucency is of uniform density. PULP VITALITY TESTS are usually positive, because although the coronal pulp is not responsive, the apical pulp is still vital. VISUAL EXAMINATION based on color change in the tooth crown is the alarming tool for spot diagnosis.

13. Variable degree of resorption of the inner or pulpal surface of the dentin & proliferation of the pulp tissue filling the defect. Resorption is of an irregular lacunar variety showing occasional osteoclasts or odontoclasts ( ODONTOCLASTOMA ) Increased cellularity, vascularity and collagenization. Numerous multinucleated dentinoclasts. Inflammatory cells infiltration. Alternating periods of resorption & repair with deposition of irregular dentin or osteodentin in lacunalike areas, which itself is undergoing resorption. HISTOPATHOLOGY

14. TREATMENT AND PROGNOSIS

15. Removal of all soft tissue from site of resorption. Endodontic treatment before perforation in internal resorption. Placement of calcium hydroxide paste for remineralization. Extraction. TREATMENT & PROGNOSIS

16. CONCLUSION Root resorption is a complex process. At present the internal inflammatory resorption is amenable to treatment and can be controlled wherein prevention should be the best approach. However, pink tooth is sign of a sinking ship which on a lighter note gives us the hope to welcome its successor in children.

17. ACKNOWLEDGEMENTS... My Sincere Thanks to Dr. K. Karunakaran M.D.S , H.O.D Department of Oral Pathology, J.K.K.Nattraja Dental College & Hospital Dr. Rajeshwar M.D.S