The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization(MIH) and pre-eruptive intracoronal lesions(PEIR)...The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization(MIH) and pre-eruptive intracoronal lesions(PEIR), in order to minimize miss-treatment of primary and permanent teeth in young children.MIH was defined as the occurrence of hypomineralization of one up to four permanent first molars from a systemic origin and frequently associated with affected incisors. PEIR are lesions that are located in the occlusal portion of the crown of unerupted permanent or primary teeth. The prevalence of MIH was reported between 2.5%-40% in the permanent first molars and 0%-21.8% in primary second molars. PEIR was observed in 2%-8% of children, mainly in mandibular second premolars and second and third permanent molars. A number of possible causes for MIH were mentioned, including environmental changes, diet and genetics in prenatal and postnatal periods, but all are questionable. In PEIR, the resorption of the intracoronal dentine begins only after crown development is complete and is caused by giant cells resembling osteoclast observed histologically on the dentine surface close to the pulp. The mineral content in MIH is reduced in comparison to normal enamel and dependent on the severity of the lesion. In PEIR the resorbed surface of enamel showed less mineral content. The hypomineralized enamel in MIH is not suitable for restorations with amalgam or composite materials, and the best material should be based on remineralization material like glass-ionomers. Similar, the resorbed dentin surface in PEIR should be covered by the biocompatible and remineralizing glass-ionomer cement.展开更多
Background Langerhans cell histiocytosis(LCH)is a group of diseases characterized by the proliferation and accumulation of Langerhans cells.Clinical presentations of LCH vary widely.Data sources A PubMed search was co...Background Langerhans cell histiocytosis(LCH)is a group of diseases characterized by the proliferation and accumulation of Langerhans cells.Clinical presentations of LCH vary widely.Data sources A PubMed search was conducted using Clinical Queries with the key term "Langerhans cell histiocytosis".The search strategy included meta-analyses,randomized controlled trials,clinical trials,observational studies,and reviews.This paper is based on,but not limited to,the search results.Results Generally,patients with LCH can be divided into two groups based on the extent of involvement at diagnosis,namely,single-system LCH and multisystem LCH.The involvement may be unifocal or multifocal.Patients with isolated bone lesions typically present between 5 and 15 years of age,whereas those with multisystem LCH tend to present before 5 years of age.The clinical spectrum is broad,ranging from an asymptomatic isolated skin or bone lesion to a life-threatening multisystem condition.Clinical manifestations include,among others,"punched out" lytic bone lesion,seborrheic dermatitis-like erup-tion,erythematous/reddish-brown crusted/scaly papules/maculopapules/plaques/patches,and eczematous lesions,diabetes insipidus,hepatosplenomegaly,cytopenias,lymphadenopathy,and an acute fulminant disseminated multisystem condition presenting with fever,skin rash,anemia,thrombocytopenia,lymphadenopathy,and hepatosplenomegaly.The diagnosis is clinicopathologic,based on typical clinical findings and histologic/immunohistochemical examination of a biopsy of lesional tissue.Positive CD1a,S100,and/or CD207(Langerin)immunohistochemical staining of lesional cells is required for a definitive diagnosis.Watchful waiting is recommended for patients with skin-only LCH.Patients with symptomatic or refractory skin-only LCH may be treated with topical tacrolimus/corticosteroids,topical nitrogen mustard,oral methotrexate,or oral hydroxyurea.The current recommended first-line therapy for patients with multisystem LCH is 12 months therapy with prednisone and vinblastine.Mercaptopurine is added for patients with risk organ involvements.Conclusions Because of the broad spectrum of clinical manifestations and the extreme diversity of disease,LCH remains a diagnostic dilemma.Morphological identification of LCH cells and positive immunochemical staining with CD1a,S100,and/or CD207(Langerin)of lesional cells are necessary for a definitive diagnosis.展开更多
文摘The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization(MIH) and pre-eruptive intracoronal lesions(PEIR), in order to minimize miss-treatment of primary and permanent teeth in young children.MIH was defined as the occurrence of hypomineralization of one up to four permanent first molars from a systemic origin and frequently associated with affected incisors. PEIR are lesions that are located in the occlusal portion of the crown of unerupted permanent or primary teeth. The prevalence of MIH was reported between 2.5%-40% in the permanent first molars and 0%-21.8% in primary second molars. PEIR was observed in 2%-8% of children, mainly in mandibular second premolars and second and third permanent molars. A number of possible causes for MIH were mentioned, including environmental changes, diet and genetics in prenatal and postnatal periods, but all are questionable. In PEIR, the resorption of the intracoronal dentine begins only after crown development is complete and is caused by giant cells resembling osteoclast observed histologically on the dentine surface close to the pulp. The mineral content in MIH is reduced in comparison to normal enamel and dependent on the severity of the lesion. In PEIR the resorbed surface of enamel showed less mineral content. The hypomineralized enamel in MIH is not suitable for restorations with amalgam or composite materials, and the best material should be based on remineralization material like glass-ionomers. Similar, the resorbed dentin surface in PEIR should be covered by the biocompatible and remineralizing glass-ionomer cement.
文摘Background Langerhans cell histiocytosis(LCH)is a group of diseases characterized by the proliferation and accumulation of Langerhans cells.Clinical presentations of LCH vary widely.Data sources A PubMed search was conducted using Clinical Queries with the key term "Langerhans cell histiocytosis".The search strategy included meta-analyses,randomized controlled trials,clinical trials,observational studies,and reviews.This paper is based on,but not limited to,the search results.Results Generally,patients with LCH can be divided into two groups based on the extent of involvement at diagnosis,namely,single-system LCH and multisystem LCH.The involvement may be unifocal or multifocal.Patients with isolated bone lesions typically present between 5 and 15 years of age,whereas those with multisystem LCH tend to present before 5 years of age.The clinical spectrum is broad,ranging from an asymptomatic isolated skin or bone lesion to a life-threatening multisystem condition.Clinical manifestations include,among others,"punched out" lytic bone lesion,seborrheic dermatitis-like erup-tion,erythematous/reddish-brown crusted/scaly papules/maculopapules/plaques/patches,and eczematous lesions,diabetes insipidus,hepatosplenomegaly,cytopenias,lymphadenopathy,and an acute fulminant disseminated multisystem condition presenting with fever,skin rash,anemia,thrombocytopenia,lymphadenopathy,and hepatosplenomegaly.The diagnosis is clinicopathologic,based on typical clinical findings and histologic/immunohistochemical examination of a biopsy of lesional tissue.Positive CD1a,S100,and/or CD207(Langerin)immunohistochemical staining of lesional cells is required for a definitive diagnosis.Watchful waiting is recommended for patients with skin-only LCH.Patients with symptomatic or refractory skin-only LCH may be treated with topical tacrolimus/corticosteroids,topical nitrogen mustard,oral methotrexate,or oral hydroxyurea.The current recommended first-line therapy for patients with multisystem LCH is 12 months therapy with prednisone and vinblastine.Mercaptopurine is added for patients with risk organ involvements.Conclusions Because of the broad spectrum of clinical manifestations and the extreme diversity of disease,LCH remains a diagnostic dilemma.Morphological identification of LCH cells and positive immunochemical staining with CD1a,S100,and/or CD207(Langerin)of lesional cells are necessary for a definitive diagnosis.
