6 yr old w/ PM's?!?

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StovePipe - 15 Oct 2004 12:33 GMT

Howdy gang.

Listen... I'd really like to have an evaluation of my case of the 6 year
old little guy and his cheek side ulcer and the fact that his 1M baby is
exfoliating and the 1PM has an radio lucency in it... someone who has a
bit of pedo experience.. The original posting is here:
You can see the photos of my 6 yr old little guy here:

http://stovepipe.freeservers.com/images/ax.jpg

and

http://stovepipe.freeservers.com/images/w.jpg

or on the site at

http://stovepipe.freeservers.com/photo.html

Briefly: Presents for pain on biting and points to upper left. We had
done an OL Am on the E of that side in March... Looked fine, no
Percussion or hot/cold.

Saw the DO caries on the D and assumed that was the cause. Prepared to
freeze and take a photo. He complained that the topic burned, so I took
out the Q-Tip and while preparing to freeze, I noticed the gum swelling.
Then decided to take photo b/4 freezing. Took photos both sides and saw
the lucency corresponding to the developing UL 1 PM and noticed it
corresponds more or less to the ulcer on the buccal gingiva between the
D & E. Noticed that the D roots were completely resorbed, and the E
roots are almost the same... Neither tooth is mobile yet.

Advised the mother that the pain is probably precocious eruption, but I
would send the photos to the Local Pedo Guy and get that confirmed.
Truth is: I really don't like the look of that lesion at the level of
the UL 1 PM... Is it inflammation due to eruption or is it a tumor????

Didn't want to scare the mother (just got divorced, having a hard
time...) so I simply told her we'd see the little guy again in a week or
so. We did: the ulcer was all but gone, but the D hadn't exfoliated yet.
If I decide to take it out, I'll scoop out some of the tissue under it
and send it off to Pathology. Haven't heard 'Boo' from the Local Pedo
Guy yet.

Any one have any thoughts as to what is going on in this 6 year old?

Thanks
SP

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Orthodmd - 16 Oct 2004 13:11 GMT

>Howdy gang.
>
[quoted text clipped - 43 lines]
>Thanks
>SP

well, I'm not pedo but in Maine there are not a lot of pedos so I tend to see a
lot of things.

A guess would be that the deciduous tooth with the DO caries has abscessed and
sometimes you will see advanced root resorption in these cases. Note the
essentailly undeveloped roots of the first premolar. It is not ready to come
into the mouth based on that but it has erupted (I think) further down because
of the early resorption of the decdisuous 1M.

Not sure if this applies to the deciduous 2M

Charlie Ruff, DMD
Specialist in Orthodontics
Diplomate American Board of Orthodontics

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StovePipe - 16 Oct 2004 18:17 GMT

... blah blah blah....

> >time...) so I simply told her we'd see the little guy again in a week or
> >so. We did: the ulcer was all but gone, but the D hadn't exfoliated yet.
[quoted text clipped - 3 lines]
> >
> >Any one have any thoughts as to what is going on in this 6 year old?

> well, I'm not pedo but in Maine there are not a lot of pedos so I tend to
> see a lot of things.

Really appreciate the time you took to look...

> A guess would be that the deciduous tooth with the DO caries has abscessed
> and sometimes you will see advanced root resorption in these cases.

That makes sense: the root resorption would perhaps induce the 1PM to
begin its eruption.

> Note the essentailly undeveloped roots of the first premolar. It is not
> ready to come into the mouth based on that but it has erupted (I think)
> further down because of the early resorption of the decdisuous 1M.

Again, this could explain the ulcer on the buccal gingiva and the
radio-lucency at the level of the root trunk of the 1 PM.

> Not sure if this applies to the deciduous 2M

Good point, but if you noticed, all the PM's are in an advanced state of
eruption, as the primary molars on both sides are losing their roots. It
would be great to force the 1M's on both sides (1-6 and 2-6) to erupt,
so I could put in a bilateral space maintainer (keep space for the
canines), but I guess we'll have to wait for that...

I'm gonna take out that D and if Path says anything about the stuff
around it, I'll post it here.

Thanks a million, Charlie.

> Charlie Ruff, DMD
> Specialist in Orthodontics
> Diplomate American Board of Orthodontics

Cheeahs
SP

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