FALSE ASSOCIATION OF DENTAL PROCEDURES WITH SOME OTHER HEALTH PROBLEMS-case studies

FALSE ASSOCIATION OF DENTAL PROCEDURES WITH SOME OTHER HEALTH PROBLEMS-case studies

Introduction

Dental treatments, like any other treatments can lead to some complications. However there are false associations between dental procedure and other oral or systemic problems. A tumor inside bone may take chance of socket as a result of tooth extraction to come out of the bone into the oral cavity. Furthermore an underlying systemic disease may coincidently develop symptoms during or after dental procedure.

In this presentation we look at two cases

1.      A patient with pleomorphic adenoma which manifested following injection for tooth extraction on the palate

2.      A patient with orthodontic problems who developed systemic symptoms following fixation of orthodontic appliances

Pleomorphic adenoma

Pleomorphic adenoma (PA) is the most common tumour of the salivary glands. Although most often found in young to middle-aged women, they can occur in either sex and at any age.

80% occur in the parotid gland, 5% in the submandibular gland, 0.1% in the sublingual gland and about 10% in minor salivary glands. In the minor glands, pleomorphic adenoma typically presents as a rubbery nodule, principally in the palate and upper lip submucosa. They present as slow growing, painless nodules, often detected on routine intra-oral examination.

 Suspected pleomorphic adenomas are normally removed by excision biopsy or conservative surgical enucleation

Case 1  

On 22^nd December 2010, a 39 year old female, reported at our clinic with the main complain of painless swelling on the upper part of the mouth for about 10 yrs

The swelling started about 10 yrs ago following injection to extract a tooth from the upper jaw. The swelling was slowly increasing in size.

The patient did not take any step as she was waiting for spontaneous disappearance with time. She strongly believed that the swelling was caused by painful injection during tooth extraction. After noting that it was not disappearing by instead increasing in size; she went to one of general clinic in Kitwe Zambia where she was sent to us for consultation under provision diagnosis of Kaposi’s sarcoma.

On examination, there was a soft swelling on the right palate extending from tooth 18-13, close to mid palate and free gingival margin. The swelling was not fixed to surrounding tissues

Our provision diagnosis was pleomorphic adenoma

After examination  we informed the referring clinic our findings and planned management. However the clinic didn’t agree with our findings and plan, so they sent her to two more clinics for further but fruitless consultations. The patient decided to come back to us for the suggested management.

Management-  excision biopsy for histological analysis was done and the tumor was found to be pleomorphic adenoma.

The patient is doing fine.

Discussion

An association of the swelling with injection of LA during tooth extraction indicates that, the patient lacked awareness about oral tumors.

Waiting for about 10 yrs without going to hospital when coupled with offended extraction indicate the patient had a tendency to delay reporting oral problems until when signs and symptoms are unbearable (pain or any discomfort due to the swelling).

Discouragement by 1^st medical personnel not to have a tumor removed when coupled with his/her provision diagnosis of  Kaposi’s sarcoma indicate that even some medical practitioners lack basic knowledge on oral tumors.