This study was conducted to determine the prevalence of pre-eruptive intracoronal dentin defects from panoramic radiographs from a group of children and young adults aged 20 years and below. The radiolucent lesions were noted with regard to which teeth were affected, the location of the defects and the size of the defects relative to the width of dentin. Out of 1007 radiographs examined, 275 (27.3%) have pre-eruptive dentin defects. The prevalence of anomaly among males was 28.4% as compared to 26.2% among females. However, the difference between genders was not significant, thus subsequent results have been combined. Of 275 subjects with dentin radiolucencies, 243 subjects (88.7%) had only one affected tooth, 30 subjects (10.9%) had two teeth affected and 2 subjects (0.7%) had three affected teeth. The tooth prevalence of the anomaly was 2.1% and most of the lesions occurred as a single occurrence on the affected tooth. Within each tooth type, the highest tooth prevalence of intracoronal dentin defect was found in the upper first premolar (5.1%). More than half of the lesions extended less than 1/3 of the width of the dentin thickness. The high prevalence of the condition indicates the need for increased awareness and recognition of this during radiographic examination of teeth in the pediatric age group in early pre-eruptive stages so that early detection and diagnosis can be made and treatment can be done at the most appropriate time.
Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological assessment diagnosed her complaint as trigeminal neuralgia but pain remained poorly controlled even with high doses of carbamazepine and gabapentin. A dental referral and orthopantomographic examination revealed multifocal sclerotic masses in her jaws, suggestive of florid cemento-osseous dysplasia (FCOD). Right mandibular incisional biopsy confirmed the diagnosis. A decision was made to curette the right mandibular masses and lateralised the right inferior dental nerve. Follow-up disclosed considerable pain reduction. This case raises the issue as to whether the sclerotic bone masses in FCOD may have caused nerve compression which
aggravated her neuralgic pain.