A case of Syndromic symptoms with generalized pulp calcification

Introduction: Calcification of the dental pulp has two forms; diffuse and discrete. Both local and systemic factors are important in formation of dental pulp calcification (۱–۳). Caries and cavity preparation, the presence of restorations, and excessive forces caused by clenching and trauma are considered as local factors (۴–۶). Hypercalcemia, gout, and end-stage renal diseases are known as systemic factors. Cardiovascular disease and long term use of glucocorticoids has been associated with pulp calcification (۷). Generalized pulp calcifications are rare and can be seen either in diffuse form or distinct form (۸,۹). Diffuse generalized pulp stone formation leads to complete pulp distraction as found in tumoral calcinosis and dentine dysplasia type I (۱۰). Distinct generalized pulp stone formation is more prevalent in multisystem genetic syndromes and dentine genetic defects, such as dentine dysplasia Moreover, etiology of some cases with distinct generalized pulp stone formation is unknown (۱۰–۱۲). هدف : Aim: In this case report we want to present a mild mentally retarded patient with generalized pulp Calcification and discuss the differential diagnosis of this clinical presentation. معرفی بیمار : Case report: A ۲۲-year-old man was referred by a general dentist to the Dental School, University of Alborz, Iran, for more detailed evaluation of multiple pulp stones in his radiographic image and orthodontic treatment. He was the first child of a healthy, non-consanguineous, Iranian parents. Family history wasn't remarkable. For more evaluations we performed complete blood investigations, which were non-contributory.Intraoral examination revealed bleeding gingival tissues and several periodontal pockets, up to ۵ mm. Moreover multiple Caries were found, especially in the posterior teeth. He also had a deep V-shaped palate and bilateral posterior cross-bite, ۷ mm of overjet, and tooth no ۱۱,۳۵,۳۲,۴۵ was missing (Fig. ۱). Also, malformation is seen in all frontal teeth .Cranium, spine and hand radiographies as well as heart and abdominal evaluations were unremarkable. In contrast, the auditory response test and ophthalmologic evaluation tests were not normal. Also he had speech disorder.Radiographic examination with a panoramic radiograph revealed generalized multiple pulp calcification, within the pulp chamber, in all of the teeth and in most of the teeth had short roots even maxillary incisor. His family history was normal. The panoramic radiographs of both parents were negative for pulp calcification. The dental treatment plan was as follows; periodontal therapy, restoration of carious teeth and orthodontic treatment.بحث و نتیجه گیری: Discussion: many reports have been documented pulp calcification in the literature, but reports presenting cases with generalized pulp calcification appearing in all teeth of a young person are less (۱۳–۱۵). In the present case, the generalized pulp stones were found in a young patient, which is opposing to the general concept of pulp stone organization that is usually seen in older age groups or in association with a certain syndrome. However, in this case, no relation could be appointed between the generalized pulp stone and any genetic, systemic or metabolic findings. Therefore, it may be suggested that these pulp stones are of idiopathic beginning.The case is of particular clinical concern due to the attendance of generalized pulp stones in a young patient. Further studies and investigations are necessary to evaluate the exact etiology of generalized pulp calcification which would be able to clarify the fact that generalized pulp calcification is not solely an age change phenomenon of the pulp tissue but other factors also can cause this presentation.

کلیدواژه ها:

Calcification ، dental pulp ، syndrome ، pulp stone