Hatem A. Alhadainy

Background: Congenital Insensitivity to Pain and Anhidrosis (CIPA) is a rare autosomal recessive disorder characterized by congenital analgesia, anhidrosis, and multisystem involvement affecting the musculoskeletal, cutaneous, oral, and para-oral structures. This case report describes the oral phenotype and multidisciplinary clinical management of a child with CIPA. Case Description: A 9-year-old boy presented with poor oral hygiene, multiple severely damaged teeth, masticatory difficulty, limited mouth opening, impaired bolus control, and para-oral traumatic injuries. Medical and orthopedic history indicated recurrent painless fractures, self-inflicted injuries, cutaneous scarring, and recurrent hyperpyrexia. Oral self-injury associated with CIPA was suspected and supported by the Nociception Assessment Test and Minor’s Iodine–Starch Test. Although the clinical findings were suggestive of CIPA, the diagnosis remained presumptive due to the absence of confirmatory molecular or histopathological testing. Management: A wearable wireless continuous temperature-monitoring device was prescribed to assist in tracking hyperpyrexia associated with CIPA (RHA-CIPA). A conservative, staged, multidisciplinary treatment was planned rather than full-mouth extraction, emphasizing prevention of dental sepsis and mitigation of future self-injury. Dental procedures were performed under local anesthesia to manage discomfort related to tactile hyperesthesia. To reduce nocturnal biting and oral trauma, a hard acrylic occlusal protector was fabricated using an intraoral scanner and a 3D-printed cast. The patient was followed for 12 months. Outcomes: At the 12-month follow-up, clinical improvement was observed, with particularly notable gains in cheek elasticity and soft tissue resilience. Conclusions: This case highlights the considerable challenges involved in the interdisciplinary management of children with CIPA, including oral self-injury prevention, limited mouth opening, and the necessity of close coordination with medical specialties. These findings are descriptive observations of a single case and do not establish efficacy or generalizability of any intervention.

Background: Displaced anterior teeth may be associated with periapical lesions and form an ortho-endo problem that requires special attention and careful planning. This case report documented the use of an intracanal medicament to stimulate the healing of a large periapical lesion and treat severely displaced incisors. Methods: A 13-year-old patient was presented with a 14x26 mm periapical radiolucency related to displaced incisors. After chemo-mechanical preparation, calcium hydroxide medicament was placed in the canals and changed every 2 weeks for 3 months. The canal was then freshly cleaned and filled with gutta‐percha and sealer. The coronal preparation was sealed with glass ionomer filling. Results: At the 24-month follow-up, the teeth were asymptomatic. The radiographs showed correction of the incisor displacement after bone regeneration, and a significant reduction in the lesion size. Conclusion: Conventional endodontics with an intracanal medicament can correct an ortho-endo problem in incisors with a large periapical lesion. Clinical significance: Dentists should not initiate orthodontic intervention for an endo-ortho problem until the periapical lesion has completely healed.

Background: Cone-beam computed tomography (CBCT) was used for a 1-year follow-up of a randomized clinical trial to compare a stainless-steel Tornado file system with OneShape and WaveOne rotary systems for biomechanical canal preparation, as indicated by radiolucency sizes of periapical lesions. Methods: Lower molars with necrotic pulps and periapical lesions were randomly divided into three groups (n = 20) according to three rotary file systems. After root canal treatment, clinical and assessment of the CBCT periapical index scores were blindly evaluated at one year using pre- and post-instrumentation CBCT images. Statistical analysis was performed to compare the three systems at a p-value of 0.05. Results: The results revealed a significant decrease in the size of apical radiolucency in each group after one-year follow-up, with no statistically significant difference among the three systems (p > 0.05). Conclusions: CBCT is a valuable biomedical imaging modality for assessing periapical lesion healing. Tornado, WaveOne, and OneShape systems can be used with similar efficacy for root canal preparation in teeth with periapical lesions. Clinical Trial Registration: The study was retrospectively registered with ClinicalTrials.gov (NCT06752837). Date of Registration: 30 December 2024. The CONSORT group has identified it as essential.

Background: This scoping review systematically summarized the available evidence about the efficacy of N-acetyl cysteine (NAC) as an intracanal antibacterial and/or anti-inflammatory.Methods: PubMed, Scopus, Web of Science, and Google scholar search engines/databases were searched up to February 2022 to retrieve relevant studies. The studies were evaluated for eligibility criteria, and identifying relevant studies.Results: Out of 193 studies, 15 fulfilled the inclusion criteria and were processed for data extraction. Thirteen in vitro studies assessed antibacterial/antibiofilm efficacy of NAC, and reported good and promising efficacy: NAC was found as efficacious as the comparators (chlorhexidine, sodium hypochlorite, calcium hydroxide), or even showed higher efficacy. Regarding the anti-inflammatory efficacy of NAC, one in vitro study found it equivalent to, while one clinical trial revealed it more efficacious than calcium hydroxide.Conclusions: There is accumulating evidence on the anti-microbial and anti-inflammatory efficacy of NAC in context of endodontics. However, further clinical trials with robust methodology and objective and reliable clinical, biological and microbial outcomes are warranted to translate its use for clinical practice on humans.

Objective: This study aimed to determine the potential association between the dental diseases and self‐reported history of stroke in the United States based on data from the Third National Health and Nutrition Examination Survey (NHANES III).Methods: Data were extracted from NHANES III. Dental variables were carious tooth surfaces, number of missing teeth, gingival bleeding, and periodontal pockets. Multiple logistic regression modeling was used to estimate the effect of these dental diseases on the self‐reported history of stroke with intent to adjust for the other potential determinants: age, sex, race, marital status, health insurance, education, exercise, body mass index, smoking, alcohol, hypertension, high serum cholesterol, and diabetes.Results: Number of missing teeth was found to be significantly associated with the self‐reported history of stroke. Associations between the self‐reported history of stroke and caries, gingival bleeding, or periodontal pockets were not statistically significant.Conclusions: Number of missing teeth was an independent determinant of the self‐reported history of stroke.

Cracked tooth syndrome is presented as pain associated with biting and sensitivity. Intracanal medication with simvastatin simulates hard tissue formation at crack line, and the tooth was functioning on the follow-ups.