Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2022

Open Access 01-12-2022 | Glucocorticoid | Case report

Generalized pulp canal obliteration in a patient on long-term glucocorticoids: a case report and literature review

Authors: Ban Jiandong, Zhang Yunxiao, Wang Zuhua, Hou Yan, Geng Shuangshuang, Li Junke, Wang Hongwei, Xu Hua

Published in: BMC Oral Health | Issue 1/2022

Login to get access

Abstract

Background

The calcification of the tooth pulp is a pathological condition that occurs in response to various factors. A uncommon haematological condition known as paroxysmal nocturnal haemoglobinuria (PNH) is characterized by bouts of haemolysis, and it requires long-term use of glucocorticoids (GCs).

Case presentation

A female patient who was diagnosed with PNH and had a history of long-term use of GCs came to our department for root canal therapy (RCT) for teeth 25, 26, and 27. The radiographs showed generalized pulp canal obliteration (PCO) in most of the patients. None of these teeth (25, 26, or 27) were sensitive to percussion, and they did not respond to thermal or electrical sensitivity tests. A diagnose of pulp necrosis was made for these teeth. RCT was carried out with the help of an oral microscope, and then a prosthodontic procedure was created for the teeth.

Conclusions

Based on the patient’s long history use of GCs and a series of related studies, we conclude that the long-term usage of GCs contributes significantly to the onset of PCO.
Literature
1.
Pettiette MT, Zhong S, Morett AJ, et al. Potential correlation between statins and pulp chamber calcification. J Endod. 2013;39:1119–23.PubMedCrossRef
2.
Sener S, Cobankara FK, Akgunlu F. Calcifications of the pulp chamber: prevalence and implicated factors. Clin Oral Investig. 2009;13:209–15.PubMedCrossRef
3.
Stanley HR, White CL, McCray L. The rate of tertiary (reparative) dentine formation in the human tooth. Oral Surg Oral Med Oral Pathol. 1966;21:180–9.PubMedCrossRef
4.
Näsström K. Dentin formation after corticosteroid treatment. A clinical study and an experimental study on rats. Swed Dent J Suppl. 1996;115:1–45.PubMed
5.
Edds AC, Walden JE, Scheetz JP, et al. Pilot study of correlation of pulp stones with cardiovascular disease. J Endod. 2005;31:504–6.PubMedCrossRef
6.
Gold SI. Root canal calcification associated with prednisone therapy: a case report. J Am Dent Assoc. 1989;119:523–5.PubMedCrossRef
7.
Mizuno N, Shiba H, Xu W, et al. Effect of neurotrophins on differentiation, calcifification and proliferation in cultures of human pulp cells. Cell Biol Int. 2007;31:1462–9.PubMedCrossRef
8.
Ranjitkar S, Taylor JA, Townsend GC. A radiographic assessment of the prevalence of pulp stones in Australians. Austr Dent J. 2002;47:36–40.CrossRef
9.
Udoye C, Sede M. Prevalence and analysis of factors related to ooccurrence of pulp stone in adult restorative patients. Ann Med Health Sci Res. 2011;1:9–14.PubMedPubMedCentral
10.
Al-Nazhan S, Al-Shamrani S. A radiographic assessment of the prevalence of pulp stones in Saudi adults. Saudi Endod J. 2011;1:19–26.
11.
Gautam S, Galgali SR, Sheethal HS, et al. Pulpal changes associated with advanced periodontal disease: a histopathological study. J Oral Maxillofac Pathol. 2017;21:58–63.PubMedPubMedCentralCrossRef
12.
Nanjannawar GS, Vagarali H, Nanjannawar LG, et al. Pulp stone– an endodontic challenge:successful retrieval of exceptionally long pulp stones measuring 14 and 9.5 mm from the palatal roots of maxillary molars. J Contemp Dent Pract. 2012;13:719–22.PubMedCrossRef
13.
Mello-Moura AC, Bonini GA, Zardetto CG, et al. Pulp calcification in traumatized primary teeth:prevalence and associated factors. J Clin Pediatr Dent. 2011;35:383–8.PubMedCrossRef
14.
Saito T, Ogawa M, Hata Y, et al. Acceleration effect of human recombinant bone morphogenetic protein-2 on differentiation of human pulp cells into odontoblasts. J Endod. 2004;30:205–8.PubMedCrossRef
15.
Matsui S, Takahashi C, Tsujimoto Y, et al. Stimulatory effects of low- concentration reactive oxygen species on calcification ability of human dental pulp cells. J Endod. 2009;35:67–72.PubMedCrossRef
16.
Zeng J, Zhang W, Jiang H, et al. Isolation, cultivation and identification of Nanobacteriafrom dental pulp stone. Chin J Stomatol. 2006;41:498–501.
17.
Parekh S, Kyriazidou A, BlochZupan A, et al. Multiple pulp stonesand shortened roots of unknown etiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:139–42.CrossRef
18.
Symons AL, Symons DJ. Pulpal obliteration related to long-term glucocorticosteroid medication. Spec Care Dentist. 1994;14:103–7.PubMedCrossRef
19.
Chigono Y, Daimon T, Miyagawa M, et al. Dental pulp changes observed in a patient on long-term corticosteroids. J Hard Tiss Biol. 2007;16:31–5.CrossRef
20.
Hill A, Kinoshita T, et al. Paroxysmal nocturnal haemoglobinuria. Nat Rev Dis Primers. 2017;18:17028–56.CrossRef
21.
22.
Hillmen P, Lewis SM, Bessler M, et al. Natural history of paroxysmal nocturnal hemoglobinuria. N Engl J Med. 1995;333:1253–8.PubMedCrossRef
23.
Socie G, et al. Changing prognosis in paroxysmal nocturnal haemoglobinuria disease subcategories: an analysis of the International PNH Registry. Intern Med J. 2016;46:1044–53.PubMedCrossRef
24.
Yu F, Du Y, Han B. A comparative analysis of clinical characteristics of patients with paroxysmal nocturnal hemoglobinuria between Asia and Europe/America. Int J Hematol. 2016;103:649–54.PubMedCrossRef
25.
Oni SB, Osunkoya BO, Luzzatto L. Paroxysmal nocturnal hemoglobinuria: evidence for monoclonal origin of abnormal red cells. Blood. 1970;36:145–52.PubMedCrossRef
26.
Takeda J, Miyata T, Kawagoe K, et al. Deficiency of the GPI anchor caused by a somatic mutation of the PIG-A gene in paroxysmal nocturnal hemoglobinuria. Cell. 1993;73:703–11.PubMedCrossRef
27.
Latour RD, Mary JY, Salanoubat C, et al. Paroxysmal nocturnal hemoglobinuria: natural history of disease subcategories. Blood. 2008;112:3099–106.PubMedCrossRef
28.
Eickstedt KW, Elsasser W. Corticotrophins and corticosteroids. In: Dukes MNG, editor. Meyler’s side effects of drugs. 11th ed. Amsterdam: Elsevier Science Publishers; 1988. p. 812–27.
29.
Atkinson JB, Kosi M, Srikanth MS, et al. Growth hormone reduces impaired wound healing in protein-malnourished rats treated with corticosteroids. J Pediatr Surg. 1992;27:1026–8.PubMedCrossRef
30.
Anneroth G, Bloom G. Structural changes in the incisors of cortisone-treated rats. J Dent Res. 1966;45:229–35.PubMedCrossRef
31.
Ball PC. Dimensional changes in the dental tissues of the rat mandibular incisor after the systemic administration of glucocorticoid hormone. J Dent Res. 1972;51:1260.
32.
Ball PC. The effect of adrenal glucocorticoid administration on eruption rates and tissue dimensions in rat mandibular incisors. J Anat. 1977;124(Pt 1):157–63.PubMedPubMedCentral
33.
Ball PC. Lack of effect of excess glucocorticoid hormone on the rate of dentin deposition in rats. J Dent Res. 1977;56:685–90.PubMedCrossRef
34.
Johannessen LB. Effects of cortisone on dentinogenesis in mandibular first molars of albino rats. Arch Oral Biol. 1964;9:421–34.PubMedCrossRef
35.
Lange A, Hammarstrom L. Cell sizes and apposition of dental hard tissues in rats. Aeta Odontol Seand. 1984;42:215–23.CrossRef
36.
Hofmman MM, Schour I. Quantitative studies in the development of the rat molar. The growth of the primary and secondary dentin from birth to 500 days of age. Anat Res. 1940;78:233–51.CrossRef
37.
Kurahashi Y, Nagai N, Watanabe K, Watanabe H, Yama K. Chronological observation of the odontogenesis of rat molars. Bull Tokyo Dent Coll. 1968;4:147–59.
38.
Griffith JQ, Farris EJ. The Rat in Laboratory Investigation. (Scientific Books: The Rat in Laboratory Investigation). J.B. Lippincott Company, 1942; 104–65.
39.
Cate RT. Oral histology: development, structure, and function. 1989:122–39.
40.
Näsström K, Forsberg B, Petersson A, et al. Narrowing of the dental pulp chamber in patients with renal diseases. Oral Surg Oral Med Oral Pathol. 1985;59:242–6.PubMedCrossRef
41.
Shinozuka O, Sekiguchi G, Tamamori Y, et al. Narrowing of the dental pulp cavity in patients undergoing long-term administration of steroids. Kokubyo Gakkai Zasshi. 2001;68:294–9.PubMedCrossRef
42.
American Association of Endodontists (2010) Contemporary endodontic microsurgery: procedural advancements and treatment planning considerations. Endodontics. Colleagues for Excellence. Chicago: American Association of Endodontists.
43.
Glendor U. Epidemiology of traumatic dental injuries—a 12 years review of the literature. Dent Traumatol. 2008;24:603–11.PubMedCrossRef
44.
45.
Andreasen FM, Zhijie Y, Thomsen BL, Andersen PK. Occurrence of pulp canal obliteration after luxation injuries in the permanent dentition. Endod Dent Traumatol. 1987;3:103–15.PubMedCrossRef
46.
Robertson A, Andreasen FM, Bergenholtz G, Andreasen JO, Noren JG. Incidence of pulp necrosis subsequent to pulp canal obliteration from trauma of permanent incisors. J Endod. 1996;22:557–60.PubMedCrossRef
47.
Holcomb JB, Gregory WB Jr. Calcific metamorphosis of the pulp: Its incidence and treatment. Oral Surg Oral Med Oral Pathol. 1967;24:825–30.PubMedCrossRef
48.
Vinagre A, Castanheira C, Messias A, et al. Management of pulp canal obliteration-systematic review of case reports. Medicina (Kaunas). 2021;57:1237.CrossRef
49.
Oginni AO, Adekoya-Sofowora CA, Kolawole KA. Evaluation of radiographs, clinical signs and symptoms associated with pulp canal obliteration: an aid to treatment decision. Dent Traumatol. 2009;25:620–5.PubMedCrossRef
50.
Fonseca Tavares WL, Diniz Viana AC, de Carvalho MV, et al. Guided endodontic access of calcified anterior teeth. J Endod. 2018;44:1195–9.PubMedCrossRef
51.
Zubizarreta-Macho A, Valle Castano S, Montiel-Company JM. Effect of computer-aided navigation techniques on the accuracy of endodontic access cavities: a systematic review and meta-analysis. Biology. 2021;10:212.PubMedPubMedCentralCrossRef
52.
Pinto D, Marques A, Pereira JF. Long-term prognosis of endodontic microsurgery-a systematic review and meta-analysis. Medicina. 2020;56:447.PubMedCentralCrossRef
53.
Mainkar A. A systematic review of the survival of teeth intentionally replanted with a modern technique and cost-effectiveness compared with single-tooth implants. J Endod. 2017;43:1963–8.PubMedCrossRef
54.
Torabinejad M, Dinsbach NA, Turman M. Survival of intentionally replanted teeth and implant-supported single crowns: a systematic review. J Endod. 2015;41:992–8.PubMedCrossRef
Metadata
Title
Generalized pulp canal obliteration in a patient on long-term glucocorticoids: a case report and literature review
Authors
Ban Jiandong
Zhang Yunxiao
Wang Zuhua
Hou Yan
Geng Shuangshuang
Li Junke
Wang Hongwei
Xu Hua
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Glucocorticoid
Published in
BMC Oral Health / Issue 1/2022
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-022-02387-9

Other articles of this Issue 1/2022

BMC Oral Health 1/2022 Go to the issue

Research

Evaluation of the antibacterial activity of Lactobacilli probiotics supernatants against Enterococcus faecalis (in-vitro study)

Research

Extraoral low-level laser therapy can decrease pain but not edema and trismus after surgical extraction of impacted mandibular third molars: a randomized, placebo-controlled clinical trial

Research article

The impact of an alkasite restorative material on the pH of Streptococcus mutans biofilm and dentin remineralization: an in vitro study

Research

Translation and validation of Sinhala version of modified EORTC QLQ-OH15 in oral cancer patients who receive radiotherapy with or without chemotherapy in Sri Lanka

Research

Oral health perceptions and practices of caregivers at children’s religious schools and foster care centers: a qualitative exploratory study in Lahore, Pakistan

Research article

A new scoring system facilitating diagnosis of oral squamous malignancy on biopsy specimens