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Call for letters to the editor
ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY Volume 92, Number 1
Letters to the editor 3
J Endod 2000;26:371-3), using the same radiograph. In Dr Selden’s report, the radiograph appears as the third in a series of 6 radiographs depicting the natural history of this particular periapical central giant cell granuloma before and after root canal treatment. In our article, we described the clinicopathologic features of a series of recently diagnosed periapically located central giant cell granulomas and stressed the potential for endodontic misdiagnosis. We were largely frustrated in obtaining the complete clinical and radiographic history of these periapical giant cell granulomas both before and after the histopathologic diagnosis was made. In this respect, the timing and content of Dr Selden’s case report is very opportune; the 2 articles complement one another and share more than a radiograph.
I had come across a case of paresthesia of the lower lip due to acute alveolar osteitis of the extraction socket of the left mandibular second premolar. Sensation returned once the extraction socket started to heal. I believe paresthesia of the mental nerve, as highlighted earlier in this letter, was more likely to occur in conjunction with periapical infection of the premolars because of the close proximity of the apices of these teeth to the mental nerve/foramen. In fact, studies have shown that the location of the mental nerve/foramen most commonly occurred along the longitudinal axis of the second premolar tooth.2,3 Thus, any spread of infection could easily reach the mental nerve merely by the pull of gravity. It is interesting to note that paresthesia caused by periapical infection is not restricted to the mental nerve area. It can also occur in the infraorbital nerve after endo-antral syndrome. Endo-antral syndrome describes the infection of the maxillary antrum, which results from periapical infection.4 For example, in a case that I recently discovered, my patient complained of numbness of the left infraorbital region and on examination was discovered to have acute left maxillary sinusitis, which was caused by the spread of infection from the upper left premolars and first molar. Sensation returned a week later, after the teeth were removed (he was not interested in root canal treatment) and the antrum drained.
Gordon A. Pringle, DDS, PhD Associate Professor Department of Pathology & Laboratory Medicine Temple University Philadelphia, Pa doi:10.1067/moe.2001.115578
Paresthesia of the mental nerve To the editor: I was very interested in the article by Di Lenarda et al (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:746-9) and wish to make a few comments based on some professional experiences. An article regarding a similar problem was published in a medical journal more than 2 years ago.1 The interesting thing about that case, of course, was the rate at which sensation returned after open drainage. The tooth concerned had a periapical lesion and before that had an endodontics procedure performed. After that, numbness set in until open drainage was performed. As in the case presented by Di Lenarda et al, the author suggested periapical infection as the cause of paresthesia.
Wei Cheong Ngeow, BDS, FFDRCSI, FDSRCS, AM Department of Oral and Maxillofacial Surgery University of Malaya Kuala Lumpur, Malaysia REFERENCES 1. Ngeow WC. Lower lip numbness due to peri-radicular dental infection. Med J Malaysia 1998;53:446-8. 2. Shankland WE II. The position of the mental foramen in Asian Indians. J Oral Implantol 1994;20:118-23. 3. Green RM. The position of the mental foramen: a comparison between the southern (Hong Kong) Chinese and other ethnic and racial groups. Oral Surg Oral Med Oral Pathol 1987;63:287-90. 4. Selden HS. The endo-antral syndrome: an endodontic complication. J Am Dent Assoc 1989;119:397-8,401-2. doi:10.1067/moe.2001.116509
CALL FOR LETTERS TO THE EDITOR A separate and distinct space for Letters to the Editor was established by Larry J. Peterson, editor in chief of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics in his Editorial in the January 1993 issue. Dr Peterson also encouraged brief reports on interesting observations and new developments to be submitted to appear in this letters section as well as Letters commenting on earlier published articles. Please submit your letters and brief reports for inclusion in this section. Information for authors for the Journal appears in this issue of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. We look forward to hearing from you.
Letters to the editor 3
J Endod 2000;26:371-3), using the same radiograph. In Dr Selden’s report, the radiograph appears as the third in a series of 6 radiographs depicting the natural history of this particular periapical central giant cell granuloma before and after root canal treatment. In our article, we described the clinicopathologic features of a series of recently diagnosed periapically located central giant cell granulomas and stressed the potential for endodontic misdiagnosis. We were largely frustrated in obtaining the complete clinical and radiographic history of these periapical giant cell granulomas both before and after the histopathologic diagnosis was made. In this respect, the timing and content of Dr Selden’s case report is very opportune; the 2 articles complement one another and share more than a radiograph.
I had come across a case of paresthesia of the lower lip due to acute alveolar osteitis of the extraction socket of the left mandibular second premolar. Sensation returned once the extraction socket started to heal. I believe paresthesia of the mental nerve, as highlighted earlier in this letter, was more likely to occur in conjunction with periapical infection of the premolars because of the close proximity of the apices of these teeth to the mental nerve/foramen. In fact, studies have shown that the location of the mental nerve/foramen most commonly occurred along the longitudinal axis of the second premolar tooth.2,3 Thus, any spread of infection could easily reach the mental nerve merely by the pull of gravity. It is interesting to note that paresthesia caused by periapical infection is not restricted to the mental nerve area. It can also occur in the infraorbital nerve after endo-antral syndrome. Endo-antral syndrome describes the infection of the maxillary antrum, which results from periapical infection.4 For example, in a case that I recently discovered, my patient complained of numbness of the left infraorbital region and on examination was discovered to have acute left maxillary sinusitis, which was caused by the spread of infection from the upper left premolars and first molar. Sensation returned a week later, after the teeth were removed (he was not interested in root canal treatment) and the antrum drained.
Gordon A. Pringle, DDS, PhD Associate Professor Department of Pathology & Laboratory Medicine Temple University Philadelphia, Pa doi:10.1067/moe.2001.115578
Paresthesia of the mental nerve To the editor: I was very interested in the article by Di Lenarda et al (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:746-9) and wish to make a few comments based on some professional experiences. An article regarding a similar problem was published in a medical journal more than 2 years ago.1 The interesting thing about that case, of course, was the rate at which sensation returned after open drainage. The tooth concerned had a periapical lesion and before that had an endodontics procedure performed. After that, numbness set in until open drainage was performed. As in the case presented by Di Lenarda et al, the author suggested periapical infection as the cause of paresthesia.
Wei Cheong Ngeow, BDS, FFDRCSI, FDSRCS, AM Department of Oral and Maxillofacial Surgery University of Malaya Kuala Lumpur, Malaysia REFERENCES 1. Ngeow WC. Lower lip numbness due to peri-radicular dental infection. Med J Malaysia 1998;53:446-8. 2. Shankland WE II. The position of the mental foramen in Asian Indians. J Oral Implantol 1994;20:118-23. 3. Green RM. The position of the mental foramen: a comparison between the southern (Hong Kong) Chinese and other ethnic and racial groups. Oral Surg Oral Med Oral Pathol 1987;63:287-90. 4. Selden HS. The endo-antral syndrome: an endodontic complication. J Am Dent Assoc 1989;119:397-8,401-2. doi:10.1067/moe.2001.116509
CALL FOR LETTERS TO THE EDITOR A separate and distinct space for Letters to the Editor was established by Larry J. Peterson, editor in chief of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics in his Editorial in the January 1993 issue. Dr Peterson also encouraged brief reports on interesting observations and new developments to be submitted to appear in this letters section as well as Letters commenting on earlier published articles. Please submit your letters and brief reports for inclusion in this section. Information for authors for the Journal appears in this issue of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. We look forward to hearing from you.