Orthotown January/February 2021 - 58

Errant Elastic
Extrudes 2 Teeth
A young patient's case illustrates a risk of DIY orthodontics
by Dr. Michael Daetwyler
with Drs. Robert Julian
and Brian Woo
Dr. Michael Daetwyler is a recent
graduate of the four-year oral and
maxillofacial surgery residency at
UCSF Fresno. After growing up in
Evansville, Indiana, he completed
his undergraduate degree in
microbiology at Brigham Young
University, then returned to
Indiana to complete his dental
training at Indiana University
School of Dentistry. He recently relocated with his wife and
three young boys to work as an associate at Fort Collins Oral
& Maxillofacial Surgery in Fort Collins, Colorado.

58

A

9-year-old patient was referred to the oral and maxillofacial surgery clinic at
UCSF Fresno for urgent evaluation of Teeth 8 and 9, with Class III mobility and
severe bone loss caused by a soft-tissue lesion. The patient and his mother both
reported no past medical or surgical history or trauma to the area, and said that
his teeth had been " normal " just one month before but gradually became more mobile,
accompanied by significant inflammation to the gingiva between them.
The patient had been seen by dentists at two different dental offices, who had started
him on amoxicillin and referred him to our clinic for evaluation of possible pathology.
Over the week before their arrival, the patient's mother reported increasing pain associated
with teeth/soft tissue to anterior maxilla as well as increased mobility, and the presentation
of a foul odor.
Evaluation revealed an erythematous, exophytic lesion between Teeth 8 and 9, resulting
in their gross mobility (Figs. 1a and 1b). Radiographic evaluation (Fig. 2) appeared to show
the teeth dislodging from their bony sockets, without any clear bony erosion of the lesion
seen clinically. Both teeth lacked any response to cold testing, while remaining dentition,
specifically Teeth 7 and 10, responded normally to cold testing and without any significant
mobility. The patient was in mixed dentition stage appropriate for his age (Fig. 3, p. 60),
and no palpable cervical lymphadenopathy
was present.
Fig. 1a
With no history of trauma to the region,
infectious and pathologic concern was raised.
The differential diagnoses for a pediatric
patient with a rapidly advancing localized
soft-tissue lesion causing displacement of teeth
included juvenile aggressive periodontitis;
Fig. 1b
aggressive necrotizing ulcerative gingivitis;
Langerhans cell histiocytosis; pyogenic granuloma; rhabdomyosarcoma; lymphoma; and
leukemia (Chart 1, p. 60).

JANUARY/FEBRUARY 2021 // orthotown.com

OT0620_Daetwyler_DIY-Ortho_AG.indd 58

1/15/21 11:26 AM


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Orthotown January/February 2021

Table of Contents for the Digital Edition of Orthotown January/February 2021

Orthotown January/February 2021 - Intro
Orthotown January/February 2021 - Cover1
Orthotown January/February 2021 - Cover2
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