Hypodontia and hypoplasia of mandible: A rare defect caused by combination therapy
A 19-year-old female patient reported to the Department of Oral Medicine and Radiology, K.S.R Dental College and Hospital with the chief complaint of missing teeth in the upper and lower jaw since childhood; she had difficulty in mastication and was feeling esthetically ill. Her medical history revealed that in her childhood she had recurrent history of fever followed, which she visited a physician and the investigation was carried out and diagnosed to have Langerhans cell histiocytosis. History reveals that she had lesions in the skull and mandible at the age of 3 years and was treated with a combination of radiotherapy and chemotherapy radiotherapy of 50 Gy was given in divided doses for a period of 1 year and chemotherapy for about 1 year, patient was under review for about 10 years with no recurrence. Her dental history was not contributory; she gave a history of spontaneous exfoliation of her few deciduous teeth, followed by delayed eruption of permanent teeth. On general examination, patient was normal in stature, appearance and gait. On extra oral examination facial asymmetry was noticed on the left side of the face (the radiation exposed side) [] temporomandibular joint movements were normal and on right and left side deep sigmoid notch was present but more prominent on the left side. On intra oral hard tissue examination revealed clinically present 11, 13, 15, 16, 17, 23, 26, 31, 33, 34, 36, 41, 42, 43, 46, 47 and RS in 62. Hence, there was hypodontia, microdontia of all the teeth and spacing between the teeth [Figures and ].\nOrthopantomogram revealed (a) hypodontia (b) hypoplasia of mandible (c) deep sigmoid notch (d) reduced vertical height of ramus (e) stunted roots of all permanent teeth (f) inversed and impacted 34 and 44 []. Lateral and posteroanterior view revealed no bony lesions, but there was hypoplasia of mandible on the left side with multiple missing permanent teeth [Figures and ].\nPatient was subjected to complete hemogram, serum calcium and phosphorus, which were in normal limits.\nOn the basis of clinical history and radiographic examination, a diagnosis of radiation induced biological changes in bone and teeth were made.