Oral Pathology
Shamus L. Cooper, DDS
Resident
Indiana University, Bloomington, IN
Indiana University School of Dentistry
Indianapolis, Indiana, United States
James E. Jones, DMD
Faculty
Indiana University/Riley Hospital for Children
Indianapolis, Indiana, United States
LaQuia A. Vinson, DDS, MPH
Pediatric Dentistry Residency Program Director
Indiana University/Riley Hospital for Children
Indianapolis, Indiana, United States
James E. Jones, DMD
Faculty
Indiana University/Riley Hospital for Children
Indianapolis, Indiana, United States
Introduction: Den invaginatus results from the invagination of the enamel organ into the dental papilla. The condition, also known as dens in dente, occurs in the cap stage of tooth development before calcification of dental hard tissues. As dental hard tissues calcify, a small tooth is formed in the future pulp chamber from the invaginated enamel organ. Explanations for why this process occurs range from genetic factors, external forces, and hyper/hypo-proliferation of tooth germ layers. Teeth with dens invaginatus are at higher risk of experiencing dental caries that contaminate the pulpal tissue leading to soft tissue infections. Soft tissue infections are mainly seen in the periapical area of the affected tooth with abbesses occasionally forming on the associated buccal gingiva.
Case Report: A 9-year-old male presented to Riley Children’s Hospital emergency department for evaluation due to severe palatal swelling with associated facial cellulitis. Parent’s chief concern was the swelling and diagnosing the cause. Health history was essentially negative with no trauma related causes for swelling. Ultimately, diagnosis of dens invaginatus was given for tooth #7 with associated periapical and palatal soft tissue infection. This report will include the methods used for diagnosis, management both acute and long term, as well as follow up management of the child.