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Surgeon Commander (D) Graeme Bryce Royal Navy, Consultant in Restorative Dentistry, Centre for Restorative Dentistry, Defence Primary Health Care (Dental), Evelyn Woods Road, Aldershot, GU11 2LS
Actinomycosis is a chronic bacterial infection caused by Actinomyces species. Actinomyces are commensals of the human oropharynx and can invade local structures when mucosal integrity is breached. Within an actinomycosis lesion chronically inflamed and necrotic tissue may undergo dystrophic calcification. This case report documents the assessment, diagnosis, and management of Actinomyces-associated calcification within a nasopalatine cyst, a previously unreported situation.
CPD/Clinical Relevance: Actinomycosis lesions of the jaws may present with radiographically detectable calcification(s).
Article
A 51-year-old male was referred by his general dental practitioner (GDP) for assessment and management of a tender swelling in his anterior hard palate. The patient's medical history was unremarkable. The patient reported a previous acute episode of swelling, with foul tasting discharge, for which his GDP had empirically prescribed a 5-day course of 500 mg amoxicillin three times daily. The antibiotic therapy reduced symptoms, but was not successful in alleviating the swelling. There were neither previous symptoms from the area, nor history of dental trauma.
The specific examination found the anterior hard palate mucosa to be tender to finger palpation with the presence of a sinus tract in the incisive papilla. The maxillary incisor teeth were unrestored, gave normal responses to pulp sensibility tests and had a periodontal probing profile that was within normal limits. There was mild anterior tooth surface loss, which was judged to be attritive in character, and associated with nocturnal parafunction as the major aetiological factor.
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