July 31, 2019
A little boy of 7 years old was brought to Saveetha Dental College and Hospital by his parents with a complaint of a swelling in the jaw. He had been taken to a nearby hospital, Chennai at the age of 3 since the parents noticed a small swelling at the right lower jaw, but he refused to co-operate for any investigative procedures as he was very young. Hence the swelling was left undiagnosed for 4 years. He was brought to our institution at the age of 7 years as the swelling was slowly increasing in size.
Here it is very important to understand that patient counseling is important. Child should also be treated as an adult and patient counseling in addition to parent counseling is important. The parents were very apprehensive as they had thought it could be a cancer of the jaw. The initial work up by the surgeons revealed a large lesion with multiple hard structures at a single site within the lower jaw. During the surgery, the operating surgeon noticed a well-defined bag like mass which was removed in its entirety.
The specimen was radiographed which revealed multiple tiny radiopaque structures. On further evaluation by the oral pathologists, and to their utmost surprise the bag revealed 526 tooth like structures. In the pathologists’ own words “it was reminiscent of pearls in an oyster”. It took 5 hours of meticulate searching to remove all the minute teeth from the opened bag like specimen. “This pandora box of miniature teeth is a jewel on our crown,” said the postgraduates.
This is the first ever case to be documented world wide, where so many minute teeth were found in a single individual. This rare lesion is termed as “compound composite odontome”. The expertise and the competence of the team of oral surgeons and oral pathologists in Saveetha Dental College and Hospitals in dealing with such a rare case are to be applauded. The surgeons’ discretion in removing the lesion in total without exploring it on the operating table (akin to opening a bag of worms) avoided a major mishap and saved the patient from being under general anaesthesia for a longer duration and the attendant complications. The mental trauma the patient and the parents had undergone was unimaginable but the team in Saveetha Dental College and Hospital has always been the epitome in patient care, and owing to their surgical decision making and pathological acumen and knowledge, the patient was treated at the right time with the appropriate treatment planning, hence they were relieved of the biggest turmoil of their life. Saveetha always believes in proving themselves to be one of the best in patient care in the global arena. Saveetha has always been the benchmark of excellence and abides by all health care schemes and is readily accessible to all strata of patients.
“Patient’s awareness on importance of oral health and reporting to oral and maxillofacial centres at the earilest is to be promoted,” says Dr. Senthilnathan, Professor Department of Oral and maxillofacial surgery. Dr. Pratibha Ramani, Professor and Head of Department of oral and maxillofacial Pathology says that, “Social consciousness on emerging environmental hazards is imperative. Every tissue information is patient’s right, surgical decision making is the key and final diagnostic expert is the pathologist.”
The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being, and not merely as the absence of disease or infirmity. Social determinants of health are the conditions in which people are born, raised and subsequently live, work and age Their social circumstances are also shaped by the distribution of money, power and resources at local, national and global levels.
For example, how children are raised has a profound impact on their health; factors include nutrition, physical activities, immediate and surrounding environment, social interactions, cultural and religious background. Health education and promotion empower people to prevent social problems from developing into health issues.
Health problems do not exist in isolation and the root causes of ill health are as much social as they are biological. Disparities in social determinants of health are largely responsible for health inequities and the unfair and avoidable differences in health status seen within countries. Acknowledging that a health problem is not limited to a patient’s illness, but is influenced by various challenges which make it impossible for them to lead a healthy life, ensures that patients are treated holistically.
Holistic treatment of the patient with credence given to each and every patient, meticulous treatment planning, the utmost care to is where Saveetha makes its mark.