Portal de Periódicos da CAPES

The Significance of “Floating Teeth” in Children

1966; Radiological Society of North America; Volume: 86; Issue: 2 Linguagem: Inglês

10.1148/86.2.215

1527-1315

Kenneth D. Keusch, Donald R. King, Catherine A. Poole,

Tumors and Oncological Cases

An opinion is frequently expressed in the literature that the radiographic finding of “floating teeth” is distinctive of or pathognomonic of histiocytosis in children (1, 10, 11, 13, 14). Numerous case reports of “floating teeth” in two variants of the histiocytoses—eosinophilic granuloma and Hand-Schüller-Cliristian disease—have appeared in the radiographic and dental literature. “Floating teeth” are teeth which have lost their supporting alveolar bone secondary to some destructive process involving the mandible or alveolar ridge of the maxillae. Radiographic manifestations include loss of alveolar bone, loss of lamina dura, and, in the case of unerupted teeth, loss of the dental follicle. The root tips of the involved teeth may undergo resorption (15). Eventually the tooth will be elevated and displaced from adjacent teeth, with a resultant radiographic appearance of the tooth hanging or floating in soft tissue without bony support. The destructive process may involve a single tooth, a group of teeth, or the complete dental arch, including erupted or nonerupted deciduous or permanent teeth. Clinically, these children usually present with pain and swelling of the mandible or maxillae. Physical examination generally reveals evidence of gingival swelling and inflammation, with or without ulceration and hemorrhage. The involved teeth may or may not appear displaced, but on palpation will be loose and freely movable (10, 11). The authors have recently studied 4 patients who presented clinically and radiographically with classical “floating teeth.” Of the 4, 3 manifested a pathological entity entirely unrelated to and much more life-threatening than histiocytosis. It is the aim of this report to present these 4 cases and emphasize the multiplicity of diseases that the radiologist, pediatrician, or oral surgeon must consider as the cause of “floating teeth.” Case Reports Case I: D. M., a 3-year-old white female, was brought to the emergency room of Jackson Memorial Hospital because of “swelling inside the mouth” and “bleeding gums” of approximately one month duration. The child had refused all solid foods for one week prior to admittance and complained increasingly of pain in the mouth which, the mother noted, had a foul odor during this period. Past medical history and family history were unremarkable. A low-grade fever of 100.2° F was recorded on admission. Pertinent physical findings were limited to the head and neck. A slight protuberance apparent along the body of the left mandible proved on palpation to be a firm, nontender mass, fixed to the mandible. Intraoral examination revealed the left lower gingiva to be swollen, ulcerated, and bleeding slightly. The deciduous second molar was loose. A soft, nontender, fixed nodule approximately one centimeter in diameter was also noted in the right parietal area. A radiograph of the left mandible (Fig. 1) revealed a classical “floating tooth.”