36 /m c/of oral pain and loose teeth since 1year. H/O loosing 4 teeth spontaneously within 6 months. C/0 increased thirst, polyuria. Dehydration +. S.E ..revealed hypernateraemia. Diagnosis? .

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Thanks Al of u. X ray image shows 2 radiolucent scooped out lesions of the mandible with floating tooth. Biopsy . of left mandibular lesions ..showed sheets of inflammatory cells and S100 +CD1a +langerhans cells . Mri brain showed increased T1 w signal in posterior pituitary and thickning of infundibulum. Dx. ..multi organ langerhans cell histiocytosis with Diabetis insipidus. Patient was treated with curettage and desmopressin.

Omg...severe bone loss is dere respect to mandible even including d lower border of mandible in 3rd quadrant... Rule out diabetes status...requires extrctn of hopeless teeth... Is it associated wd extraoral sinus (3rd quadrant)....?

Take more detailed history and also post clinical picture.. ask for family history.. and prescribe HLA test..this can be case of localized aggressive periodontitis or periodontitis associated with systemic disease..

Severe bone loss in the mandibular molar regions that resembles advanced periodontitis. These symptoms may associated with systemic disorders. D.diagnosis may Langerhans cell histiocytosis.

Aggressive periodontitis of mandibular arch. Followed by DM-2 Evaluate BSL levels. Then proceed for extraction may require ridge augmentation to proceed for rehabilitation.

Amazing case never seen this level of bone loss in agressive periodontitis!! @Dr. Rustom Lahon Sir how does that even happen

Such conditions are often related to systemic diseases.... first we have to correct them... this very case certainly needs bones grafting or plating...
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the radiolucency in 3rd quadrant is extending to lower border. Has it become osteomyelitis? swelling/draining sinuses are there?

Premature loss of teeth with hypernatremia indicates diabetes mellitus. Send hba1c, fbs, ppbs, RFT.

Hypernatremia is due to renal water bcoz of osmotic diuresis secondary to hyperglycemia
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Extensive bone loss...pls check for eosinophilic granuloma/ LCH

A chronic case of aggressive Periodontitis.....

Sir I beg to disagree with you... there is no such terminology or description of a case which could be chronic case of aggressive... as if it's aggressive it will remain that. Also without looking for all criteria simply based on the bone loss you can't term a case as aggressive. Kindly share your opinion.
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