Australian Dental Journal

The official journal of the Australian Dental Association

Letters to the Editor that dental caries is considered an infection in which the resistance of the host – in this case the tooth without lamellae – could play a part in the disease, and that surely warrants further attention.

REFERENCES 1. Salanitri S, Seow WK. Developmental enamel defects in the primary dentition: Clinical complications and management. Aust Dent J 2013;58:133–140. 2. Miller WD. The presence of bacterial plaques on the surface of the teeth and their significance. Dental Cosmos 1902;44:425–446.

REFERENCES 1. Salanitri S, Seow WK. Developmental enamel defects in the primary dentition: aetiology and clinical management. Aust Dent J 2013;58:133–140. 2. Gottlieb B. Dental caries. Philadelphia, Lea & Febiger: 1947. 3. Walker BN, Makinson OF, Peters MC. Enamel cracks. The role of enamel lamellae in caries initiation. Aust Dent J 1998; 43:110–116.

DR EDMOND A ADLER Mt Lawley, Western Australia

(Received 11 July 2013.)

DEVELOPMENTAL ENAMEL DEFECTS IN THE PRIMARY DENTITION: AUTHORS’ REPLY Thank you for your invitation to respond to the letter from Dr Adler who suggested that enamel lamella could be included as a type of developmental defect in our review paper, Developmental defects in the primary dentition: aetiology and clinical management, published recently in the ADJ.1 As our paper was written with a clinical focus, we did not delve into the histology of enamel defects. Thus, we did not include dental lamellae in the review because these defects are not visible clinically and are usually noted only in histological sections of the teeth seen under light microscopy. Furthermore, their aetiology and significance are still unclear. As mentioned in Dr Adler’s letter, the dental lamellae were first noted in histological sections of the enamel by Miller in 19022 and described as ‘lamellae’ by Bodecker in 1905.3 They are thought to be a form of developmental enamel defect due to their appearance under light microscopy, as areas of irregular ‘imperfections’ within the depth of enamel that are filled with organic material.2–5 The significance of dental lamellae is controversial.4 They have been suggested to be signs of enamel fractures or as channels for enamel metabolism.4,5 If dental lamellae are considered as areas of weaknesses within the enamel structure, it is quite possible that they act as convenient conduits for bacterial ingress into enamel and thus have a role in the aetiology of caries as suggested by Gottlieb6 and Walker et al.7 However, more research is required before the aetiology and significance of the dental lamellae can be established. We thank Dr Adler for his comments. © 2013 Australian Dental Association

3. Bodecker CF. A report of further investigations on the organic matrix in human enamel. Dent Res J 1924;6:117–130. 4. Lester KS. Some controversies concerning enamel histology. Aust Dent J 1964;9:82–89. 5. Awazawa Y. Optic and electron microscope observation of the tissue composition of enamel lamellae. J Nihon Univ School Dent 1959;2:23–34. 6. Gottlieb B. A new concept of the caries problem and its clinical applications. J Am Dent Assoc 1944;31:1588–1609. 7. Walker BN, Makinson OF, Peters MC. Enamel cracks–the role of lamellae in caries initiation. Aust Dent J 1998;43:110–116.

PROFESSOR W KIM SEOW Director, Centre for Paediatric Dentistry The University of Queensland DR STEPHANIE SALANITRI Metro-South Health District Queensland Health

(Received 12 July 2013.)

JAW NECROSIS AFTER HERPES ZOSTER INFECTION DUE TO HIV/AIDS AS UNDERLINING DISEASE A 43-year-old male was referred by his dentist to our department for a non-healing wound after extraction of upper and lower right third molars six months earlier (Fig. 1). The patient reported that the intraoral wound was initially healing well followed by wound breakdown in the lower right region. On examination, there was a wound dehiscence with exposed necrotic alveolar bone on the adjacent tooth, while the lower right 7 was still vital and immobile. The orthopantomogram revealed no healing of the alveolar cavity with diffuse irregular moth-eaten destructive radiolucencies extending to the region of lower right 7 (Fig. 2). Regarding his past medical history, the patient was receiving treatment for herpes zoster infection of the first, second and third trigeminal branch on the right side, two weeks before the extractions were performed. Additionally, the patient reported herpes infection in the genital region in the past, which was treated by his dermatologists. Otherwise his medical history was unremarkable. Considering his previous medical history, we initiated a blood test for Human Insufficiency Virus (HIV), which revealed to be positive for HIV. The patient was admitted to the Department of Infectious Diseases for 539

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