The Boy With 526 Teeth!
A visit to the dentist brought this kid into the limelight! ParentCircle brings you an interesting story from last year which made a stir worldwide - the boy with 526 teeth!
By Team ParentCircle
When a 7-year-old boy was brought to Saveetha Dental College and Hospital complaining of tooth ache, little did his parents know that their little boy was going to make news. Little Ravindranath’s right cheek started swelling up when he was just 3 years old, and his parents assumed it was due to tooth decay. However, the swelling kept increasing and he was referred to Saveetha Dental College when he was 7 years old. After careful examination, the doctors advised surgery to remove the mass in his jaw. During surgery, the doctors retrieved 526 teeth in various sizes from the mass they removed. The successful surgery and the boy with 526 teeth made global headlines shortly after. ParentCircle reached out to four key members of the team from Saveetha Dental College who helped the boy and his parents get through this miraculously!
On National Dentist Day, read this incredible story through the words of these dental experts!
Dr. Deepak Nallaswamy, Director of Saveetha Dental College and Hospital:
PC: It was in the news that you did a surgery to remove 526 teeth, so when the boy came in, what was the first reaction of the hospital?
Dr: : I would like to thank ParentCircle for showing keen interest in the health and welfare of children and we are happy to participate in any kind of collaborative activities to awareness. Speaking of this child, he reported to the hospital on 12 July 2019. There was a swelling in his jaw, and this was not uncommon. We call this a compound composite odontoma, a kind of a tumour in the jaw which leads to multiple teeth formation. It does not spread and is therefore not life threatening.
Initially there was swelling so we looked at radiographs, advanced CT scans, 3D prints and other kinds of virtual planning tools we have. We could then see that it was a compound composite odontoma, and we noticed some amount of calcification. However, we could not guess the number of teeth inside the tumour. We have done surgeries to remove extra teeth for patients in our hospital, but 500 was an unheard number. The highest number of teeth removed in a similar case was around 200 by a hospital in Mumbai.
We told Ravindranath’s parents that we will have to remove the tumour from his mouth and then remove all the extra teeth from the mass. They were initially worried as any parent would be. We understood that it was shocking for them to know their son had a tumour in his mouth.
PC: Compound composite? Can you please help us understand using simpler terms?
Dr: ‘Odont’ means tooth and ‘oma’ means tumour, so odontoma means tumour of the tooth. There are complex odontomas and then there is a compound complex odontoma. A complex odontoma is a tumour where you have calcified mass. It will not have a shape of a tooth. A compound composite is a type of odontoma which is extremely rare, which is not like a single mass, but a cluster of teeth like berries on a twig. That is how Ravindranath had 500 teeth in one area.
PC: Is this a benign tumour? Is there a possibility that it will recur? And will there be any after-effects for the child as he grows?
Dr: Odontomas do not become cancerous, as far as we know. The child might have a defect in his jaw, which is an after-effect of this condition. He might need to do grafting later to reduce visible defects. Judging by the fact that the tumour had a potential to grow 500 teeth, there is a possibility that the child might have aggressive healing. So, if the bone heals very well, it will calcify well, and will lead to lesser damage. Nevertheless, I am anticipating that he might require one or two surgeries when he is around 18 or 20 years old. The tumour might recur in very rare cases, but the defect will stay.
PC: So, till he is 18 years old, he has nothing to worry about?
Dr: He will need regular check-ups and undergo therapy for now. We are not sure how effective these will be in his growing years. But we will monitor him and wait till he has grown a bit older to determine the nature of the defect.
PC: Can you tell us what causes this condition?
Dr: Complex composite odontoma is a genetic condition. It can also occur due to environmental conditions, where radiation is a major cause. Radiation of any type - ionizing or non-ionizing radiation and artificial radiation from cell phones can cause this. People must be aware of the things which emit harmful radiations and use them moderately.
PC: Please give us an insight into the surgery.
Dr: Our surgical team was very prudent during and after the surgery. They incarcerated and removed the entire mass without opening it up in the affected site. Opening the jaw would have taken 10 to 12 hours so we avoided that, and it would have been risky to put the child under anaesthesia for such a long time. We were able to encapsulate and remove the extra teeth with special procedures, thereby avoiding any risks to the child. We used Sevoflurane, an advanced anaesthesia, for the procedure. Here we give it free of charge, but if taken elsewhere it costs around Rs 7000. Our only concern was saving the lower jaw and we were happy that we were able to do it. We saved the lower margin of the mandible, preventing the boy’s face from being distorted after the surgery.
PC: That’s good to hear. Can you tell us how many hours the surgery took?
Dr: Not exactly sure, but around 90 minutes.
PC: This case also received global attention. Were you expecting that?
Dr: Absolutely not. The case where they removed 200 teeth did flare up pretty big, but we thought it was a one-time thing where there was so much attention to this one-of-a-kind condition. Besides, the way a dentist looks at a condition is different from how a common person looks at it. So honestly, we never thought this might get so much attention. We are happy though, because it has raised awareness among people, and they are reporting even micro swellings. Thanks to the media for doing an excellent job in spreading the word.
PC: How often would you recommend kids to have dental check-ups?
Dr: According to UNESCO guidelines kids should have a dental check-up once in 3 months. There is significant evidence to suggest that those children who have regular dental check-ups spend much less on dentistry when they grow up. Another important thing is to diagnose tooth related conditions at a very early stage and protecting your child from the same with regular therapy. When I was doing my master’s degree in Canada, I learnt that they have good follow up programs for kids. They have been doing this for over two decades now and as a result of this, the incidence of new dental diseases has become almost zero. Such good awareness, oral health care protocols and community outreach from institutions can give the promise of a much brighter, healthier future.
PC: Can you throw light on common dental problems which affect kids today and how to deal with them?
Dr: Paediatric dentists might be able to give you a clearer picture about this. Decay seems to be a common problem among kids. People however miss to take some simple measures which can prevent tooth decay.
For example, a power brush is proven to provide better dental health, but its usage is not much known in our community. Even when a tooth decay is found in a kid, people tend to neglect it because they assume that a milk tooth may not require care. However, the infection may remain and affect the child’s permanent tooth, even after the decayed milk tooth has been removed.
If you have bad breath or teeth which do not look visibly good, it might even affect your promotion! We live in a society where people are ready to spend time on material things but are reluctant to spend time for their health. It is important to take precautionary measures so that you can have good health. Genetic conditions do exist, but we have noticed that patients who are co-operative and have regular check-ups have better oral health than those who rush in at a later stage.
PC: You talked about a power brush. Can you tell us about it?
Dr: A power brush is an electric brush. Go for a single-head brush for maximum efficiency. Using a proper power brush reduces the need to floss as well. First time users might have bleeding, but that is very normal. On repeated use, it firms your gum tissue and you will find it as a good cure to dental problems.
PC: Any message for parents?
Dr: Oral health is very important. In fact, there are extensive studies which suggest that the chance of having a heart attack is more in people who have gum diseases. Like how smoking can cause lung cancer, para dental diseases can lead to cardiac conditions. Germs can enter your blood stream through the gums and deposit in the heart valves. So please don’t take dental problems for granted and visit the dentist regularly, for better oral health.
Dr Senthilnathan, surgeon who removed the tumour:
PC: What was your reaction when the child came to you?
Dr: The 7-year-old boy reported to the department with a swelling in his right lower jaw. The permanent tooth on the right jaw had fallen out and the parents were concerned so they brought him here. After thorough checking of his medical history and scans, we noticed that there was a small rudimentary tooth present in the right lower jaw. We removed this with surgery and saw that it had more than 500 teeth. We couldn’t believe it at first.
PC: Did you expect that this would become global headlines?
Dr: No, we did not expect it at all. We went about this surgery as we normally do for a compound composite odontoma. Our motive was to remove the tumour completely without breaching it, but we did not expect that this case would become viral.
PC: How did the child and his parents react?
Dr: The previous hospital had not been able to treat him, and the parents had not received any counselling regarding the treatment. We took 3 to 4 sessions to counsel the boy’s parents, telling them about the procedures and risks involved. We also explained this to the child in ways he could understand, and he co-operated well after that.
PC: Did you face any challenges during the surgery?
Dr: We have performed many surgeries like this, so we were not nervous. Our meticulous planning and scan evaluations before the surgery made the surgery less complicated and took lesser time. We planned beforehand on where to do an incision and how to remove the tumour without breaching. If the sac had been breached during surgery, all the small rudimentary teeth would have been pulled in through suction or we may not have been able to remove it completely.
PC: You knew that the tumour sac had 526 teeth only after the surgery?
Dr: After the surgery we removed the complete sac and sent it to the Histopathology department. The surgery took only 1 to 2 hours, but the histopathology department took 5 to 6 hours to remove all the teeth from the sac. Only then we came to know that the sac had 526 teeth.
PC: Can you tell us more about this condition – how does it occur and how rare is it?
Dr: This compound composite odontoma mimics a tooth’s structure. Whatever the tooth has, like dentine and pulp, is present in each odontoma. This odontoma is rare. We have operated on people who had below 100 teeth with this condition, but we have not operated with so many teeth within the same odontoma before this.
PC: Will there be any after-effects for the child due to this condition?
Dr: The tumour has caused a hole, so it will weaken his jaw a little. We have instructed him to be careful while biting food and avoid eating hard items which may cause the jaw to break or fracture.
PC: Will he need more treatment?
Dr: There is a big opening in his jaw, which will heal naturally. Within 3 to 4 months, the child will be able to use his jaw normally, and he won’t have any deformity in his face. For now, he will need therapy.
PC: The surgery could have become more challenging or taken more time. What are the achievements of this hospital on these terms?
Dr: We roped in our paediatrician anaesthetist who is a specialist in administering anaesthesia for children, starting from 6-month-old infants. The surgical team then removed the tumour completely from the jaw, without causing damage to the jaw or the face.
PC: What are the common cases which require surgery for children?
Dr: We have handled cases where children came in with tumours or cleft palates. Mostly the children are 6 months to 12 years old.
PC: Can ignoring cavity lead to surgery?
Dr: Nowadays, children are consuming a lot of chocolates and sweets. Within 3 to 4 years of age, they end up having cavities in multiple teeth. However, they are not very co-operative in a dental chair, and it is difficult to keep their mouth open for more than 5 minutes. So, if a child has at least 10 teeth to be filled, we give them general anaesthesia with the parents’ consent to complete the procedure in a single sitting, without any hassle. also, if the child is above 9 to 10 years old, we can manage them in a dental chair. For multiple teeth decay in 3.5 to 4-year-old children, it becomes more difficult.
PC: Is taking too much chocolate the main reason for tooth cavities in children?
Dr: Any sweet or food which contains sucrose causes tooth decay in children. These foods are sticky and hence stick to the teeth. Bacteria then act on the sweets, eroding the tooth and slowly forming a cavity. Improper oral hygiene is another main cause.
PC: Would you like to convey any message to parents?
Dr: As a parent, pay close attention to your child’s oral health from the age of two. Mostly, you will be able to see this condition when the child’s primary teeth start growing. Taking the kids to a dentist if he/she complains of pain in the tooth also helps in early diagnosis of any dental problem, and treatment can be done more conservatively.
Dr. Pratibha Ramani, Professor and Head, Department of Oral Maxillofacial Pathology, Saveetha Dental College:
PC: Can you please tell us what you thought when you came to know about 526 teeth in the boy’s mouth?
Dr: When we first received the tumour sac, we found it quite interesting. I asked my post graduate residents to do a specimal radiography, to analyse how to remove the contents of the lump that was removed from the boy’s mouth. After the radiography we knew we were looking at some teeth-like structures, but we never imagined that the number was going to be 526. It was a big surprise. It is very rare.
PC: Where was the tumour located?
Dr: The tumour sac was located at the posterior part of the jaw, which we call a mandible. Posterior indicates behind something, as in this case, behind his jaw.
PC: Can you tell us what was the range of sizes of teeth from the smallest to the largest?
Dr: The teeth were of variable sizes and shapes, the smallest being 0.1mm and the largest 14mm. The bigger teeth came out in the beginning, and the smaller ones came out as we went deeper into the sac.
PC: What was the weight and size of the sac?
Dr: The size of the sac was 4 x 3.5 cm, and its weight was 200 gm.
PC: Would you like to share anything specific related to the experience?
Dr: Parents play a very important role in detecting early signs of such conditions. Ravindranath’s parents were shrewd enough and they had taken the child to a hospital nearby when he was 3 years old, but he had not co-operated back then. When they saw the swelling get bigger, they were referred to us. Our counselling team made sure the boy was comfortable and helped him co-operate with the doctors. We treated him like an adult, giving him importance to help him consent to the tests and procedures. Our surgical and counselling teams explained everything to him to win his trust.
PC: Did the fact that 526 teeth were removed from his mouth have any psychological impact on the child?
Dr: He seemed casual and was discharged the third day after the surgery. The child’s only concern was that the doctors were repeatedly asking him to open his mouth. He might not have understood the entire process, but he enjoyed the limelight.
PC: What was his parents’ reaction when they were told he had 526 teeth?
Dr: The parents were pretty excited and happy that it was a world record when we relieved that we had removed all the teeth. Saveetha Dental College has 3D printing equipment exclusively for the jaw and the surgeons were able to plan the surgery properly. The surgeons managed to pull off the surgery in 1 to 2 hours because they had planned it meticulously. The parents were happy that the society learnt more about this condition through them.
PC: Would you like to convey a message to parents?
Dr: Parents must ensure that children brush their teeth and visit a dentist regularly. The mouth serves as a mirror to the body, and sometimes even before a fever starts, a redness in the mouth is observed. So, when the kids feel slightly uneasy, the best thing to do is look at their mouth. If you find any abnormal swelling or redness, visit a paediatrician immediately.
Dr Subramaniam, Professor and Head of Pedodontics, who first met the boy:
PC: What are the common dental problems in children?
Dr: 80 per cent of the children have dental cavities. The remaining 20 per cent of problems –10 per cent is due to habits like thumb sucking or breathing through the mouth, while another 10 per cent is caused by trauma like fracturing of tooth during fights or accidents.
PC: Can you tell us more about tooth cavities and the different stages?
Dr: Cavities are not only those black spots in the tooth, some cavities also start as white spots. A tooth cavity generally starts with a white spot. The outer part of a tooth is the enamel, then comes the dentine and the innermost part is the pulp. When the cavity reaches the dentine, children start feeling sensitivity. Children less than 3 years of age cannot explain this, so they might start avoiding food. When the cavity reaches the pulp, which has nerves and blood vessels, the children start experiencing severe pain. Parents take the kids to a dentist only after this. I would suggest taking your kids to the dentist when they start noticing white spots in their teeth. By the time the cavity reaches the pulp, there is a swelling and, in such cases, we sometimes need to extract the tooth completely.
So, yes, when a child complains of tooth ache or tooth sensitivity, take them to a dentist as soon as possible. It is always easier to remove the cavity at an earlier stage.
PC: Can you kindly share dental tips to prevent cavities and maintain oral health in children?
1. Encourage children to brush twice a day. Brushing at night is equally important to ensure good oral health.
2. Visit your dentist regularly. When you diagnose symptoms earlier, you can prevent invasive treatments which are painful to children, and also save considerably on cost of treatment.
3. Cut down snacking between meals. Eating five chocolates at five different times is more dangerous than eating ten chocolates at a single time. The oral cavity (mouth) has a defence mechanism which fights against germs when you eat a chocolate. Once activated, it takes about twenty minutes for this defence mechanism to get back to normal. However, when you keep eating chocolates you don’t let the oral cavity get back to normal.
PC: What about oral care for infants and toddlers?
Dr: Sure. To prevent oral cavities in infants, after every feed clean the child’s oral cavity using a wet cloth. For children who are 6 months to a year old, when their first teeth start growing, use a peanut-size amount of age-appropriate toothpaste to brush the child’s mouth. After 3 years of age, you can let them use fluoride toothpastes. The fluoride in the toothpaste prevents tooth cavity.
PC: Do parents assume that baby teeth need not be taken care of because they are replaced anyway?
Dr: Yes, most parents think that primary teeth or baby teeth are not important and need not be treated. However, caring for the primary teeth is very important, as they lead to the permanent teeth.
A mind-boggling story indeed! Ravindranath sure did help us get a heads up on some dental problems which affect kids and what dentists advice about them. So, don’t forget to urge your child to brush twice a day, to flash that big smile all the way!
About the author:
Written by Team ParentCircle on 04 March 2020.
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