Geographic Tongue Symptoms and Treatments

This is also known as benign migratory glossitis. This is usually not painful but this may lead to sensitivity problems and discomfort.Geographic tongue is a harmless condition which affects only the tongue surface.

In normal tongue there are small, pink bump like structures which are called papillae. With geographic tongue these papillae lost and that area looks smooth and reddish in colour. Also these areas are appeared to be like small islands which surround slight raised borders. Sometimes these raised borders may be in white. This can persist for more than a month. These lesions may move around the tongue. This movement is very rapid. The lesion heals and moves to another area of the tongue causing the same appearance. Due to this movement of these lesions it is known as geographic tongue.

The exact cause for geographic tongue is unknown. Vitamin B deficiency may be involved. This condition may occur due to irritations from hot and spicy foods or from alcohols. But in very rare cases that smoking patients are present with geographic tongue. Also following factors may link with geographic tongue, such as psoriasis, pustular psoriasis, fissured tongue. Also can be associated with anemia, oral contraceptive use, diabetes, stress and other skin disorders. In some cases certain foods such as cheese may trigger this condition. Also this may be a genetically inherited condition and with women it can be associated with menstrual cycle. It is now found that this may result from the activity of some of the white blood cells, but still the condition is not understood. Geographic tongue usually occurs around 2% of the population. This condition is more common in adults. Geographic tongue appears more often in females than in males.

Symptoms include smooth, red, irregular shaped lesions on the top or /and slides of the tongue. Rapid changes occur in the location, shape and also in the size of the lesions. Soreness and burning pain. These symptoms may increase during the women’s menstruation cycle and during her pregnancy period. These lesions may sometimes moves to the other parts of the mouth or in the lips.

If the lesion does not cure within a week or 10 days, consult a dentist or a doctor. Diagnosis of geographic tongue is usually done by examining the tongue using a lighted instrument. And effective diagnosis is carried out by moving the patient’s tongue around in various positions. Gentle touch will identify the firmness or tenderness in the texture of those lesions. Also checking for swollen lymph nodes or checking for fever.

In severe conditions breathing troubles may occur, and tongue may severely swell. This may lead to speaking, chewing or swallowing problems. If so it is important to consult a dentist or a doctor immediately.

Since this condition is harmless but irritable, to cure or control the irritation or the pain the doctor will give medications such as, pain relievers, antihistamine mouth rinses, corticosteroid ointments or rinses and mouth rinses which contains anesthetic. Also this can be reduced or most probably recover by avoiding eating hot, spicy, acidic or salty foods. Avoiding alcoholic drinks, tobacco products and toothpastes which containing high flavoring agents, whitening agents and tartar control additives will also prevents geographic tongue

Telediagnosis of Oral Disease- A Research Report

Jair Carneiro LEÃO^1,2
Stephen R. PORTER¹

¹Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, London, England
²Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, PE, Brasil

Computers have increasingly found application in dentistry over the past 15 years, but at present there has been no investigation of the application of the Internet for distance diagnosis purposes in oral medicine. As a consequence, the objective of this article was to determine the acceptability to patient and clinician of the distant diagnosis of common orofacial diseases using the Internet. The study group comprised 20 patients who attended the Oral Medicine unit of the Eastman Dental Institute and Hospital, London, UK, for the diagnosis and management of oral mucosal diseases. Digital images of each patient's oral mucosal lesion were captured and stored on a personal computer and later transmitted via the Internet to a distant site. Patients were asked to complete a self-administered questionnaire detailing their opinion of the use of an intra-oral camera and a group of clinicians were asked to compare and contrast the original and transmitted images. The majority of patients found the procedure of recording images of their mouth very comfortable, were happy to view the inside of their mouths, and found the procedure generally useful in understanding their clinical problem. The clinicians were often not able to differentiate between the original and transmitted image but were able to accurately diagnose the patients oral mucosal problems in 64% of the instances. The results of the present study suggest that telediagnosis of orofacial disease may be a feasible prospect.

Introduction
    Computer technology has increasingly found application in clinical dentistry, particularly as computer hardware becomes cheaper, more widely available and more effective. In 1991, only about a quarter of all UK dental practices had appropriate computers (Eaton, 1994); however, the number of dental practices using computers is likely to increase significantly following the introduction of electronic data transmission of treatment schedules (Hammond et al., 1993). In addition, the rapid acceptance of the Internet and the World Wide Web as means of communication (Sund and Rinde, 1995) suggests that increasing numbers of medical and dental clinicians will use computers for many applications in clinical practice.
    To date computers have principally been employed in clinical dentistry for tasks such as recording patient appointments (Zimmerman et al., 1986), treatment schedules (Hammond et al., 1993) and other administrative duties (Abbey, 1987; Lee et al., 1995). There is, however, a great need to develop appropriate methods for distance diagnosis using computer technology.
    Telemedicine (telecommunication-supported medicine) permits doctors to investigate and treat patients via videoconferencing and electronic information exchange. Instead of patients being transported to the site of a clinician (or vice versa), digitized patient information is transmitted to the clinician thus saving time, transport and money.
    Use of telemedicine systems has varied between medical specialties. Radiology is probably the main user of telemedicine technology: digitized radiological images can be electronically distributed to distant clinical settings, for example Saudi Arabia to the USA (Goldberg et al., 1994).
    In addition, studies have also been undertaken in psychiatry (Kavanagh and Yellowlees, 1995; Baer et al., 1995), pathology (Nagase, 1995; Eusebi et al., 1997), rheumatology (Pal, 1997), orthopedics (Delaplain et al., 1993), dermatology (Norton et al., 1997; Perednia, 1997; Kvedar et al., 1997), otorhinolaryngology (Crump and Driscoll, 1996), oncology (Kunkler et al., 1997) and HIV medicine (Frank et al., 1997).
    In the UK, medical clinicians have assessed the possible benefits of communication between primary and secondary health care providers using ISDN (Integrated Systems Digital Network)-based technology. The ISDN-2 system employed in most of these evaluations permits digitized data to be transmitted rapidly at a bandwidth of 128 kilobytes per second and thus allows still and moving color images to be transmitted in real time, without visual degradation with distance.
    Evaluation of ISDN-2 technology in the practices of dermatology, histopathology and psychiatry suggest that such off-the-shelf technology may be of some clinical benefit in the diagnosis of disease by specialist health care workers at sites distant from the patient and primary health care worker (Malone et al., 1997). The ISDN-2 system does not provide appropriate bandwidth for real-time transmission of moving images, but this can be overcome by the use of additional ISDN lines.
    Although ISDN technology is readily available worldwide, the necessary hardware is still expensive in relation to the cost of a personal computer (PC). In contrast, the hardware and software required for the use of the Internet is inexpensive and all countries have ready access to it. The aim of this study was thus to determine the possible acceptability of recording and transmitting clinical images of patients with orofacial diseases via the Internet, and thus develop the application of the use of this network in the distant diagnosis of oral disease.


Discussion
    Computers have had many applications in clinical dentistry, but to date their possible use in teledentistry has not been fully investigated. The ability for clinicians to communicate quickly and effectively is important to ensure appropriate patient management (e.g., the early diagnosis of oral malignancy), and subsequent education of the primary health care staff. To date the distant diagnosis by electronic means has principally been employed in medical specialities such as radiology, dermatology pathology and psychiatry; there is little data on the practical aspects and benefits of this to dentistry.
    The present study is the first to investigate the practical aspects of teledentistry, i.e. acceptability to patients and the ability of clinicians to provide provisional diagnosis of orofacial disease when provided with images and clinical details transmitted from a distant site via the Internet.
    In the present study only one of the twenty study patients had previously had images of their orofacial tissues captured electronically, nevertheless after appropriate explanation by the attending clinician the majority of patients believed that they understood why they were having the procedure and generally did not find it to be time consuming or uncomfortable. Only 12 (60%) of the patients regarded their viewing of the images of their orofacial disease as acceptable, but 13 (65%) did believe that it provided a fuller understanding of their orofacial problem. All images were transmitted during working hours as attached files, thus there was a delay of up to 30 minutes in the images arriving at the second PC. There was, however, no notable degradation of the images as a result of transmission, as both clinical and non-clinical judges could not reliably distinguish between the original and transmitted images.
    The clinicians could generally make a differential diagnosis based upon the electronic data transmitted. Indeed, despite the clinical judges being relatively junior clinicians, they provided the appropriate provisional diagnosis in 64% of instances. It is thus evident that if this method of communication was to be employed in regular clinical use, it is likely to be of practical benefit, permitting secondary health care staff with appropriate information to give primary health care staff the appropriate advice. The personal computers and videocapture card used in this study were, deliberately, not especially complex or expensive models, and thus likely to be within the financial constraints of general dental practitioners likely to have intra-oral digital cameras. Thus as the cost of such equipment continues to fall, the potential for distant diagnosis of orofacial disease will increase.
    Despite the aforementioned data suggesting that the digital recording of images of orofacial disease and the transmission via the Internet is a practical and effective means of communication, not all images were adequately interpreted by clinicians. In addition, although the clinical images and patients details were transmitted separately there is a need for some method of encryption to ensure the data cannot be read by non-involved parties, if data is inadvertently transmitted to the wrong site. The clinical judges did not view the transmitted images at the time of their transmission (i.e., interpretation was not in real-time). Information sent via the Internet generally does not pass directly from the sender to the recipient, instead as found in this study it can take considerable time before the message reaches the recipient, thus this means of transmission of clinical data may be inappropriate when a clinical opinion, based upon transmitted data, is required urgently.
    In conclusion the results of the present study suggest that teledentistry using the Internet may be a practical means of communication between dental clinicians and hence improve the management of patients with orofacial disease. There is, however, a need to undertake a more detailed study of a wider variety of orofacial diseases and compare the efficacy of transmission of clinical data via the Internet with other technologies, such as ISDN, that permits rapid transmission of a large amount of data, hence, real-time diagnosis of disease.

For details of the report, click here

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1. Diagnosis of selected pulpal pathoses using an expert computer system
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3. Click here to get various Journal articles related to use of computers in Oral Diagnosis

Development of two maxilla together- Genetic Malformation

Talon Cusp Affecting Two Generations: Report of Two Cases and Proposed Comprehensive Classification

Syed Nabeel, Usha Hegde, Paras Mull, Gazala Danish 

Abstract

Talon cusp is an anomalous hyperplasia manifesting as an accessory cusp-like structure projecting from the lingual or facial surface of anterior teeth in both the primary and permanent dentition. Cases of talon cusp affecting two generations in each of the two different families, both belonging to ethnic South Indian population are reported. This is suggestive of a probable genetic etiology. The expression of the talon cusp was more prominent in the second generation. All the cases presented in this case report are the progeny of non-consanguineous marriages. Clinical and radiographic features are described. Considering the varied clinical presentations, association with other dental anomalies and the lack of precise criteria in categorizing talon cusp, a comprehensive classification is proposed.

Key Words: Developmental; Disorders; Genes; Hereditary; Talon Cusp; Genetic Etiology; Classification; Human Dental Anomalies;

Syed Nabeel, Usha Hegde, Paras Mull, Gazala Danish. Talon Cusp Affecting Two Generations: Report of Two Cases and Proposed Comprehensive Classification. International Journal of Oral & Maxillofacial Pathology; 2011:2(3):36-41. ©International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.

Received on: 20/06/2011 Accepted on: 03/08/2011

Introduction

Talon cusp is an uncommon dental anomaly manifesting as an accessory cusp like structure, projecting from the lingual or facial surface of anterior teeth of either dentition.1 The etiopathogenesis is multifactorial, and is thought to be polygenetic with some environmental influences.2 It has a definite predilection for permanent maxillary lateral incisor and is more common in males.1Clinically it can pose esthetic and functional problems to the patient.1,3,4,5 Histologically, it is composed of normal enamel and dentin and it may or may not contain pulpal tissue.3 Radiographically, the talon cusp is usually superimposed over the tooth on which it occurs.6 This article reports talon cusp affecting two generations, in both the families.

Case reports

The case no. one to four belongs to family one (Table 1), whereas the case no. five and six belong to family two (Table 2). The examination of the other members from both the families did not reveal any significant findings. In all the six patients, the vitality of the teeth with the talon’s cusp was found to be positive and there was no significant attrition noted on the taloned teeth or on the opposing teeth. None of the cases were associated with any syndromes. There was no history of consanguineous marriage among parents in either family. Based on Hattab et al1 classification, cases one, two, five were true talon, cases four and six were semi talon, and case three was trace talon.

Discussion

Talon cusp is defined as an uncommon dental anomaly manifesting as an accessory cusp-like structure, projecting from the lingual or facial surface of anterior teeth, on either dentition.7 In 1970 Mellor and Ripa named the accessory cusps as talon cusp because of itsresemblance in shape to an eagle’s talon.8 As in the case of any other abnormality of tooth shape and size, talon cusp occurs early in odontogenesis during the morphdifferentiation stage.1 Another possible cause of the condition that is discussed is hyperproductivity of the anterior segment of the dental lamina.9 Bilateral distribution of talon cusp in some cases, its association with other dental abnormalities, talon cusp occurring in family members, twins, off springs from consanguineous marriages and in some genetic syndromes support genetic etiology of the condition.2,4,9,10

We report talon cusp affecting two different families. The expression of the talon cusp was more exaggerated in the off springs (True Talon) than in the parents (Semi and Trace talon) in both the families. In both the families

the talon cusp was seen in two generations, strongly suggesting a genetic etiology with a probable polygenetic mode of inheritance as the talon cusp was seen associated with other developmental dental anomalies. However, there was no history of consanguineous marriages among the parents. Prevalence of talon cusp is low, affecting less than 1% to approximately 8% of the population.11,12 We present six cases of talon cusp occurring in ethnic South Indian population.

All the six cases reported showed talon cusps on permanent anterior teeth; with five cases affecting maxillary anterior teeth and one case affecting the mandibular anterior tooth. Three cases reported here were seen affecting females and others affecting males. Talon cusp is not an entirely innocuous defect. It may present a number of problems both to the patient and the clinician. They include compromised aesthetics, occlusal interferences, displacement of affected tooth, carious developmental grooves, pulpal necrosis and periapical pathosis, periodontal problems due to excessive occlusal forces, advanced attrition leading to pulp exposure, irritation of the tongue during speech and mastication, interference with tongue space, problems in breast feeding, accidental cusp fracture and temporomandibular joint pain.1,3,4,5 All the cases did not have any clinical implications with the exception of the cases one and two, which posed aesthetic problem to the patients.

Case	Age/ Sex	Tooth no.	Clinical presentation	Other dentalanomalies	IOPAR findings
1	25yrs / M(son)	21	Palatal surface revealed a well delineated projection extending throughout the length of the clinical crown, giving T-shaped appearance to the crown whenviewed incisally. (True talon) The labial surface showed a facial groove. (Fig 1)	Exaggeratedcusp of Carabelli on tooth 26	Radiopaque V-shaped areasuperimposing the crown.
2	23yrs / F(daughter)	31	The talon tooth was rotated and the lingual surface exhibited an exaggerated cingulum extending half way from the cervical margin of the crown to the incisal edge. (semi–talon) (Fig 2)	-	Radiopaque V-shaped areasuperimposing the crown.
3	56yrs / F(mother)	12,11,21,22	Small tubercle-like projections from the cingula. (Trace talon) (Fig 3)	Deep palatal pits on tooth 12 and 22	Small cone-shapedradiopacitiessuperimposing the crowns. Type 1 - Dens invagianatus
4	58yrs / M(father)	11	Cusp-like structure extending up to the middle third on the palatal surface. (Semi- talon) (Fig 4)	Exaggeratedcusp of Carabelli on tooth 16 and26.	Radiopaque V-shaped areasuperimposing the crown Pulp stones in relation to 11 & 21.

Table 1: Family one having talon cusp in four members

Case	Age/Sex	Tooth no.	Clinical presentation	Other dentalanomalies	IOPAR findings
5	14 yrs / M (son)	12	Palatal surface showed two separate cusp-like structures depicting a double talon. They were separated by a deep developmental groove. Cervico-incisally the mesial talon cusp was higher than the distal and it was connected to the incisal edge. (Fig 5)	Labialgroove was seen on the crown.	RadiopaqueW-shaped areasuperimposing the crown.
6	40 yrs / F (Mother)	21	Double talon. (Fig 6)	-	-

Table 2: Family two having talon cusp in two member.

Apart from the classical talon cusp occurring on the lingual surface of maxillary or mandibular anterior teeth in either dentition, there are various reports of uncommon presentations of talon cusp. Talon cusp has been noted to occur on a single tooth or bilaterally on many teeth in the same patient.1 Talon cusp has been found to occur as an isolated dental anomaly or in association with other dental anomalies and/or syndromes.1,10,13 Although Hattab et al1 classified of talon cusp as True talon, Semi talon and Trace talon gives an insight to the degree of formation and extension of the talon cusp on the lingual surface of the anterior teeth in either dentition, it does not tell us all the details associated with its occurrence such as – the particular dentition involved (deciduous or permanent), the type of the tooth involved (morphologically normal or an anomalous tooth), the surface of the tooth affected (lingual or facial) and its association with other dental anomalies or syndromes. Taking all the above factors into consideration, there appears a need for a comprehensive classification encompassing all the conditions with which it occurs. This kind of a comprehensive classification will help the clinician in identifying this particular anomaly, by putting forth the criteria for identifying and categorizing talon cusp. It will also be of help in studying the prevalence of this particular dental anomaly.

Hence, the authors Gazala, Usha, Paras & Nabeel suggest a classification for talon cusp which is modified, precise and comprehensive. According to which the talon cusp can be classified based on two parameters:

I. Based only on the extension of the talon cusp as:

Type 1 (Talon / True talon): A morphologically well delineated additional cusp that prominently projects from any of the tooth surface of a primary or permanent anterior tooth and extends at least half the distance from the cementoenamel junction to the incisal edge.1

Type 2 (Semi talon): A morphologically well delineated additional cusp that prominently projects from any of the tooth surface of a primary or permanent anterior tooth and extending less than half the distance from the cementoenamel junction to the incisal edge. It may blend with the palatal surface or stand away from the rest of the crown.1

Type 3 (Trace talon): Enlarged or prominent cingula and their variations i.e., conical, bifid or tubercle-like.1

II. Based on the surface and anomaly of the involved tooth:

Type A: Talon cusp occurring on the lingual or palatal surface of the permanent anterior teeth, without any anomaly on the same tooth

Type B: Talon cusp occurring on the facial surface of the permanent anterior teeth, without any anomaly on the same tooth.

Type C: Talon cusp occurring on lingual or palatal surface of an anomalous tooth i.e. talon cusp occurring on a supernumerary tooth, a fused tooth, geminated tooth, dens invaginated tooth or on a tooth with a facial groove / cleft.

Type D: Talon cusp occurring on facial surface of an anomalous tooth i.e. talon cusp occurring on a supernumerary tooth, a fused tooth, geminated tooth, dens invaginated tooth or on a tooth with a facial groove / cleft. (Note: Type a, Type b, Type c and Type d is used to describe the same, but on a deciduous tooth) (Tabel 3)

	Type 1	Type 2	Type 3
Type A /Type a	Type 1A / Type 1a	Type 2A / Type 2a	Type 3A / Type3a
Type B / Type b	Type 1B / Type 1b	Type 2B / Type 2b	Type 3B / Type 3b
Type C / Type c	Type 1C / Type 1c	Type 2C / Type 2c	Type 3C / Type 3c
Type D/ Type d	Type 1D/ Type 1c	Type2D/ Type 2d	Type 3D/ Type 3d

Table 3: Combining both the above parameters we can simply express the different types of talon cusp in a grid system:

Use of suffixes “N” and “S”

The suffix "N" is used in the above classification when the talon cusp on a tooth occurs along with other dental anomalies, in the same patient such as bifid cingulum, tubercle-like cingulum, cingulum hypertrophy, accessory cusps of premolars, prominent cusps of Carabelli, microdont, agenesis of teeth, odontome and double tooth. The suffix "S" is used when the talon cusp is seen as a part of few syndromes such as Sturge-Weber syndrome, Mohr syndrome, Ellis-Van Creveld syndrome, Rubinstein-Taybi syndrome and incontinentia pigmenti achromians.

Figure 1: Occlusal view of maxillary teeth showing Type 1 talon cusp on the palatal surface of maxillary left central incisor. (Mirror image)

Figure 2: Occlusal view of the cast showing rotated mandibular left central incisor with Type 1 talon cusp on the lingual surface.

Figure 3: Occlusal view of maxillary teeth showing trace talons on the cingula of all the maxillary incisors. (Mirror image)

In case the patient shows both the association of talon cusp with other dental anomalies and a syndrome, then the suffix “NS” is used. Examples: Type 1A, Type 1B-S, Type 3A-N, Type 2C-NS, Type 2b, Type1AB, Type 2A3B, Type 3D etc. In case of multiple talon teeth in the same patient, each tooth has to be classified separately.

Figure 4: Occlusal view of maxillary teeth showing semi talon on maxillary right central incisor. (Mirror image)

Figure 5: Occlusal view of maxillary teeth showing Type 1 talon cusp on the palatal surface of maxillary right lateral incisor. (Mirror image)

Figure 6: Occlusal view of maxillary teeth showing Type 2 talon cusp on the palatal surface of maxillary left central incisor. (Mirror image)

Based on the above proposed classification, the cases presented are;

Case 1: Type 1C-N (1 - True talon, C - on palatal aspect of permanent maxillary left incisor associated with facial groove and N - presence of prominent cusp of Carabelli on permanent maxillary left first molar) (Fig 1).

Case 2: Type 1A (1 - True talon, A - on the lingual surface of permanent mandibular incisor) (Fig 2).

Case 3: Type 3A on permanent maxillary central incisors and right lateral incisor. (3 - Trace talon, A - on the palatal aspect of permanent maxillary incisors). The permanent maxillary left lateral incisor is Type 3C (3 - Trace talon, C - on palatal aspect of an anomalous permanent maxillary incisor tooth, dens invaginatus) (Fig 3).

Case 4: Type 2A-N (2 - Semi talon, A - on palatal aspect of a permanent maxillary incisor and N - presence of cusp of Carabelli on permanent maxillary right and left first molars) (Fig 4).

Case 5: Type 1C (1 - True talon, C - on palatal aspect of permanent maxillary incisor associated with facial groove) (Fig 5).

Case 6: Type 2A (2- Semi talon, A - on palatal aspect of permanent maxillary incisor) (Fig 6).

Treatment may differ depending on each case. Small talon cusps are usually asymptomatic, necessitating no treatment. However, large, prominent and separated talon cusps require definitive treatment.1

Conclusion

In conclusion, we report six cases of talon cusp, affecting the permanent incisors in two generations, in each of the two different families. The talon cusps showed varied clinical presentations with more prominent extension in the second generation than the first generation. Three of the six cases were also associated with other dental anomalies. The presence of talon cusp in two generations of two different families with history of non-consanguineous marriage strongly supports the genetic etiology. A polygenetic pattern of inheritance could be suspected because of the varied presentation of talon cusp and its association with other dental anomalies. Further prevalent and genetic studies, with larger samples would definitely help in understanding and arriving at a conclusive etiopathogenesis. Many authors who have reported talon cusp have stressed on the need for a precise criteria to clearly identify and categorize talon cusp, including all the variant forms, the dentition involved and its association with other pathological conditions. Hence, we propose a classification based on precise criteria to categorize the talon cusp.

Author Affiliations

1. Dr. Syed Nabeel, Director, 2. Dr. Usha Hegde, Consultant Oral & Maxillofacial Pathologist, 3. Dr. Paras Mull J, Consultant Endodontist, 4. Dr. Gazala Danish, Consultant Oral Diagnostician & Radiologist, Smile Maker Clinics, Mysore, India.

Acknowledgement

We would like to thank all the staff members from the Smile Makers Clinics, Mysore.

References

1. Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp in permanent dentition associated with other dental anomalies: review of literature and reports of seven cases. ASDC J Dent Child 1996;63(5):368-76.

2. Segura JJ, Jimenez-Rubio A. Talon cusp affecting permanent maxillary lateral incisors in 2 family members. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88(1):90-2.

3. Gungor HC, Altay N, Kaymaz FF. Pulpal tissue in bilateral talon cusps of primary central incisors: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89(2):231-5.

4. Hattab FN, Yassin OM, Al-Nimri KS. Talon cusp - clinical significance and management: case reports. Quintessence Int 1995;26(2):115-20.

5. Soares AB, De Araujo JJ, De Sousa SM, Veronezi MC. Bilatéral talon cusp: case report. Quintessence Int2001;32(4):283-6.

6. Goaz PW, White SC. Dental anomalies. In: Goaz PW, White SC, (editors) Oral Radiology: Principles and Interpretation. 2nd ed. BI Publication; New Delhi: 1999. 421-51 p.

7. Davis PJ, Brook AH. The presentation of talon cusp: diagnosis, clinical features, associations and possible aetiology. Br Dent J 1986;160(3):84-8.

8. Mellor JK, Ripa LW. Talon cusp: a clinically significant anomaly. Oral Surg 1970;29:225-8.

9. Dumancic J, Kaic Z, Tolj M, Jankovic B. Talon Cusp: a Literature Review and Case Report. Acta Stomatol Croat 2006;40(2):169-74.

10. Segura-Egea JJ, Jimenez-Rubio A, Rios-Santos JV, Velasco-Ortega E. Dens evaginatus of anterior teeth (talon cusp): report of five cases. Quintessence Int 2003;34(4):272-7.

11. Sedano HO, Carreon Freyre I, Garza de la Garza ML, Gomar Franco CM, Grimaldo Hernandez C, Hernandez Montoya ME, et al. Clinical orodental abnormalities in

Mexican children. Oral Surg Oral Med Oral Pathol 1989;68(3):300-11.

12. Chawla HS, Tewari A, Gopalakrishnan NS. Talon cusp- a prevalence study. J Indian Soc Pedod Prev Dent 1983;1(1):28-34.

13. Abbott PV. Labial and palatal "talon cusps" on the same tooth: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85(6):726-30.

Corresponding Author

Dr. Syed Nabeel

Smile Maker Clinics,

#187, 2nd Stage, M.G Road, 2nd Main, Udayagiri, Mysore-570 019, India.

E Mail: dr.syednabeel@gmail.com

Phone: +91-98451-06626

Source of Support: Nil, Conflict of Interest: None Declared.

Source- International Journal of Oral and Maxillofacial Pathology