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Bains AB, Bains SK. Pulp stones’ association with renal stones: “A minute one can help detect a large one”. Ann Trop Med Public Health 2015;8:19-20
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Bains AB, Bains SK. Pulp stones’ association with renal stones: “A minute one can help detect a large one”. Ann Trop Med Public Health [serial online] 2015 [cited 2020 Sep 19];8:19-20. Available from: https://www.atmph.org/text.asp?2015/8/1/19/156725
The following annotations are an effort to explore the association of pulp stones with renal stones, and subsequently with cardiovascular diseases (CVDs). Early recognition of pulp stones may be useful in the identification of renal stones and also in the prevention of developing CVDs.
Pulp stones are the foci of calcification in the dental pulp. These may be free, attached to, or embedded to the dentine. Histologically, they are classified into “true” and “false” pulp stones, the former containing irregular dentine and the latter being degenerative pulp calcifications.  Pulp stones may impinge the nerve to which they are closely attached and hence, some pain of an idiopathic nature may be caused by these. There could be release of pain, causing substances like 5-hydroxytryptamine and potassium ion from blood platelets and red blood cells. 
Urolithiasis is a problem that has confronted clinicians since the time of Hippocrates, and many family physicians have extensive experience in its clinical management. 
The prevalence of urolithiasis is approximately 2-3% in the general population, and the estimated lifetime risk of developing a kidney stone is about 12% for white males. The overall probability of forming stones differ in various parts of the world and is estimated to be 1-5% in Asia, 5-9% in Europe, and 13% in North America (Robertson 1993); the recurrence rate of renal stones is about 75% in a 20-year span (Sutherland et al. 1985). Approximately, 50% of the patients with previous urinary calculi have recurrence within 10 years.  Kidney stone disease is a multifactorial disorder resulting from the combined influence of epidemiological, biochemical, and genetic risk factors.  It occurs in both men and women, but the risk is generally high in men and is becoming more common in young women (Selvem 2002).
The formation of pulp stones resembles the formation of kidney stones. A recent immunohistochemical study by Ninomiya et al. investigated the organic matrix component of human pulp stones, using specific antibodies to type I collagen and noncollagenous proteins (osteopontin, osteonectin, and osteocalcin). It was found that type I collagen was evenly located throughout the pulp stones, showing that it is a major matrix component of the free pulp stones, whereas osteopontin was found in the peripheral area of the pulp stones, suggesting that it plays an integral part in the calcification front and that it has come from less differentiated pulp cells.  In a study by Couble et al. it was shown that osteopontin produced cells from third molar germs that have odontoblastic features, which include the formation of type I collagen and the subsequent hydroxyapatitic mineralization of the same.  In their immunohistochemical study on atherosclerotic plaques and urinary stones, Hirota et al. and Kohri et al. found similar occurrence of osteopontin in these calcifications. 
Nephrolithiasis is gradually being recognized as a systemic disease, indicative of an adverse metabolic environment.  Previous studies have documented an increased prevalence and incidence of hypertension in stone formers and a higher incidence of nephrolithiasis in hypertensive patients. 
Patients having pulp stones should be screened for the possible presence of renal stones, as the formation of both carries similar pathogenesis. Authors suggest that routine dental radiographs could possibly have prognostic significance or even theoretically be used as a rapid screening method for early identification of potential pulp stones and renal stones. Dental radiographs require minimal radiation, especially the newer digital imaging techniques available. Such a screening method could easily be employed on a large scale as a public health measure, perhaps many years before renal diseases and cardiovascular symptoms occur.  There is a need for prospective long-term studies to assess the risk for CVDs, and it is recommended that a careful assessment of cardiovascular risk factors be undertaken in patients with pulp stone formation.
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Source of Support: None, Conflict of Interest: None