Avaliação da condição de saúde bucal como um indicador de progressão da doença em crianças HIV positivas / Evaluation of oral health status as an indicator of disease progression in HIV positive children

Objetivo: Avaliar a condicao de saude bucal (condicao gengival, carie dentaria, lesoes na mucosa oral) em um grupo de criancas HIV positivas em relacao a contagem de CD4. Metodo: Um total de 234 criancas HIV positivas com idades entre 2 e 15 anos foram examinadas. A carie dentaria foi avaliada segundo os criterios da OMS. Os tecidos gengivais foram analisados sendo empregado o indice de sangramento gengival. Para a presenca de biofilme dental empregou-se o indice de Sillness e Loe. As criancas encontravam-se sob terapia anti viral e a contagem de CD4 de cada um dos pacientes foi obtida por meio dos prontuarios hospitalares. Resultados: Os escores maximos ceo-d/ceo-s foram observados nas criancas cuja contagem de CD4 estava entre 200 - 500. Entretanto, as medias mais altas do cpo-d/cpo-s foram vistas nas criancas com contagem de CD4 menor de 200. As medias de placa, sangramento gengival foram mais elevados nos individuos com contagem de CD4 menor que 200, sem diferenca estatisticamente significante. Candidiase pseudomembranosa foi a lesao oral mais observada. A lingua foi o local mais comum de ocorrencia de lesoes bucais em todos os grupos. Conclusao: A condicao de saude bucal em criancas HIV positivas deteriora-se com o declinio da contagem de celulas CD4.

Objective: To evaluate the oral health status i.e., gingival condition, dental caries, oral mucosal lesions progression in a group of HIV positive children in relation to CD4 count. Method: A total of 234 HIV positive children in the age group of 2-15 years were included in the present study. Dental caries status was evaluated as per the criteria devised by WHO. Gingival condition index was used to assess and criteria given by Muhlemann was used for Papillary Bleeding scores. Plaque was assessed using the Sillness and Loe Index. The children were under active anti retroviral therapy the CD4 count of each patient was available from the hospital records. Results: Maximum dmft /defs, score was observed in individuals with CD4 count 200 - 500. Whereas highest mean DMFT/DMFS score was seen in children with CD4 count less than 200. The mean plaque, gingival and papillary bleeding score were highest in individuals with CD4 count less than 200 but the difference was statistically insignificant. Pseudomembranous candidiasis was the most observed oral lesion. Tongue was the most common site of occurrence of oral lesions in all groups. Conclusion: The study confirms that the oral health status in HIV positive children deteriorates with the decline in CD4 count.

Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry.

The safe and effective treatment of uncooperative or combative preschool children with extensive dental needs is one of pediatric dentist's ongoing challenges. The traditional methods of behavior management are no longer acceptable to parents as they are not ready to spare more time for dental treatment of their children. Keeping this in mind, the present study was designed and carried out to evaluate the sedative effects of oral ketamine and oral midazolam prior to general anesthesia. Twenty uncooperative children in the age-group of 2-6 years were selected after thorough medical examination and investigations. Informed consent was obtained from the parent. This was a randomized double-blind study. An anesthesiologist administered either 0.5 mg/kg midazolam or 5 mg/kg ketamine orally. The heart rate, respiratory rate, and oxygen saturation were recorded at regular intervals. The sedation and anxiolysis scores were also recorded. The parents were asked to answer a questionnaire at the follow-up session the next day on the surgical experience of the parent and the child and side effects experienced, if any. When the data was subjected to statistical analysis, it was observed that both drugs resulted in adequate sedation at the end of 30 min, with oral midazolam providing significantly better anxiolysis. The heart rate and respiratory rate were marginally higher with oral ketamine. The questionnaire revealed a better response with oral midazolam; side effects were more prominent with oral ketamine.

Dentigerous cysts of anterior maxilla in a young child: a case report.

Dentigerous cysts are the most common bony lesions of the jaws in children. It is one of the most prevalent types of odontogenic cysts associated with an erupted or developing tooth, particularly the mandibular third molars; the other teeth that are commonly affected are, in order of frequency, the maxillary canines, the maxillary third molars and, rarely, the central incisor. Radiographically, the cyst appears as ovoid well-demarcated unilocular radiolucency with a sclerotic border. The present case report describes the surgical enucleation of a dentigerous cyst involving the permanent maxillary right central incisor; the surgery was followed by oral rehabilitation. Careful evaluation of the history and the clinical and radiographical findings help clinicians to correctly diagnose the condition, identify the etiological factors, and administer the appropriate treatment.

Comparison of salivary fluoride levels following use of dentifrices containing different concentrations of fluoride.

Many industrialized countries have reported a decline in caries prevalence over the past few decades. These reductions have been related to the regular use of fluoride dentifrices. Fluoride dentifrices are the most cost-effective and efficient means of caries prevention. However, there have been concerns regarding the risk of fluorosis in children due to the ingestion of dentifrices. This has led to the use of dentifrices with low concentration of fluoride. Salivary fluoride levels after tooth-brushing have been shown to be related to the anticaries efficacy of fluoride dentifrices. The present study was designed to evaluate the effect of the concentration of fluoride in the dentifrice, on the salivary fluoride level in children. Twenty children in the age group of five to six years were randomly selected and divided into two groups using, either 500ppm or 1000ppm fluoride dentifrice (sodium monofluorophosphate). Salivary fluoride levels at 0, 15, 30, 45, 60, minutes after brushing were estimated. The data collected was statistically evaluated using the unpaired t-test. The results showed that salivary fluoride levels following use of 500ppm fluoride dentifrice were significantly lower than 1000ppm fluoride dentifrice. The low salivary fluoride levels may thereby reduce the anticaries efficacy. Hence, the pros and cons of recommending a low fluoride concentration dentifrice must be judiciously considered.

Osteogenesis imperfecta.

Osteogenesis imperfecta is an inherited disorder of the connective tissue. The extreme bone fragility seen in patients suffering from osteogenesis imperfecta pose a series of problems with regard to behavior management and rendering of quality dental treatment. Presented here a case of a four year old child suffering from osteogenesis imperfecta.

Loss of permanent mandibular lateral incisor and canine tooth buds through extraoral sinus: report of a case.

Extraoral sinus tract may occur as a result of an inflammatory process associated with the necrotic pulp. Several non odontogenic disorders may also produce an extraoral sinus tract, the differential diagnosis of these clinical findings is of prime importance in providing appropriate clinical care. Presented here is a case report of 4 year old female child with extraoral sinus tract through which the tooth buds of mandibular permanent left lateral incisor and mandibular permanent left canine were lost. The extraoral sinus was due to mandibular left primary canine with class IX fracture (Ellis and Davey's classification).

Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient.

Nasally erupting tooth is a rare finding seen associated with cleft lip and alveolus. It may be diagnosed as a result of symptoms such as difficulty in breathing, pain on sneezing or blowing the nose or may remain asymptomatic. A case of a 4 year old male child operated for bilateral cleft lip and alveolus with unilateral right sided nasally erupting deciduous canine is presented here.

An unusual presentation of all the mandibular anterior teeth with two root canals - A case report.

A rare case of two root canals in all mandibular anterior teeth is presented. The patient initially reported for the treatment of mandibular right central and lateral incisors. However, radiographic evaluation revealed variant root canal and apical foramen patterns.