Henoch-Schönlein Purpura (Childhood Immunoglobulin A Vasculitis) caused by dental infection in one of fraternal twins: A case report

@#Henoch-Schönlein purpura (HSP) is the most common form of vasculitis in children that is clinically characterized by the classic triad of palpable purpura, joint symptoms, and abdominal pain. A 6-year-old girl, one of fraternal twins, was admitted to the Pediatric Department, Universitas Airlangga with fever, rashes on legs and arms and intermittent mild abdominal pain. She had multiple purpuric rashes on her extremities, abdomen and buttocks. Laboratory investigation revealed immunoglobulin A level of 289.6 mg/dL. The patient was diagnosed as HSP vasculitis according to EULAR criteria and treated with intravenous methylprednisolone. She was discharged after three days with normal physical examination and laboratory findings. Intraoral examination showed dental infection in the upper tooth region. The paediatrician suspected a correlation between HSP and her dental infection. The dental infection and genetic susceptibility may be the stimulant factors for the autoimmune reactions that caused HSP vasculitis. Hence, it might be useful to investigate the presence of dental infection in the etiology of HSP cases.

Pubertal growth spurt peak in angle class I and II Malocclusions using cervical vertebrae maturation analysis in Deutero-Malay children

Background@#The incidence rate of Angle Class I and Class II malocclusions in mixed dentition is higher than Class III. In orthodontic interceptive treatment, it is necessary to identify pubertal growth spurt peak individually because the best growth modification could be obtained during this period. One of the methods in assessing the pubertal growth spurt peak is cervical vertebrae maturation (CVM), which is done using a lateral cephalometric radiograph. CVM evaluates potential growth and skeletal maturity by assessing cervical vertebrae anatomy. Identifying the duration of growth spurt peak on both malocclusion classes is the most pivotal aspect of optimizing remodeling and correction of children’s malocclusion. @*Objective@#Distinguishing the duration of pubertal growth spurt peak of children with Angle Class I and II malocclusions based on CVM analysis in Deutero-Malay children so that it can be used in determining optimal orthodontic treatment plan and timing in children with Class I and Angle II malocclusion for Deutero-Malay children. @*Methods@#Analytical observational with cross-sectional approach was applied using lateral cephalometric radiographic images from patients’ medical records attending or had attended orthodontic treatment in the Pediatric Dentistry Clinic, Airlangga University Dental Hospital, Surabaya, Indonesia, in 2014-2019 that met the inclusion criteria and were analyzed with Baccetti’s method of CVM analysis. This study involved 66 conventional lateral cephalometric photographs that were selected using total sampling. The data were analyzed using Independent T-Test and Mann Whitney U Test. @*Result@#The duration of pubertal growth spurt peak in Angle Class I and II malocclusions was 11 and 7 months, respectively. The age of onset for Class I with CS3 was 9 years and 5 months, while for Angle Class II malocclusion starts entering the stage at 10 years 3 months of age, while for CS4 skeletal maturity we found that the age of onset for subjects with Angle Class I and II were 11 years 2 months and 12 years 4 months, respectively. The average duration of the pubertal growth spurt peak in female and male patients was 11.3 months and 18.2 months, respectively. All of these results were statistically significant (p ≤ 0.001) and representative of the population, in this case, Deutero-Malays. @*Conclusion@#Four-month differences in the duration of pubertal growth spurt peak of children with Angle Class I and II were found. This may lead to a shorter treatment duration of 4 months in children with Angle Class II malocclusion when compared to children with Angle Class I malocclusion. Angle Class II malocclusion exhibit shorter pubertal growth spurt peak duration, which may account for the difference in mandibular growth on the two malocclusion classes.

Myofunctional therapy using twin block appliance in a class II Malocclusion patient with ADHD

@#A 9-year-old male ADHD patient with class II dentoskeletal malocclusion came to the Pediatric Department of Universitas Airlangga, Surabaya, with a chief complaint of a protrusive look. The patient had a behavior disorder of ADHD (Attention Deficit Hyperactivity Disorder), in which its symptoms may be challenging in dental treatment since it heavily depends on the patient’s obedience and case selection. References and similar studies of myofunctional therapy in Class II Malocclusion Patients with ADHD are still scarce. Most patients with class II malocclusion present with hyperactive perioral muscle and altered tongue position. Hence, myofunctional appliance is a reliable treatment choice. A special rule where the patient was asked to focus on the operator’s instruction for 10 minutes and then a 5-minute break, was applied to this patient to overcome ADHD symptoms as a behavior management strategy. This is in line with a theory stating that children with ADHD are prone to distraction, causing them to have a shorter duration of focus, limited sustained attention span, poor impulse control, and motor overactivity compared to normal children. This strategy gave a positive result in maintaining the cooperation of the patient using the twin block for 6 months which is lead to positive progress in malocclusion correction.

Correlation between mother's behavior with periodontal status and periodontal treatment needs in children with autism

Background@#Autism is a neurological and developmental disorder. Children with autism have problems related to physical, psychological, and mental barriers that can hinder their ability to achieve optimal dental health status. Maintaining the dental health of children with autism is influenced by parents' teaching skills and habits. From previous study, there were about 17.4% children with autism in Saudi Arabia suffering from bleeding of the gingiva. Periodontal disease is often found in children with autism.@*Objective@#This study analyzes the relationship between mother’s behavior with periodontal status and periodontal treatment needs of children with autism.@*Methods@#Analytical observational study with cross-sectional approach at AGCA Centre Surabaya with a total sample of 34 pairs of children with autism and their mothers. This study used the HU-DBI questionnaire which consisted of knowledge, attitude, and mother’s action and oral examination of children with autism with the CPITN index.@*Results@#Of the children with autism, 55.8% had healthy periodontal status. The knowledge, attitudes, and actions of mothers were high. Statistical results with Spearmen correlation test obtained a value of p>0.05 on aspects of knowledge, attitudes, and actions towards the CPITN index and periodontal treatment needs.@*Conclusion@#There was no significant correlation between the mother’s behavior and the periodontal status and periodontal treatment needs of children with autism in managing their oral health.