Pre-eruptive intra-coronal resorption of dentine: a review of aetiology, diagnosis, and management.

AIM: To discuss prevalence, characteristics, aetiology and pathophysiology, diagnosis and management of pre-eruptive intra-coronal radiolucency/resorption (PEIR) defects, and to highlight the clinical significance of PEIR. METHODS: A literature research from Pubmed Medline database was adopted to identify the relevant published articles related to PEIR using keyword search strategy; other papers were obtained through searching the reference lists. Significant findings were summarised and presented in this review. RESULTS: Subject prevalence was (0.2-27.3%) and tooth prevalence was (0.2-3.5%); depending on factors such as type of radiograph used for assessment, demographic factors, age range included, and dentition stage. Currently, the most acceptable etiologic theory for PEIR is intra-coronal resorption by invasion of resorptive cells into forming dentine via an interruption of crown formation; most likely to be caused by local factors such as ectopic position of affected tooth or adjacent tooth next to it. Diagnosis of PEIR lesions occurs, as they are noted incidentally on routine dental radiographs of unerupted teeth. A management protocol for PEIR defects has been suggested based on the literature. The clinical significance of these lesions is that they could constitute a large proportion of occult caries, and can be associated with developmental defects, ectopic positioning and supernumerary teeth, and a delay in dental development. CONCLUSIONS: Early diagnosis of PEIR defects by careful viewing of radiographs of unerupted teeth is important as part of clinical examinations to allow early treatment.

Assessment of the effects of a fluoride dentifrice and GC Tooth Mousse on early caries lesions in primary anterior teeth using quantitative light-induced fluorescence: a randomised clinical trial.

PURPOSE: To compare the effects of a fluoride dentifrice alone, versus a topical CPP-ACP crème used as a dentifrice, versus the combination of both agents (fluoride dentifrice followed by CPP-ACP crème) on early caries lesions (ECL) in primary anterior teeth of children over a 6-month period. METHODS: In this single blinded randomised clinical trial, children (n = 114, aged 4-5 years) with high caries risk and who had at least one ECL (ICDAS 2) on their primary anterior teeth were allocated to three groups. Subjects used different agents twice daily: fluoride dentifrice (500 ppm F, n = 42), CPP-ACP crème (10% w/v, n = 35), and the fluoride dentifrice followed by CPP-ACP crème (n = 37). Changes in lesions were tracked using QLF, comparing the baseline situation to 3 and 6 months of treatment. RESULTS: QLF changes consistent with mineral gain (∆F/fluorescence, lesion area) occurred in all three groups (baseline versus 3 months or 6 months, p ≤ 0.05 for all three groups). Differences between treatment groups were not statistically significant (p > 0.05). CONCLUSION: The topical CPP-ACP crème used alone gave effects similar to the fluoride dentifrice; however, the combination of the two did not give additive benefits over either agent used in isolation.

Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders.

PURPOSE: The Picture Exchange Communication System (PECS) is a communication system for children with autism spectrum disorders (ASD). The aim of this study was to assess the effect of a PECS-based tooth-brushing programme on gingival health in children with ASD and assess parents' perception of PECS. METHODS: This was a prospective interventional study. Using PECS as a pictures/cards series showing a structured tooth-brushing method, 37 children with ASD (31 males, 6 females) (average age 9.49 ± 4.10, 4-16 years) and their parents/caregivers were trained on tooth-brushing twice, 2 weeks apart. Data collected after examinations (baseline, 3, 6-months) included gingival and plaque indices (GI, PI) and two questionnaires (baseline, 6-months) for demographic data and parents' perception of PECS including difficulty rating (easy, hard, very hard) and PECS usefulness. RESULTS: Most children with ASD had language abilities (64.9%) and prior PECS use (67.6%). Both GI and PI significantly dropped between baseline and both re-evaluations, (P < 0.001). Age, among studied factors, significantly affected PI only at all stages (P < 0.001). Most parents/caregivers (75.7%) rated PECS as hard, but useful (100%). Age and PECS prior use significantly affected PECS difficulty rating (P = 0.000 and 0.031, respectively), while sex did not (P > 0.05). CONCLUSION: PECS though rated as hard was useful in improving gingival health in children with ASD.

Effect of CPP-ACP on Streptococcus mutans in saliva of high caries-risk preschool children: a randomized clinical trial.

PURPOSE: The aim of this study was to assess the efficacy of CPP-ACP in reducing salivary S. mutans levels and compare its effect as a dentifrice to use of a fluoride dentifrice alone, or with the sequential use of a combination of both agents (fluoride, then CPP-ACP) in three groups of preschool children over a 6-month period. METHODS: This was a double-blinded clinical trial, the sample (n = 127, age 4.6 ± 0.47 years), with high caries risk, was randomized into three groups which applied different agents twice daily; fluoride toothpaste (500 ppm, n = 50), CPP-ACP (10% w/v, n = 38), and combination group (n = 39) applied fluoride, then CPP-ACP. S. mutans salivary levels were measured by GC Saliva-Check Mutans™. RESULTS: Within groups, a significant decrease in S. mutans-positive children (SMPC) occurred in fluoride and combination groups at 3-months, (P < 0.05), and in all groups at 6-months, (P < 0.05). The highest reduction in SMPC occurred in the CPP-ACP group, however, there were no significant differences in SMPC between groups at all study intervals, (P > 0.05). CONCLUSION: Although all agents were effective, CPP-ACP showed the highest reduction in SMPC over 6-months.

Does acid etching enhance remineralisation of arrested white spot lesions?

AIM: To investigate the effect of acid etching procedure on the remineralisation of white spot lesions (WSL) which had undergone an initial phase of arrest, and to compare between the effect of fluoride and/or CPP-ACP on remineralisation before and after acid etching. STUDY DESIGN: In vitro study. METHODS: WSL were prepared in vitro on 130 human enamel slabs which were allocated into four experimental groups (N = 30) and one control group (N = 10). Changes in mineral content were registered weekly by Quantitative Light Induced Fluorescence QLF. When changes had arrested (after 8 weeks), the enamel surface of 20 slabs in each group were acid etched. The remineralisation process was continued until it slowed down again (after 5 weeks). RESULTS: Mean fluorescence gain was 13.7 ± 0.9% in the fluoride group, 16.5 ± 1.1% in the CPP-ACP group, and 11.4 ± 1.2% in the combination of fluoride and CPP-ACP group. CONCLUSIONS: There was a tendency toward better remineralisation after acid etching but this did not reach a significant level; the effect of etching was more pronounced in the presence of fluoride. Although CPP-ACP seemed to give a steadier rate of remineralisation over time when compared with fluoride, the overall remineralisation in the regimens was similar. In this model, combined treatment of fluoride and CPP-ACP did not have an extra benefit over the fluoride or CPP-ACP alone.

Pre-eruptive intracoronal dentine radiolucencies in the permanent dentition of Jordanian children.

PURPOSE: To determine the prevalence of pre-eruptive intracoronal dentine radiolucencies (PEIR) and subject factors or dental conditions associated with PEIR from orthopantograms (OPGs) in unerupted permanent teeth of children. METHODS: OPGs were evaluated for 1,571 subjects (807 males, 764 females) with mean age (8.72 ± 2.5) years. Unerupted permanent teeth prior to emergence into the oral cavity were assessed. The Chi square test was used to determine statistical differences between the group showing and the group not showing the defect with regards to sex, stage of dental development, presence of developmental anomalies, and condition of primary predecessor teeth. RESULTS: Prevalence was (8.1%) by subject and (0.62%) by teeth. All subjects showed only one affected tooth per subject with no significant gender differences. The highest prevalence was in mandibular first premolars (3.02%). Most defects were noted in the mixed dentition stage (89.06%), mainly in the mandible (79.7%) as single lesions at a mesial location intracoronally, and a size of less than one-third of dentine thickness in (50%). Among all variables examined, PEIR defects were significantly associated with mixed dentition stage (p = 0.000) and decayed/filled primary predecessor teeth (p = 0.028). CONCLUSIONS: PEIR defects occur at a significant prevalence rate in unerupted teeth. Increased awareness and careful radiographic examination of unerupted teeth may improve early detection and treatment of PEIR defects in children.

The alveolar bone height of the primary and first permanent molars in healthy 6- to 9-year-old Jordanian children.

AIM: To establish a threshold cemantoenamel junction (CEJ)-alveolar bone crest (ABC) distance in healthy 6- to 9-year-old Jordanian children and determine the effect of pathological changes, physiological changes, gender, and age on the CEJ-ABC distance. DESIGN: Bitewing radiographs were made for 539 6- to 9-year-old children. Plaque index (PI), gingival index (GI), calculus index (CI), DMFS score, and pocket depth were all assessed through clinical examination. CEJ-ABC distance was measured from radiographs at the mesial surface of permanent first molars (PFM), and the mesial and distal surfaces of primary molars. RESULTS: The CEJ-ABC distance ranged from 0.00 to 4.49 mm, the mean for all surfaces was 0.84 ± 0.44 mm, no gender or age group differences were found. The mesial surface of the PFMs had the smallest mean CEJ-ABC distance. The CEJ-ABC distances were greater in the maxilla than in the mandible. No significant effect of PI, GI or CI on CEJ-ABC distance was found. Caries, faulty restorations, exfoliation, and partial eruption adjacent to measured surfaces had significant effect on the CEJ-ABC distance. CONCLUSION: The mean CEJ-ABC distance was <1 mm. Threshold CEJ-ABC distances of 1.0 and 1.5 mm for PFMs and primary molars, respectively, are suggested to be used in 6- to 9-year-old children.

Missense mutation of the EDA gene in a Jordanian family with X-linked hypohidrotic ectodermal dysplasia: phenotypic appearance and speech problems.

Mutations in the EDA gene are responsible for X-linked hypohidrotic ectodermal dysplasia, the most common form of ectodermal dysplasia. Males show a severe form of this disease, while females often manifest mild to moderate symptoms. We identified a missense mutation (c.463C>T) in the EDA gene in a Jordanian family, using direct DNA sequencing. This mutation leads to an amino acid change of arginine to cysteine in the extracellular domain of ectodysplasin-A, a protein encoded by the EDA gene. The phenotype of a severely affected 11-year-old boy with this mutation included heat intolerance, sparse hair (hypotrichosis), absence of 17 teeth (oligodontia), speech problems, and damaged eccrine glands, resulting in reduced sweating (anhidrosis). Both the mother (40 years old) and the sister (10 years old) were carriers with mild to moderate symptoms of this disease, while the father was healthy. This detailed description of the phenotype caused by this missense mutation could be useful for prenatal diagnosis.

Challenging parents' myths regarding their children's teething.

OBJECTIVES: The aims of this study were to (i) investigate the parental beliefs about teething signs and symptoms, (ii) investigate the parents' practices used to alleviate teething troubles and (iii) provide an educational basis for dental healthcare providers to better educate parents on this subject. METHODS: A cross-sectional survey was conducted in a random sample of 1500 parents attending Maternity and Child Health Care Centers. The self-administered questionnaire contained three sections: Section I surveyed parents' and their children's demographic characteristics, Section II aimed to assess the general knowledge and beliefs of parents regarding their children's teething. Section III aimed at investigating the practices that the parents would do to manage teething problems and relieve pain. The analysis of data was carried out using spss computer software. Descriptive statistics and Chi-squared test were utilized. RESULTS: Almost 75% of the participants incorrectly attributed fever, diarrhoea and sleep disturbances to teething, and more than 50% believed systemic symptoms are not related to the process. More than 50% of the participants allowed their children to bite on chilled objects, (76.1%) used systemic analgesics and (65.6%) rubbed the gums with topical analgesics to relieve the symptoms associated with teething. CONCLUSIONS: This study shows a common lack of knowledge about teething among parents. Parents should be better educated about the teething process and the proper management of teething troubles by the dental health care providers.