A Comparison of Hard and Soft Occlusal Splints for the Treatment of Nocturnal Bruxism in Children Using the BiteSTRIP®.

OBJECTIVE: Bruxism is defined as a parafunctional activity. It could be in diurnal or nocturnal form, based on the time it occurs. The purpose of the study compares the effectiveness of occlusal splint treatments in children with nocturnal bruxism using the BiteStrip®. STUDY DESIGN: The muscle activity of children was measured using the BiteStrip®. The groups used occlusal splints during nighttime sleep for three months, at the end of which their muscle activity were measured again through the use of the BiteStrip®. RESULTS: Muscle pain in palpation and pain in the dynamic position of TMJ pain was significantly reduced in patients using soft occlusal splint (p=0.01). There was no significant change in the BiteStrip® score in both group I (p=0.11) and group II (p=0.61). CONCLUSION: Soft occlusal splints could reduce pain caused by nocturnal bruxism on muscle and TMJ. The relationship between treatment results and BiteStrip® scores of patients using soft occlusal splint or hard occlusal splint are not significantly.

Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial.

OBJECTIVES: The present study evaluates the efficacy of warm local anesthetic (37 °C) administration and injections of local anesthetics at room temperature (21 °C) in reducing pain during injections in children undergoing dental procedures. MATERIALS AND METHODS: Enrolled for this split-mouth randomized clinical study were 100 children aged 5-8 years. Within the random crossover design selected for the study, each patient was randomly assigned to receive either a body or room temperature local anesthesia in the first session and the other local anesthesia on the second session. During the injection, the Wong-Baker Faces Pain Rating Scale was used as a subjective measure of discomfort, and heart rate as an objective measure. The Face, Legs, Arms, Cry, and Consolability (FLACC) scale was used to record the child's pain, based on the perception of the dental assistant. The data were analyzed using a Wilcoxon sign rank test and a paired t test. RESULTS: Based on the score of the Wong-Baker Faces Pain Rating Scale, the FLACC scale, and heart rate, the sensation of pain during dental injection in both girls and boys is statistically significantly lower at body temperature than at room temperature (p < 0.05). CONCLUSIONS: It was determined that the application of local anesthetic at body temperature reduces dental injection pain significantly when compared with local anesthetics administered at room temperature. CLINICAL RELEVANCE: The successful management of dental injection pain is an important issue during dental procedures in children. Accordingly, warming the local anesthesia prior to use in children can be recommended to clinicians.

Postoperative Pain After Root Canal Preparation with Hand and Rotary Files in Primary Molar Teeth.

PURPOSE: The purpose of this study was to evaluate the intensity and duration of postoperative pain after root canal preparation of primary maxillary molar teeth using two preparation techniques. METHODS: A total of 110 patients requiring pulpectomy for asymptomatic primary molar teeth with non-vital pulps were included in the study. The patients were randomly assigned to two groups of 55 patients each, according to the canal preparation method used. In Group one, teeth were prepared up to size 35 with hand files. In Group two, teeth were prepared up to size 35 with Revo-S rotary instruments. Following canal preparation, teeth were obturated with zinc-oxide eugenol paste and then permanently restored. The presence of postoperative pain was assessed after six, 12, 24, 48, and 72 hours and after one week, using a four-point pain-intensity scale. RESULTS: Except for those assessed after 72 hours and one week, patients who had their teeth prepared with hand files reported more intense postoperative pain than those who had their teeth prepared with Revo-S rotary files (P<0.05). In both groups, postoperative pain decreased over time. CONCLUSIONS: Hand files caused more postoperative pain after pulpectomy in primary maxillary molar teeth compared to the rotary system.

Evaluation of root canal morphology of human primary molars by using CBCT and comprehensive review of the literature.

OBJECTIVE: Knowledge of primary tooth morphology is essential for clinical dentistry, especially for root canal treatment and dental traumatology. However, this has not been well documented to date with a large sample. This study was carried out to investigate the variation in number and morphology of the root canals of the primary molars, to study the applicability of cone beam computerized tomography (CBCT) in assessing the same and to provide a comprehensive review of the literature. MATERIALS AND METHODS: A total of 343 primary molars, without any root resorption, were divided into four main groups including the maxillary first molars, maxillary second molars, mandibular first molars and mandibular second molars. All of them were analysed in CBCT images in the axial, sagittal and coronal planes. Various parameters such as the number of roots, number of canals, the root canal type, diameter of root and root canal and root canal curvature were studied. RESULTS: Primary molars in all four groups showed variability in the number of roots and root canals. As far as length of the roots was concerned, the palatal root of the maxillary molar was found to be longest, while the distobuccal root was shortest. In mandibular molars, the mesial root was longer than the distal root. The length of distobuccal root canal of the maxillary molars and the distolingual canal of the mandibular molars was found to be shortest. The number of roots and root canals varied from two to four and three to four, respectively. The maxillary molars exhibited more one-canal than two-canal roots. CONCLUSION: The present study provides comprehensive information to the existing literature concerning the variation in root canal morphology of the maxillary and mandibular primary molar teeth. These data may help clinicians in the root canal treatment of these teeth.

Cone beam computed tomographic analysis of neurovascular anatomical variations other than the nasopalatine canal in the anterior maxilla in a pediatric population.

PURPOSE: This study aimed to analyze and assess the presence of accessory foramina and canals other than the nasopalatine canal (NPC) in the anterior palate region in a pediatric population, through cone beam computed tomography (CBCT) images, describing their location, direction, and diameter. STUDY DESIGN: Reformatted sagittal, coronal and axial slices of 368 individual CBCT images were analyzed. Any bone canal with a minimum diameter of 1.00 mm other than the nasopalatine canal was analyzed regarding size, location, and course, as well as patient gender and age. RESULTS: Eighty-two patients (22.3 %); presented additional foramina in the anterior palate (AFP) and in total 131 additional foramina were registered. A higher frequency of accessory canals was observed in girls (29.5 %) than in boys (15.7 %) (p = 0.012). The average diameter of AFP was 1.2 mm. Their location was variable, with most of the cases occurring in the alveolar process near the incisors or canines. Gender and age did not significantly influence the diameter. CONCLUSIONS: The study confirms the presence of bone channels within the anterior maxilla other than the NPC in a pediatric population. Over 22 % of the population studied had additional foramina other than the NPC in the anterior palate, between 1 and 1.7 mm wide, with variable locations.

Prevalence of dental anomalies in the permanent dentition of children with Down syndrome.

PURPOSE: The purpose of this study was to evaluate the prevalence of various congenital dental anomalies in the permanent dentition of Turkish children with Down syndrome. METHODS: The sample consisted of 216 diagnostic records of children diagnosed with Down syndrome. All subjects had a clinical examination as well as radiographs and photographs taken. Anomalies in the permanent dentition were documented. RESULTS: There was a high incidence of dental anomalies, the most frequent being taurodontism (81 percent), rotation (28 percent), hypodontia (26 percent), tooth impaction (18 percent), ectopic eruption (14 percent), microdontia (13 percent), and hyperdontia (9 percent). Differences in prevalence of congenitally missing teeth, structural anomalies, and positional anomalies reached a statistically significant level regarding gender (P<.05). CONCLUSION: Turkish children with Down syndrome presented a high incidence of anomalies affecting the permanent dentition, and, in most cases, individuals presented with more than one anomaly.

Implants in children with hypohidrotic ectodermal dysplasia: an alternative approach to esthetic management: case report and review of the literature.

Ectodermal dysplasia (ED) is a rare congenital disease that affects several ectodermal structures. Children with ED may have various manifestations of the disease that differ in severity. In addition to its other symptoms, ED causes anadontia and hypodontia of the primary or permanent teeth, impacted teeth, malformed and widely spaced peg-shaped teeth, and underdeveloped alveolar ridges. Since the oral rehabilitation of these cases is often difficult, particularly in pediatric patients, treatment should be provided by a multidisciplinary team. Dental implants are the treatment of choice when growth has stabilized, and implants can be used to support, retain, and stabilize the prosthesis. The purpose of this paper was to present a case report of implant placement in a 7-year-old girl with hypohidrotic ectodermal dysplasia and review the current literature to discuss the use of dental implants in such patients.

Cone beam computed tomographic analysis of the shape, height, and location of the mandibular lingula in a population of children.

OBJECTIVES: This is the first study to identify and classify the different morphological shapes of the mandibular lingula (ML) in children using cone-beam computed tomography (CBCT). MATERIAL AND METHODS: A retrospective study was performed to evaluate the shape, height, and location of the ML in relation to the surrounding structures using CBCT images of mandibles obtained from 269 children. The shape of the ML was classified into triangular, truncated, nodular, or assimilated types. The location was determined by five distances. The height of the lingula was also measured from the lingular tip to the mandibular foramen. RESULTS: A nodular shape of the ML was most commonly found (48.3%, n = 260) followed by truncated (23.4%, n = 126), assimilated (14.4%, n = 78), and triangular (13.7%, n = 74). The mean distance of ML from the anterior and posterior borders of mandibular ramus was 13.3 ± 2.3 mm and 10.2 ± 1.6 mm, respectively. In the majority of the mandibles studied, the ML was located above the occlusal plane. CONCLUSION: The present study provides new information to the literature concerning the shape, height, and location of the lingula in a Turkish pediatric population. This finding may assist clinicians to localize the lingula and avoid intraoperative complications.

Infantile malignant osteopetrosis: report of 2 cases with osteomyelitis of the jaws.

Infantile malignant osteopetrosis (IMO) is an uncommon autosomal recessive disease characterized by dense, brittle, sclerotic, radiopaque bones, which generally results in neurological and hematological abnormalities. In general, IMO is fatal, as patients fail to grow and expire due to complications of the disease such as severe chronic anemia, bleeding, and/or infections. In children with IMO, the development of the dentition is seriously disturbed. Patients with infantile osteopetrosis have a variety of signs and symptoms, including osteomyelitis of the jaws, which frequently and generally resists treatment. Infections may eventually become lethal; hence, jaw infection control is an important aspect of the disease for dentists and oral surgeons to consider. The purpose of this case report was to present 2 rare cases of pediatric patients (one of them died due to respiratory failure at 10 years old) diagnosed with osteopetrosis complicated by osteomyelitis of the jaw.

Solitary median maxillary central incisor: a report of 2 cases.

A single median maxillary central incisor (SMMCI) is a rare dental anomaly that may occur alone or be associated with growth deficiency or other systemic abnormalities. The best known association is with holoprosencephaly (HPE). HPE is a complex brain malformation that affects both the forebrain and the face. Early diagnosis of SMMCI is important, since it may be a sign of other severe congenital or developmental abnormalities. Therefore, systematic follow-up and close monitoring of the growth and development of SMMCI patients is crucial. The purpose of this paper was to report the cases of 2 children, each with a single median maxillary central incisor, and describe important symptoms of this syndrome that have not yet been reported.

Do fluoride and casein phosphopeptide-amorphous calcium phosphate affect shear bond strength of orthodontic brackets bonded to a demineralized enamel surface?

OBJECTIVE: To compare the effects of fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing topical agents on shear bond strength (SBS) and fracture mode of orthodontic brackets bonded to demineralized enamel. MATERIALS AND METHODS: Eighty freshly extracted human premolar teeth were randomly divided into four equal groups. The first group was the control, and no pretreatment was performed on this group. In the remaining three groups, demineralization process was performed and teeth were stored in artificial saliva. In group II, bonding was performed after demineralization. Pretreatment with fluoride and CPP-ACP gels was performed in groups III and IV, respectively. Brackets were bonded using a conventional system. The SBS of these brackets was measured and recorded in MPa. Adhesive remnant index (ARI) scores were determined after the brackets failed. Data were analyzed with analysis of variance (ANOVA), Tukey, and G-tests at the P < .05 level. RESULTS: ANOVA comparison of four groups revealed statistically significant differences. No significant differences were found between control and CPP-ACP-treated groups. However, lower SBS values were recorded for group II (6.6 ± 3.9 MPa) and group III (17.1 ± 2.9 MPa). ARI scores were significantly different among the four groups (P < .001). No enamel detachment was found in the control group, and enamel detachment measured 75% for group II. CONCLUSIONS: Fluoride and CPP-ACP gel applications showed higher debonding forces compared to bonding in untreated demineralized samples. CPP-ACP pretreatment resulted in comparable SBS values compared with the control group.

Periodontal status in two siblings with severe congenital neutropenia: diagnosis and mutational analysis of the cases.

BACKGROUND: Severe congenital neutropenia (SCN), also known as Kostmann syndrome, was originally reported as an autosomal recessive disease of neutrophil production. The disease is characterized by a maturation arrest of neutrophil precursors at the promyelocytic stage of differentiation and by extremely low levels of mature neutrophils in peripheral blood. METHODS: A 6-year-old male presented with a complaint of gingival swelling and bleeding, and swelling at the left side of his face. Upon clinical examination, severe inflammation of all gingival tissues was apparent, and a periapical abscess with mobility was noted on the left mandibular second molar. Medical and dental histories revealed numerous recurrent bacterial infections associated with oral and non-oral tissues. His medical history with recurrent infections led us to evaluate his 3-year-old sister to determine the status of her oral health. Inflammation of her oral tissues and recurrent bacterial infections were apparent. Their consanguineous parents were in good health. To assist in identifying possible systemic diseases underlying the inflammatory situation in the siblings, consultations were requested from the Pediatric Hematology Department at Selcuk University and Pediatric Oncology Department at Gulhane Military Medical Academy. RESULTS: Based on absolute neutrophil count (< or =200/mm(3)) and bone marrow aspiration findings consistent with early maturation arrest in myelopoiesis, the cases were diagnosed as SCN. No chromosomal abnormality was detected upon cytogenetic examination. Sequencing analysis also revealed no mutation in the neutrophil elastase or growth factor independent-1 (GFI-1) genes in these patients. Severe periodontal disease, attachment loss, and mobility for over 50% of the deciduous teeth were noted. Within 6 months, the male sibling lost all of his deciduous teeth due to periapical and periodontal infections. His sister presented with tooth mobility for all mandibular incisors. Monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to support their oral hygiene and to avoid recurrent oral infections. We have been able to stabilize these patients' periodontal conditions during a 2-year follow-up period. CONCLUSION: This case report emphasizes the role of periodontists and pediatric dentists in the diagnosis of diseases linked with neutrophil and other systemic disorders and highlights the need to optimize the health of oral tissues with regular appointments.