Portland cement as pulp dressing agent in pulpotomy treatment of primary molars: a 12-month clinical study.

AIM: Pulpotomy is the most frequent endodontic treatment performed on primary teeth. Different pulpotomy procedures and materials have been studied during the last years and recently interest has been focused on the use of Portland Cement (PC) as an alternative to these materials including Mineral Trioxide Aggregate (MTA), but still few clinical studies have been carried out. The aim of this study was to analyse the clinical and radiographic response to the use of Portland cement (PC) in primary molars pulpotomies through a clinical study in paediatric patients. MATERIALS AND METHODS: Eleven carious primary mandibular molars of children aged 3-9 years old were treated by a conventional pulpotomy technique using PC. The teeth were restored with stainless steel crown. Clinical and radiographic follow-up was performed 6 and 12 months after the treatment. RESULTS: All the treated molars were clinically and radiographically successful at all the follow-up appointments as no pathological findings were observed in any molar. Reparative dentin formation was observed in 100% of the treated molars. CONCLUSIONS: PC could be considered a reasonable alternative to the use of MTA in pulpotomy treatments in primary molars, although more long-term clinical studies are needed to confirm these results.

[Unexpected death due to eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)]. / Muerte inesperada debida a granulomatosis eosinofílica con poliangeítis (síndrome de Churg-Strauss).

Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg-Strauss syndrome, is a rare disease characterized by disseminated necrotizing vasculitis with extravascular granulomas occurring among patients with asthma and tissue eosinophilia. Clinically, it presents in various ways and progresses in three phases: prodromic (asthma and rhino-sinusitis), eosinophilic (peripheral eosinophilia and organ involvement), and vasculitic (clinical manifestations due to small vessel vasculitis). The differential diagnosis of EGPA principally includes eosinophilic and vasculitic disorders, early treatment is needed to avoid a fatal outcome. We present the case report of a 38-year-old male with a history of asthma. After a month-and-a-half of progressive weakness, no fever, diarrhea, vomiting and abdominal pain associated with weight loss, he was diagnosed of intestinal parasitosis. He later died of a massive myocardial necrosis due to EGPA with multiple organs affected.

Renal excretion of fluoride after fluoride mouth rinses in children.

AIM: This study was conducted to determine if there was an increase in the urinary excretion of fluoride, after the use of fluoride mouth rinses in children. MATERIALS AND METHODS: The sample consisted of 58 children aged 5-8 years, randomly selected, residents in non-fluoridated water areas. Urine samples were collected prior to mouthwash and also 2 hours after use. The control sample, which received no treatment, consisted of 16 children of equivalent age and from the same community. Urinary excretion of fluoride was analysed by determining the pH, creatinine, F- ion and fluoride (mg)/creatinine (g) (F/Cr) ratio in urine. Results In the studied sample, the mean F/Cr ratio before fluoride mouth rinse was 0.26 mg/g and it rose to 1.58 mg/g 2 hours after mouth rinse. This difference of 1.33 mg/g was statistically highly significant (p<.001). In the control group no significant changes occurred. The average 2 hours afterward F/Cr ratios were 0.29 and 0.27 respectively (p=0.426). CONCLUSION: After the use of a fluoride mouthwash, in children, there is a statistically significant increase of fluoride ion in urine, which can be attributed to the application of this product.

Muerte por uso incorrecto del «pa˜nuelo portabebés»: necesidad de un abordaje multidisciplinar en las lesiones infantiles / Death by incorrect use of baby sling: multidisciplinary approach to infant injuries

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Renal fluoride excretion in children following topical application of fluoride varnish.

AIM: To demonstrate that the application of dental fluoride varnishes in children increases urinary fluoride excretion. MATERIALS AND METHODS: From a randomly assembled group of 42 children aged between 5 and 8 years, residing in a community with non-fluoridated water, spot urinary samples were taken before the topical application of dental fluoride varnish and 2 hours afterwards. In an age-matched control group of 16 children from the same community, who received no treatment, samples were taken the same way. The urinary excretion of fluoride was analysed by determining fluoride ion (F-) level and fluoride/creatinine (F/Cr) ratio in the urine. RESULTS: In the study group, the average pre- and post-treatment F/Cr ratios were 0.42 and 1.38 mg/g, respectively (p < .001). No significant changes were observed in the control group, which received no treatment. The average 2 hours afterward F/Cr ratios were 0.29 and 0.27 respectively (p = 0.426). CONCLUSION: The topical application of dental fluoride varnish leads to a significant increase in urine F-, which is attributable to the application of the product.

Regional odontodysplasia. A literature review and three case reports.

AIM: The purpose of this article is to report some unusual characteristics related to gender, location and manifestations of severe Regional Odontodysplasia detected in three subjects. Regional Odontodysplasia is a rare disturbance of dental development whose aetiology is still unknown. Anomalies involve enamel, dentin, pulp and dental follicle causing atypical structure, colour, shape, size and eruptive disturbances of the affected teeth. Its early onset may lead to craniofacial development disturbances. CASES REPORTS: This article reports three cases with unusual characteristics observed in male children who were assisted by a paediatric dentist. Generally the disease affects one hemiarch and it is very rare that it crosses the midline as in one of the presented cases. Regional Odontodysplasia has been predominantly described in the maxilla and in women, however these three cases are in boys and two of them occured in the mandible. CONCLUSION: Regional Odontodysplasia is a rare disease, causing severe dental, growing and craniofacial development anomalies. Treatment needs to be personalised, aiming at preservation of the affected teeth taking into account their risk to develop severe infections. Parents should be made aware of the need for an extensive follow-up.

Guía para prevenir las reclamaciones por presunta mala praxis médica, de cómo actuar cuando se producen y cómo defenderse judicialmente / Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts

Las reclamaciones por presunta mala praxis médica aumentan en todos los países desarrollados, y muchas de ellas no tienen fundamento. Para prevenir las reclamaciones judiciales los médicos deberían conocer las razones por las que son reclamados por sus pacientes y adoptar las medidas preventivas adecuadas. En caso de reclamación es indispensable seguir unas normas que permitan una defensa jurídica adecuada, así como una actuación del médico ante el juez que inspire confianza y credibilidad. El riesgo de reclamaciones puede reducirse con una adecuada información al paciente, el seguimiento de las guías clínicas, el control de los factores de riesgo, y la adopción de listas de verificación en cada procedimiento invasivo. En caso de complicación o efecto adverso grave debe procederse a dar explicaciones al paciente y a sus familiares, y comunicarlo a la institución donde trabaja y a la compañía de seguros. Si el médico recibe una reclamación, debe comunicarlo a su compañía de seguros para que esta designe el abogado responsable de la defensa jurídica, que asesorará al médico para su comparecencia ante el juez(AU)

Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. of the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge(AU)

[Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts]. / Guía para prevenir las reclamaciones por presunta mala praxis médica, de cómo actuar cuando se producen y cómo defenderse judicialmente.

Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge.

Microbiological analysis of gingivitis in pediatric patients under orthodontic treatment.

AIM: The aim of this study was to determine the relationship between gingival inflammation and changes in bacteria of the gingival sulcus in children in orthodontic treatment with brackets. STUDY DESIGN: this prospective study assessed gingival and plaque index of two groups: children with brackets (Group 1) and without brackets (Group 2). The sample was selected from patients treated at the Faculty of Dentistry, Complutense University of Madrid, Spain. Microbiological assessment was performed in every child and all data were statistically analysed. RESULTS: Group 1 showed significantly higher microbiological values and the difference was greater in lower teeth. Comparing the total plaque percentage, it was significantly higher in Group 1. STATISTICS: there was no significant correlation between gingival and plaque indexes in any group. No significant correlation was found between plaque index and bacteria. CONCLUSION: Children using brackets showed significantly higher gingival and plaque indices than children without brackets. No direct relationship was found between the increase in gingival and plaque indices and the presence and quantity of bacteria; therefore it was not possible to identify specific bacteria as responsible for the high gingival index in patients with brackets.

Relationship between mesiodistal crown diameters of permanent first molars and deciduous second molars.

AIM: To determine whether there is a relationship between the mesiodistal crown diameters of permanent first molars and deciduous second molars, and to update their odontometric values for the Spanish population. MATERIALS AND METHODS: A cross-sectional descriptive study was performed of a sample of molars in 101 children (46 boys and 55 girls) of Spanish parents.The measurements were performed on cast dental models using a fine-tipped caliper with accuracy of ± 0.05 mm. RESULTS: Statistically significant differences were detected between sexes both for the permanent first molars and for the deciduous second molars. However, no differences were detected between antimeric teeth. The size of the deciduous second molars was related to the size of the permanent first molar, and this relationship was statistically significant. CONCLUSION: As a correlation was found between the mesiodistal crown diameters of permanent first molars and deciduous second molars, the findings of this study may be used as a predictive factor for tooth-jaw size disharmony, and therefore for possible crowding of the permanent dentition.

Standards for mesiodistal and buccolingual crown size and height of primary molars in a sample of Spanish children.

AIM: The aim of this study was to obtain mesiodistal, buccolingual and height sizes of dental crowns of first and second primary molars in a sample of Spanish children given, not only their anthropological and forensic significance, but also their clinical interest for the future analysis of restorative and orthodontic treatments. MATERIALS AND METHODS: Measurements of mesiodistal, buccolingual size and height of the crowns of primary molars were studied. A transversally descriptive design was carried out and the interrelationship between these three dimensions was established. A sample of 703 first and second primary molars was selected from healthy Spanish boys and girls from 4 to 9 years old. Molars presenting anomalies of the crowns, caries or restorations were excluded. Measurements were made on dental plaster models, using a vernier caliper. Descriptive statistics and Pearson correlation coefficient was obtained and Wilcoxon's non- parametric test was applied for comparison of the mean, analysis of sexual dimorphism and comparison of antimeric teeth. RESULTS: Average sizes of each group of molars were obtained. Sexual dimorphism was studied utilizing the Wilcoxon test. A variability of relationship between the measurements was found in each molar studied. Primary second molars had less variability than first molars in the three measurements obtained. The measurement with the least variability was height, followed by mesiodistal size. CONCLUSIONS: Measurements of primary molars showed that average sizes of boys' molars were significantly larger than those of girls. Relationship between the three measurements studied was variable but second molars showed less variability than first molars. The relationship between height and width was found significant in most of the molars. i.

Paediatric patients receiving oncology therapy: review of the literature and oral management guidelines.

AIM: In recent years, neoplastic diseases in children have acquired growing importance in the field of paediatrics. This has been accompanied by significant advances in the treatment of children's cancer, with long-term survival rates of 90% in the case of some tumors, resulting in the need for more medical and health care on all levels. With these advances comes a new responsibility to do everything possible to prevent complications stemming from neoplasia and its treatment. Among the side effects of cancer therapies (mainly chemotherapy and radiation treatment) are chronic or acute oral manifestations that are frequent sources of discomfort, focal points of systemic infections and other side effects, depending on the child's stage of development. In most cases, the incidence and severity of oral complications are associated with preexisting factors (cavities, gum disease and poor hygiene) that clearly affect their emergence, increase and persistence. The aim of this article is to propose a guideline for managing oral complications of paediatric cancer treatments. CONCLUSIONS: It is fundamental for the patient and their parents to be aware of the possibility of preventing or reducing problems in the oral cavity through preventive measures and simple oral treatment.

Correlation between dental maturation and bone growth markers in paediatric patients.

AIM: Many studies have been made to evaluate the growth, development and maturation of cervical vertebrae. These studies make clear how those vertebrae have growth patterns and centre of ossification similar to those in carpal bones, therefore cervical vertebrae can be used to determine bone age. The aim of the present study is the observation of cervical vertebrae in cephalometric radiographs to determine the bone age in a paediatric population and relate it to dental maturation. MATERIALS AND METHODS: The sample was composed of 203 children from Madrid, aged between 2 and 10 years. There were 86 males and 117 females, in each case a panoramic was taken to determine dental calcification using Demirjian method and a cephalometric radiograph was taken to evaluate cervical vertebrae maturation. Different vertical and horizontal dimensions were measured to determine maturation. RESULTS: The results show that there is a positive relationship between age and size of cervical vertebrae. The average horizontal measurements of the third, fourth and fifth cervical vertebrae presented statistically significant differences in size (p<0.05), being larger in boys than in girls. Statistical correlation was found between dental maturation and increased left vertical measures from third (C3VI) and fourth cervical vertebrae (C4VI), as well as middle vertical measure from fourth cervical vertebra (C4VMD). CONCLUSION: Significant changes in size were observed only in vertical measurements and the predictive measurements for dental maturation were C4VI, C4VMD and C3VI.

An audit of paediatric dental treatments carried out under general anaesthesia in a sample of Spanish patients.

OBJECTIVE: To evaluate the success and failure rates of the clinical procedures carried out under general anaesthesia in disabled or medically comprised and healthy children. BASIC RESEARCH DESIGN: Retrospective study included 47 patients who received dental treatment under general anaesthesia, grouped according to whether they were disabled or medically compromised (group A, n = 16) or not (group B, n = 31), and subgrouped according to whether they were under or over 6 years of age. RESULTS: Mean duration of anaesthesia was 2 hours and 25 minutes, with a range of 1 to 4 hours. The percentage of children followed up was 87%. The procedures performed were: 105 preformed metal crowns, 142 restorations, 85 pulpotomies and 166 extractions. The success rate was 93% for preformed metal crowns, 96% for pulpotomies and 90% for restorations. CONCLUSIONS: General anaesthesia is necessary in some children, but should be complemented with a preventive programme, behavioural remodelling and a follow-up schedule to avoid having to repeat the use of general anaesthesia.

Multiple agenesis and anhidrotic ectodermal dysplasia: a comparative longitudinal study of dental similarities and genetic differences in two groups of children.

AIM: Dental anomalies in shape and number may be present isolated or associated with other manifestations. In anhidrotic ectodermal dysplasia they occur more frequently and severely. The authors examined a group of children with similar dental anomalies but no other ectodermal or extra-ectodermal signs. METHODS: This study makes a comparative evaluation of similarities and differences of dental anomalies between two groups: A anhidrotic ectodermal dysplasia and B similar dental finding but without extra- dental anomalies. RESULTS: In group A, the average number of agenesis in primary teeth was 3.5 (upper) and 5.33 (lower); in permanent teeth it was 5.4 and 5.8, respectively. In group B, the average was 1.62 (upper) and 0.25 (lower) in primary teeth, and 4.0 and 4.25 in permanent teeth respectively, with no constant pattern of occurrence. The study of tooth morphology of both groups revealed numerous anomalies in both dentitions. No differences were found in the average number of agenesis and morphological anomalies in the permanent teeth between both groups, but in the primary dentition group B presented a lower degree of incidence. CONCLUSION: The presence of almost normal primary dentition (regarding to number), but with morphological anomalies, should lead to suspect their exacerbation in the permanent dentition.

Dentin bond strength of fluoride-releasing materials.

PURPOSE: To evaluate the shear bond strength to dentin of fluoride-releasing materials. MATERIALS AND METHODS: Human, noncarious extracted permanent molars stored in distilled water were used. Flat buccal and lingual dentin surfaces were ground wet on 600-grit silicon carbide paper. The teeth were then distributed at random into three groups of 8 teeth (16 surfaces) each: Group 1: Compoglass; Group 2: Fuji II LC; Group 3: Dyract. Cylindrical samples of the materials were prepared in plastic molds and bonded to the dentin surface according to the manufacturers' instructions. All samples were placed in distilled water for 24 hours, thermocycled for 500 cycles in distilled water at 6 degrees C and 60 degrees C and sheared with an Instron at a crosshead speed of 0.5 mm/minute. RESULTS: In MPa: Group 1: 16.29 +/- 5.35; Group 2: 15.42 +/- 4.77; Group 3: 15.33 +/- 6.96. ANOVA revealed that there was no statistically significant difference between the groups. Fracture patterns, examined with the SEM, revealed material cohesive failures for all groups.

Age and order of eruption of primary teeth in Spanish children.

A longitudinal study on primary tooth eruption was performed in 114 Spanish children in two Primary Care Centers over 3 yr. Data from periodic observations and data collected by previously instructed parents was studied. Ages of tooth eruption were calculated for both sexes. Comparison between the two sides of the jaws showed a nonsignificant tendency towards earlier left side eruption. Comparison between maxillary and mandibular showed a significant earlier mandibular eruption for central incisors and second molars and a significant earlier maxillary eruption for lateral incisors. Comparison between sexes showed a tendency towards earlier eruption in boys for all teeth, significant only for mandibular central incisors, maxillary and mandibular lateral incisors and mandibular canines. Order of tooth eruption and its most frequent changes were also studied. When these findings were compared to studies performed in other populations it was concluded that ages and order of primary tooth eruption in Spanish children are similar to those found in other populations.