Epidermolysis bullosa: case report of appropriate classification of subtype because of an early dental exam.

Epidermolysis bullosa is a unique group of disorders that have blister formation as the common feature. Although there are many variants of this disorder, the subtypes are classified into three groups based upon the level of tissue separation that occurs after mechanical trauma is sustained by the skin. Specific subtypes of EB may have substantial involvement of extracutaneous areas such as the oral cavity and dentition. This case report demonstrates the importance of a dental examination at an early age in order to facilitate the correct subtyping of EB. For the very young patient, correct classification of the subtype of EB may be very important in identifying the severity of clinical features associated with the disorder, and with this information the patient and family may become better aware of potential complications of the disorder such as the dental defects described in this report.

In vitro comparative fluoride release, and weight and volume change in light-curing and self-curing glass ionomer materials.

The purpose of this study was to evaluate and compare in vitro fluoride release from and weight and volume changes of Photac-Fil, a light-curing polymaleinate restorative glass ionomer, with Ketac-Fil, a self-curing glass ionomer, and Ketac-Silver, a metal reinforced glass ionomer. Five discs of each material, measuring 2 mm height and 5 mm diameter, were suspended in separate vials of distilled water and laboratory artificial saliva. Fluoride release into the solutions was measured using a calibrated fluoride-sensitive ion meter initially at 24 hr and then weekly from 1 to 9 weeks. These results were evaluated statistically using repeated measures analysis of variance. Volumes and weights were recorded at the start and end of the experiment and analyzed using the paired t-test. Photac-Fil released similar amounts of fluoride to Ketac-Silver, but significantly less than Ketac-Fil in distilled water (P < or = 0.05). In artificial saliva, Photac-Fil released similar amounts to Ketac-Fil, but significantly more than Ketac-Silver (P < or = 0.05). Photac-Fil volume increased in distilled water and artificial saliva (P < or = 0.05) as did Ketac-Fil and Ketac-Silver in artificial saliva (P < or = 0.05). The only material that demonstrated significant net weight increase was Ketac-Silver in artificial saliva (P < or = 0.05). In summary, differences in fluoride release between these three glass ionomer materials varied as a function of the media in which they were stored. Whereas Ketac-Fil exhibited significantly greater fluoride release than the other materials in distilled water, in artificial saliva Ketac-Fil and Photac-Fil exhibited comparable fluoride release. Dimensional change, as evaluated by volume and weight differences, was also affected by storage media.

Pediatric dental education and community service: a combined approach.

Dental educators nationwide have expressed concern regarding the decreasing pediatric clinical experience available to undergraduate dental students. Some educators have suggested that dental programs should utilize extramural clinics and rotations to enhance current patient pools. This paper presents a successful clinical program that is designed to 1) augment the dental education of predoctoral dental students, and 2) provide dental care for an underserved pediatric dental population in an urban community.

Trends in dental treatment rendered under general anesthesia, 1978 to 1990.

While it is generally accepted that the prevalence of dental caries is decreasing, many institutions report an increase in the demand for dental rehabilitation under general anesthesia. This paper compares the characteristics of patients and types of dental treatment delivered under general anesthesia at the same hospital during 1978-1980 and 1988-1990. Patient records for children, who received dental care under general anesthesia during the two time periods examined were reviewed. Demographic data as well as data pertaining to types of dental treatment performed were collected from each patient record. Demographic characteristics were analyzed with a chi square analysis, and results regarding the types of dental treatment were analyzed using a Students t-test. Results were considered significant at p less than 0.05. There were no statistically significant differences in gender or ethnicity of the patients treated during 1978-1980 compared to 1988-1990. There were statistically significantly more patients treated in the 4-6 age group during 1988-1990 than during 1978-1980. There were no statistically significant differences in the number of dental procedures completed per patient during 1978-1980 compared to 1988-1990 in any procedure category except for dental sealants. This study indicates that the majority of pediatric dental patients being treated under general anesthesia at this hospital facility, still require an extensive amount of restorative dental care. Although most children can be successfully treated in the dental office, there is a group of pediatric patients, who require dental treatment in the hospital, under general anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic peroral administration of Streptococcus sobrinus to conventional laboratory rats produces cycling levels of salivary antibodies.

Conventional outbred rats were fed Streptococcus sobrinus for 24 weeks and ELISA was used to identify isotypes of antibodies against bacteria in saliva and serum. Quantities of antibodies from experimental rats were compared with values derived from the control population. Saliva IgM and IgA anti-S. sobrinus from experimental rats were greater than controls at week 3, were much less at week 9, but normal levels were found by week 13. IgG antibodies in saliva peaked at weeks 5 and 9 but fell to control levels by week 13. Relative levels of antibodies in saliva of experimental animals continued to cycle during weeks 13-24 but did not differ greatly from controls. Serum IgM and IgG antibodies to S. sobrinus were essentially like controls throughout the experiment. Serum IgA increased briefly during the first 12 weeks then returned to normal levels. The results suggest that prolonged peroral exposure to cariogenic bacteria ultimately leads to modulation of antibody around unimmunized control levels even though antigenic stimulation persists.

Change in dental treatment needs in an urban pediatric population, 1977 to 1987.

Decreasing caries activity in children has adversely affected the education programs in clinical pediatric dentistry. This paper presents a program designed to facilitate the educational requirements of undergraduate dental students as it meets the dental needs of an urban pediatric population in Kansas City, MO. Changes in dental treatment needs that have occurred in this population over the past decade are evaluated. Dental records of 760 children from four urban schools were examined; data from the dental records were categorized according to the type and number of operative procedures completed. Results indicated a significant decrease in the percentage of patients requiring simple or complex amalgams from 1977 to 1987. Similar decreases were noted in other operative procedures. However, comparisons between the proportion of patients requiring multiple operative procedures indicate less changes during the ten-year period. These results suggest that there is still a percentage of patients requiring substantial dental care as a result of dental caries.

The prevalence of fluorosis-like lesions associated with topical and systemic fluoride usage in an area of optimal water fluoridation.

The frequency of using self-applied (over-the-counter) fluoride products and prescribed supplemental fluorides, and the prevalence of fluorosis-like enamel lesions in the permanent dentitions of children living in an optimally fluoridated urban community were investigated. Subjects were selected randomly, and consent forms and questionnaires concerning fluoride usage and residency status were provided to guardians prior to examination. After a supervised tooth brushing event, 300 consenting subjects were examined by the principal investigator using Dean's index to assess levels of fluorosis-like lesions. The principal investigator was standardized with another investigator prior to the examinations to obtain an interexaminer agreement level of 97%, and an intraexaminer agreement level of 96%. Portable dental equipment was used during all examinations. Chi-square analysis indicated no statistically significant difference between the frequency of tooth brushing with a fluoridated dentifrice at an early age and the prevalence of fluorosis-like enamel lesions. However, there was a significant difference (P less than 0.05) between the prevalence of fluorosis-like lesions, and the frequency of using prescribed fluoride supplements and gels, and over-the-counter rinses.