Oral microbial dysbiosis in patients with Kostmann syndrome.

PURPOSE: The oral microbiome is maintained by host- and microbe-derived factors. A shift in microbial composition, as a result of diseases related to the immune system, is the most important step in the development of oral and dental diseases. The aim of this study was to investigate the oral microbial composition of patients with Kostmann syndrome, who have severe neutropenia, compared with healthy children. METHODOLOGY: A group of nine Kostmann syndrome patients and a group of nine healthy controls participated. After clinical investigation, DNA from stimulated saliva specimens was examined by high-throughput sequencing of the V3-V4 hypervariable region of the 16S rRNA gene using Illumina sequencing. The QIIME software package was used for 16 S rRNA amplicon analysis, while the Greengenes database was used for taxonomic classification. RESULTS: The periodontal pocket depths, plaque indices and bleeding-on-probing percentages and caries status on the deciduous teeth of the patients with Kostmann syndrome were statistically higher than those for the healthy controls. Patients with Kostmann syndrome had significantly lower bacterial diversity as compared to the controls. The presence of Firmicutes was statistically higher in patients with Kostmann syndrome, while that for Proteobacteria was higher in samples from the healthy controls (P<0.05). Streptococcus, Rothia, Granulicatella, Actinomyces, and genera from the family Gemellaceae were present as the core microbiome (abundance >1 % in at least 75  % of samples) in all groups, whereas the genus Porphyromonas was only detected as a member of the core microbiome in Kostmann patients. CONCLUSIONS: The evidence of lower bacterial diversity and differences in microbial profile for patients with Kostmann syndrome not only shows the impact of immune system-related diseases on oral microbiota, but also endorses the ecological plaque hypothesis proposed for the aetiology of oral diseases such as dental caries and periodontitis.

Importance of knowledge of the management of traumatic dental injuries in emergency departments.

BACKGROUND: Hospital emergency departments (EDs) are confronted with managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests inadequate knowledge of the management of traumatic dental injuries (TDIs) among medical professionals. The aim of this study was to investigate the knowledge and attitudes regarding management of TDIs among Istanbul ED physicians. METHODS: Surveys were distributed to emergency departments (ED) directors and their physicians. The survey contained questions about their characteristics and tested their knowledge of managing dental trauma. RESULTS: A total of 126 surveys (13 ED directors and 113 physicians) were returned and included in the analysis. ED physician's knowledge of the appropriate management of crown fractures and avulsion was generally good (p=0.221), but poor for luxation injuries (p=0.0001). Physicians were more likely to have a better knowledge about permanent teeth than about primary teeth (p=0.027). CONCLUSION: Education, monitoring, improved availability of resources, and disciplinary measures in cases of poor compliance are necessary to improve TDI management in hospitals, especially among physicians.

The prevelance of mesiodens in a group of non-syndromic Turkish children: a radiographic study.

PURPOSE: The aim of the present study is to determine the prevelance and clinical status of mesiodens in a group of non-syndromic Turkish children, with an analysis of the associated clinical-eruptive complications. MATERIALS AND METHODS: This study sample consists of 58142 pediatric patients'. Standard equipment and films were used in the suspected patients. The examination of all radiographs was performed under standard conditions by two pediatric dentists with over 10 years experience. Age, gender, number of mesiodens, morphology and clinical status were recorded in forms. RESULTS: A total of 83 mesiodentes were diagnosed in 59 children with ages ranging from 6-14 years. The prevelance of mesiodens was estimated as 0.1%. Males were more frequently affected than females in the ratio of 2.3:1. Of the 83 mesiodentes, 48.2% were conical, 31.3% were tuberculate and 20.5% were incisor like, 22.9% were inverted, and 68.7% were fully impacted. The number of mesiodens was one in 36 cases (61.0%), two in 22 cases (37.3%) and three in one case (1.7%). The mean age at the time of diagnosis of the mesiodens was 9.5 years. The main complication associated with the mesiodens was displacement or rotation of the permanent teeth (73.3%). CONCLUSION: This study presents 0.1% prevelance of mesiodens in a group of Turkish children sample. The majority of the mesiodentes were unilateral located in the premaxillary region, were conical shaped, and remained unerupted. The mean age at the time of diagnosis of the mesiodens in this study was 9.5 years, with this period being later than the eruption time of the maxillary central incisor.

Maxillary incisor trauma in patients with class II division 1 dental malocclusion: associated factors.

PURPOSE: The aim of this study was to assess the association between the presence of maxillary incisor trauma (MIT) with age, gender, dentition type, the degree of overjet (OJ), lip form, respiratory type and dental arch form in patients with Class II division 1 dental malocclusion. SUBJECTS AND METHODS: 256 patients (mean age: 15.80 ± 2.2) were included in this study. The patients' gender, dentition type, superior lip form, dental arch form and respiratory type were recorded. Participants were divided into four groups according to the severity of OJ: 3.5 mm

Relationship between mandibular incisor irregularity and type of occlusion in ankyloglossia.

PURPOSE: To investigate the relationship between the lingual frenulum length with mandibular incisor irregularity and type of occlusion in children with ankyloglossia. MATERIALS AND METHODS: Eighty children aged between 7 and 12 years with ankyloglossia enrolled in the study. The patients were classified according to Kotlow's classification. Mandibular incisor crowding was measured and the molar relationship was determined. The data were analysed statistically using Fisher's exact test, X2 and Pearson's correlation. RESULTS: Of the 80 patients, 45 (56.3%) had mild, 23 (28.8%) had moderate and 12 (15%) had severe ankyloglossia. Fifty-nine (73.8%) of the patients had mild irregularity, 18 (22.5%) had moderate and 3 (3.8%) had severe irregularity. In 56 (70%) of the patients, Class I occlusion was observed, 17 (21.3%) had Class II and 7 (8.8%) had Class III occlusion. No significant differences were found between types of ankyloglossia with mandibular incisor irregularity and occlusion types. A significant positive correlation was determined between the length of the lingual frenulum length and mandibular incisor irregularity. There were significant positive correlations between the lingual frenulum length, incisor irregularity and age. CONCLUSION: Mild and moderate types of ankyloglossia are unrelated to mandibular incisor crowding and occlusion type.

Oral manifestations may be the first sign of Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of histiocytes characterised by a proliferation of abnormal and clonal Langerhans cells. LCH most commonly occurs as a localised solitary bone lesion and appears predominantly in paediatric patients. This case report presents clinicopathological features of this disorder in a 2-year-old boy. The presenting features of the patient included fever, bleeding gums and seborrheic dermatitis-like rash. Intraoral examination and radiographs revealed deep pockets and severe bone loss around all primary molars. Due to severe periodontal destruction, a gingival biopsy was taken. The biopsy specimen revealed heavy infiltration of Langerhans histiocytes. Chemotherapy was administered. Although no clear cause of LCH has been identified, the disease can be triggered by environmental agents and viruses, in particular Epstein-Barr virus. Oral manifestations may be the first or only signs of LCH.

A new method to estimate dental age.

OBJECTIVE: The aim of this study was to evaluate the accuracy of Demirjian's method in estimating the dental age in Turkish children and to estimate the validity of Demirjian's standards for the studied population. MATERIALS AND METHODS: Panoramic radiographs of 756 northwestern Turkish children aged 5-13 years were examined. The new method for dental age estimation for both genders was studied to determine the relationship between dental age, chronological age and Demirjian's scores. Descriptive statistics were used and analysis of correlation was carried out between chronological age, dental age and Demirjian's scores. The difference between dental age and the chronological age was determined with the paired t-test. RESULTS: The results showed that northwestern Turkish children had delays in dental maturity. The new method was applied to Demirjian's scores and dental age scales for both genders were obtained. The tables were used to adapt Demirjian's scores to dental age determination in Turkish children using the new formula. CONCLUSIONS: The developmental standards used by Demirjian are not suitable for northwestern Turkish children. The methods for determining dental development must have population-specific standards. The established gender-specific equations and the new tables are more appropriate for dental age assessment in northwestern Turkish children.

Evaluation of light-emitting diode (LED-660 nm) application over primary osteoblast-like cells on titanium surfaces: an in vitro study.

BACKGROUND: The goal of this study was to evaluate the behavior of neonatal rat calvarial osteoblast-like cells cultured on different implant surfaces and exposed once or three times to a 660-nm light-emitting diode (LED). METHODS: An LED with a 660-nm wavelength was applied once or three times to cultured cells on standard and modified sandblasted acid-etched surfaces (SLA and SLActive; Straumann, Basel, Switzerland). To analyze the effect of the LED on cell proliferation, numbers, and viability, cells were cultured on titanium discs, and measurements were taken after 72 h. Cell proliferation rates were assessed using a bromodeoxyuridine immunohistochemical technique. Cell morphologies were evaluated by scanning electron microscopy (SEM). RESULTS: Osteoblast-like cells proliferated on all tested surfaces, with differences among groups in cell counts and DNA synthesis values. The application of one LED treatment caused a significant increase in cell count in the SLActive group in comparison with the SLA group (p = 0.001), whereas the application of three LED treatments caused a significant decrease in cell count in the SLA group compared with the SLActive group (p < 0.001). After 72 h, the number of cells was highest in the SLActive group exposed once to the LED. CONCLUSIONS: One LED application in the SLActive group resulted in significantly increased cell numbers. However, these findings were not exactly compatible with the SEM findings, which demonstrated fewer cells and weak attachments between cells and to the surface. Thus, further studies using different LED application times are needed to clarify the reason for the increased number of cells that are apparently incapable of attaching to the titanium surfaces after 72 h.

Success rates of mineral trioxide aggregate, ferric sulfate, and formocresol pulpotomies: a 24-month study.

PURPOSE: The purpose of this study was to evaluate the total success rates of mineral trioxide aggregate (MTA), ferric sulfate (FS), and formocresol (FC) as pulpotomy agents in primary molars. METHODS: A randomized, split-mouth study design was used in 32 healthy 5- to 7-year-old children with 128 carious primary molars without clinical or radiographic evidence of pulp degeneration. The pulpotomy agents were assigned as follows: Group 1=MTA; Group 2=FS; Group 3=1:5 diluted Buckley's FC; and Group 4=zinc oxide eugenol (ZOE) base. Clinical and radiographic follow-up at 6, 12, and 24 months used the following criteria: pain; swelling; sinus tract; mobility; internal root resorption; and furcation and/or periapical bone destruction. The data were analyzed using chi-square. RESULTS: No significant differences in success rates were found among the groups at 6 and 12 months. Success rates in groups 1 to 4 at 24 months were 96%, 88%, 88%, and 68% respectively. There was a significant difference (P<.001) between the MTA and ZOE groups at 24 months. CONCLUSIONS: ZOE, as the only pulpotomy medicament, had a significantly lower success rate than MTA. No significant differences were observed, among the 3 experimental materials (MTA, FC, and FS) at 2 years follow-up.

Effect of CPP-ACP and APF on Streptococcus mutans biofilm: A laboratory study.

PURPOSES: (1) To determine the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and acidulated phosphate fluoride (APF) on S. mutans viability, (2) to observe their effects on biofilm structure, and (3) to examine the element content of the hydroxyapatite (HA) surfaces after exposure to CPP-ACP and APF. METHODS: HA discs were coated with: CPP-ACP (GC Tooth-Mousse), APF, CPP-ACP+APF (1/1). Uncoated HA discs were used as control. Following application of the materials, the discs were immersed in human saliva and incubated with S. mutans ATCC (27315) for 24 hours. Growth of bacteria on the discs was evaluated by microbial culturing methods. The structure of the biofilm was examined with confocal laser scanning microscope (CLSM). The change in element content of HA surfaces (without biofilm) was evaluated with energy-dispersive x-ray spectroscopy (EDS). The values were statistically analyzed using Kruskal-Wallis and Dunn's test. RESULTS: The total number of bacteria of APF and CPP-ACP+APF applied groups were found significantly lower than the control group (P< 0.05). All specimens showed similar microbial colonization structure. No statistically significant differences were observed in O, F, Na, P, Ca content on HA surfaces after exposure to the tested agents, although fluoride concentration of the APF treated HA surfaces were increased compared to CPP-ACP, CPP-ACP +APF.

Mineral trioxide aggregate for obturation of maxillary central incisors with necrotic pulp and open apices.

There are few reports on treatment of necrotic pulps with mineral trioxide aggregate (MTA) for apexification. Five immature teeth with necrotic pulps were treated with the use of an apical plug of MTA for apexification. All teeth were central incisors that had premature interruption of root development caused by a previous trauma. According to the treatment protocol, the root canals were rinsed with 5% NaOCl; then calcium hydroxide paste was placed in the canals for 1-6 weeks. The apical portion of the canals were filled with MTA. The rest of the canals were obturated with lateral condensation of the gutta-percha applied with a canal sealer. At 6 months, 1 year and 2 year follow-up periods the clinical and radiographic appearance of the teeth showed the resolution of the periapical lesions and continued root end development in all except in the one case in which the MTA was extruded out the apex. MTA can be considered a very effective option for apexification with the advantage of reduced treatment time, good sealing ability and high biocompatibility.