Nonsurgical endodontic treatments in molar teeth with large periapical lesions in children: 2-year follow-up.

Profound caries lesions may lead to invasion of microorganisms to the dental pulp, and periapical areas can promote the development of dentoalveolar abscess and periapical bone loss. Treatment options to manage large periapical lesions range from nonsurgical root canal treatment and/or apical surgical procedure to extraction. Young molar teeth with pulp necrosis and large periapical lesions in children are frequently treated with root canal treatment because the therapy is more difficult in multirooted teeth. In these case reports, nonsurgical endodontic treatments performed on 6 molar teeth with large periapical lesions, by repeated intracanal dressing with calcium hydroxide, are presented. Radiographs displayed significant bony healing at the end of the second year. In conclusion, large periapical lesions can respond favorably to nonsurgical treatment, and complex and difficult endodontic treatments in children might not be required.

Fluoride levels of human plasma and breast milk.

OBJECTIVES: The aim of this study was to determine the fluoride levels in breast milk and plasma of lactating mothers who regularly consumed drinking water with low levels of fluoride. METHODS: One hundred twenty five healthy mothers aged between 20-30 years old who had given birth within 5-7 days were included in the study. Besides being otherwise healthy, the primary selection criteria stipulated the absence of fluoride supplement consumption one month before delivery. Approximately 5 ml breast milk and 5 ml blood samples were obtained from each participating mother at a hospital setting, where the mothers were scheduled for a regular hospital diet. The blood samples were centrifuged in fluoride-free heparinized polyethylene tubes and stored at -18 degrees C until measurements were made. Breast milk samples were directly refrigerated as with blood samples until measurements. The fluoride concentrations of milk and blood samples were assessed using an ion-selective fluoride electrode combined with an ion analyzer. RESULTS: The fluoride levels of the plasma and breast milk samples were measured as 0.017+/-0.011 ppm and 0.006+/-0.002 ppm, respectively. The fluoride concentration of plasma was significantly higher than that of breast milk (P<.01). Correlation analysis revealed a significant relation between the groups (P<.01). CONCLUSION: A limited level of fluoride transmission from plasma to breast milk was detected. Nevertheless, a significant correlation between the fluoride concentrations of breast milk and plasma was evident.

Shear bond strengths of self-etching adhesives to caries-affected dentin on the gingival wall.

The purpose of this study was to evaluate the bonding ability of five current self-etching adhesives to caries-affected dentin on the gingival wall. Seventy extracted human molars with approximal dentin caries were employed in this study. In order to obtain caries-affected dentin on the gingival wall, grinding was performed under running water. Following which, specimens mounted in acrylic blocks and composite resins of the bonding systems were bonded to dentin with plastic rings and then debonded by shear bond strength. With Clearfil SE Bond, bonding to caries-affected dentin showed the highest bond strength. With Optibond Solo Plus Self-Etch, bonding to caries-affected dentin showed higher shear bond strength than AQ Bond, Tyrian SPE & One-Step Plus, and Prompt-L-Pop (p<0.05). Further, the bond strengths of Clearfil SE Bond and Optibond Solo Plus Self-Etch to sound dentin were higher than those of Prompt-L-Pop, AQ Bond, and Tyrian SPE & One-Step Plus (p<0.05). In conclusion, besides micromechanical interlocking through hybrid layer formation, bond strength of self-etch adhesives to dentin may be increased from additional chemical interaction between the functional monomer and residual hydroxyapatite. The results of this study confirmed that differences in bond strength among self-etching adhesives to both caries-affected and sound dentin were due to chemical composition rather than acidity.

Clinical, genetic, and biochemical findings in two siblings with Papillon-Lefèvre Syndrome.

BACKGROUND: Papillon-Lefèvre Syndrome (PLS) is an autosomal recessive disease characterized by palmoplantar hyperkeratosis and severe periodontitis affecting both primary and secondary dentitions. Cathepsin C (CTSC) gene mutations are etiologic for PLS. The resultant loss of CTSC function is responsible for the severe periodontal destruction seen clinically. METHODS: A 4-year-old female (case 1) and her 10-year-old sister (case 2) presented with palmoplantar skin lesions, tooth mobility, and advanced periodontitis. Based on clinical findings, the cases were diagnosed with PLS. Mutational screening of the CTSC gene was conducted for the cases, and their clinically unaffected parents and brother. Biochemical analysis was performed for CTSC, cathepsin G (CTSG), and elastase activity in neutrophils for all members of the nuclear family. The initial treatment included oral hygiene instruction, scaling and root planing, and systemic amoxicillin-metronidazole therapy. RESULTS: CTSC mutational screening identified a c.415G>A transition mutation. In the homozygous state, this mutation was associated with an almost complete loss of activity of CTSC, CTSG, and elastase. Although monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to stabilize the periodontal condition, case 1 lost all her primary teeth. In case 2, some of the permanent teeth could be maintained. CONCLUSIONS: This report describes two siblings with a cathepsin C gene mutation that is associated with the inactivity of cathepsin C and several neutrophil serine proteases. The failure of patients to respond to periodontal treatment is discussed in the context of these biological findings.

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.