Caries experience between primary teeth at 3-5 years of age and future caries in the permanent first molars.

BACKGROUND/PURPOSE: Past caries experience remains the most powerful predictor of future caries. This study was aimed at exploring the possible relationship between the caries statuses at 3-5 and 8-10 years of age and examining the predictive power of caries experience at 3-5 years of age for the caries pattern at 8-10 years of age. MATERIALS AND METHODS: A total of 76 children (43 boys and 33 girls) were included in this study from 2012 to 2018. The first caries examination, performed in 2012, was completed when participants underwent dental rehabilitation under general anesthesia at 3-5 years of age. Tooth decay was recorded based on the International Caries Detection and Assessment System criteria. The caries examination was repeated in the clinic in 2018 when the participants were 8-10 years old. Associations between the permanent and primary teeth were analyzed using the Mann-Whitney U test. The receiver operating characteristic curve analysis was performed to determine the predictive accuracy of the primary dentition. RESULTS: A significant dmfs score of the primary second molar was found between groups of free dentin caries and dentin caries of the permanent first molars (p = 0.002). The calculated areas under the receiver operating characteristic curve for the dmfs score of the primary second molar was 0.74. CONCLUSION: Caries in the primary second molars is a clinically useful predictor at 3-5 years of age for future dentin caries development on surfaces of the first permanent molars in the following 5 years.

Success rates of mineral trioxide aggregate, ferric sulfate, and sodium hypochlorite pulpotomies: A prospective 24-month study.

BACKGROUND/PURPOSE: Several medicaments have been used as alternatives to formocresol (FC) for pulpotomy in primary molars with deep carious lesions. However, no prospective study has observed and compared the outcomes of different medicaments. The aim of this prospective study was to compare 12- and 24-month success rates among sodium hypochlorite (NaOCl), ferric sulfate (FS), and mineral trioxide aggregate (MTA) pulpotomies performed in primary molars. METHODS: A total of 108 primary molars in 27 children (18 boys and nine girls) were selected. All subjects exhibited one primary molar indicated for indirect pulp therapy (IPT; control group) and three carious primary molars indicated for pulpotomy with 5% NaOCl, 15.5% FS, and MTA. Clinical and radiographic assessments for determining success rates were performed using established criteria before and at 12 and 24 months after treatment. All data were analyzed using the chi-square test. RESULTS: Clinical treatment success was observed for all teeth during the first 12 months. At 24 months, the clinical and radiographic success rates were both 100% in the control and MTA groups, both 92.6% in the NaOCl group, and 92.6% and 88.9%, respectively, in the FS group. There were no significant differences in the clinical (p = 0.328) and radiographic (p = 0.164) success rates among the four groups. CONCLUSION: NaOCl is easily available and less expensive than MTA, and our results suggest that the outcomes of NaOCl pulpotomy and MTA pulpotomy are similar. Therefore, NaOCl may be a practical alternative to FC for pulpotomy in primary molars.

Dental plaque pH in predicting caries relapse after general anaesthesia - an exploratory study.

OBJECTIVES: Numerous caries risk assessment tools have been proposed in the literature, with few validated in preschool children especially those receiving oral rehabilitation under general anaesthesia (GA). Past caries experience, the best predictor thus far, may not be a reliable indicator after effective clinical intervention. Hence, this longitudinal study was aimed to explore the potential role of plaque pH in predicting future caries incidence after GA among preschool children. METHODS: Oral examination, plaque pH measurements and questionnaire survey were performed, among pre-schoolers indicated for GA, at baseline (n = 92), 6-month (6M; n = 83), 12-month (12M; n = 79) and 24-month (24M; n = 66) recall visits after GA. Multivariable logistic regression and receiver-operating characteristic analysis were performed to evaluate the predictive value of models with plaque pH and past caries experience. RESULTS: Individuals with low resting plaque pH at 6M and 12M were shown to be at high risk of 1-year caries incidence at 12M [relative risk (RR) 1.41, 95% confidence interval (CI) 1.09-1.48] and 24M (RR 1.61, 95% CI 1.22-1.73) recall visit, respectively. Moreover, plaque pH demonstrated a statistically significant predictive value in the 12M and 24M models (12M/24M: 85%/77%) compared with past caries experience, which was not a significant predictor in both models (both P > 0.05). CONCLUSIONS: Plaque pH may be a promising prognostic and predictive marker for early identification of high-risk children undergoing oral rehabilitation under GA.

Comparison of long-term outcomes between ferric sulfate pulpotomy and indirect pulp therapy in primary molars.

BACKGROUND/PURPOSE: There is no long-term study on the comparison of indirect pulp therapy with ferric sulfate pulpotomy in primary molars. This retrospective study aimed to compare the success rates of ferric sulfate pulpotomy with those of indirect pulp therapy in primary molars during a 4-year follow-up. MATERIAL AND METHODS: A total of 114 primary molars from 38 children (16 females and 22 males) with deep carious lesions were selected. Among these molars, 71 indicated for ferric sulfate pulpotomy and 43 indicated for indirect pulp therapy were treated under general anesthesia according to a standard protocol by two senior pediatric dentists. Clinical and radiographic assessments for determining success rates were performed using established criteria at initial, post-operatively, and at 24 and 48 months. Data were analyzed using Fisher's exact test to compare success rates of ferric sulfate pulpotomy and indirect pulp therapy at the 24- and 48-month follow-ups. RESULTS: The overall success rates for indirect pulp therapy and ferric sulfate pulpotomy were 100% (43/43) and 91.5% (65/71), respectively, at the 24-month follow-up; the difference was not significant (P = 0.08). However, the success rate for indirect pulp therapy (93.0%, 40/43) at the 48-month follow-up was significantly higher than that for ferric sulfate pulpotomy (70.4%, 50/71) (P = 0.008). CONCLUSION: Indirect pulp therapy showed a significantly higher success rate at the 4-year follow-up than did ferric sulfate pulpotomy for treating deep carious lesions in primary molars. Earlier exfoliation was observed after treatment with ferric sulfate pulpotomy compared to indirect pulp therapy.

Risk assessment models to predict caries recurrence after oral rehabilitation under general anaesthesia: a pilot study.

OBJECTIVES: Oral rehabilitation under general anaesthesia (GA), commonly employed to treat high caries-risk children, has been associated with high economic and individual/family burden, besides high post-GA caries recurrence rates. As there is no caries prediction model available for paediatric GA patients, this study was performed to build caries risk assessment/prediction models using pre-GA data and to explore mid-term prognostic factors for early identification of high-risk children prone to caries relapse post-GA oral rehabilitation. METHODS: Ninety-two children were identified and recruited with parental consent before oral rehabilitation under GA. Biopsychosocial data collection at baseline and the 6-month follow-up were conducted using questionnaire (Q), microbiological assessment (M) and clinical examination (C). RESULTS: The prediction models constructed using data collected from Q, Q + M and Q + M + C demonstrated an accuracy of 72%, 78% and 82%, respectively. Furthermore, of the 83 (90.2%) patients recalled 6 months after GA intervention, recurrent caries was identified in 54.2%, together with reduced bacterial counts, lower plaque index and increased percentage of children toothbrushing for themselves (all P < 0.05). Additionally, meal-time and toothbrushing duration were shown, through bivariate analyses, to be significant prognostic determinants for caries recurrence (both P < 0.05). CONCLUSIONS: Risk assessment/prediction models built using pre-GA data may be promising in identifying high-risk children prone to post-GA caries recurrence, although future internal and external validation of predictive models is warranted.

Influence of dental plaque pH on caries status and salivary microflora in children following comprehensive dental care under general anesthesia.

BACKGROUND/PURPOSE: There is no report in examining dental plaque pH after dental care under general anesthesia. This study investigated the effects of comprehensive dental rehabilitation under general anesthesia on the oral environment of children with severe early childhood caries (S-ECC) and the influence of dental plaque pH on caries recurrence and salivary microflora. MATERIALS AND METHODS: Thirty-seven children (mean age, 51.08 ± 9.68 months) with S-ECC who underwent comprehensive dental treatment under general anesthesia were selected. Caries index, plaque pH, and Streptococcus mutans (SM) and Lactobacillus (LB) counts were evaluated during the initial examination and 6-month and 12-month follow-ups. RESULTS: The plaque pH was significantly greater at the 6-month follow-up examination than at the initial examination (P = 0.006) and at the 12-month follow-up (P = 0.002), but there was no significant difference in plaque pH between the initial examination and the 12-month follow-up (P = 0.942). SM and LB counts at the sixth and twelfth months were significantly lower than the initial counts (P < 0.001). Plaque pH did not show strong correlations with caries index and SM and LB counts at the three time-points (P > 0.05). CONCLUSION: The comprehensive dental rehabilitation under general anesthesia for children with S-ECC caused a temporary significant increase in the plaque pH at the sixth month and a significant reduction in the salivary microflora during the 12-month follow-up. Plaque pH did not demonstrate any strong correlations with caries status and salivary microflora in children with S-ECC.

Long-term space changes after premature loss of a primary maxillary first molar.

BACKGROUND/PURPOSE: The consequence of premature loss of primary teeth resulting in the need for space maintainers has been controversial for many years. There is no longitudinal long-term report in literature regarding the premature loss of a primary maxillary first molar. The aim of this study was to continue observing the long-term space changes of 19 cases following premature loss of a primary maxillary first molar during the transition from primary to permanent dentition. MATERIALS AND METHODS: Ten of the 19 original participants were excluded because of extensive decay or loss to follow-up. Nine children (mean age at time of tooth extraction, 6.0 ± 0.42 years) with unilateral premature loss of a primary maxillary first molar were examined. Maxillary dental study casts were obtained 2 days or 3 days after tooth removal and, on average, 81 months later. The contralateral intact primary molars in each participant served as controls. The arch width, arch length, intercanine width, intercanine length, and arch perimeter of each study cast from the initial and follow-up examinations were measured and compared using paired t-tests. RESULTS: Eight of nine cases (88.9%) did not show crowded permanent successors or canine block-out at the extraction site. Interestingly, the permanent dentition was more crowded at the control site (2/9) than at the extraction site (1/9). The arch width, arch length, intercanine width, and intercanine length significantly increased at 81 months (P < 0.05), whereas the arch perimeter increases approached significance (P = 0.071). CONCLUSION: The anterior and posterior arch dimensions significantly increased 81 months after premature loss of a primary maxillary first molar, which suggested that space maintainers were not needed in these cases.

A survey of natal and neonatal teeth in newborn infants.

BACKGROUND/PURPOSE: Since there is no comprehensive research of natal and neonatal teeth in Taiwan, careful investigation of natal or neonatal teeth is worthy of being studied. This retrospective study investigated the prevalence and clinical characteristics of natal or neonatal teeth in a hospital setting, and analyzed the possible relationships between investigated variables of the natal or neonatal teeth. METHODS: All of the 12,019 infants born at an assigned hospital between January 1, 2008 and December 31, 2014 were investigated for natal or neonatal teeth. The identified individuals were reviewed for systemic diseases. Dental examinations included the location, clinical appearance, and degree of mobility. A positive family history of natal or neonatal teeth and mother's physical condition before delivery were also investigated. The collected data were analyzed using Fisher's exact test. RESULTS: Thirty infants were identified with a total of 43 natal or neonatal teeth (females, 19; males, 11). Most of the teeth were in the mandibular primary incisor position (97.6%). A radiographic examination confirmed that not all of the natal or neonatal teeth were supernumerary. No significant differences were observed between males and females in tooth morphology, positive family history, and treatment methods (p > 0.05) or between normal and conical shapes in positive family history, premature infant, mother's physical condition before delivery, and treatment methods (p > 0.05). CONCLUSION: Most of the natal or neonatal teeth were in the mandibular primary incisor position and not all of them were supernumerary. No gender differences were found in tooth morphology, positive family history, and treatment methods. The tooth morphology was not significantly related to a positive family history, premature delivery, or the mother's physical condition before delivery.

Factors associated with the risk of caries development after comprehensive dental rehabilitation under general anesthesia.

BACKGROUND/PURPOSE: The aims of this cross-sectional study were to determine the possible risk factors of caries development in children with early childhood caries (ECC) and to perform a caries risk assessment using Cariogram over a 12-month period. There is no report in examining caries risk assessment under 6 years old children in Taiwan. MATERIALS AND METHODS: Seventy-nine children (mean age 48.80 ± 10.71 months) with ECC indicated for comprehensive dental reconstruction under general anesthesia were selected. A questionnaire was completed by the parents to assess the possible caries-related factors at a 12-month follow-up. Data were collected for caries index, plaque index, Streptococcus mutans (SM) and Lactobacillus (LB) counts, and salivary buffering capacity at the initial examination and at the 12-month follow-up. Children were divided into two groups: caries-free (decayed, extracted, and filled teeth = 0) and caries-recurrent (decayed, extracted, and filled teeth > 0). The children's caries risk was assessed using the Cariogram software program. RESULTS: At the 12-month follow-up, 79.7% of the children had developed new caries. No significant differences were found in parents' education levels, child's oral health practices, or parental knowledge and attitudes toward oral health (P > 0.05) between the caries-free group and the caries-recurrent group. The SM count (P = 0.001) and caries risk assessment (CRA) score (P < 0.001) were found to be significantly associated with new caries development. CONCLUSION: This study has shown that SM count and CRA score were associated with new caries development in ECC children who needed to be treated under general anesthesia. The modified Cariogram used in this study is another significant tool for predicting new carries development in this particular population.

Twelve-month space changes after premature loss of a primary maxillary first molar.

BACKGROUND: Many early investigations concerning space changes following premature extraction of primary molars had a cross-sectional design, a small sample size, and a somewhat crude methodology, which may have led to misunderstandings. AIM: The aim of this study was to use established longitudinal data to investigate ongoing (12-month) dental-arch space problems arising as a result of premature loss of a primary maxillary first molar. DESIGN: Thirteen children (mean ± SD age at time of tooth extraction, 6.0 ± 0.74 years) with unilateral premature loss of a primary maxillary first molar were selected for this study. Maxillary dental study casts were obtained from participants 2 or 3 days after the tooth was removed, as well as at a follow-up appointment 12 months later. Six reference lines were measured on the study cast: D + E space, arch width, arch length, intercanine width, intercanine length, and arch perimeter. For each participant, the D + E space of the contralateral intact primary molar served as a control. A paired t-test was used to compare the cast measurements between initial examination and 12-month follow-up. A t-test was used to compare D + E space changes with those of the control group. RESULTS: The D + E space of the extraction side after 12 months was significantly smaller than that of the control side (P < 0.05) and the initial D + E space (P < 0.05). A significantly greater arch perimeter, intercanine width, and intercanine length were found after 12 months compared with the initial parameters. No significant differences were found, however, in arch width or arch length between the initial examination and the 12-month follow-up examination (P > 0.05). CONCLUSIONS: The 12-month space changes in the maxillary dental arch after premature loss of a primary maxillary first molar consist mainly of distal drift of the primary canine toward the extraction site. Mesial movement of permanent molars or tilting of the primary molars did not occur. An increased arch dimension was found especially in the anterior segment (intercanine width and length). There is no need for the use of space maintainers from the results in this study in cases of premature loss of a primary first molar.

Double primary teeth in children under 17 years old and their correlation with permanent successors.

BACKGROUND: The existence of double primary teeth associated with further problems in permanent successors may have deleterious effects on occlusion and esthetics. The purposes of this study were to investigate the prevalence of double teeth in a group of Taiwanese children under 17 years old, and to compare the distribution of the different types of double primary teeth and their relationship to permanent successors. METHODS: A total of 7868 qualified dental records of children under age 17 from the pediatric dental clinic of Chang Gung Memorial Hospital-Kaohsiung Medical Center were selected for this study. Panoramic radiographs were obtained from each child. The distribution of double teeth was investigated according to sex differences, types and clinical positions. The occurrence of double primary teeth and their effects on the permanent dentition were also recorded. RESULTS: The prevalence of double primary teeth in children under 17 years old in this study was 0.72%. Double primary teeth were found mostly in the mandibular lateral incisors and canines (63.2%). Approximately 56% of cases experienced further problems in the permanent successors. Hypodontia (51.5%) was the most common problem in the permanent successors. CONCLUSION: The close relationship between double primary teeth and permanent successors justifies radiographic examination to evaluate the number and condition of permanent successors and determine a proper treatment plan.

Immediate and six-month space changes after premature loss of a primary maxillary first molar.

BACKGROUND: Premature loss of primary maxillary first molars has been associated with a number of consequences (such as tipping of the first permanent molar). The aim of the authors' study was to investigate dental-arch space problems arising as a result of premature loss of a primary maxillary first molar. METHODS: This study was composed of 19 children who experienced unilateral premature loss of a primary maxillary first molar. The authors used each patient's intact contralateral arch segment as a control. The authors obtained maxillary dental study casts two or three days after the tooth was extracted, as well as six months later. RESULTS: The D + E space from the extraction side six months after removal of the tooth (mean +/- standard deviation, 15.62 +/- 1.13 millimeters) was significantly smaller than the space on the control side (16.88 +/- 1.12 mm) and the initial D + E space (16.70 +/- 0.69 mm). The authors found a significantly shorter arch length (25.47 +/- 1.58 mm) and larger intercanine width (31.29 +/- 2.49 mm) six months after the tooth was extracted compared with the initial arch length (25.66 +/- 1.64 mm) and intercanine width (30.42 +/- 2.64 mm). CONCLUSIONS: The early space changes to the maxillary arch subsequent to premature loss of a primary maxillary first molar are primarily distal drift of the primary canines toward the extraction space and palatal migration of the maxillary incisors. Although 1 mm of space was lost, which is statistically significant, this is not likely to be of sufficient clinical significance to warrant use of a space maintainer. If palatal movement appears to be needed, the dentist should consider use of a palatal arch rather than a band-and-loop maintainer. CLINICAL IMPLICATIONS: The effects of space maintainers need to be re-evaluated in cases of unilateral premature loss of a primary maxillary first molar.

A retrospective study of dental treatment under general anesthesia of children with or without a chronic illness and/or a disability.

BACKGROUND: The indications for dental treatment under general anesthesia have been described by various authors as extensive decay, behavioral management problems, a medically compromised patient, a handicapped patient, and a combination of these. Few studies have been undertaken to identify the range of treatment provided for chronically sick children. The aim of this study was to identify the characteristics of dental procedures performed under general anesthesia on children with a chronic illness and/or a disability, and compare these findings with other normal children. METHODS: A retrospective, comparative study was designed. Children who received comprehensive dental treatment under general anesthesia at Kaohsiung Chang-Gung Memorial Hospital, Taiwan, in 2002 were enrolled in this study. Patients with a chronic illness and/or a disability were included in group I, and other relatively normal patients were placed in group II. RESULTS: Group I children were significantly older than those of group II (p < 0.0001). Different patterns of dental treatment were noted when the 2 groups were compared. Significantly greater numbers of stainless steel crown build-ups (p = 0.028) and pulpal treatments (p = 0.003) were found among group II patients. There was no significant between-group difference in restorations (p = 0.934); however, group I had a significantly higher (p = 0.006) number of extractions. CONCLUSIONS: By comparing the different patient groups receiving comprehensive dental treatment under general anesthesia, it was found that patients with a chronic illness and/or a disability had a significantly higher average surgical age and fewer pulpal treatments, received fewer stainless steel crowns, and underwent more extractions. Providing early treatment for children with a chronic illness and/or a disability may improve their dental health and maintain full dentition so as to reduce the number of subsequent tooth extractions. Thus, it is highly recommended to refer these children at an earlier age to a hospital where tooth restoration under general anesthesia can be performed.

A survey of the oral status of children undergoing liver transplantation.

BACKGROUND: The purposes of this study were to examine the oral tissues and caries prevalence of children undergoing liver transplantation, and to evaluate the relationship between tooth staining and serum bilirubin level. METHODS: Thirty-four children (22 boys and 12 girls) under the age of 6 years with end-stage liver disease were referred from the Liver Transplantation Center at Kaohsiung Chang Gung Children's Hospital, Taiwan. Oral tissues were examined, and photographs taken to determine the green staining of the teeth and gingiva. A questionnaire was completed by their parents. Serum bilirubin levels were collected preoperatively in these children. Student's t-test was used to compare the mean decayed, missing, and filled tooth (dmft) difference between night-fed and non-night-fed groups, and to test the relationships between tooth staining and serum bilirubin levels. RESULTS: The caries prevalence of the 34 children undergoing liver transplantation was 61.8%. The mean dmft score of children 2 to 6 years old who were night-fed was significantly higher than that of children who were not (10.1 +/- 1.2 vs. 6.3 +/- 1.2; p = 0.038). Green staining of the teeth and gingiva was found in 61.3% of cases in children with biliary atresia. Total serum bilirubin levels were significantly higher in the green-stained group than in the non-stained group (17.87 +/- 2.50 vs. 2.20 0.65; p < 0.01). CONCLUSIONS: Oral findings of children undergoing liver transplant presented significant green staining of the teeth and gingiva related to high serum bilirubin levels. Children who were night-fed showed an increased risk of developing caries suggesting that oral hygiene instructions should begin as early as possible before liver transplantation.

Dentinogenesis imperfecta associated with osteogenesis imperfecta: report of two cases.

Osteogenesis imperfecta (OI) is a heritable systemic disorder of the connective tissue. Dentinogenesis imperfecta (DI), which is sometimes an accompanying symptom of OI, belongs to a group of genetically conditioned dentin dysplasias and is characterized clinically by an opalescent amber appearance of the dentin. Although the teeth of DI cases wear more easily and excessively compared to normal teeth, they do not appear to be more susceptible to dental caries than normal teeth. Two cases of DI associated with OI are presented in this paper, with 1 case suffering from nursing bottle caries. The purposes of this paper are to present the dental and skeletal characteristics of moderately and mildly involved DI associated with OI, and to discuss the possible methods of dental treatment. Patients with OI and opalescent teeth should be evaluated as soon as the deciduous teeth erupt; immediate dental involvement and oral hygiene instruction can be of help in reducing the necessity of extensive dental care.