Maxillary incisor palatal erosion: no correlation with dietary variables?

The objectives of the study were to examine a relationship between tooth erosion affecting the palatal aspects of permanent maxillary central incisors with dietary, behavioral and medical variables. The methods included, 251 schoolchildren aged 11 to 13 years were recruited to participate. Each subject had dental impressions of the palatal aspects of both upper central incisors recorded at baseline, 9 and 18 months intervals. From these, electroconductive replicas were fabricated, mapped and compared using a surface matching technique. At the end of the study all participants underwent a structured interview that sought to assay the level of potential erosive dietary, behavioral and medical risk factors. Correlation analyses of the responses given in the final structured interview with the degrees of palatal tooth substance loss (both previous and measured) were under taken. The results showed: (1) The degree of previous erosion did not predict the level of measured ongoing erosion. (2) Brushing the teeth more frequently with fluoridated toothpaste correlated significantly with lower levels of ongoing erosion (P = 0 011). It was concluded that: (1) Evidence of previous palatal erosion did not predict future erosion. (2) The application of topical fluoride as a by-product of tooth brushing may provide an element of protection against palatal erosion. (3) In view of the lack of correlation between exposure to potential risk factors and the level of ongoing palatal tooth surface loss in this study, other factors (such as an individual's susceptibility and salivary buffering power) may well be more important predictors. The clinical relevance included: Preventive advice to patients with dental erosion should not only include the use of topical fluoride, in the form of toothpaste, but recognize individual susceptibility to this condition.

Assessment of a procedure for detecting minute levels of tooth erosion.

Over a period of some years, the components of a system for discerning erosion on children's teeth have been progressively developed, for use in an extensive project seeking correlations between erosion and various perceived risk factors. The aim was the detection of minute levels of erosion, based on mappings of the palatal surfaces of the maxillary central incisors in children. Significant challenges were encountered, the primary problem being the impracticality of placing control marks that would aid the realignment of successive measurements. The paper describes the erosion detection system and initial experiences based on the results of the first 100 subjects measured after 9 months. The procedures detected the occurrence of erosion of 50 microm magnitude on about one-quarter of the teeth over the 9 month period, at a precision estimated to be +/- 15 microm. The occurrence of some anomalous incidents prevented the procedure from being fully automatic, and it necessitated human examination of a graphical diagram derived from the surface matching program, but it was nevertheless superior to current practices of examining impressions or replicas entirely by eye.

Root agenesis in developing canines as a complication of intranasal antrostomy.

A case is reported in which the roots of both maxillary canines failed to develop, a defect that could be traced to antral surgery when the patient was 8 years of age. The differential diagnosis of such a finding is proffered. The maxillary antrum is described, and aspects of the surgical procedure, the nasal antrostomy, used in this patient are discussed. A brief outline of current thought on the mechanisms of eruption of teeth is appropriate, and treatment of the symptomatic tooth is mentioned.

Mucous membrane pemphigoid: an elusive diagnosis?

Vesiculobullous diseases, including mucous membrane pemphigoid (MMP), are uncommon. This study was a retrospective examination of the clinical findings, histopathologic findings, and lesional immunostaining with respect to 76 consecutive patients referred to the Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School, between 1982 and 1985 with a potential diagnosis of MMP. Of these, 42 patients were assigned alternative clinical diagnoses, 71% of which were confirmed by immunostaining and histology. Thus, MMP was clinically diagnosed in 34 patients (28 women and 6 men, with an average age of 59 years). However, unequivocal histologic confirmation of this diagnosis was obtained for only 4 patients, and direct immunostaining confirmation was obtained for just 7 patients. On the basis of a combination of the clinical, histopathologic, and direct immunofluorescence examinations, in only 3 of the 34 patients (8%) was an unequivocal diagnosis of classic MMP possible.