Optimal recall intervals in child dental care.

A favorite quote from John Fowles can be applied to the debate over the optimal recall intervals for children: "Total sight or all else is desolation." Piecemeal considerations such as the patient's caries prevalence or the rate of progression of a carious lesion, on their own, are insufficient to determine the optimal time for a recall examination. Only a regular, comprehensive examination permits the dentist to understand and apply the ecological model--how best to reduce the incidence of a oral disease and how best to care for or alleviate a disease process. This knowledge permits a practitioner to customize, to individualize his decisions with respect to frequency of examination, and when and where to apply preventive and/or treatment regimens. This applies to the management of dental caries, periodontal conditions, and growth and development problems of the dental/oral-facial complex. A practitioner can only manage the whole patient-as opposed to just the disease entity-by individualizing the frequency of recall examinations. Similarly, we can only implement optimal preventive measures-and ethically postpone invasive procedures-by individualizing recall examinations.

The effects of hypocalcemia/hypophosphatemia on porcine bone and dental hard tissues in an inherited form of type 1 pseudo-vitamin D deficiency rickets.

The effects of Vitamin D deficiency rickets on the formation of mineralized dental tissues were studied in a breed of pigs which had moderate and marked hypocalcemia because of an inherited defect in the renal production of the biologically-active Vitamin D metabolites. Affected piglets developed classical symptoms of rickets which were fatal unless Vitamin D supplements were given. The dissected mandibles of homozygous (rickets) and heterozygous (normal) pigs were photographed and radiographed. Compared with those of normal pigs, the mandibles of homozygous pigs demonstrated slowed development/eruption of permanent teeth, under-mineralized bone, underdeveloped dentin (enlarged pulp chambers), interglobular dentin, and enamel hypoplasia. Enamel defects in rachitic pig teeth were difficult to observe radiographically, but could be detected visually and by SDS-PAGE analysis of the enamel protein components of developing and maturing enamel. There was significant retention of amelogenins in the enamel maturation zones of developing molars taken from rachitic pigs, but there was no obvious difference in the patterns of amelogenin processing.

Risk factors for dental fluorosis in a fluoridated community.

We conducted a case-control study to determine the sources of fluoride which are particular risk factors to dental fluorosis. Cases and non-cases were identified by the screening of 8-, 9-, and 10-year-old schoolchildren in the fluoridated community of East York, Ontario. Parents were interviewed about the child's first five years of residence and about diet and preventive caries practices. The Mantel-Haenszel odds ratio and associated chi-square tests were used to assess the association of fluorosis with several potential sources, controlling for other sources of fluoride and mother's education. The prevalence of mild fluorosis [1-4 on the Thylstrup and Fejerskov (1978) Index] was 13%. Those who brushed their teeth before the age of 25 months had 11 times the odds of fluorosis compared with those beginning toothbrushing later; prolonged use of infant formula (greater than or equal to 13 months) was associated with 3.5 times the risk of fluorosis, compared with no, or shorter duration of, formula use. We estimate that these factors were responsible for 72% and 22%, respectively, of the cases in our population. Dental fluorosis is not a public health problem in East York, but parents should be advised to supervise toothbrushing by children under 2 years of age.

Fluoride and dental health.

Studies conducted under the widest variety of controlled conditions attest to the safety, efficacy, and cost benefits of fluoridation. A program that combines the use of systemic and topical fluoride results in maximum benefits. The author of this article reviews the metabolism of fluoride and its mechanism of action, and discusses practical modes of employing fluoride in caries prevention with special emphasis on the use of fluoride supplements for infants and young children in areas of non-fluoridated water. The author also discusses the factors responsible for the dramatic decline in caries prevalence in the industrialized nations.

The etiology of enamel hypoplasia: a unifying concept.

In a study of children with chronic disorders of calcium and phosphate homeostasis, enamel hypoplasia was found in hereditary vitamin D-dependency rickets and in hypoparathyroidism, conditions characterized by hypocalcemia, and was not found in X-linked hypophosphatemic rickets, a condition in which the plasma calcium concentration is normal. The occurrence of enamel hypoplasia bore no relation to the plasma phosphate concentration. Enamel hypoplasia has also been reported in other pediatric disorders in which hypocalcemia is a major sign (for example, vitamin D deficiency, prematurity, and neonatal tetany). The existence of enamel hypoplasia in a hypoparathyroid or rachitic patient, when correlated with the chronology of enamel mineralization, helps to establish the time of onset of hypocalcemia. The observations led us to the hypothesis that a low serum calcium concentration during enamel formation is a specific determinant of enamel hypoplasia. This hypothesis may be relevant to the etiology of linear enamel hypoplasia, an endemic lesion of primary teeth in children of many Third World countries that predisposes the teeth to dental caries. The hypothesis may therefore be relevant also in explaining the prevalence of caries in the primary teeth of children in many underdeveloped countries.

Calcific bridging of dental pulp caused by iatrogenic hypercalcemia. Report of a case.

A case of renal osteodystrophy treated with high doses of vitamin D is presented. The treatment, carried out when the patient was between 3 1/4 and 6 years of age, induced hypercalcemia (up to 13.9 mg./dl.) which resulted in dentinal bridging corresponding chronologically to the part of the root developing at this age. Dentinal bridging associated with iatrogenic hypercalcemia has not been reported previously.

Chemical determinants of enamel hypoplasia in children with disorders of calcium and phosphate homeostasis.

Studies of children with disorders of calcium and phosphate homeostasis indicate that hypocalcaemia, but not hypophosphataemia, is a significant and specific factor in the etiology of enamel hypoplasia. Only those teeth were affected that had developed during the hypocalcaemic episodes.

Health for and by the people.

The need to extend the search for health beyond the current efforts to control disease is emphasized by citing the deficienceis of the current health care model systems. The escalating costs of health care delivery, the emphasis of the current system on treating episodic illnesses rather than chronic disabilities, and the fact that the health care system has less of an impact on health status than socio-economic and life style factors represent major deficiencies in health care delivery. Further, the fragmentation and specialization in education and health care, the exclusion of behavioral science teaching, and the teaching of behavioral determinants of diseases are additional deficiencies of health professions education. The need to develop clear and explicit national health policies, including monitoring of health both of people and communities using indices that relate not only to diseases but also to the qualitative aspect of life, is viewed as an essential prerequisite for the health care system. The assignment of much greater priority to the training of a community health worker and health educator is stressed.