ABSTRACT
The dental findings are presented of a mother and daughter who suffer from an as yet unclassified bone dysplasia that shows features of both hereditary hyperphosphatasia and familial expansile osteolysis. Both patients have experienced progressive root resorption of permanent teeth, deafness, and high alkaline phosphatase levels. The mother has a more advanced bone dysplasia which has led to progressive skeletal deformity and bone pain. The kindred is consistent with an autosomal dominant pattern, and the mutation(s) is thought to be in chromosome 18q21-22 region. Conventional treatment strategies of root resorption offer only a poor prognosis for the dentition. Therapy using alendronate, a bisphosphonate compound and a potent inhibitor of osteoclastic activity, has reduced alkaline phosphatase levels, bone pain, and may offer an effective strategy to prevent tooth root resorption in this group of diseases.
Subject(s)
Bone Diseases, Developmental/diagnosis , Bone Diseases, Developmental/genetics , Root Resorption/diagnosis , Root Resorption/genetics , Adult , Bone Diseases, Developmental/therapy , Child , Chromosomes, Human, Pair 18/genetics , Deafness/diagnosis , Deafness/genetics , Diagnosis, Differential , Female , Genetic Linkage , Humans , Osteolysis/diagnosis , Osteolysis/genetics , Phosphates/blood , Root Resorption/therapy , SyndromeABSTRACT
We have systematically studied the aerobic nasopharyngeal bacteria isolated from swabs by unselective subculturing on 5% horse blood agar and chocolate agar in 70 healthy children aged 0-1, 3-5 and 8 years in Nuuk and Sisimiut, Greenland. The purpose was to provide a basis for a better understanding of the infectious pathology and blind antibiotic treatment against potential pathogens thereby improving standard antimicrobial treatment of upper respiratory tract infections (URTI) and otitis media (OM) among children in Greenland. The study serves also as a baseline for future microbiological and immunological research projects. The children were clinically examined for any infectious diseases and a medical history was obtained which allowed for selection of children without a history of severe clinical infection. Nasopharyngeal swabs obtained via the oral route were instantly spread on 5% blood agar and chocolate agar culture plates and incubated aerobically. Subsequently, potentially pathogenic as well as non-pathogenic bacteria were identified by conventional methods. Healthy children in Greenland carry grossly the same aerobic bacterial flora as children in other parts of the world but potentially pathogenic bacteria were found in very high frequency (94%). Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis were found in higher frequencies in the youngest children. Haemophilus influenzae non-b was found in high frequencies in all age groups (67-76%). H. influenzae type b was carried by 11.4%. Group A streptococci were found more frequently in older children and in children from Sisimiut. Of M. catarrhalis strains 88% produced beta-lactamase. Neisseria meningitidis, Mycoplasma pneumoniae and chlamydiae were not detected at all. The high carrier frequency of potentially pathogenic bacteria in healthy children in Greenland may be related to the high frequency of URTI's and episodes of OM among children in Greenland.
Subject(s)
Bacteria, Aerobic/isolation & purification , Nasopharynx/microbiology , Bacteriological Techniques , Child , Child, Preschool , Culture Media , Female , Greenland , Humans , Infant , Male , Otitis Media/microbiologyABSTRACT
This case reports the early diagnosis and treatment of an iatrogenic acute localized periodontitis arising from the incorrect use of orthodontic elastic rubber bands to close a maxillary midline diastema in an eight-year-old girl. The case illustrates the misdiagnosis and mismanagement of a transitional diastema in the "ugly duckling" stage of the mixed dentition. The nine-year follow-up shows that thorough periodontal and orthodontic management has allowed successful retention of both maxillary permanent central incisors, which had initially pathological grade 3 vertical mobility, little remaining alveolar bone, and a hopeless prognosis.
Subject(s)
Alveolar Bone Loss/etiology , Orthodontic Appliances/adverse effects , Acute Disease , Alveolar Bone Loss/diagnosis , Alveolar Bone Loss/therapy , Child , Dentition, Mixed , Diastema/therapy , Esthetics, Dental , Female , Follow-Up Studies , Humans , Iatrogenic Disease , Incisor , Maxilla , Orthodontics, Corrective , Periodontitis/diagnosis , Periodontitis/etiology , Periodontitis/therapy , Prognosis , Rubber , Tooth Mobility/diagnosis , Tooth Mobility/etiology , Tooth Mobility/therapyABSTRACT
These two case reports highlight the enormous clinical difficulties faced by dentists in providing satisfactory long-term dental care to patients who suffer from Epidermolysis bullosa. Problems of bullae formation in oral soft tissues and subsequent scarring are outlined in relation to the difficulty of maintaining satisfactory oral hygiene and a diet leading to minimal dental caries experience. The behavioural problems of maintaining patient compliance for preventive and restorative dentistry in this painful and debilitating disease are illustrated in these case reports. Difficulties in providing restorative care, either under local anaesthesia or general anaesthesia are discussed, and a novel replacement of non-viable carious anterior teeth using a nine-unit porcelain fused to metal Rochette type bridge is presented. Dental management of patients with Epidermolysis bullosa should commence at birth, and non-compliance in dental attendances should be followed up by social workers to prevent the disastrous oral morbidity that frequently occurs in such patients.
Subject(s)
Dental Care for Chronically Ill , Epidermolysis Bullosa Dystrophica/complications , Adult , Child , Dental Caries/etiology , Dental Prophylaxis , Denture, Partial, Fixed, Resin-Bonded , Follow-Up Studies , Genes, Recessive , Humans , MaleABSTRACT
Uncooperative or disabled children who present with an anterior crossbite provide the clinician with a challenge to use innovative strategies to attempt crossbite correction. The following case reports provide possible treatment strategies as well as showing some pitfalls in both diagnosis and treatment of anterior crossbites in this difficult to treat group of patients.
Subject(s)
Child Behavior Disorders , Disabled Persons , Malocclusion/therapy , Attention Deficit Disorder with Hyperactivity , Child , Dental Care for Children , Dental Care for Disabled , Developmental Disabilities , Down Syndrome , Female , Follow-Up Studies , Humans , Intellectual Disability , Male , Malocclusion, Angle Class III/therapy , Orthodontic Appliance Design , Orthodontic Retainers , Orthodontic WiresABSTRACT
Three hundred and ten children from three schools were examined before and after a dental health promotion program targeted at one of the schools. Parents of subjects at the experimental school were visited at home by a community health worker who provided individualized information on dental services and preventive strategies. Parents of subjects at the control school were provided with similar information by way of general written documentation, not tailored to specific needs, and distributed as part of the traditional school take home system. The experimental hypothesis proposed that, at re-examination, subjects from the experimental school would show a measurable improvement in caries increment, and a reduced plaque index over subjects from the control schools. Although the individualized social intervention strategy did not demonstrate a major shift in use of dental services or improvement in health status some improvement in caries experience was obtained in the target group. The multifactorial nature of dental disease and the limited contact of the health worker with the families involved would account for the low success rate of this strategy.
