Dental treatment of children referred to general anaesthesia--association with country of origin and medical status.

BACKGROUND: A small proportion of children and adolescents need dental treatment with general anaesthesia (DGA). The aim of this retrospective cross-sectional study was to analyse how country of origin and medical status were related to age at treatment, waiting times in the system, and dental treatment provided in general anaesthesia. METHODS: A total of 786 patients received DGA at the University Hospital of Aarhus, Denmark in the period from 1990 to 2001. Information on the date of referral, the date of examination, the date of treatment, country of origin (Danish or non-Danish), medical status (non-special needs or special needs), and dental treatment performed was collected from patient records. RESULTS: Patients with special needs were older when treated than non-special needs patients, whereas patients with a non-Danish origin were younger than those with a Danish origin when treated. There were no differences between non-special needs and special needs patients in waiting times from referral to examination and from examination to dental treatment. In contrast, patients from a non-Danish origin waited longer from examination to treatment than patients of Danish origin, whereas no difference was found in waiting time from referral to examination. Patients with special needs had fewer teeth treated than non-special needs patients, whereas patients with non-Danish origin had more teeth treated than those of a Danish origin. CONCLUSION: Age at treatment, waiting times in the system, and dental treatment received under general anaesthesia vary according to medical status and country of origin of the patients in Denmark. These findings should be considered in the organization and the funding of this type of service.

Dental findings in three siblings with Morquio's syndrome.

Three siblings with Morquo's syndrome are described. Cultured fibroblasts from the youngest sibling demonstrated a total absence of N-acethylgalactosamine-6-sulphate-sulphatase whereas beta-galactocidase activity was normal, thus verifying the diagnosis of MPS-IV A. Dental features such as pointed cusps, spade-shaped incisors, thin enamel and pitted buccal surfaces were observed in all three children. Furthermore, in all three siblings the TMJ was affected with severe resorption of the head of the condyle. Histological examination of exfoliated primary molars showed a band of increased porosity following the striae of Retzius in the outer part of the enamel. These developmental disturbances were occasionally associated with minor localized defects in the enamel surface. The importance of close monitoring of dental development and regular dental care in order to prevent attrition of the teeth, loss of vertical face height and subsequent risk of TMJ dysfunction is emphasized.

Histomorphometric analysis of primary teeth during the process of resorption and shedding.

The state of pulp tissue and periodontal root surface of 90 non-carious human primary teeth during the process of resorption and shedding was assessed by histomorphometric means. The teeth were classified into preshedding, shedding and delayed-shedding groups according to age of the child at the time of extraction. The root surface length measured from the cementoenamel junction was related to stages of shedding. Inflammatory cells in the pulp tissue were observed in all three groups (p less than 0.005). Odontoclasts in the pulp tissue could be demonstrated in the shedding and delayed-shedding stages (p less than 0.05). Polymorphonuclear leukocytes and odontoclasts were not observed before resorption had occurred approximately 1 mm subjacent to the cementoenamel junction. Active resorption of the periodontal root surface was observed in all stages. Deposition of cementum-like tissue in resorption lacunae on the root surface was most pronounced in the delayed-shedding stage showing repair in 30% of resorbing root surface length. Findings indicate that the process of resorption occurs mainly during the shedding stage and repair tends to accelerate in the delayed-shedding stage. The predentin appears to have more power of resistance than any other part of the tooth and there is no reason to believe that the pulp participates in the process of resorption of human primary teeth under physiologic conditions.

Dentin formation in formocresol pulpotomized primary monkey teeth studied by tetracycline and 3H-proline incorporation.

The influence of formocresol treatment on the pulp tissue of 24 primary monkey teeth was studied using tetracycline and 3H-proline labeling techniques. Six untreated monkey teeth served as controls. The tetracycline labeled teeth were examined between 352 and 600 d, following treatment. The 3H-proline labeled teeth were observed over a period of 22-607 d, the isotope being administered 15 d before extraction. The labeling was evaluated in the coronal, middle and apical area of the roots. Dentin formation as indicated by tetracycline labeling was observed in both control teeth and successfully treated teeth, as well as in some of the unsuccessfully treated teeth. The average dentin formation rate per day varied from 1 micrometer in the control teeth to 0.14 micrometer in the pulpotomized teeth (P less than 0.01). Success of treatment was of significant importance for the amount of dentin formation (P less than 0.001). Labeling with 3H-proline, indicating collagen synthesis, could be observed in the pulp and predentin of the majority of areas judged to be normal, degenerated or inflamed. Labeling was not observed in fixed or necrotic tissue. In degenerated pulp tissue the proline labeling was clearly reduced. The findings indicate that dentin formation and collagen synthesis may take place in formaldehyde influenced pulp tissue although at a decreased rate.

Morphologic and enzyme histochemical observations on the pulp of human primary molars 3 to 5 years after formocresol treatment.

The state of the pulp of twenty-seven primary teeth treated by formocresol pulpotomy (clinically and radiographically successful) was assessed 3 to 5 years after treatment. A wide variation was found in the pulpal condition, from normal pulp tissue to total necrosis. Resorption and apposition of hard tissue were common findings. Five teeth were freeze-sectioned and incubated for histochemical demonstration of oxidative enzymes. The pulps of two teeth were vital; two teeth had necrotic areas subjacent to the amputation paste; and one pulp was totally necrotic. Six teeth were extracted 5 minutes after formocresol pulpotomy and incubated for demonstration of oxidative enzymes. An unstained zone, 1 to 2 mm. deep, was seen in all incubated sections. In conclusion, it seems that the formocresol method should be regarded only as a means to keep primary teeth with pulp exposures functioning for a relativley short period of time.

Allergy tests against formaldehyde, cresol, and eugenol in children with formocresol pulpotomized primary teeth.

One hundred and twenty-eight children in the age range 5-14 years with formocresol pulpotomized teeth were tested for sensitivity againist formaldehyde, eugenol, and cresol using the patch test. The number of treated teeth on each child varied from one to six and the time between the pulpotomy and patch test varied from 2 months to 8 years. None of the children showed positive results.

A 3-year clinical follow-up study of pulpotomized primary molars treated with the formocresol technique.

The purpose of the present investigation was to evaluate the prognosis of primary molars treated with pulpotomy employing formocresol. The material consisted of 98 primary molars. The study included clinical and radiographic observations 3, 12, 24 and 36 months after treatment. The survival rate at the 3-month follow-up was 91%, whereas the rate was 83%, 78% and 70% - 12, 24 and 36 months respectively after the treatment. The results were computed according to the life table method.