Developmental defects of enamel increase caries susceptibility in Chinese preschool children.

OBJECTIVES: The present epidemiological study aimed to compare the prevalence and severity of developmental defects of enamel (DDE) and dental caries between urban and suburban Chinese preschool children. METHODS: A total of 1351 3- to 6-year-old children were invited to participate in this study and received dental examinations. A modified DDE index was used to assess the prevalence and severity of DDE. The dental caries diagnosis was based on the World Health Organization (WHO) health survey methods for field studies and was recorded using the decayed, missing and filled tooth (dmft) index. The caries status was further classified as caries or severe caries according to a modification of the American Academy of Pediatric Dentistry definition. RESULTS: Overall, the DDE prevalence was 48.3% among the 1351 preschool children. The DDE prevalence was higher in innercity children (54.1%) than in suburban children (42.0%; P < 0.001). In contrast, the suburban children had a higher prevalence of dental caries (65.2% vs 57.5%; P = 0.004) and a higher mean dmft score (3.5 ± 4.2 vs 2.9 ± 3.8; P = 0.005) than the innercity children. Only 23.9% of the children were free of both DDE and caries. The caries risk increased significantly and independently as DDE severity increased (linear trend, 95% confidence interval = [1.32, 1.69], age [1.60, 1.88], urban residence [1.18, 2.15] and breastfeeding experience [1.04, 1.60]) after controlling for other demographic risk factors. CONCLUSIONS: The study provides new evidence that DDE is a significant contributing factor for the highly prevalent and progressive dental caries observed in Chinese preschool children. These results highlight the importance of including DDE in caries risk assessments.

Oral Health Characteristics of Preschool Children with Autistic Syndrome Disorder.

OBJECTIVE: to assess the dental status of young children with Autistic Syndrome Disorder (ASD) in order to allow better understanding of the dentist's role in treating these children. STUDY DESIGN: The ASD group consisted of 47 children diagnosed as ASD from three special kindergartens from three towns in Israel. The control group was 44 normally developed children from 4 kindergartens from 2 neighboring towns. Parents were asked to complete a questionnaire requesting the following: socio-demographic information, general medical condition, dental information (previous visit to a dentist, feeding habits, oral hygiene behavior, oral habits and the Vinland Adaptive Behavioral Scales (VABS). RESULTS: While in the control group there was no report of no brushing at all, among the ASD children 25% did not brush at all. Use of pacifier, fussy eating and eating problems were significantly more prevalent among the ASD group. In addition, the ASD children significantly preferred more salty, spicy and sweet foods than the control. There were more cariesfree children among the ASD group. In the ASD group, the ability to perform everyday life functions was slightly more than half of what is expected for age. CONCLUSIONS: autistic children have a relative age of one half, meaning they function at half the level of normally developed children at their chronological age, more eating problems and more persistent oral habits yet no correlation to dental health could be shown. Caries experience of autistic children was lower than in the control group, maintaining good oral hygiene is difficult for autistic children yet their gingival health was found to be good.

Nephrocalcinosis associated with continuous enamel hypoplasia and severe alveolar bone loss: a case report and literature review.

Enamel-renal syndrome (ERS) is a rare manifestation of nephrocalcinosis that has been associated with generalized enamel hypoplasia. The purpose of this paper was to describe, for the first time, the association of enamel-renal syndrome with severe localized periodontal bone loss. A 13-year-old boy presented with: generalized hypoplastic enamel; intrapulpal calcifications; retention of primary teeth; delayed eruption of permanent teeth; enlarged dental-follicles; misshaped roots of permanent teeth; gingival overgrowth; severe localized alveolar bone loss; and severe malocclusion. His parents were first cousins, suggesting autosomal recessive inheritance. Further studies are necessary to clarify whether the etiology of the oral disturbances relates to the genetic defect in the dental tissue or to the continuous metabolic distress associated with renal dysfunction. Nevertheless, since nephrocalcinosis is often asymptomatic, dentists should refer children with generalized enamel hypoplasia or/and multiple intrapulpal calcifications to nephrologists.

The relationship between nurses' oral hygiene and the mouth care of their patients.

To investigate the extent to which a relationship may exist between nurses' own oral hygiene and their commitment and capability of following instructions for tooth brushing with conventional and triple-headed toothbrushes, to cerebral palsy (CP) children. The study included 43 individuals with CP and their 44 nurses. A structured questionnaire was designed to assess I. Demographic characteristics of the nurses II. Nurses' knowledge and maintenance of their own oral-hygiene and that of their CP patients. Nurses' ability to follow instruction for tooth-brushing was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing, as well as on a recall visit one month later. More nurses (72.7%) reported routine tooth-brushing in the morning than in the evening (40.9%). Most nurses (73%) reported not flossing their teeth at all, and more than half reported visiting their dentist only when they suffer pain. A positive correlation was found between the nurses' knowledge of preventive oral measures and their compliance with their own oral hygiene and with that of their CP patients. Similarly, a positive correlation was found between nurses' receiving previous instruction for correct oral hygiene and their maintenance of their patients' oral hygiene. Institutions for CP patients should disseminate information on oral hygiene to staff, as a means of increasing their maintenance of their patients' oral health.

The effect of toothbrush design on the ability of nurses to brush the teeth of institutionalized cerebral palsy patients.

AIM: To compare the effectiveness of two toothbrush designs in tooth brushing by nurses of individuals with cerebral palsy. METHODS: Following instruction, nurses brushed the teeth of 21 individuals with a single-headed-toothbrush, and 22 with a triple-headed-toothbrush. After one month, the nurses brushed their patients with the other toothbrush, following instruction. Tooth brushing performance skill was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing as well as on a recall visit one month later. RESULTS: After 1 month, 7.6% of the nurses required further instruction following brushing with the triple-headed toothbrush compared to 15% after brushing with the single-headed. Reductions in plaque and gingival indices were greater after using the triple- headed than single-headed toothbrush. More nurses preferred the triple-headed toothbrush (75.5% compared to 22.6%). CONCLUSION: Brushing by nurses of cerebral palsy patients was more effective and instruction better retained with a triple-headed compared to single-headed toothbrush.

Knowledge of elementary school teachers in Tel-Aviv, Israel, regarding emergency care of dental injuries.

BACKGROUND: Immediate management of traumatized teeth is often critical to the prognosis of the teeth. Most of the traumatic dental injuries occur at home, followed by school. There is a high probability that first aid would be given by lay people such as parents, teachers, or coaches. Knowledge of those people regarding emergency management of dental trauma is crucial for better prognosis. AIM: To investigate: (i) the knowledge of elementary school teachers regarding traumatic dental injuries to permanent teeth and emergency treatment, (ii) their source of information, and (iii) the demand for more education in dental trauma. MATERIALS AND METHODS: A three-part questionnaire comprised of questions regarding demographic data, attitude, and knowledge about dental injuries was distributed to teachers in 12 elementary schools in the Tel-Aviv area, Israel. RESULTS: The average knowledge score was 4.59 (in a scale of 0-10). Three individual predictors significantly improved the respondents' knowledge: being in the 35-49-year age group (P-value = 0.042), those who had children themselves (P-value = 0.002) and those who had previous experience with trauma (P-value = 0.049). There was no correlation between the demand for further education in dental trauma and knowledge score. CONCLUSIONS: The knowledge regarding management of traumatic dental injuries in a group of teachers in the Tel-Aviv area is inadequate. Educational programs as well as addition to the curriculum are necessary to improve their emergency management of traumatic dental injuries and provide better protection to the students.

Relations between dental and somatic pain in children.

PURPOSE: To study relations between somatic and dental pain complaints among children who attend a university pediatric dental clinic. METHODS: Forty-seven boys, 32 girls aged 4-13 years (mean age 8.41 +/- 2.29 years) participated in the study. Demographic information was obtained from the parents. Children were asked if they had experienced any dental pain during the previous week, the time of day the dental pain had appeared, and their actions when pain had been felt. Then, children were asked to complete a Pain Rating Scale for subjective evaluation of pain regarding various potentially painful organs. RESULTS: The majority of the children suffered headaches, stomachaches, and leg pains, regularly. The younger children, aged 4-7 years, significantly reported more ear and stomach pains than the older group, aged 8-13. Significantly, more children who suffered from dental pain also reported more stomachaches. Firstborn and second children had significantly less current dental pain, compared with third children or more. CONCLUSIONS: The results of our study suggest that children with dental pain suffer more often of stomachaches than children without dental pain. This may occur because these children are possibly more anxious about a potential treatment.

Coffin-Lowry syndrome: findings and dental treatment.

Coffin-Lowry Syndrome is characterized by mental retardation, skeletal abnormalities, delayed bone development, short stature, tapered fingers, large ears, orbital hypertelorism, anteverted nares, and a prominent frontal region. This inherited disorder is x-linked and is genetically mapped to the Xp22.2 chromosomal region. This report presents the dental findings of three male members of the same family: an older brother and younger identical twins; all three were first examined at age 10. The father's family came from North Africa and the mother's from Eastern Europe. In addition to the reported typical characteristics of Coffin-Lowry Syndrome, a number of specific dental findings were found in all of the brothers, namely, maxillary protrusion, open bite, two-year retardation in age of eruption, agenesis of the permanent mandibular central incisors in all of the brothers, and a marked oligodontia in the oldest. Despite difficulties in management, the dental treatment for caries and gingivitis could be completed on the brothers without sedation.

Eruption cysts: a clinical report of 24 new cases.

The eruption cyst (EC) occurs within the mucosa overlying a tooth that is about to erupt. In the past EC was considered a type of dentigerous cyst (DC) occuring in the soft tissues. Twenty four patients (mean age 4.44 years, range 1.0 month-12 years) with EC were diagnosed and treated. EC was associated with natal teeth in two (8.3%) cases, with primary teeth in 10 (41.6%) cases and with permanent teeth in 12 (50%) cases. There was a gender predilection, the male to female ratio was 2:1. The primary mandibular central incisors and the permanent first molars were the most common site affected. The clinical appearance was a raised, bluish gingival mass on the alveolar ridge. The size was variable and dependent on the size and number of the associated teeth. The type of treatment provided was one of the following: no treatment (10 cases, 42%), extraction (2 cases, 8%) and marsupialization (12 cases, 50%). All surgical specimens underwent histopathologic examination. EC should be recognized as a separate entity from DC and a conservative treatment approach is recommended.

Developmental stages of the third molar in Israeli children.

PURPOSE: The purpose of this study was to examine the developmental stages of the third molar in Israeli children, compare its development in boys and girls, in the maxilla and mandible, right to left sides in various age groups, and relate the developmental stage to chronological age. METHODS: Panoramic radiographs of 693 healthy children and adolescents (328 boys and 365 girls) ages 7 to 16 were analyzed using a modified 6-stage method. Since the 16-year-old group was too small for statistical analysis, it was later excluded from the study. Radiographs were obtained from patient files. RESULTS: There were no significant differences in the development of the third molar between boys and girls and between right and left sides. Slight differences were found between the maxilla and mandible. The first appearance of a radiolucent bud was at age 8.7 in the mandible and 9.3 in the maxilla. Crown completion was observed on average at age 11.7 in the maxilla and 11.8 in the mandible. CONCLUSIONS: There was a high correlation between third molar development and chronological age. Agenesis can be determined conclusively if no radiolucent bud is present beyond age 14. The modified 6-stage method allowed more accurate determination of developmental stages.

Dental fear and knowledge of children treated by certified pediatric dentists and general practitioners.

The purpose of this study was to compare knowledge regarding preventive measures and reported dental fear, of children treated by certified pediatric dentists (CPDs) to those treated by general practitioners (GPs). A questionnaire was given to 300 children, 150 were treated by GPs and the others by CPDs. Children treated by CPDs provided more correct answers to questions about prevention of oral disease (p < 0.001). However, the percentage of children that showed good knowledge was small (14%-82%), and the differences between the two groups on the various questions was only 7%-20%. Children treated by CPDs reported more frequently that they were not afraid of dental treatments (75.3% vs. 39.3%), loved their dentists (50% vs. 31.5%) and received prizes (85.3% vs. 32.7%). These findings suggest that CPDs invest more effort in communication and education of their patients concerning preventive dentistry. There is a need to improve these skills of GPs and CPDs.