Human Primary Tooth Histology Six Months after Treatment with Silver Diamine Fluoride.

OBJECTIVE: To describe the histological characteristics of a human primary tooth with deep caries next to the dental pulp 6 months after being treated with silver diamine fluoride (SDF). STUDY DESIGN: A tooth that was considered to be not restorable 6 months after being treated with SDF was examined with light microscopy. RESULTS: the histologic examination revealed no carious pulp exposure, tertiary dentin, a flattened odontoblastic layer adjacent to irregular tertiary dentin, dentinal tubules with silver deposits to a depth of 1 mm and no bacteria, and a pulp with no significant inflammation. CONCLUSIONS: The use of silver diamine fluoride as an interim treatment of deep caries on vital carious primary teeth of children, leads to histologic changes that prevent pain and pulp deterioration, and most likely facilitate pulp healing. These unique findings expand the knowledge about the effect of SDF on the human dental tissues.

The Need of Interdisciplinary Approach for the Treatment of Children with Down Syndrome with Severe Caries Unintentionally Facilitated by Hypotonia Therapy.

This manuscript describes a case of a 4-year-old child with Down syndrome involving hypotonia in which the use of sweets to induce oral muscular function contributed to the need to extract all the primary teeth due to extensive caries. The need for interdisciplinary education and practice targeted to the treatment of children with special health care needs is emphasized.

Radiographic Description of the Distribution of Aggressive Periodontitis in Primary Teeth.

OBJECTIVE: To describe the prevalence by site and tooth of aggressive periodontists (AP) in primary teeth of children with AP, that will facilitate the early diagnosis of AP. STUDY DESIGN: Radiographic evidence of AP by tooth and site of primary teeth of 29 children with AP was analyzed by gender, ethnicity, type of dentition (primary or mixed), alveolar bone site and type of tooth. RESULTS: The range and mean ± standard error of number of sites and teeth per patient with AP were 4 to 28, 13.1±1.2 and 4 to 12, 8.3±0.5 respectively. The differences in prevalence of AP by gender, ethnicity, dentition and homologous sites at both sides of the mouth were not statistically significant (Chi square). AP was mostly diagnosed at the distal area of the maxillary canine, the proximal areas of the first maxillary primary molars, and the distal area of the mandibular first primary molar. The most affected teeth with AP were the first primary molars followed by the maxillary cuspid, and the second molars. CONCLUSIONS: Examination of children's primary teeth should include abnormal mobility, when found it should be followed by radiographic evaluation for the presence of AP, taking in consideration the present findings.

Cvek pulpotomy - revisited.

BACKGROUND/AIM: While some studies support the notion that the time elapsed from coronal fracture and treatment with Cvek pulpotomy in permanent teeth plays an important role in minimizing the possibility of pain and discomfort, microbial pulp invasion, and ensuring pulp and periodontal healing, others consider that neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to the level of a healthy pulp. This study compares published data in an attempt to assess whether the outcome of Cvek pulpotomies is affected by these factors. RESULTS AND CONCLUSIONS: Evidence in the literature suggests to treat a permanent tooth with a complicated crown fracture as soon as possible to diminish the possibility of pain and prevent necrosis and infection of the pulp. Delay of treatment by 9 days or less may have minimal effect on the outcome of Cvek pulpotomies. While the literature indicates that pulp exposures of 4 mm or less may have a good prognosis after a Cvek pulpotomy, the prognosis in teeth with pulp exposures of more than 4 mm has not yet been clarified. Although the literature is not conclusive regarding a difference in the outcomes of Cvek pulpotomies in teeth with open or closed apices, it appears that teeth with open apices have a better prognosis. The outcome of a Cvek pulpotomy may be compromised by a luxation injury that diminishes the tooth's blood supply and innervation. A good restoration that prevents bacterial penetration into the tooth is essential for the success of a Cvek pulpotomy.

Oral characteristics of children with visual or auditory impairments.

PURPOSE: The purposes of this study were to: (1) describe the demographics and oral characteristics of deaf or blind children and adolescents receiving dental treatment at an institution for the deaf and blind (DBC); (2) compare this information to children and adolescents with no systemic disease or impairments attending a dental university clinic (UC); and (3) compare the oral characteristics between visually or auditorily impaired children and adolescents. METHODS: The demographics and oral characteristics of 120 DBC patients and 119 UC patients and between 35 visually impaired and 85 auditorily impaired were compared using analysis of variance, chi-square, Fisher's exact, and multiple regression analyses. RESULTS: When controlling for age, there was no statistically significant difference between the UC and the DBC patients regarding caries prevalence. A significantly higher proportion of DBC children had gingival inflammation. Visually impaired patients had a statistically higher level of dependence on caretakers and higher gingivitis and plaque scores than the auditorily impaired. CONCLUSIONS: Under oral health supervision, children and adolescents with or without hearing or visual impairment develop similar dental caries prevalence. Oral hygiene and resulting gingival inflammation are a challenge for the visually impaired and, to a lesser degree, the auditorily impaired.

The potential lifespan impact of gingivitis and periodontitis in children.

The prevalence of gingivitis in children can be similar to or greater than dental caries, but has received much less attention in understanding the long-term impact on overall health. Oral health providers must take into consideration that the clinical presentation of the gingivitis progression/severity in the primary dentition is only evident when the magnitude of the inflammatory cell infiltrate approximates the gingival surface reflected by inflamed tissues. Moreover despite its relatively benign clinical appearance, the establishment of chronic inflammation of the periodontal tissues in childhood may have the potential for local tissue destruction leading to periodontitis, and/or create an "at-risk" environment in the tissues that could adversely affect the health of these tissues across the lifespan. The present manuscript presents some fundamental information regarding the characteristics of chronic inflammation in gingival tissues of children and adolescents and speculates about the lifetime impact of gingival and periodontal infections in childhood on future oral and systemic health in the adult.

Preferences of parents of children with autism spectrum disorders concerning oral health and dental treatment.

PURPOSE: The purpose of this study was to describe the preferences of parents of children with or without autism spectrum disorders (ASDs) concerning oral health and dental treatment. METHODS: A questionnaire that queried demographics, dental needs, perceptions of dental materials and treatments, and parental concerns regarding relevant ASD issues in medicine and dentistry was distributed in the waiting rooms of a pediatric dental clinic and an autism clinic to parents or legal guardians of children undergoing treatment. The responses for the children with or without ASDs were compared. RESULTS: Statistically significant differences between the ASDs (N=23) and non-ASDs (N=33) groups existed for: parental age; frequency of dental visits per year; supervision of tooth-brushing; and use of a fluoridated toothpaste. Statistically insignificant differences were found in attitudes toward: amalgam; composite; fluoride products; or behavior guidance techniques. CONCLUSIONS: Parents or legal guardians of children with autism spectrum disorders are likely to have special beliefs and preferences regarding dental materials and dental behavior guidance.

Pediatric obesity and periodontal disease: a systematic review of the literature.

OBJECTIVE: Childhood obesity is a looming epidemic affecting western society, caused by a sedentary lifestyle and high-energy diet, and is associated with a severe morbidity. Obesity in adults has been associated with increased incidence and prevalence of periodontal disease. This association is considered to be bidirectional: Not only are obese subjects prone to periodontal disease, but periodontal disease may also exacerbate dyslipidemia. The objective of this study was to review the current literature on the association between obesity and periodontal diseases in children. METHODS: Using Medline, Cochrane, and Current Contents Clinical Medicine databases, we searched the literature for articles published in the English language between 1990 and 2009. Key words used were "periodontal disease," "periodontitis," and "tooth loss," linked with "obesity," "BMI," "weight," "overweight," and "children." RESULTS: Only a few relevant studies have been conducted in children of specific age groups. Further studies are needed to support the hypothesis that obesity in children may be associated with increased rates of periodontal disease. CONCLUSION: Since periodontal disease is a rare finding in children, general practitioners should be aware of the link among obesity, dyslipidemia, and periodontal disease.

Predoctoral and postdoctoral students' perspectives about pediatric dental behavior guidance.

This study compared acceptability scores of pediatric dental behavior guidance between predoctoral senior dental students and postdoctoral pediatric dentistry graduates. The scores were obtained with an anonymous survey that included twenty-five items related to behavior guidance techniques or situations, with the degree of acceptability of each being marked on a visual analog scale. Demographic data collected included year of graduation from the postdoctoral program, type of employment, being board-certified or not, gender, marital and parental status, previously receiving dental or medical treatment, and degree of unpleasantness from these treatments. Thirty-nine predoctoral and fifty-one postdoctoral surveys were compared. Analysis of variance (ANOVA) indicated that the predoctoral acceptability scores were statistically significantly higher than the postdoctoral scores for not allowing the child to speak during treatment, voice control, hand over mouth, active immobilization, and providing an exact explanation to the child. The predoctoral scores were lower than the postdoctoral scores for not using local anesthetic when the child does not want it, parent's presence in the operatory during treatment, or talking with the dentist during treatment. ANOVA of the predoctoral and postdoctoral scores combined indicated statistically significant differences between scores from male and females respondents for parent talking with the dentist during treatment; between married and not married respondents for hand over mouth, encouraging the child not to be a coward, the child being allowed to stop the treatment, and the parent being in the operatory during treatment; and between parents and not parents respondents for child not allowed to speak during the treatment, voice control, and hand over mouth. This study found that perspectives about pediatric dental behavior guidance are influenced by pre- and postdoctoral education and postgraduate experience.

Gingival RAGE expression in calorie-restricted versus ad libitum-fed rats.

BACKGROUND: The receptor for advanced glycation end products (RAGE) is a multiligand receptor expressed in a number of cell types, including gingival epithelia. RAGE mediates inflammation and induces cellular oxidative stress. Upregulation of RAGE is associated with various diseases, such as periodontal and cardiovascular diseases. This study examines the hypothesis that the gingiva of rats fed a calorie-restriction (CR) diet expresses lower levels of RAGE than the gingiva of rats fed an ad libitum (AL) diet. METHODS: Male F344BN rats (n = 16) from the National Institute on Aging (NIA) were fed a CR (n = 8) or AL (n = 8) diet according to NIA recommendations. Rats were sacrificed by guillotine at 8 (n = 5), 18 (n = 3), 29 (n = 4), and 38 (n = 4) months of age. The gingiva from around the molars was dissected and submitted for histologic and molecular analyses. RESULTS: Immunohistochemistry revealed that RAGE was expressed in the plasma membrane and cytoplasm of gingival epithelial cells and endothelial cells from both groups. RAGE mRNA levels were quantified relative to levels of GAPDH mRNA by real-time reverse-transcriptase polymerase chain reaction. The mean relative RAGE mRNA level in the CR group (7.26 ± 0.54) was lower than in the AL group (10 ± 1.4) (P <0.05). There were no detectable differences in RAGE expression according to animal age. CONCLUSION: Gingival RAGE expression in rats is reduced by calorie restriction.

Students' perceptions about pediatric dental behavior guidance in an undergraduate four-year dental curriculum.

Students' acceptability scores of pediatric dental behavior guidance techniques and clinical situations were measured with visual analog scales in a four-year dental curriculum. At the end of the curriculum, the highest scores were for positive reinforcement (94.7+/-4.7), use of nitrous oxide (93.1+/-7.5), stimulating the child's imagination (90.4+/-11.1), tell-show-do (90.4+/-10.0), distraction (89.7+/-11.6), use of euphemisms (88.3+/-14.4), voice control (86.2+/-12.4), and promising a toy (83.6+/-17.7). The lowest scores were for showing a needle (23.1+/-20.9), treatment without local anesthetic (25.4+/-24.2), parent talking with the child during treatment (35.3+/-22.4), hand over mouth (37.1+/-25.4), dentist/assistant being quiet (38.5+/-25.3), and not allowing the child to speak (38.6+/-26.8). Comparison of scores after only didactic education versus after clinical plus didactic education indicated a significant increase in acceptability for general anesthesia and significant decreases for situations involving the parent in the clinic. Ranking of scores before and after the dental curriculum showed the largest change in ranking for general anesthesia (+10), telling that the treatment may involve pain (-9), parent's presence (-8) or talking with the child during treatment (-10), and use of nitrous oxide (+7). Dental education has the potential to shape students' perceptions about pediatric dental behavior guidance.

Gingival overgrowth in a child with arthrogryposis treated with a Er,Cr:YSGG laser: a case report.

The present manuscript reports a case of a 21/2 year old girl, diagnosed with arthrogryposis, presenting increasing gingival hyperplasia which was treated with Er,Cr:YSGG Laser. The patient was treated under general anesthesia by the Pediatric Dentistry and Periodontics departments. Er,Cr:YSGG laser G6 tip was used at 1.50 watts, 20 pps, 8% water and 11% air, which is recommended by the manufacturer. Scalpel and periodontal curettes were used to complement the laser. Tissue samples from the anterior maxilla, anterior mandible and palatal sites were formalin-fixed and submitted for evaluation. The samples biopsied revealed prominent hyperplasia of the fibrous connective tissue with areas of the epithelium exhibiting pseudoepitheliomatous hyperplasia. At 1 week and 3 months follow up, oral examination showed appropriate healing of gingival tissue. The use of Er,Cr:YSGG laser in the present case proved to be effective in the removal of large amounts of hyperplasic gingival tissue and resulted in fast heeling and mild discomfort.

Obesity in children: a challenge that pediatric dentistry should not ignore--review of the literature.

The link between childhood oral diseases and obesity is demonstrated by their increasing prevalence, potential cause and effect relationship, the significant deleterious effect on the child's present and future oral and systemic health, and the influence of obesity on conscious sedation. The purpose of this manuscript is to review the literature on the relationships between childhood oral diseases and obesity, and between obesity, breathing and conscious sedation. While some reports suggest a connection between caries and obesity others do not, and it is unclear if they correlate or they just coexist since they have common etiologic and/or facilitating factors. Deleterious effects of dental caries and obesity on the systemic condition are clear, may potentiate each other, and facilitate the development and progress of chronic or acute systemic conditions. Obesity may interfere with the possibility to sedate patients because of potential breathing problems, or modify the effect of the sedative agents. Health providers should be aware of the increasing challenge posed by the correlations between dental caries, obesity, oral and systemic diseases. Furthermore, pediatric dentistry should team with other health professions in order to cooperate in the prevention and treatment of these diseases.

Educational, personal, and cultural attributes of dental students' humanitarian trips to Latin America.

This article evaluates the educational, personal, and cultural attributes that motivate or inhibit dental students' participation in humanitarian and educational trips to underserved communities in Latin America. Interviews, concentrating on students' expectations and experiences, were conducted with students who participated in the trips and with those who did not. A survey of a larger group of students (including those interviewed) was also conducted; the survey included demographic data, ethnic affiliation, cultural competence, motivators and inhibitors to attend trips, and trip attributes. One hundred and seventy-four students at one dental school completed the survey; the group interviews were conducted with twenty-three students who attended humanitarian and educational trips and nine students who did not. This research found that skill development, educational opportunity, and philanthropy were the most important motivators for trip participation. Cost and time commitments were the strongest inhibitors to participate. Exposure to infectious diseases, substandard working and living conditions, threat of crime, and language barriers were mostly considered as "not important." However, female dental students were more concerned than males about crime, living conditions, and infectious diseases during the trips. Cultural education, increased knowledge, cross-cultural professional relationships, increased self-confidence, and public health awareness were the most important attributes of the trips. This study indicates that the undergraduate humanitarian educational trips to underserved Latin American communities have a most significant personal, professional, and social impact on dental students.

First-year students' perceptions about pediatric dental behavior guidance techniques: the effect of education.

The purpose of this study was to evaluate the effect of a dental education component on dental students' perceptions toward behavior guidance techniques in pediatric dentistry. A questionnaire was completed by seventy-three first-year dental students, before and after a course on human development and behavior guidance techniques in pediatric dentistry. The acceptability of behavior guidance techniques and situations in pediatric dentistry was scored with a visual analog scale before and after the course, compared, and evaluated in relation to demographic data. After the course, statistically significant increases (ANOVA) in the acceptability of aversive behavior guidance (voice control, hand over mouth, and immobilization), sedation, general anesthesia, and modeling were found. Statistically significant decreases (ANOVA) in acceptability were found in mentioning the possibility of pain during treatment and with a parent being in the clinic or talking with the child during treatment. Female or married students, those who had previously received dental treatment, or those who had a dentist in the family showed statistically significant changes that indicated more empathy toward the children. We conclude that undergraduate dental education may have a significant short-term influence on dental students' perceptions of behavior guidance in pediatric dentistry.

Shear bond strength of one etch-and-rinse and five self-etching dental adhesives when used by six operators.

OBJECTIVE: To test the hypothesis that some single-bottle self-etching adhesives bond as well to enamel and dentin as a typical two-bottle etch-and-rinse adhesive. MATERIAL AND METHODS: Six operators used one two-bottle etch-and-rinse dentin adhesive (Scotchbond MP) and five all-in-one self-etching adhesives (iBond Gluma Inside, Clearfil S(3) Bond, iBond Experimental, Xeno IV, and G-BOND). Each operator carried out six bondings to enamel and six bondings to dentin with each adhesive. After 24 h of storage in water at 37 degrees C, bond strength was determined in shear. RESULTS: The pooled results of all the adhesives revealed no significant difference (p>0.05) in bond strength between dentin and enamel. However, there were significant differences (p<0.0001) between the different adhesives. The etch-and-rinse adhesive did better than the self-etching adhesives when substrate was not an issue (pooled enamel and dentin results). On comparing the performance of the different adhesives, it became clear that there were significant interactions (p<0.0001) between substrates and products. There were also significant differences (p<0.0001) between operators, and the interaction between operators and products was significant (p<0.0002). CONCLUSIONS: The tested etch-and-rinse adhesive did better than the tested self-etching adhesives. The shear bond strength results were also strongly affected by the operator as well as by the interaction between operator and used product. The pooled bond strength values of the different adhesives revealed no difference in bond strength to dentin versus enamel.

Oral characteristics of children with attention-deficit hyperactivity disorder.

The purpose of this study was to compare the oral and demographic characteristics of children with attention-deficit hyperactivity disorder (ADHD) to those of a control group of children. A sample of 25 dental records of children medicated for ADHD was compared to 127 records of healthy children not receiving any medication. The children with ADHD had a statistically higher prevalence of toothache, bruxism, bleeding gums, and oral trauma histories than the control group (chi square, p < 0.05). The differences in other recorded oral characteristics and habits, such as plaque accumulation, gingival inflammation, calculus, oral hygiene compliance, dental caries experience, and unmet dental needs, were not statistically significant. The demographic characteristics such as age, gender, residence, ethnicity, income, and payment method were also not significantly different between the two groups. There is a need to develop and implement specific strategies for the early prevention and treatment of oral diseases in children with ADHD.

Congenital epulis of the newborn: a case report.

Congenital epulis of the newborn is a rare soft tissue manifestation that affects infants, involving predominantly the maxillary ridge. When identified, generally at birth, excisional biopsy is recommended to avoid feeding and respiratory disturbances. This article presents a case report of a female infant who was referred to an oral and maxillofacial surgery facility for removal of a fibrotic mass present on the mandibular alveolar ridge. Diagnosis and prompt intervention can prevent expected complications such as failure to thrive or respiratory difficulty. Pediatric and general dentists should be familiar with oral pathologies that may affect the newborn or infants so that early diagnosis and treatment can be accomplished.