Pathophysiology, therapy, and oral implications of renal failure in children and adolescents: an update.

The objective of this manuscript was to describe the pathophysiology and the systemic and oral implications of chronic renal failure (CRF), end-stage renal failure (ESRF), and renal replacement therapy (RRT) in children and adolescents. Improvement in treatment modalities of CRF, ESRF, and RRT have resulted in an increase in survival, and better health in children and adolescents with renal failure. Therefore, dentists are expected to encounter an increasing number of patients with renal failure needing oral care. Renal failure leads to a state of intoxication known as uremia, which is associated with extra-renal multi-organ involvement. Oral findings frequently include: (1) excessive plaque accumulation; (2) gingivitis; (3) gingival overgrowth; and (4) enamel hypoplasia. Some cases develop periodontitis. It is hoped that the present review will lead to a better understanding of the systemic and oral abnormalities in children and adolescents with renal failure and provide guidance for their treatment and, ultimately, better treatment outcome.

Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol.

PURPOSE: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). METHODS: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). RESULTS: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%). CONCLUSIONS: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.

Mutans streptococcus counts following treatment for early childhood caries.

PURPOSE: The purpose of the study was to assess mutans streptococci (MS) count in children who were treated for early childhood caries (ECC) in a follow-up examination. METHODS: Forty-four children who were treated for ECC in the pediatric dentistry clinic of the Hebrew University-Hadassah School of Dental Medicine were given paraffin film to chew. A blade containing children's saliva was placed inside a test tube containing MS selective medium to allow bacteria growth. The kits were transferred immediately to the laboratory and incubated for 48 hours in a 37 degrees C incubator. After incubation, bacterial growth was counted by the amount of colonies formed. RESULTS: Children who were examined closer to the end of the dental treatment demonstrated significantly lower MS counts. In addition, children who had higher birth weight also demonstrated lower bacterial counts. Significantly more parents of children with the high MS group than in the low MS group count reported that oral hygiene instructions greatly reduced children's plaque levels. All the children who were born preterm had high MS count, while 77% of children who were born at term demonstrated high MS count. CONCLUSIONS: Children who had dental treatment due to ECC may have high MS count in the future and are at risk for caries attack. Factors that may be associated with high MS counts are low birth weight and mother's education.

Root fillings with Endoflas in primary teeth: a retrospective study.

The aim of this retrospective study is to report the success rate of root canal treatments (RCT) using Endoflas as a filling material in primary teeth. Fifty-five (55 teeth, 27 maxillary incisors and 28 molars) of 47 children fulfilled the criteria to be included in the study. The immediate post-operative radiograph was evaluated and the root filling was rated overfilled, flush or underfilled. Thirty-one (31) teeth were overfilled; of these 9 (29%) were normal pre-operatively and the remaining 22 (71%) presented with bone pathology. Twenty-four (24) teeth were flush or underfilled; of these, 50% had preoperative bone pathology. The children were examined clinically and radiographically at follow-up visits ranging from 6 to 52 months. Approximately 70% of the cases were successful at the last followup examination. The remaining 30% presented with pathology (Po); however, only one tooth had to be extracted (Pi). Overfilling led to a success rate of 58%, while in the combined flush and underfilled the success rate was 83%.

Shear strength of sealants placed with non-rinse conditioning compared to a conventional acid etch-rinse technique.

The present study compared the shearing strength of a non-rinse conditioning (NRC) compomer sealant to that of a conventional sealant. Thirty molars and premolars were sectioned longitudinally. The resulting halves were divided into 4 groups. Cylinders of sealants were bonded to the sections using a gelatin capsule as a matrix, as follows: Group A (n = 15) NRC + Prime & Bond + Dyract Seal; Group B (n = 15) same as group A but with phosphoric acid and rinse; Group C (n = 15) conventional phosphoric acid + Helioseal; Group D (n = 15) NRC + Helioseal. After immersing the specimens in water for 7 days, the samples were mounted on the Instron testing machine at a 20 mm/min crosshead speed. The results were subjected to ANOVA with Scheffe test, with a significant level of .05. No shearing strength values could be obtained for the specimens of group D. Some cylinders separated from the enamel while still immersed in the water, and in others the adhesion was too low, and no readings could be observed. For all groups, failure occurred at the sealant-enamel interface. The mean value for group A was 5.33 MPa, significantly less than that of groups B 9.12 MPa and C 9.63 MPa (p < 0.006). No significant difference of the mean shear strength was evident between groups B and C. No rinse conditioning with Dyract Seal led to a considerably lower bond strength value than Dyract Seal and Helioseal with phosphoric acid and rinsing.