Peripheral complex odontoma in a pediatric dental patient: a case report.

Odontomas are the most commonly occurring benign odontogenic tumors of the jaws. Although a majority of odontomas are intraosseous, there are case reports of odontomas that erupted into the oral cavity. Even less common are peripheral or soft-tissue odontomas, only a few of which have been reported to date. We report a peripheral odontoma that arose in the alveolar mucosa of the posterior maxilla in a young child. The diagnosis, complications, treatment, and prognosis of this entity will be discussed.

Taurodontism and learning disabilities in patients with Klinefelter syndrome.

PURPOSE: The purpose of this descriptive clinical study was to determine the prevalence rates of taurodontism and learning disabilities in a sample of patients with Klinefelter syndrome. METHODS: Questionnaires and dental radiographs of Klinefelter syndrome patients were obtained and analyzed using previously published methods. Prevalence rates were determined for taurodontism and learning disabilities in the sample population and compared to the general population. Statistical analyses included a Fisher's exact 2-sided test to compare the prevalence rates to that found in the general population and subsequent determination of the positive predictive value. RESULTS: Taurodontism was found in 75% of the 24 participants. Eighty-three percent of the participants reported having a learning disability. These rates are significantly higher than the general population, as reported in the literature. CONCLUSIONS: The positive predictive value for Klinefelter syndrome, given a male patient with taurodontism and a learning disability, is 84%. In this case, the dentist should recommend karyotyping to the patient, parent, or physician. This demonstrates how important it is for dentists to understand and assist physicians in the diagnosis of genetic disorders.

Localized aggressive periodontitis in a six-year-old: a case report.

The purpose of this report was to describe an approach to diagnose and effectively treat a pediatric patient with localized aggressive periodontitis. A 6-year-old female presented with clinical and radiographic evidence of severe attachment loss around several primary teeth. She had no history of systemic disease, periodontal disease, or caries prior to the periodontal abscess that prompted her referral. Routine immunological tests did not reveal any functional defects, but DNA testing for periodontal pathogens revealed the presence of all 8 aggressive periodontal pathogens assayed. Treatment consisted of the extraction of 2 severely affected primary teeth, increased frequency of recall appointments, and administration of systemic antibiotics. The patient's periodontal condition was stabilized 18 months post-treatment, and the 8 pathogens were no longer at detectable levels. With a treatment goal of preventing disease progression into the erupting permanent dentition, this treatment regimen provides an effective alternative to more aggressive strategies.

Do pediatric dentists practice the orthodontics they are taught?

PURPOSE: The purpose of this study was to determine whether the orthodontic treatment provided by pediatric dentists reflects the orthodontic training received in pediatric dental residency programs. METHODS: Five questions from a survey of the American Academy of Pediatric Dentistry (AAPD) diplomates in August 2002 and a survey of pediatric dental residency program directors in June 2002 were statistically analyzed to compare the orthodontic treatment provided by diplomates to that provided within pediatric dental residency programs. RESULTS: Patient populations differed financially between pediatric dental residencies and diplomates of the AAPD. Residents treated significantly more public assistance patients. The residents were more likely than diplomates to use most orthodontic appliances and treat most stages of dental development and most conditions/malocclusions with orthodontics. Diplomates anticipated a decrease in the amount of orthodontic treatment provided in the next 5 years, while program directors anticipated an increase. CONCLUSIONS: The majority of the orthodontic treatment provided by pediatric dental residents and diplomates was similar, although the residents were exposed to more diverse orthodontic treatment modalities than those used by diplomates. The residencies were also more likely than the diplomates to increase the amount of orthodontic treatment provided in the next 5 years.

Adolescent pregnancy: a review of dental treatment guidelines.

More than 6% of adolescent females become pregnant in the United States per year, yet there is no concise guide for their dental treatment. The principles for medical management of these patients are not unlike those used for adult females, but the higher incidence of complications coupled with social and consent issues make their overall management more complex. Whether treating a pregnant adolescent or an adult, the primary goal is to maintain a safe environment for both the fetus and mother. Untreated dental disease can compromise the health of the mother and unborn child; therefore, dental treatment should not be withheld. In complicated pregnancies, dental practitioners should contact the patient's obstetrician prior to providing treatment or prescribing medication. With proper technique, dental radiographs do not place the fetus at risk and should be taken if they are of potential benefit. Preventive care should be delivered throughout pregnancy, and elective routine care is best delivered during the second trimester.

Prevalence of dental caries and enamel defects in Connecticut Head Start children.

PURPOSE: The aim of this study was to determine the prevalence of dental caries and enamel defects in a sample of predominantly African American and Hispanic children from an inner city Head Start program located in Connecticut. METHODS: A total of 517 children were examined for dental caries and enamel defects. Children's caries experience was described using the dmfs/t indices, and dental defects were described using a modified developmental defects of enamel index. RESULTS: The mean dmfs was 3.0, and 38% of the children had caries. The prevalence of enamel defects was 49%. When analyzed by race/ethnicity no significant differences in dmfs scores or the prevalence of defects were observed. The majority of defects were located on anterior teeth, and the type of defect varied with the location. On the buccal surface of canines, hypoplasia accounted for 70% of the lesions. On maxillary anterior teeth, linear opacities accounted for 50% of the lesions. A positive association between enamel defects and caries was observed. CONCLUSIONS: The prevalence of caries and defects in these Head Start children was high, with most defects located on anterior teeth. Enamel defects were associated with an increased caries incidence.

Orthodontic training in pediatric dental residencies.

The purpose of this study was to determine the amount and types of orthodontic training in pediatric dental residencies. A twenty-one-item survey was mailed to sixty directors of pediatric dental residencies. Follow-up surveys were sent to those who had not responded. Fifty-two surveys were returned for a response rate of 87 percent. Most programs provided forty-eight formal orthodontic course hours, one-half to one day of clinical orthodontic experience per week, and six to ten case starts for each resident. Most program directors anticipated this amount of experience would increase or stay the same in the future. Though most programs had an affiliated graduate orthodontic program, fewer than half of the programs had an orthodontist on faculty from the affiliated program (43 percent). As expected, orthodontic training varies with different program characteristics. The faculty members teaching orthodontics in pediatric dental residencies are often not from affiliated graduate orthodontic programs. Most program directors do not anticipate a decrease in the didactic or clinical components in the next five years.

Acute onset of facial nerve palsy associated with Lyme disease in a 6 year-old child.

Pediatric facial nerve palsy (FNP) can result from a variety of etiologies including Lyme disease, varicella, primary gingivostomatitis, herpes zoster oticus (Ramsay Hunt syndrome), coxsackievirus, trauma, otitis media, HIV, diseases causing tumors or demyelinations, compressions, and possibly Epstein Barr virus. Lyme disease has been implicated as the cause of over 50% of the FNPs in children. The paralysis of the facial nerve disturbs motor function to the muscles of facial expression and results in a flaccid appearance of the face (unilateral or bilateral). This case report derails undiagnosed Lyme disease presenting as a facial palsy in a 6 year, 5 month-old white female. The palsy was recognized and consultation with the child's physician prompted definitive diagnosis and treatment. A review of the literature and the implications of facial nerve palsy are discussed.