[Periodontal health during pregnancy and the dental health of the child].

Several studies have shown an association between local/systemic infections and preterm-low birth weight (PTLBW), and it might be an important part of the etiology. Oral Infections such as periodontitis may act as a distant reservoir of microbes, microbial products and inflammatory mediators. These might influence pregnancy and contribute to restriction of fetal growth and induction of early labor and PTB. Enamel formation of the primary teeth begins at 11-14 weeks of fetal life and is completed by the end of 3rd postnatal month. The initial phase consists of matrix formation, followed by calcification in utero. Since enamel is a stable structure, defects involving its matrix secretion and/or maturation of primary teeth can act as a permanent record of insults occurring pre- or perinatally. Any stressful event during pregnancy and birth may lead to metabolic changes in the formation of the enamel, resulting in clinically enamel defects. Severe infections occurring during amelogenesis may be associated with enamel hypoplasia. Babies born after maternal complications during pregnancy or babies who experience a traumatic birth must be considered to be at risk of developing Early Childhood Caries - ECC when exposed to excessive bottle nursing. Therefore oral healthcare should be kept during pregnancy.

Birth-Weight, Pregnancy Term, Pre-Natal and Natal Complications Related to Child's Dental Anomalies.

OBJECTIVES: This cross-sectional study was aimed at determining whether certain pre-natal and natal conditions can predict specific dental anomalies. The conditions observed were: low birth-weight, preterm birth, pre-natal & natal complications. The dental anomalies observed were: enamel defects, total number of decayed, missing and filled teeth (total DMFT), disturbances in the tooth shape and disturbances in the number of teeth. STUDY DESIGN: Out of more than 2000 medical files of children aged 2-17 years old which were reviewed, 300 files met the selection criteria. Information recorded from the files included: age, gender, health status (the ASA physical status classification system by the American Society of Anesthesiologists), birth week, birth weight, total DMFT, hypomineralization, abnormal tooth shape, abnormal number of teeth and hypoplasia. RESULTS: Twenty one children out of 300 (7%) were born after a high-risk pregnancy, 25 children (8.3%) were born after high-risk birth, 20 children (6.7%) were born preterm - before week 37, and 29 children (9.7%) were born with a low birth weight (LBW) - 2500 grams or less. A relationship between a preterm birth and LBW to hypomineralization was found. And a relationship between a preterm birth and high-risk pregnancy to abnormal number of teeth was found. No relationship was found between birth (normal/high-risk) and the other parameters inspected. CONCLUSION: Preterm birth and LBW may predict hypomineralization in both primary and permanent dentitions. Furthermore, the study demonstrated that preterm birth and high-risk pregnancy may predict abnormal number of teeth in both dentitions.

Chemotherapy induced dental changes in a child with medulloblastoma: a case report.

We describe the dental findings and therapeutic management of a child aged three years and eight months with medulloblastoma treated by surgical resection at age eight months followed by 20 months of chemotherapy. Thin and short roots of the primary molars were observed, as were microdontia and anodontia of the premolars. The boy suffered from severe early childhood caries (ECC). Dental treatment was carried out under general anesthesia. Follow-up examinations at three, six and twelve months after the initial dental treatment revealed healthy gingival tissue and no new caries. The boy passed away before the next scheduled follow-up dental examination.

Bone-like material growth in a replanted immature central incisor following avulsion.

BACKGROUND: Avulsion is one of the most complicated types of trauma to the teeth. After replantation of an avulsed immature tooth, numerous pulpo-dentinal responses may occur. CASE REPORT: This study reports a case of a seven-and-a-half-year-old boy in whom an immature maxillary permanent central incisor was replanted following avulsion due to a fall from a tree, and a bone-like growth was observed in the pulp chamber 6 months after the trauma, with a thin radiolucent line on the inner surface of the dentinal walls. The bone-like structure eventually filled the pulp chamber of the tooth. FOLLOW-UP: The tooth was followed up 4 years after the replantation with no evidence of pathology. CONCLUSION: This case demonstrates an immature avulsed tooth which did not present positive vital signs, but still maintains the potential of survival, and endodontic intervention may not be required. Instead, follow-up visits are recommended as long as there are no pathologic signs, especially in teeth with questionable prognosis.

The use of a self-report questionnaire for dental health status assessment: a preliminary study.

OBJECTIVES: The aim of this work was to evaluate and validate a new questionnaire for caries assessment of large populations as well as to correlate the results from the questionnaire with the caries lesions detected in clinical and radiographic evaluation. METHODS: The study population included 460 young adults who arrived to a dental screening provided to all army recruits. Clinical and radiographic examinations were performed to all participants as part of the routine dental screening; two bite-wing radiographs were taken as well. The World Health Organization (WHO) caries diagnostic criterion for decayed, missing and filled teeth (DMFT) was also calculated. First, a questionnaire that included 20 questions regarding different caries risk factors such as socioeconomic status, dietary habits, smoking habits, dental treatment experience etc was filled by all participants. At the next stage, according to the statistical analysis finding, a new questionnaire based on the most predictive questions and answers for DMFT forecast was developed. RESULTS: The mean total DMFT was 3.71 ± 4.2. DMFT value of 0 (caries free) was found in 28.8% of the participants while no caries lesion (D = 0) was detected in 52.9%. The new questionnaire developed consisted of the most predictive ten questions. When evaluating the ROC curves for the new questionnaire score in prediction of dental caries lesions, the area under the curve was found to be 85.7% (95% confidence interval was between 81.2% and 90.2%). The total value of 5.5 points in the new questionnaire was chosen as a cut-off for caries risk assessment and revealed sensitivity of 85.1% and false positive of 29%. CONCLUSIONS: The use of a simple and easy questionnaire might serve as a good screening tool for large populations such as army recruits in order to identify the group of high risk populations that require more intensive intervention.

Candida, mutans streptococci, oral hygiene and caries in children.

OBJECTIVE: to test the association between Candida and mutans streptococci (ms), oral hygiene and caries levels and in children. METHODS: 22 boys and 12 girls (age 6 to 14.5 years) participated in the study. Each participant received a toothbrush, and was asked to brush his/her teeth after proper instructions. Dental caries and oral hygiene were recorded. Candida and ms levels were determined in saliva samples. RESULTS: Candida colonies were observed in 70.5% of the children. No association was found between Candida and caries or plaque and gingival indices. C. albicans-positive children demonstrated significantly higher brushing scores. CONCLUSIONS: Our findings may suggest that there is no clear association between Candida in saliva, and levels of cariogenic bacteria and caries risk in children.

Case report: Sanjad--Sakati syndrome: dental findings and treatment.

BACKGROUND: Sanjad--Sakati syndrome (SSS) is a genetic disease confined to Arab populations in the Middle- East countries and characterized by hypoparathyroidism, hypocalcaemia and hyperphosphataemia, severe intrauterine and postnatal growth failure, respiratory infection susceptibility prone, dwarfism, mental retardation, seizures, craniofacial dysmorphic features as retromicrognathia and abnormal dentition. CASE REPORT: A 12 year-old child was referred who needed dental treatment because of his oral and systemic condition. Radiographic findings showed agenesis of 12 permanent teeth (all canines and premolars). TREATMENT: Because of the child's physical limitations and cooperation, treatment was under general anaesthesia. Plaque removal, restorations and extractions of infected teeth were performed. FOLLOW-UP: The child was observed after one year, plaque removal was carried out and fluoride varnish was placed on all teeth. However, the patient died 18 months later as a result of pulmonary complications. CONCLUSION: People with poor systemic conditions and physical limitations are prone to dental health neglect. Early professional advice and treatment, and periodical follow-up can improve quality of life of these patients.

Digital images obtained with a digital camera are not associated with a loss of critical information--a preliminary study.

AIM: To investigate whether digital images obtained by a digital camera are deficient compared to the original radiographs. MATERIALS AND METHODS: Twenty pairs of bitewing radiographs of children and 40 anterior periapical radiographs were photographed using a digital camera. Images were saved as JPEG files and loaded onto a laptop. Film radiographs and digital images as scanned and after adjustments were evaluated for proximal caries and for periapical pathologies. RESULTS: A not statistically significant higher number of proximal lesions were observed on plain-film and enhanced digital images than on unenhanced images. Enhanced digital images resulted in significantly more diagnoses of external root resorption compared with conventional radiographs. Pulp canals appeared significantly more abnormal (obliterated or enlarged) in digital images compared with film radiographs. CONCLUSIONS: Storing existing radiographs in a digital medium for space saving purposes using a digital camera does not loose critical information.Clinical implication Clinicians can use digital cameras to digitise and store radiographic images without losing important diagnostic information.

Calculus in a toddler with end-stage renal disease due to prune-belly syndrome.

Prune-belly syndrome is a congenital kidney and urinary tract anomaly which may lead to end-stage renal failure (ESRF). The present case describes an infant suffering from end-stage kidney disease due to prune-belly syndrome, undergoing chronic hemodialysis, with excessive calculus deposits which disappeared following kidney transplantation. Possible explanations are discussed. The first mechanism is associated with lack of oral function which may have caused pooling of saliva around the teeth enhancing precipitations of minerals. The second possible mechanism is associated with the child's uremic state. The third mechanism could be a disturbance in calcium-phosphor metabolism. It is possible that in the present case, the gastrostomy and the electrolyte disturbances characterizing ESRF had an additive effect.

Magic trick: a behavioural strategy for the management of strong-willed children.

OBJECTIVE: The purpose of this study was to compare the effectiveness of using a magic trick to persuade strong-willed children who refuse to sit in the dental chair at the first visit with more conventional methods like tell-show-do (TSD). METHODS: Seventy children aged 3-6 years of age who were identified as manifesting strong-willed behaviour were selected for this study. The children were randomly assigned to be managed either by a magic trick distraction or by TSD. There were 35 subjects in each group. The following variables were recorded for each child: time from the beginning of the session to sitting on the dental chair (in minutes); ability to perform a dental examination (yes or no); and Frankl's behavioural category. RESULTS: Children who were shown a magic trick (Magic+) sat significantly faster on the dental chair than children who were not shown the magic trick (Magic-) (141.2+/-71.5 and 221.7+/-110.7 s, respectively). In addition, radiographs could be taken in significantly more Magic+ children (91% and 54%, respectively). When time till sitting on dental chair, radiographs taken and Frankl's behavioural categories were examined by gender, age, first time at the dentist and by parent assessment, the following pattern emerged: (1) Children in the Magic+ group sat on the dental chair significantly faster than children in the Magic- group. (2) Radiographs could be taken for more Magic+ children. (3) The Magic+ children demonstrated more cooperative behaviour (Frankl's categories 3 and 4). CONCLUSION: This study demonstrates that a magic trick is able to facilitate two types of cooperative behaviour: (1) it expedites the movement of the child into the dental chair; and (2) it enables the dentist to take radiographs more easily.

The effect of an intermediate layer of flowable composite resin on microleakage in packable composite restorations.

OBJECTIVES: The aim of the present study was to evaluate the effect of a thin layer of flowable composite on microleakage in Class II direct packable composite resin restorations on young permanent teeth in vitro. METHODS: Twenty sound human premolars and molars extracted for orthodontic reasons were selected for this study. The teeth were randomly assigned into two groups of 10 teeth each (groups A and B). Class II cavities were prepared as uniformly as possible in the mesial and distal aspects of each tooth. The gingival margin extended apically approximately 0.5 mm beyond the cemento-enamel junction, in the dentin. Cavities in group A were restored with packable composite and Alert/Flow-it flowable composite, while groups B cavities were restored with Pyramid/Aeliteflo. The control cavities in groups A1 and B1 were restored with only packable composite. The teeth were immersed in 2% methylene blue solution for 24 h to allow dye penetration into possible existing gaps between the tooth substance and the restorative material. All teeth were subjected to thermocycling. RESULTS: The dye penetration ranged between 6.6 and 7.2 mm. No significant difference was found between the control and the experimental groups. CONCLUSION: The use of flowable composite resin as intermediate material does not reduce microleakage.

Acid-etched and erbium:yttrium aluminium garnet laser-treated enamel for fissure sealants: a comparison of microleakage.

OBJECTIVES: A pilot study aimed to compare the microleakage of pit and fissure sealants in acid-etched and Erbium:Yttrium Aluminium Garnet (Er:YAG)-treated enamel. METHODS: Forty permanent noncarious young molars and premolars, which were extracted for orthodontic reasons, were selected. The teeth were divided into four groups, with five molars and five premolars in each group. The groups were treated as follows: (1) group A--laser irradiation of the enamel of the occlusal surface without contact and in scanning mode was carried out using an Er:YAG laser, placement of sealant material, light curing, and thermocycling between 6 degrees and 55 degrees C; (2) group B--the same as group A, but with no thermocycling; (3) group C--acid etching of the enamel surface, placement of sealant material, light curing and thermocycling; and (4) group D--the same as group C, but with no thermocycling. After being immersed in 1% methylene blue solution, all teeth were sectioned in the mesio-distal dimension into four slices. Images of the slices were then scanned to a Macintosh G3 computer and examined for marginal leakage. Leakage was measured by the degree of dye penetration. Three independent examiners evaluated the dye penetration. RESULTS: No penetration of dye material was observed in any of the slices in any of the four groups by any of the examiners. CONCLUSIONS: No difference in microleakage was seen between lasing or acid etching, and therefore, the results of the present study would suggest that the technique may be efficacious.

Meningococcal septicaemia and dental complications: a literature review and two case reports.

The present report describes two cases of dental complications of meningococcemia at an early age. The meningococcal infection in these young children resulted in limb amputation and significant plastic surgery. Dental treatment and psychological considerations are described in both cases. Similar dental complications, especially in the premaxilla, were found. Some of the severely affected teeth were extracted.

A behavioural approach in the treatment of elderly patients: a new philosophy.

Complete denture prosthodontists are very well aware of the influence of psychological factors in the success of their treatment. Recently, a number of authors tried to ascertain some psychosocial criteria in the predictability of patients' satisfaction. Although special attention was paid to concerns of socio-demographic and educational status, it was demonstrated that there is little relationship between quality of dentures and patients' satisfaction, nor a relationship between satisfaction and anatomical conditions. The purpose of this paper is to give a better understanding of the behavioural problems of this treatment and offer some solutions. Educational programmes should be influenced by behavioural problems in the management of the elderly patient.

The use of restraint in the treatment of paediatric dental patients: old and new insights.

OBJECTIVE: This article reviews aspects of the restraint strategies in paediatric dentistry that have been reviewed in recent years and point out those strategies that remain controversial as well as questionable. METHODS: Studies that evaluated demographic and cultural factors that influence dentists' use of restraint, discussion of the rationale behind the use of restraint, the role of parents, informed consent, use of restraints at the undergraduate and at the postgraduate level, and some ethical questions were selected. CONCLUSIONS: Practice location, caries prevalence, and the educational backgrounds of the dentist played a role in the selection of behavioural strategies. Use of these techniques varied depending on the age of the dentist and the dental school from which the dentist had graduated. Parents are one leg of the child/dentist/parent triangle and therefore have a role to play in the determination of treatment strategies. Dentists must select techniques that help to instill a positive dental attitude in the child by performing treatment effectively and efficiently. Dentists must inform parents of all aspects of the applied strategy and must have their approval.

Administering local anaesthesia to paediatric dental patients -- current status and prospects for the future.

UNLABELLED: Fear-related behaviours have long been recognized as the most difficult aspect of patient management and can be a barrier to good care. Anxiety is one of the major issues in the dental treatment of children, and the injection is the most anxiety-provoking procedure for both children and adults. There is a constant search for ways to avoid the invasive, and often painful, nature of the injection, and to find more comfortable and pleasant means for anaesthesia before dental procedures. OBJECTIVE: The purpose of the present review is to summarize relevant data on topics connected with the administration of local anaesthesia. METHODS: The review will survey the current available methods, viz. electronic anaesthesia, lidocaine patch, computerized anaesthesia (the Wand), and the syrijet as well as the conventional injection, used for paediatric patients. CONCLUSIONS: Usually new techniques for locally anaesthetizing dental patients are tested on adults. However, despite recent research in the field, the injection remains the method of choice. It is necessary to continue to conduct studies using new techniques on adults and children, so that a more acceptable technique can be found.

Reactions of children to maxillary infiltration and mandibular block injections.

PURPOSE: The purpose of this study was to assess children's reactions to the administration of local anesthetic injection in the mandible and in the maxilla, and to study their sensation of pain after each type of injection. METHODS: Twenty-six children between the ages of 4 to 6 (mean age 5.3+/-0.7 years), and 34 children aged between 7 to 10 (mean age 8.1+/-1.1 years,) who were undergoing dental treatment in a pediatric dental clinic, were selected for this study. A random crossover design was used. Each patient was randomly assigned to receive either maxillary infiltration or mandibular block on the first visit, and the remaining local anesthesia on the second visit. During the injection, the modified Behavioral Pain Scale, was used. It comprised the following parameters: a) facial display, b) arm/leg movements, c) torso movements, and d) crying. Immediately after administering the local anesthesia, children were asked to rate their feeling according to the Facial Affective Scale. RESULTS: The children in each group responded positively to both techniques revealing that there was no difference in either one. Subjective and objective evaluation disclosed no difference when mandibular block was administered during the first or second visit. Regarding the objective evaluation, in all parameters, more children reacted positively during administration of mandibular block than during maxillary infiltration. CONCLUSION: a) mandibular block and maxillary infiltration are similarly accepted by children when first administered, and b) children may feel inconvenience or pain and react by crying, yet may report a positive feeling in general.

Recurrent oral ulcerations associated with recurrent herpes labialis--two distinct entities?

We investigated the prevalence of recurrent aphthous ulcerations (RAU) and recurrent herpes labialis (RHL) in a young adult population. The study group consisted of 20,689 soldiers (aged 18-21 years, mean 19.8 +/- 1 years). There were 14,991 men and 5,698 women. Every patient was asked to complete a self-report health questionnaire which requested information about the occurrence of either RAU or RHL. Data were analyzed using the chi-square test, and the odds ratio was also determined. The prevalence of RAU and RHL was 6.2% and 5.4%, respectively. The prevalence among women was significantly higher (P<0.001), than among men for both RAU (7.1% and 5.8%, respectively) and RHL (6.8% and 4.9%, respectively). Among women, the chance of having RAU for those who were RHL positive was 6.88 greater than for those RHL negative. Among men, the chance of having RAU for those who were RHL positive was 12.37 greater than for those RHL negative. In women, the chance of having RHL for those who were RAU positive was 6.88 greater than for those who were RAU negative. In men, the chance of having RHL for those who were RAU positive was 12.37 greater than for those who were RAU negative. It is concluded that a similar underlying pathological process or unknown cofactor may be involved in both RAU and RHL.