Progression of proximal caries in children with different caries indices: a 4-year radiographic study.

AIM: This was to investigate survival rate, median survival time and differences in the progression of different stages of proximal caries in 196 children, aged 6 to 8 years old, with different caries index at baseline examination. METHODS: Based on DMFS/dmfs values, children were categorized as low, moderate and high caries index groups. Subjects with DMFS/dmfs smaller or equal to half of a child's age were classified as low caries index group, children with DMFS/dmfs greater to half and smaller than or equal to the child's age as moderate, while those with DMFS/dmfs greater than the child's age as high. Proximal caries and its progression were diagnosed from bitewing radiographs taken at 1-year intervals over a period of 4 years. The mesial surface of the first permanent molars, mesial and distal surfaces of the first and second primary molars and distal surfaces of the primary canines were examined. Sound surfaces, caries lesions in the external and internal half of the enamel and external, middle, internal third of the dentine as well as filled, extracted and exfoliated teeth were recorded. STATISTICS: A life table analysis was performed to estimate survival rate and median survival time of each state of proximal caries and differences between the groups in the progression of the proximal lesions were tested with the Wilcoxon pairwise comparison statistic. RESULTS: There were statistically significant differences in the caries rate of the sound proximal surfaces of the primary teeth between the low and high caries index groups. Also, statistically significant differences between these two groups were found in the progression of the external half of the enamel caries in the first permanent molars and in the primary teeth. CONCLUSIONS: A high caries index increases the risk of developing caries in the sound proximal surfaces of posterior primary teeth and causes faster progression of the external half of the enamel lesions in the first permanent molars and posterior primary teeth.

A comparative study on the prevalence of enamel defects and dental caries in children and adolescents with and without coeliac disease.

AIM: This was to test for differences in the prevalence of enamel defects and dental caries between children and adolescents with and without coeliac disease (CD). MATERIALS AND METHODS: The sample consisted of 27 children and adolescents, aged 3 to 18 years with CD, and a control group of 27 healthy subjects matched by age and gender. Enamel defects were diagnosed and classified according to criteria described by Aine [1986], while dental caries was recorded as DMFT(S) and dmft(s) indices [Koch, 1970]. Dental plaque was recorded by the Plaque Control Record Index. Information related to medical history, oral hygiene habits, use of fluoride, history of dental trauma and socioeconomic factors was collected by a structured parental questionnaire. Also, in children with CD the age of initiation and diagnosis of the disease was recorded. STATISTICS: The chi square and the paired t-test were used for the statistical analysis of the qualitative and quantitative data respectively. The logistic multiple regression analysis was applied to test whether the time period between the initiation and diagnosis of CD and other related factors had a significant (p

Effectiveness of preventive treatment on approximal caries progression in posterior primary and permanent teeth: a review.

AIM: A literature review to assess the effectiveness of preventive treatment on approximal caries progression in posterior teeth is presented. METHODS: Retrospective and prospective studies conducted on primary and permanent teeth published in the literature were identified and reviewed. RESULTS: The assessment of the reviewed studies showed that they were inconclusive regarding the primary teeth. The studies reviewed showed that different preventive measures, especially fluoride varnish, fluoride solution and fluoridated toothpaste, had a significant effect on the retardation of the progression of approximal lesions in permanent teeth. However, the survival time of approximal caries at the non-restorative stage after application of a preventive treatment, the frequency of application of a preventive measure, the most effective preventive measure, the suitable interval of taking radiographs to evaluate the progression of a lesion and the health and economic benefits cannot be determined from the reviewed studies. CONCLUSION: It was concluded that further studies are needed to evaluate the effectiveness of various preventive measures on approximal caries progression.

Multifactorial analysis of the aetiology of craniomandibular dysfunction in children.

OBJECTIVES: It is generally accepted that the aetiology of craniomandibular dysfunction (CMD) is multifactorial. Different types of malocclusion, oral parafunctions especially bruxism, trauma of the mandible or temporomandibular joint (TMJ) and emotional stress are known aetiologic factors. Research has been conducted into the relationship between each of these aetiologic factors and the signs and symptoms of CMD. However, such an approach does not control for the simultaneous effect of other factors responsible for the development of the dysfunction. The purpose of this study was to investigate the effect of each aetiologic factor on the signs and symptoms of CMD in children, controlling for the effect of all other known factors by means of a multifactorial analysis. METHODS: A sample of 314 children, aged 6-8 years, was examined clinically for signs of CMD and morphologic and functional malocclusion. Symptoms of CMD and oral parafunctions were recorded by the same investigator in an interview. Emotional stress was measured through urinary catecholamines including epinephrine, norepinephrine and dopamine, detected in a 24-h urine sample, using high performance liquid chromatography. A questionnaire was distributed to the parents to collect information regarding socioeconomic factors and the history of dentofacial injuries. A logistic multiple regression was carried out to estimate the partial effect of each aetiologic factor. A 95% probability level was used. RESULTS: Posterior crossbite with lateral shift significantly affected the probability of child developing deviation of the mandible on opening. Similarly, posterior crossbite and epinephrine had a significant impact on TMJ tenderness, overjet had an effect on clicking, clenching and biting of objects had an effect on muscle tenderness, and lip/cheek biting influenced dysfunctional opening. Of the symptoms reported, pain on wide opening was affected significantly by lip/cheek biting. CONCLUSION: On the basis of these results, it can be suggested that parafunctional and some structural and psychological factors may increase the probability of the child developing the signs and symptoms of CMD.

Urinary catecholamines as a measure of emotional stress in children with a digit-sucking habit: a preliminary study.

This cross-sectional study investigated the relationship between digit-sucking habit and emotional stress measured by the urinary catecholamines in 314 children, boys and girls, ages six to eight years. The digit-sucking habit was recorded by an interview. A twenty-four hour urine sample was collected for each subject and a representative sample was analyzed by the HPLC technique to assay the catecholamine content. Socioeconomic factors were recorded by a questionnaire distributed to the parents. The logistic multiple-regression analysis was used to test the impact of catecholamines and other related factors on the presence of a digit-sucking habit. The results showed that emotional stress measured by the urinary catecholamines did not have a significant effect on the presence of a digit-sucking habit. Of the socioeconomic factors, father's education had a significant negative effect on the presence of the habit. The evidence provided by this investigation cannot support the view of psychoanalytic theory that continuation of the habit beyond the early childhood is due to emotional stress.

Emotional stress and craniomandibular dysfunction in children.

This study investigated the relationship between craniomandibular dysfunction (CMD) and emotionally stressful states measured by the urinary catecholamines in 314 children aged six to eight years. The children were examined clinically and interviewed by the same investigator. During the clinical examination the following variables were recorded: maximal mouth opening with and without pain, deviation of the mandible in opening wide, muscle and temporomandibular joint (TMJ) tenderness or pain and sounds from the TMJ. The variables recorded during the interview were headaches, difficulties in opening wide, pain upon opening wide, and clicking. A questionnaire was distributed to the parents to collect information regarding socioeconomic factors. A 24-hour urine sample was collected for each subject and analyzed by the high performance liquid chromatography (HPLC) technique to assay the catecholamine content. The logistic multiple regression analysis was carried out to test whether craniomandibular dysfunction was affected by the studied variables. A 95% probability level was used. The results showed that epinephrine had a significant effect on TMJ tenderness, while norepinephrine and dopamine did not have a significant association with any of the signs and symptoms of CMD. The data suggest that emotionally stressful states increase the probability of developing TMJ tenderness in children of this age.

Caries increment in children and urinary catecholamines: findings at one-year.

This one-year follow-up study investigates the relationship between urinary catecholamine levels and dental caries increment in 314 children, boys and girls, ages six to eight years. Dental caries was recorded clinically and radiographically and oral hygiene was evaluated by recording the dental plaque. A 24-hour urine sample was collected for each subject, in a year interval, and a representative sample was analyzed by the HPLC technique to assay the catecholamine content. Socioeconomic factors such as parental age, education, and profession were recorded by a questionnaire distributed to the parents. Of the examined children, forty-four (16 boys and 28 girls) did not develop new dental caries and constituted the Caries-Free group. Two New Caries groups, A and B, of forty-four children each (16 boys and 28 girls) were matched by age and sex. Differences were tested in the quantitative and qualitative data by the paired t-test and the chi 2 test, respectively, while a regression analysis was applied to measure the effects of norepinephrine and dopamine on epinephrine. The logistic multiple-regression analysis was used to test, in the entire population, the impact of catecholamines and other related factors on the probability of a subject's developing new dental caries. The 95 percent probability was used. The results showed statistically significant differences in epinephrine and norepinephrine values between Caries-Free and New Caries group A in both examinations. Also, significant differences were found between Caries-Free and New Caries group B in epinephrine and norepinephrine at the first examination, while at the second examination the difference was significant only in epinephrine. The data provide evidence, therefore, that an emotionally stressful state can be an etiologic factor of dental caries.

Urinary catecholamine levels and incidence of dentofacial injuries in children: a 2-year prospective study.

Urinary catecholamines have been used to measure emotionally stressful states which may have an impact on dentofacial injuries. This prospective study investigated the hypothesis that urinary catecholamines such as epinephrine, norepinephrine and dopamine do not affect significantly the incidence of dentofacial injuries in children. As a test of this hypothesis 204 children, males and females, aged 8 to 10 years, were included in the study. After a first examination, each subject was re-examined, at one-year intervals, over a period of two years. Dentofacial injuries were recorded by a clinical examination and a questionnaire. Three 24-h urine samples, with an interval of one year between each, were collected and analyzed by the high performance liquid chromatography technique to assay the catecholamine content. Socio-economic factors were recorded by a questionnaire. Using the panel of data collected, the logistic multiple regression model was employed to test whether the incidence of dentofacial injuries was affected by the studied variables. The 95% probability level was used. Specificity and sensitivity as well as the positive and negative predictive rates were computed. The results showed that epinephrine had a significant correlation with the incidence of dentofacial injuries. Other factors found to have a significant impact were child's age and gender. The values of sensitivity and specificity were 81% and 69% respectively, while the positive and negative predictive rates were 68% and 82% respectively. The data, therefore, provided evidence that emotionally stressful states measured by the urinary catecholamines were prominent etiologic factors of dentofacial injury.

Urinary catecholamine levels and bruxism in children.

This study was performed to test the hypothesis that emotionally stressful states measured by the urinary catecholamines may affect the development of bruxism. Three hundred and fourteen children, boys and girls, aged 6-8 years were included in this study. Bruxism was recorded by a clinical examination and an interview. Positive evidence of this parafunction was defined as the presence of both historical and clinical indicators. Information concerning systemic and socio-economic factors was collected by a questionnaire. A 24-h urine sample was collected for each subject and analysed by the high performance liquid chromatography technique to assay the catecholamine content. Of the total of 273 children who had a complete 24-h urine sample, 167 were identified to be with and without positive evidence of bruxism. The logistic multiple-regression analysis was carried out to test whether the presence of bruxism was affected by the variables studied; 95% probability was used. The results showed that epinephrine and dopamine had a significant and strong association with bruxism. The data therefore provide support for the concept that emotional stress is a prominent factor in the development of bruxing behaviour.

Incidence of dentofacial injuries in children: a 2-year longitudinal study.

In this prospective study the incidence of dentofacial injuries in 199 children aged 8 to 10 years was analyzed. Dentofacial injuries were recorded by a questionnaire and a clinical examination. After the first examination, each subject was re-examined at yearly intervals over a period of 2 years. Incidence rates were calculated in percentages and the chi-square was applied to test statistical differences. The 95% probability level was used. Results showed that the overall incidence of dentofacial injuries was 45.2%. The percentages for boys and girls were 28.6 and 16.6 respectively. The chi-square test showed significant gender differences, while differences by age were not significant. The highest incidence was recorded for dental injury followed by facial injury, historical evidence of injury and dental and facial injury.

Urinary catecholamine levels and gingivitis in children.

This study investigated the relationship between gingivitis and emotionally stressful states measured by the urinary catecholamines in children. Three-hundred and fourteen (314) children, boys and girls, aged 6 to 8 years were included in the study. Gingivitis was recorded by the gingival bleeding index and dental plaque by the plaque control record index. Proximal decayed surfaces, faulty restorations, and stainless steel crowns were diagnosed clinically and radiographically. Information concerning systemic and socioeconomic factors was collected by a questionnaire. A 24-hour urine sample was collected for each subject and analyzed by the HPLC technique to assay the catecholamine content. The multiple-regression analysis was carried out to test whether gingivitis was affected by the studied variables. The 95% probability was used. The results showed that epinephrine, norepinephrine, and dopamine did not have a significant association with gingival index. Dental plaque and proximal decayed surfaces significantly affected gingivitis. Of the socioeconomic factors, mother's education had a significant association with gingivitis when all factors were included in the analysis. The data suggest that emotionally stressful states may not increase the probability of developing gingivitis in children of this age.

Urinary catecholamine levels and dentofacial injuries in children.

This study investigated the relationship between urinary catecholamine levels and dentofacial injuries in 221 children, boys and girls, aged 8 to 10 years. Dentofacial injuries were recorded by a questionnaire and a clinical examination. Three 24-h urine samples, taken with an interval of 1 year between each, were available for each subject. A representative urine sample from each examination was analyzed by the high-performance liquid chromatography technique to assay the catecholamine content. Socioeconomic factors were recorded by a questionnaire. Of the examined children 58 (24 boys and 34 girls) with complete 24-h urine samples showed neither historical nor clinical evidence of dentofacial injuries and constituted the control group. Two case groups, A and B, with historical and/or clinical evidence of dentofacial injuries were matched by age and gender. Differences in the quantitative and qualitative data were tested by the paired t-test and the chi 2 test, respectively, while a regression analysis was applied to measure the effects of norepinephrine on epinephrine and dopamine. The 95% probability level was used. The results showed significant differences between control and case group A in the epinephrine and norepinephrine levels of the second urine sample. Significant differences were also found between control and case group B at the first urine sample in epinephrine and dopamine and at the second in epinephrine. Injured boys had significantly higher values of all catecholamines except for epinephrine in the second urine sample than injured girls. The only significant difference found between boys and girls without dentofacial injuries was in norepinephrine in the second urine sample. The data suggested that children with dentofacial injuries are more frequently under emotional stress and consequently emotionally stressful children run a greater risk of sustaining such injuries.

Craniomandibular dysfunction in children with clefts and noncleft children with and without unpleasant life events: a comparative study.

An epidemiologic study was conducted to investigate any difference in the prevalence of signs and symptoms of craniomandibular dysfunction on children with clefts and noncleft children with and without unpleasant life events. The experimental group consisted of thirty white children six to ten years of age with unilateral cleft lip and cleft lip and palate. On the basis of the sex and age distribution of the experimental group 30 out of 25 white children without unpleasant life events and 30 out of 105 white children with unpleasant life events were selected as control group I and control group II, respectively. The results showed statistically significant difference in the prevalence of temporomandibular joint tenderness between experimental and control group I, while the difference between experimental and control group II was not significant. Statistically significant difference in the frequency of temporomandibular joint tenderness was also revealed between the control groups. With respect to the severity of the symptoms, the only statistically significant difference was that of the anamnestic dysfunction index with severe symptoms (AiII) between the experimental and control group I. The other differences were not significant. The present study suggests that children with clefts and those with unpleasant life events run a greater risk of developing temporomandibular joint tenderness.

Synergistic effect of malocclusion and oral parafunctions on craniomandibular dysfunction in children with and without unpleasant life events.

An epidemiological study was conducted on 386 children aged 6-10, with and without unpleasant life events, to investigate the synergistic effect of malocclusion and oral parafunctions on craniomandibular dysfunction. The results showed that the synergistic effect of certain occlusal factors and oral parafunctions was significantly correlated with clicking and symptoms of dysfunction in both groups and with TMJ and muscle tenderness in subjects without unpleasant life events. In children with unpleasant life events TMJ and muscle tenderness were not correlated with any combination of malocclusion and oral parafunction. The present study suggests that the synergistic effect of malocclusion and oral parafunctions is a 'sufficient' cause for development of clicking and symptoms of dysfunction in both groups and TMJ and muscle tenderness in subjects without unpleasant life events. Also, in children with unpleasant life events, other aetiologic factor(s) can be responsible for the development of TMJ and muscle tenderness.

Urinary catecholamine levels in children with and without dental caries.

Urinary catecholamines have been used to measure emotionally stressful states which may affect the development of dental caries. This study investigates the hypothesis that children with and without dental caries do not differ significantly in the mean values of urinary catecholamines such as epinephrine, norepinephrine, and dopamine. As a test of this hypothesis, 314 children, males and females, aged from 6 to 8 years, were included in the study. Dental caries were recorded clinically and radiographically, and oral hygiene was evaluated by the recording of dental plaque. A 24-hour urine sample was collected for each subject, and a representative sample (25 mL) was analyzed by the HPLC technique to assay the catecholamine content. Socioeconomic factors such as parental age, education, and profession were recorded by a questionnaire distributed to the parents. Of the examined children, 38 (14 males and 24 females) were free of dental caries and constituted the case group. Two control groups, A and B, of 38 children each (14 males and 24 females) with dental caries were matched by age and gender. Differences in the quantitative and qualitative data were tested by the paired t test and the X2-test, respectively, while a regression analysis was applied to measure the effects of norepinephrine and dopamine on epinephrine. The logistic multiple-regression analysis was used to test, in the entire population, the impact of catecholamines and other related factors on the probability of subjects' developing dental caries. The 95% probability was used. The results showed statistically significant differences in epinephrine values between the case group and control groups A and B. The data suggest, therefore, that children with emotionally stressful states have higher probability of developing dental caries.

Urinary catecholamine levels in children with and without a history of dentofacial injuries.

This study was conducted to investigate the existence of any differences in the urinary catecholamine levels in children with and without a history of dentofacial injuries. Three hundred fourteen children, boys and girls, aged 6 to 8 years were included in this study. A questionnaire was distributed to the parents to collect information about the child's history of dentofacial injuries. A 24-h urine sample was collected for each subject and a representative sample (25 ml) was analyzed by the HPLC technique to assay the catecholamine content. Of the examined children 68 (43 boys and 25 girls) had a history of dentofacial injury and constituted the experimental group. A control group of 68 children (43 boys and 25 girls) without a history of dentofacial injury was matched by age and sex. The Student t-test was used to identify any differences in urinary catecholamine levels between the two groups. The 95% probability was used. The results showed statistically significant differences in the mean values of epinephrine, while the differences in norepinephrine and dopamine were not significant. This study suggested that children with emotionally stressful states run a greater risk of having dentofacial injuries.

Relationship between craniomandibular dysfunction and oral parafunctions in Caucasian children with and without unpleasant life events.

An epidemiological study was conducted to investigate the relationship between craniomandibular dysfunction and oral parafunctions in 386 children aged 6-10 years with and without unpleasant life events. The results showed statistically significant correlations between grinding, clenching, lip/cheek biting and muscle tenderness or pain, and clicking in subjects without unpleasant life events. Also, significant correlations were found in the same group between these parafunctions and difficulties in opening wide and pain on movements. When the definitional symptoms of craniomandibular dysfunction were aggregated, the chi-square test revealed significant correlations between them and the same oral parafunctions. The correlations in subjects with unpleasant life events between grinding, clenching, lip/cheek biting and each sign and symptom of craniomandibular dysfunction were close to the significance level. No significant correlations were detected between the definitional symptoms and these parafunctions in this group. The present study suggests that in patients without unpleasant life events grinding, clenching, and lip/cheek biting cannot be considered 'necessary' but can be 'sufficient' cause for the development of craniomandibular dysfunction. In subjects with unpleasant life events the origin of signs/symptoms of the dysfunction can be attributed to muscle tension or to another unknown aetiological factor.

Relationship between malocclusion and bruxism in children and adolescents: a review.

A review of the literature on the relationship between malocclusion and bruxism is presented. Statistically significant correlations were found between different types of morphologic malocclusion such as Class II and III molar relationship, deep bite, overjet, and dental wear or grinding. The types of functional malocclusion correlated with dental wear or bruxofacets were mediotrusion interferences, anterior-posterior and vertical distance between retruded position and intercuspal position, lateral shift of the mandible together with nonfunctional side interferences. However, all studies that reported significant correlations were cross-sectional, which implies that the relationship between malocclusion and bruxism was investigated at a certain point of time. The results were not confirmed by the two longitudinal studies. Besides, the correlations were found in different age groups. Finally, the reported correlations cannot have biological significance since the biological plausibility of the causal hypothesis cannot be inferred. On the basis of this study, malocclusion does not increase the probability of bruxism, and therefore early treatment of occlusal conditions to prevent bruxism is not scientifically justified.

Relationship between oral parafunctions and craniomandibular dysfunction in children and adolescents: a review.

A review of the literature on the relationship between oral parafunctions and craniomandibular dysfunction is presented. The interpretation of the results was performed by applying the epidemiologic approach of "necessary and sufficient" which implies that there must be a one-to-one relationship between the factor and the disease. In all studies but one bruxism was constantly correlated with signs and/or symptoms of craniomandibular dysfunction indicating that a one-to-one relationship exists between this parafunction and the dysfunction of the masticatory system. Also, the reported correlations were highly significant. The strength and consistency of correlations support causality. The causal relationship between the rest of the oral parafunctions and craniomandibular dysfunction needs further investigation. On the basis of the evidence provided by the reviewed studies, bruxism cannot be considered as necessary, but a sufficient cause of craniomandibular dysfunction for a certain group of individuals.

Relationship between craniomandibular dysfunction and malocclusion in white children with and without unpleasant life events.

An epidemiologic study was conducted to investigate the relationship between craniomandibular dysfunction and malocclusion in 386 children aged 6 to 10 years with and without unpleasant life events. The results showed no statistically significant correlations between each clinical sign and each type of morphologic malocclusion in both groups. The chi-square test, however, revealed statistically significant correlation between the pain in the temple region and posterior crossbite in the calm group but not in the not calm group. With respect to the functional malocclusion, the chi-square test showed statistically significant correlations between interferences in the terminal hinge movement and TMJ tenderness and difficulties in opening wide. However, these correlations were found only in the calm group. When the definitional symptoms of craniomandibular dysfunction were aggregated, no statistically significant correlations were found between them and each type of malocclusion in both groups. The results of this study showed that the correlations between malocclusion and craniomandibular dysfunction were inconsistent.