Molar-incisor-hypomineralisation: a literature review.

BACKGROUND: Molar-Incisor-Hypomineralisation (MIH) is a qualitative defect of 1-4 first permanent molars with or without the maxillary and mandibular permanent incisors. It seems to have been recognised first in the 1970s and prevalence varies between 2.8% and 25%, dependent upon the study. METHODS: The dental literature was searched using a number of key terms entered into MEDLINE, the reference list of each paper as located was examined for further papers that had been missed in the initial search. RESULTS: The review of the literature showed that teeth that are affected indicate a systemic cause at around the time of birth; investigators have put forward a number of possible causes; asthma, pneumonia, upper respiratory tract infections, otitis media, antibiotics, dioxins in mother's milk, tonsillitis and tonsillectomy and exanthamatous fevers of childhood. However, at the present time the aetiology remains unclear. Treatment of the affected permanent first molars can include restorations using adhesive intra-coronal restorations to extra-coronal restorations (e.g. preformed metal crowns). There is little evidence to support one option over another. In severe cases extraction at the optimum time may be the best option; allowing the permanent second molars to come forwards. There is little improvement in affected anterior teeth with microabrasion and direct or indirect composite resin restorations may be appropriate in some children. Ultrastructural and biochemical make up of MIH affected teeth seem to have been investigated less than other areas. CONCLUSION: It is important that children with MIH are diagnosed as early as possible and managed appropriately; this will involve multidisciplinary input.

Case report: scurvy in an epileptic child on a ketogenic diet with oral complications.

BACKGROUND: Epilepsy is a symptom of cerebral dysfunction, where there is a sudden and disorganised discharge of electrical activity from a group of neurones, producing symptoms that range from sensory absences to convulsive movements and unconsciousness. Fasting is recognised as reducing the frequency of epileptic seizures in difficult to control patients. The ketogenic diet is a high fat, low carbohydrate and adequate protein diet that mimics the biochemical effects of fasting. It is deficient in some essential elements that require supplementation. CASE REPORT: A 9-year old girl with learning difficulties, developmental delay and refractory epilepsy was placed on the ketogenic diet in 2003. Prior to starting the diet she had had as many as 12 tonic seizures/day, with prolonged periods of non-convulsive status epilepticus. Subsequent to being placed on the diet, the frequency of her seizures reduced markedly; there were long periods during which she had none. In late 2006, the patient inhaled a primary molar. This was retrieved by emergency bronchoscopy and at the same time the remaining primary teeth were extracted. Three weeks later she was admitted to hospital with low-grade fever, persistently bleeding sockets, oedema of her hands and feet, a petechial rash and bruising. A differential diagnosis included: liver disease, bleeding dyscrasia, oncological pathology or scurvy. The most striking finding amongst a number of investigations was a vitamin C level of 0.7 micromol/l (Deficiency: < 11 micromol/l). Accordingly a diagnosis of scurvy was made. TREATMENT: The patient was prescribed ascorbic acid 500 mg twice/day. Three weeks later the patient's vitamin C level was 141.5 micromol/l; the dose was therefore reduced to 250 mg once/day. FOLLOW-UP: At two-month review, the signs and symptoms of scurvy had resolved. CONCLUSION: Inhaling a tooth and scurvy are both rare occurrences. Paediatric dentists should be aware of the possible implications of a ketogenic diet.

Treatment of aesthetic problems in paediatric dentistry.

Aesthetic problems in childhood and adolescence can have a significant effect on psychosocial development and interaction with peers. Abnormalities of shape, size, colour and structure of the whole or part of the anterior dentition of children can lead to such problems. This article outlines the most appropriate options for the clinical management of different aetiological categories of aesthetic problems, and develops a hierarchy of intervention that should be pursued in a logical order until a satisfactory cosmetic outcome is achieved. These techniques are readily available to most dental practitioners and there is no reason for a child to have to wait until late adolescence for treatment. Dent Update 2003; 30: 307-313 CLINICAL RELEVANCE: Aesthetic problems in children and adolescents may be treated by a variety of techniques.

Factors affecting outcomes of traumatically extruded permanent teeth in children.

PURPOSE: The objectives of the present study were to determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors. METHODS: Seventy-two traumatically extruded permanent incisors were studied at the Departments of Paediatric Dentistry in Belfast, Newcastle upon Tyne, and Glasgow. The mean age of the patients was 10.1 years (range=6 to 18 years). Clinical and radiographic outcomes were analyzed and related to presenting and treatment factors. RESULTS: The initial degree of extrusion was moderate for 46 teeth (64%), and the median delay prior to repositioning was 3 hours (range=1 to 168 hours). Pulp necrosis occurred in 31 teeth (43%), residual extrusion was present in 16 teeth (23%), and inflammatory resorption occurred in 11 teeth (15%). Residual extrusion was significantly associated with a delay in repositioning the tooth, pulpal necrosis was significantly more common in teeth with closed apices and in severely extruded teeth, and inflammatory resorption was more common after pulpal necrosis. CONCLUSIONS: Residual extrusion could be minimized by earlier presentation and repositioning. The risk of pulpal necrosis is greatest for severely extruded teeth and for those with closed apices.

The success of inhalation sedation for comprehensive dental care within the Community Dental Service.

OBJECTIVES: To assess the outcomes of treatment with nitrous oxide/oxygen inhalation sedation (IS). To relate these to the age and previous dental experience of the child and the experience of the operator. To provide base-line information and identify training needs. METHODS: A retrospective examination of the clinical records of all children treated with IS within the Community Dental Service of Harrow and Hillingdon NHS Trust (HHHT) over a 3-month period was made. Personal details and previous dental experience were recorded. The outcome of the planned treatment was identified. RESULTS: Two hundred and eleven sets of records were reviewed from eight clinicians. The average age of the children was 7.2 years. Treatment plans were successfully completed in 83.9% of cases. Records showed that 18.5% of the children had previously had general anaesthesia (GA) for dental treatment, 27.5% had received IS and 5.2% had no previous dental experience. Of the 'failed' treatments, 50% were under 7 years of age and 31.3% were referred for GA. There was no difference in the proportion of failures in relation to the experience of the operator. CONCLUSION: This review shows that inhalation sedation with nitrous oxide/oxygen is a very successful adjunct to the clinical management of children within the Community Dental Service.

Infraocclusion: a case report with an unexpected outcome.

The management of infraoccluded primary molars can pose some difficult clinical questions: when to treat? What treatment to provide? Why treat? How long to wait and watch? The definition and aetiology of infraoccluded primary molars is discussed. Some of the sequelae of different treatment options are described. A case is presented of the management of a ten and a half year old girl with a severely infraoccluded maxillary left second primary molar. The initial treatment plan included surgical removal of both the infraoccluded primary molar and the permanent successor, which was impacted high in the maxilla. However, the sudden unexpected eruption of the permanent tooth allowed a successful non-surgical outcome.