Expert consensus on pediatric orthodontic therapies of malocclusions in children.

Malocclusion, identified by the World Health Organization (WHO) as one of three major oral diseases, profoundly impacts the dental-maxillofacial functions, facial esthetics, and long-term development of ~260 million children in China. Beyond its physical manifestations, malocclusion also significantly influences the psycho-social well-being of these children. Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition, by mitigating the negative impact of abnormal environmental influences on the growth. Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development, ranging from fetal stages to the early permanent dentition phase. From an economic and societal standpoint, the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated, underlining its profound practical and social importance. This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children, emphasizing critical need for early treatment. It elaborates on corresponding core principles and fundamental approaches in early orthodontics, proposing comprehensive guidance for preventive and interceptive orthodontic treatment, serving as a reference for clinicians engaged in early orthodontic treatment.

Anatomical and immunohistochemical analyses of the fusion of the premaxillary-maxillary suture in human fetuses.

PURPOSE: The development of the premaxillary-maxillary suture (PMS) in human fetuses and a possible association between the fusion time of the PMS and maxillary deficiency were investigated. Expression of transforming growth factor beta (TGF-ß1 and TGF-ß3) and of fibulins (fibulin­1 and fibulin-5) were also investigated. METHODS: We analyzed 36 human fetus cadavers (19 males, 17 females; average age 23.97 ± 2.57 gestational weeks [gws], range 11-35 gws). Two cases, diagnosed with Down syndrome (DS), were characterized with maxillary deficiency; 34 fetus cadavers did not show any craniofacial abnormalities. The PMS was analyzed anatomically, followed by semi-quantitative immunohistochemical (IHC)-based expression analyses (i.e., TGF-ß1/-ß3, fibulin-1/-5). Spearman correlation test was conducted to investigate correlations. RESULTS: In the fetuses without DS, the labial region of the PMS was open at 11 gws, after which it began to ossify from the middle to the upper and lower ends of the suture, typically fusing completely at 27 gws. Fetuses with DS demonstrated complete fusion of the labial region of PMS with a spongy bone structure at 23 gws and those without DS at 27 gws. IHC revealed similar patterns of TGF-ßs and fibulins expression in the PMS during the human fetal period. There were significant positive correlations between the expression of TGF-ß1 and TGF-ß3 (r = 0.64, p = 0.009), TGF-ß1 and fibulin­1 (r = 0.66, p = 0.008), and TGF-ß3 and fibulin­1 (r = 0.67, p = 0.006). CONCLUSION: Premature fusion of the PMS in the labial region during the human fetal period may be associated with maxillary deficiency, which is related to a class III malocclusion. Overall, the similar expression patterns of TGF-ß1, TGF-ß3 and fibulin­1 suggested a close relationship between these factors in regulating the development of the PMS.

China experts' consensus on preventive and interceptive orthodontic treatments of malocclusions of children.

Malocclusion is one of the three most common oral diseases reported by World Health Organization(WHO). In China, its incidence rate is rising. Malocclusion seriously affects the dental and maxillofacial function, facial appearance and growth development of nearly 260 million children in China, and what is more, it affects their physical and mental health development. Malocclusion occurrence is related to genetic and environmental factors. Early treatment of malocclusion can create a good dental and maxillofacial development environment, correct abnormal growth and control the adverse effects of abnormal genetic factors. It can effectively reduce the prevalence of children's malocclusion and enhance their physical and mental health. This is an urgent need from the economic perspective of our society, so it has great practical and social significance. Experts from the project group "standard diagnose and treatment protocols for early orthodontic intervention of malocclusions of children" which initiated by China National Health Institute of Hospital Administration wrote the "China Experts' Consensus on Preventive and Interceptive Orthodontic Treatments of Malocclusions of Children", which aims to guide and popularize the clinical practice, improve the clinical theory and practice level, and accelerate the disciplinary development of early treatment of children's malocclusion in China. The consensus elaborates the harmfulness of malocclusion and the necessity of early treatment, and brings up the principles and fundamental contents. Based on the law of dental and maxillofacial development, this paper puts forward the guiding suggestions of preventive and interceptive treatments in different stages of dental development ranging from fetus to early permanent dentition. It is a systematic project to promote and standardize the early treatment of malocclusion. Through scientific and comprehensive stratified clinical practice and professional training, the clinical system of early treatment of malocclusion in China will eventually be perfected, so as to comprehensively care for children's dental and maxillofacial health, and improve their oral and physical health in China.

Metaproteomics associated with severe early childhood caries highlights the differences in salivary proteins.

OBJECTIVE: To investigate the salivary metaproteomic characteristics of the children with and without severe early childhood caries (S-ECC). DESIGN: In this study, we collected unstimulated saliva samples from 34 children (age 3-4 years) with caries free (NC, dmfs (= index of decayed, missing due to caries, or filled tooth surfaces) = 0, n = 23) and with S-ECC (dmfs≥10, n = 11). Salivary proteins were extracted and reduced, and then a Liquid Chromatography/Mass Spectrometry system was used to identify proteins. RESULTS: Nearly 3000 proteins were identified in this study, and about 3.5 % of the proteins originated from human while 86 % were derived from microbes. The salivary protein types in the NC group were statistically greater than those in the S-ECC group (P <0.05). Specifically, the salivary protein types derived from microbes in the NC group were significantly greater than those in the S-ECC group. Three proteins, human lactoferrin, penicillin-binding protein 1C [Burkholderia ubonensis], human alpha-defensin 1 (F28a mutant), were decreased statistically in the NC group compared to the S-ECC group (P < 0.05). Only one protein, 50S ribosomal protein L17 secreted by Haemophilus haemolyticus, was significantly increased in the NC group compared to the S-ECC group. Salivary IgA was the top highest protein in the NC group whereas human lysozyme was the top highest protein in the S-ECC group. CONCLUSIONS: The differential proteins recognized in this study may be conducive for finding a caries biomarker. Understanding the metaproteomic characteristics can help us to control the caries from human origin and microbial origin.

Tigecycline-Induced Tooth Discoloration in Children Younger than Eight Years.

Tetracycline may cause tooth discoloration when used in young children during tooth development. Whether tigecycline, a tetracycline derivative, has either a similar adverse event or not remains unclear. We assessed the discoloration of the permanent teeth of patients <8 years old after tigecycline exposure. These patients were identified through a retrospective chart review in a Chinese children's hospital. Those who had at least one erupted permanent tooth after tigecycline exposure were interviewed, examined, and photographed by an experienced pediatric dentist and independently assessed by another senior dentist to detect tetracycline-like tooth discoloration. We identified 101 patients who were exposed to tigecycline, 12 of whom were included. The mean daily dose of tigecycline was 2.3 mg/kg of body weight (standard deviation, 0.6), and the median duration was 12.5 days (interquartile range [IQR], 8.0 to 19.3). The median age of exposure was 5.2 years (IQR, 4.5 to 7.4), and the median age of dental examination was 9.1 years (IQR, 9.0 to 10.3). Two patients (16.7%) developed yellow discoloration: a girl having yellow discoloration with white-to-yellow opacities in the upper lateral incisors and lower incisors and a boy with a suspicious buccal yellow discoloration and enamel dysplasia in the second molars. The incidence and extent of tigecycline-associated dental adverse events remain unclear due to the small sample size and inadequate follow-up period.

A rare case of pediatric Crohn's disease and alveolar bone loss: a report and review.

Crohn's disease (CD) is a granulomatous inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, but its etiology is still unclear. CD patients usually have extraintestinal manifestations including oral manifestations, and this can also occasionally appear in children. Oral manifestations, including aphthous stomatitis, typically develop on the mucocutaneous tissue. As pediatric CD is not common, there have been no reports concerning alveolar bone resorption for these kinds of patients. An 11-year-old Chinese girl was referred to our hospital because of reoccurring painful oral ulcers, with a 2.5-year history of CD and recurrent oral ulcers. Clinical examinations revealed intestinal lesions, oral ulcers, and alveolar bone loss. CD and its related periodontitis were diagnosed. After comprehensive therapy, including periodontal scaling and anti-inflammatory treatment, the oral ulcers gradually healed. One year later, follow-up visit showed the anterior alveolar bone to be stable and new alveolar bone regenerating around the mandibular anterior teeth at some sites. It is rare for CD children to have periodontitis, especially with severe alveolar bone loss. This case suggests that when treating periodontitis in children, the possibility of systemic disease, such as CD, should be considered and attended to. Early diagnosis and symptomatic treatment and care are crucial.

The prognostic role of C-reactive protein in patients with head and neck squamous cell carcinoma: A meta-analysis.

BACKGROUND: The prognostic role of the C-reactive protein (CRP) in head and neck squamous cell carcinoma (HNSCC) has not been well investigated. This meta-analysis aimed to evaluate the prognostic relevance of elevated CRP levels in patients with HNSCC. METHODS: A relevant literature search was performed in PubMed, Web of Science, and Embase up to September 1, 2020. The pooled odds ratio and hazard ratio (HR) with 95% confidence interval (CI) were applied to evaluate the difference in overall survival (OS), progress-free survival (PFS), and cancer-specific survival (CSS) between patients with high CRP and those without. The pooled odds ratio (OR) with 95% CI were used to assess the association between CRP and clinicopathological features. RESULTS: A total of 17 studies, including 4449 patients, were included. Pooled results showed that an elevated CRP was associated with worse OS (HR = 1.48, 95% CI: 1.24-1.77), CSS (HR = 1.85, 95% CI: 1.38-2.46), and PFS (HR = 1.73, 95% CI: 1.38-2.17). Male patients, lymph node metastases, and higher tumor stage were related to elevated CRP level (OR = 1.67, 95% CI: 1.34-2.09; OR = 2.40, 95% CI: 1.44-3.99; OR = 1.39, 95% CI: 1.12-1.74). CONCLUSION: Our meta-analysis demonstrated that an elevated pretreatment of CRP indicates poor prognosis in HNSCC. Therefore, CRP is an indicator of the prognosis of patients with HNSCC and can be recommended for assessing prognoses in clinical work.

[Diagnosis and treatment of ankyloglossia in newborns and infants].

Ankyloglossia is a congenital condition characterized by a short lingual frenulum, which may result in the restriction of tongue movement and function. Considerable controversy regarding the diagnosis, clinical significance, and management of the condition remains, and great variations in practice have been recorded. Indeed, attitudes toward ankyloglossia differ among professional groups, and opinions may vary remarkably even among those within the same specialty. This article reviews the embryology, genetics, diagnosis, clinical presentation, and treatment of ankyloglossia to help physicians better understand and treat the condition.

Premaxillary-maxillary suture development in the first trimester : An ultrasound study.

PURPOSE: Our study was designed to investigate premaxillary-maxillary suture growth in fetuses from the first trimester of pregnancy using the B­ultrasound technique in order to determine the suture fusion time. METHODS: We selected 169 healthy Han singleton pregnancies as subjects. All subjects received routine pregnancy tests and were divided into three groups based on the gestational age of the fetus: group 1, the 11th gestational week; group 2, the 12th gestational week; and group 3, the 13th gestational week. Fetal biometric measurements were recorded during consecutive prenatal ultrasonographic examinations. These measurements included nuchal translucency thickness, crown-rump length, and premaxillary-maxillary length. Intergroup comparisons were performed using analysis of variance (ANOVA). RESULTS: The premaxillary-maxillary suture grows gradually and its measured length at the 11th, 12th and 13th week was 0.54 cm, 0.65 cm, and 0.74 cm, respectively. We observed a significant linear correlation between the premaxillary-maxillary length and the week of gestation in the first trimester. The growth rate of the maxilla at the 11th, the 12th and the 13th week are significantly different with a descending order of growth rates being week 12, week 11 and week 13, with the 12th week rate being the most rapid. CONCLUSION: The premaxillary and maxillary growth at 11 and 12 gestational weeks in the first trimester steadily accelerated, peaking at the 12th week. The rate of growth slows down after week 12 which may be associated with the fusion of the premaxillary-maxillary suture.

Effects of huangqi and bear bile on recurrent parotitis in children: a new clinical approach.

OBJECTIVE: To evaluate the pharmacological effects of traditional Chinese medicine, bear bile capsule and Huangqi granule, on recurrent parotitis in children. METHODS: In this prospective, controlled, and randomized study, a total of 151 young children were divided into three groups: Group A included massaging the children's parotid region and melting vitamin C in their mouth daily; Group B included swallowing bear bile capsule and Huangqi granule daily; and Group C included massages and vitamin C as prescribed in Group A, and traditional Chinese medicine as prescribed in Group B. Children were treated individually for one month and then a follow-up study was conducted for 1 to 3.5 years. Analysis of variance (ANOVA) and Ridit analysis were employed for statistical analysis. RESULTS: The recurrence rate decreased in every group, but was significantly more in Groups B and C when compared to Group A. The recurrences significantly decreased (P<0.01) in Group B and their recovery rate was as high as 63%, significantly better than those of the other groups (P<0.01). CONCLUSIONS: Huangqi and bear bile could be a novel clinical approach for treating recurrent parotitis in children.

[The study of emergency facial trauma in children and parents' cognition on it].

OBJECTIVE: To analyze the characteristics of emergency facial trauma in children and mother's cognition on it. METHODS: Descriptive analysis was undertaken for 216 children with maxillofacial trauma. The analysis included age distributions of the children, reasons and places for the trauma, and positions and severity degrees of the trauma. The questionnaires were carried out for the patients' mothers, to understand the cognition degrees and prognosis factors. RESULTS: Most of the patients with facial trauma were aged 1-6, with the male and female ratio of 1.4:1. Falls were the leading cause for the maxillofacial injuries(83.33%). The most common types of injury were the soft tissue injuries (63.43%) and the teeth injuries (31.94%), the jaw fractures were least. 50.00% accidents occurred at home. 97.22% mothers had no knowledge of the facial injuries in children. 69.44% mothers thought it avoidable. It were relevant between mothers' educations and injuries times (chi2 = 18.16, P < 0.05). CONCLUSION: Mothers lack the knowledge is one of the most important reasons for the maxillofacial injuries in children. Propaganda should be increased among them to reduce risks of maxillofacial injuries.

Effect of ovariectomy and alendronate on implant osseointegration in rat maxillary bone.

Bisphosphonates such as alendronate (ALD), although controversial, are worthy of investigation for the enhancement of implant osseointegration in patients with low bone mass who are already taking bisphosphonates for osteoporosis. These patients may receive additional benefits and be acceptable candidates for dental implants without needing to change their medication regimen and possibly as a result of their medication regimen. The purpose of this study was to compare implant osseointegration in maxillary bone of normal rats with a rat model of postmenopausal estrogen deficiency (ovariectomized [OVX]), with and without ALD. An experimental group of 32 rats was divided in 4 groups: ALD-OVX (n=8 OVX with ALD), OVX (n=8 OVX without ALD), ALD (n=8 normal rats with ALD), and control (n=8 normal rats). All rats received one titanium microscrew implant in the left edentulous region of the maxillary arch. The ALD-OVX and ALD groups received subcutaneous injections of ALD 3 times a week. On the fourth week after ALD administration, an implant was placed in all 32 rats. The maxilla of each rat was radiographed 4 times: at 0, 7, 14, and 28 days. On day 28 after implant placement, all rats were killed, and the peri-implant tissue was embedded in plastic or paraffin for histological examination. The X rays were used for a chronologic calculation of the contact ratio between implant and bone surfaces. Radiographic bone density was determined at 3 points: mesial, apical, and distal. The results show that osseointegration of the implants was impaired in the estrogen-deficient OVX rats compared with the ALD-OVX rats. Fifty percent of the implants were lost at 2 weeks in the OVX group. Radiographic evidence suggested that none of the implants in the OVX group osseointegrated. In the histologic examination more bone was observed around implants from the ALD-OVX and ALD groups than around implants from the OVX group. The OVX group presented a dramatic reduction in implant bone contact at 2 weeks and a significant 13% reduction at 4 weeks vs day of implant (P = .006). The ALD-OVX group presented 50% more bone density than the OVX group (P = .0003). Both ALD groups (ALD and ALD-OVX) had significantly higher radiographic bone density than the other groups (P < .01 for each comparison). In conclusion, osseointegration of implants was enhanced by ALD. Radiographic bone density and contact ratio improved with ALD administration. Implant osseointegration was impaired by estrogen deficiency in the OVX group.

Effects of induced premaxillary suture fusion on the craniofacial morphology in growing rats.

OBJECTIVE: Due to premaxillary rapid development and fusion with the maxilla at the fetus stage, the functions of the premaxillary suture still remain unclear. This study was designed to explore the effect of artificial induced premaxillary suture fusion on craniofacial morphology. METHODS: Thirty Sprague Dawley rats were divided into control and experimental groups, with 3 week, 5 week and 8 week subgroups of five animals each. An incision was made in each rat along the premaxillary suture and cyanoacrylate was administered to immobilize the exposed premaxillary suture for experimental rats. No glue was applied to controls. Weights, dental impressions and radiographs were taken before and after surgery until sacrifice and used to determine the differences between groups using the one-way ANOVA test. RESULTS: After immobilizing the premaxillary suture, significant changes in the craniofacial morphology were measured at the different time points. In the experimental groups, local changes occurred at the 3rd week. A global alteration in craniofacial morphology was apparent at the 8th week in the experimental group compared to the control. At each successive time point, craniofacial morphological alterations increased in rats with fused premaxillary sutures. CONCLUSIONS: Induced premaxillary suture fusion can inhibit the growth of the premaxilla and cause extensive craniofacial morphological changes. These findings suggest that premaxillary suture fusion may be related to craniofacial malformation or malocclusion and to the formation of the flattened craniofacial profile in humans.

[Children's temperament characteristics and dental fear].

OBJECTIVE: To evaluate the relationship between children's temperament and dental fear. METHODS: 254 children(aged 4-6 years) during first dental treatment took part in the investigation. Their parents answered the Chinese preschool children's temperament scales (CPTS). The Frankl method was used to classify the degree of the children's dental fear. The K independent samples test and One-way ANOVA test were performed to find the differences of the type of temperament and the scores of temperament dimension among three groups. RESULTS: Among the 254 children(aged 4-6 years), 104 had no fear, 80 had fear and 70 had extreme fear. The incidence of dental fear in children was 59.06%. There were no statistical differences (P > 0.05) of dental fear between boys and girls. There were statistically significant differences for the type of temperament among no fear group, fear group and extreme fear group. The scores of adaptability and quality of mood were higher in the extreme fear group and fear group than that in the no fear group. The differences in scores of adaptability and quality of mood was statistically significant between the extreme fear group and no fear group. But the scores of other seven temperament dimensions had no statistical significant differences among three groups. CONCLUSION: Children's dental fear is correlated to their temperaments. The tendencies of negative mood and slow adaptability should be considered that the patients were at risk of developing dental fear problem.

Pressure from the lips and the tongue in children with class III malocclusion.

OBJECTIVE: To discuss possible relationships between class III malocclusion and perioral forces by measuring the pressure from the lips and the tongue of children with class III malocclusion. METHODS: Thirty-one children with class III malocclusion were investigated and their perioral forces were measured at rest and during swallowing under natural head position by a custom-made miniperioral force computer measuring system. RESULTS: The resting pressures exerted on the labial side and palatine side of the upper left incisor, as well as the labial side and lingual side of the lower left incisor, were 0 g/cm(2), 0 g/cm(2), 0.57 g/cm(2) and 0.23 g/cm(2), respectively. Correspondingly, the swallowing forces were 2.87 g/cm(2), 5.97 g/cm(2), 4.09 g/cm(2) and 7.89 g/cm(2), respectively. No statistical difference between muscular pressure and gender existed. During swallowing, the lingual forces were significantly higher than the labial forces (P<0.01), however, at rest there was no significantly different force between these two sides. Compared to the normal occlusion patients, children with class III malocclusion had lower perioral forces. The upper labial resting forces (P<0.01), the lower labial resting forces (P<0.05) and all the swallowing pressures from the lips and the tongue (P<0.01) showed statistical differences between the two different occlusion conditions. Meanwhile, no significant difference was found for the resting pressure from the tongue between class III malocclusion and normal occlusion. CONCLUSION: Patients with class III malocclusion have lower perioral forces and this muscle hypofunction may be secondary to the spatial relations of the jaws. The findings support the spatial matrix hypothesis.

[The characteristics of uncooperative children's temperament during dental treatment].

PURPOSE: To compare the temperament of uncooperative and cooperative children during dental treatment, and find out the characteristics of the uncooperative children's temperament. METHODS: Fifty-two cooperative children (aged from 3 to 7 years) and thirty-five uncooperative children (aged from 3 to 7 years) during dental treatment were included in the investigation. Their parents were asked to answer the Chinese Preschool Children's Temperament Scale (CPTS). The two independent sample's Mann-whitney test and Student's t test were performed to find the difference of the type of temperament and the temperamental dimension between the two groups. RESULTS: (1) There was a statistically significant difference (P<0.05) in the type of temperament between the uncooperative group and the cooperative group. In the uncooperative group, the number of difficult temperament children was significantly larger than that in the uncooperative group. (2) The scores of adaptability and quality of mood were significantly higher in the uncooperative group than that in the cooperative group. CONCLUSIONS: Children's cooperation in pediatric dentistry was correlated to their temperament. The tendencies of negative mood and slow adaptation and difficult temperament should be considered patients at risk of uncooperation in pediatric dentistry.

Muscular forces exerted on the normal deciduous dentition.

This study evaluated the distributing characteristic of the forces exerting on the normal deciduous dentition and the relationship between the muscular forces, sex, and oral function. The pressure measurements were made with a computer-aided perioral force-measuring system designed by the authors. The forces were measured when the subject's head position was in a state of natural head position and oral function was at rest or with swallowing. The results indicated that the forces from lips, cheeks, and tongue at rest were about 37-208 N/m2, whereas the pressure during swallowing was about 1009-1679 N/m2. At rest, the pressure from lips and cheeks was higher than that from tongue (P < .05), whereas during swallowing, the lingual pressure was statistically larger (P < .001). A significant correlation existed between the muscular pressure and sex. When at rest, the boy's force from cheeks was higher than that of the girl's (P < .05) but during swallowing the boy's labial pressure was statistically higher than that of the girl's (P < .01). It was concluded that (1) the deciduous teeth are not in a state of absolute balance between external and internal forces, (2) the distributing manner and unbalanced mode of the forces are different with the different oral functions, (3) the lingual side of the mandibular anterior teeth endures great differences during oral functions and it may account for high incidence of malocclusion in this segment, and (4) a statistical difference between muscular forces and sex exists.

[Study of muscle pressure exerted on deciduous normal occlusion].

OBJECTIVE: To measure the muscle pressure exerted on the deciduous normal occlusion and to explore the relationship between the denture,occlusion, skeleton and muscle pressure. METHODS: Thirty volunteers of deciduous normal occlusion were included in the study. The muscle pressure of natural head posture (NHP) was measured at rest and during swallowing by a PC real-time measuring system and the data were analyzed by statistical software SAS. RESULT: The forces from lips, cheeks and tongue at rest were 0 approximate, equals 1.47 g/cm(2), while the pressure were increased to 9.60 approximate, equals 20.13 g/cm(2) during swallowing. The lip pressure was higher than the lingual side but there was no statistical difference at rest. The boys had higher pressure than girls,but there was also no statistical difference at rest. The pressure of normal occlusion was related to sex at the position of the upper labial incisor and the side of the dental arch during swallowing. The pressure of both sides of the dental arch increased significantly during swallowing. CONCLUSION: The deciduous dentition is in a state of dynamic equilibrium. This equilibrium may result in a special facial morphology.