Eating Disorders in the Adolescent Patient.

Eating disorders such as anorexia nervosa, female athlete triad, bulimia nervosa, obesity, and binge eating initially emerge during adolescence. These disorders are present primarily in females, but males may also present with these conditions. Dentistry has a pivotal role in the management of patients with such diet-related disorders. Because dentists examine their patients at frequent intervals and may be the health care professionals with whom patients feel more comfortable discussing eating disorders, dentists must have knowledge of the etiology, diagnostic criteria, systemic effects, and intraoral manifestations of eating disorders. In addition, the dental professional may be the first health care provider to identify the condition and refer the patient appropriately to medical colleagues for subsequent treatment. This chapter provides dentists with current and relevant information to recognize, diagnose, and integrate dental treatment for their adolescent patients who may exhibit manifestations of an eating disorder.

Gene-environment interaction in molar-incisor hypomineralization.

Molar incisor hypomineralization (MIH) is an enamel condition characterized by lesions ranging in color from white to brown which present rapid caries progression, and mainly affects permanent first molars and incisors. These enamel defects usually occur when there are disturbances during the mineralization or maturation stage of amelogenesis. Both genetic and environmental factors have been suggested to play roles in MIH's development, but no conclusive risk factors have shown the source of the disease. During head and neck development, the interferon regulatory factor 6 (IRF6) gene is involved in the structure formation of the oral and maxillofacial regions, and the transforming growth factor alpha (TGFA) is an essential cell regulator, acting during proliferation, differentiation, migration and apoptosis. In this present study, it was hypothesized that these genes interact and contribute to predisposition of MIH. Environmental factors affecting children that were 3 years of age or older were also hypothesized to play a role in the disease etiology. Those factors included respiratory issues, malnutrition, food intolerance, infection of any sort and medication intake. A total of 1,065 salivary samples from four different cohorts were obtained, and DNA was extracted from each sample and genotyped for nine different single nucleotide polymorphisms. Association tests and logistic regression implemented in PLINK were used for analyses. A potential interaction between TGFA rs930655 with all markers tested in the cohort from Turkey was identified. These interactions were not identified in the remaining cohorts. Associations (p<0.05) between the use of medication after three years of age and MIH were also found, suggesting that conditions acquired at the age children start to socialize might contribute to the development of MIH.

Childhood Obesity, Genetic Variation, and Dental Age.

Purpose: The purpose of this study was to determine if dental ages are more advanced in overweight children and influenced by genetic variation. Methods: Panoramic radiographs from 577 children were obtained. For performing genetic studies, an additional 236 subjects had panoramic radiographs and whole saliva samples collected. Genotyping of IGF, FGF, and FGFR markers was done. Dental age was determined in 177 patients utilizing Demerjian's method and panoramic radiographs. Skeletal maturation was determined in 28 patients using Baccetti's cervical vertebral maturation method on lateral cephalograms. PLINK was used to test for over-representation of alleles. Results: FGF7, FGF10, and FGF13 were significantly associated with obesity (P = 0.02). When dental age was considered, overweight and obese children are more likely to have dental ages more advanced than their chronological ages (P = 0.05). An excess of heterozygotes of FGF18 rs4073716 was found in children with dental age more advanced than their chronological age (P=0.04). Conclusions: Overweight and obese children have dental ages more advanced than their chronological ages, and this occurrence may be influenced by genetic variation in FGF18.

Medical sequencing of de novo ectodermal dysplasia in identical twins and evaluation of the potential eligibility for recombinant EDA therapy.

The purpose of this study was to test two 8-year-old identical twins with ectodermal dysplasia (ED) and their unaffected parents for the presence of mutations in the EDA gene with the hypothesis that they might be carrying a de novo mutation in EDA and potentially eligible for recombinant EDA therapy. DNA was extracted using saliva samples obtained from the identical twin girls and both parents. PCR products of Ectodyplasin A (EDA), Ectodysplasin Receptor (EDAR), Ectodysplasin Receptor Associated Death Domain (EDARADD), and Connexin-30 (GJB6) were sequenced by the Sanger method and the results analyzed using a reference sequence. Exons and exon-intron boundaries of EDA, EDAR, EDARADD, and GJB6 were sequenced in both parents and the affected identical twin pair. No mutations were detected in EDA or GJB6. Genetic variants located in the intron of EDAR were found but determined to be non-contributory to the twins' ED. A microsatellite polymorphism was detected in all four subjects in exon 4 of the EDARADD gene but determined not to be causal to the ED. There was a silent mutation detected in exon 6 of the EDARADD gene of both the daughters and their unaffected mother but also unlikely to be the cause of ED. These results suggest that ED of the subjects is caused by a de novo mutation in a gene not studied here. It is likely these subjects and their future offspring would not benefit from the development of recombinant EDA replacement therapy.

Reversal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients.

BACKGROUND: The authors evaluated the safety and efficacy of a formulation of phentolamine mesylate (PM) as a local anesthesia reversal agent for pediatric patients. METHODS: A total of 152 pediatric subjects received injections of local anesthetic with 2 percent lidocaine and 1:100,000 epinephrine before undergoing dental procedures. The authors then randomized subjects to receive a PM injection or a control injection (sham injection in which a needle does not penetrate the tissue) in the same sites as the local anesthetic was administered in a 1:1 cartridge ratio after the procedure was completed. Over a two- to-four-hour period, they measured the duration of soft-tissue anesthesia and evaluated vital signs, pain and adverse events. RESULTS: The median recovery time to normal lip sensation was 60 minutes for the subjects in the PM group versus 135 minutes for subjects in the control group. The authors noted no differences in adverse events, pain, analgesic use or vital signs, and no subjects failed to complete the study. CONCLUSIONS: PM was well-tolerated and safe in children 4 to 11 years of age, and it accelerated the reversal of soft-tissue local anesthesia after a dental procedure in children 6 to 11 years of age. CLINICAL IMPLICATIONS: PM can help dental clinicians shorten the post-treatment duration of soft-tissue anesthesia and can reduce the number of posttreatment lip and tongue injuries in children.

Periodontal and soft tissue prevention strategies for the adolescent dental patient.

Recent research has refocused attention on the contribution of periodontal health to the general health of patients at various ages. This article describes changes in the periodontal tissues of adolescent dental patients related to hormonal fluctuations, lack of proper oral hygiene, and risk-taking behaviors. Attention is placed on the development and prevention of acute and chronic gingival conditions in addition to gingival tissue enlargement as one side effect of certain medications.

Management of Class III crown fractures in the permanent dentition.

Management of Class III crown fractures in the permanent dentition can be both challenging and rewarding for practitioners. Several of the techniques described require further investigation to determine clinical efficacy based on scientific research. In addition to evidence-based protocols, treatment outcomes will continue to be related to the technical proficiency of the dentist, including diagnostic acumen and appropriate treatment planning decisions. A treatment planning decision paradigm, as described in this article for management of Class III fractures to permanent teeth, is summarized in Table 1.

Practitioner's guide to fluoride.

The current health care trend is to provide evidence-based recommendations and treatment. Many literature reviews have shown fluoride's effectiveness against caries. The current use of fluoride in the prevention of dental caries is based on community, professional, and individual strategies. Personalized fluoride regimens should include a risk analysis and a review of the patient's current fluoride exposure. The future of fluoride may be found in its slow release and retention in the oral cavity through various modalities. Because of the many uncertainties still associated with fluoride, further research is needed.

Outreach activities: focus on troubled youth.

The Department of Pediatric Dentistry at the University of Pittsburgh School of Dental Medicine has a commitment to community service. Two programs that provide care to incarcerated adolescents are described. One facility is a large second-chance detention center for males; the other is a small second-chance facility for female juvenile offenders. Not only do these programs offer dental services to these underserved adolescents, they provide a wider range of clinical experiences to predoctoral dental students. The inception of this project, its evolution, and implementation are described. Characteristics of adolescents in general and those of incarcerated adolescents are presented. Modifications in treatment considerations and behavioral characteristics are compared.

Women's oral health across the lifespan. Part Two: Developmental perspectives.

This two-part series is intended to provide dental practitioners with information related to the clinical aspects of women's health in general and women's oral health in particular. Part One in the series presented a historical perspective from the inception and evolution of women's oral health to current issues of relevance. Part Two in the series presents a developmental perspective on women's oral health across the lifespan from infancy through the post-menopausal stages. Emphasis is focused on medical and dental aspects of each developmental stage.

Women's oral health across the lifespan. Part One: Historical perspectives.

This two-part series is intended to provide dental practitioners with information related to the clinical aspects of women's health in general and women's oral health in particular. Part One in the series presents a historical perspective from the inception and evolution of women's oral health to current issues of relevance. Part Two in the series will present a developmental perspective on women's oral health across the lifespan from infancy through the post-menopausal stages. Emphasis will be focused on medical and dental aspects of each developmental stage.

Oral piercing in athletes: implications for general dentists.

General dentists need to be aware of the growing number of athletes who display various forms of body art. Intraoral piercing and tongue jewelry place athletes at greater risk for serious medical and dental consequences that are confounded when the athlete attempts to compete while wearing a mouthguard with the tongue jewelry in place. All body jewelry should be removed during sporting events. General dentists have a professional responsibility to: become more aware of the extent and implications associated with tongue piercing in athletes to discourage athletes from having the tongue pierced; be prepared to manage postpiercing intraoral and dental complications; provide proper advice for the care and use of a mouthguard in the presence of tongue jewelry; and develop educational strategies that address the medical and dental complications of intraoral piercing.