Radiographic Description of the Distribution of Aggressive Periodontitis in Primary Teeth.

OBJECTIVE: To describe the prevalence by site and tooth of aggressive periodontists (AP) in primary teeth of children with AP, that will facilitate the early diagnosis of AP. STUDY DESIGN: Radiographic evidence of AP by tooth and site of primary teeth of 29 children with AP was analyzed by gender, ethnicity, type of dentition (primary or mixed), alveolar bone site and type of tooth. RESULTS: The range and mean ± standard error of number of sites and teeth per patient with AP were 4 to 28, 13.1±1.2 and 4 to 12, 8.3±0.5 respectively. The differences in prevalence of AP by gender, ethnicity, dentition and homologous sites at both sides of the mouth were not statistically significant (Chi square). AP was mostly diagnosed at the distal area of the maxillary canine, the proximal areas of the first maxillary primary molars, and the distal area of the mandibular first primary molar. The most affected teeth with AP were the first primary molars followed by the maxillary cuspid, and the second molars. CONCLUSIONS: Examination of children's primary teeth should include abnormal mobility, when found it should be followed by radiographic evaluation for the presence of AP, taking in consideration the present findings.

The Need of Interdisciplinary Approach for the Treatment of Children with Down Syndrome with Severe Caries Unintentionally Facilitated by Hypotonia Therapy.

This manuscript describes a case of a 4-year-old child with Down syndrome involving hypotonia in which the use of sweets to induce oral muscular function contributed to the need to extract all the primary teeth due to extensive caries. The need for interdisciplinary education and practice targeted to the treatment of children with special health care needs is emphasized.

Human Primary Tooth Histology Six Months after Treatment with Silver Diamine Fluoride.

OBJECTIVE: To describe the histological characteristics of a human primary tooth with deep caries next to the dental pulp 6 months after being treated with silver diamine fluoride (SDF). STUDY DESIGN: A tooth that was considered to be not restorable 6 months after being treated with SDF was examined with light microscopy. RESULTS: the histologic examination revealed no carious pulp exposure, tertiary dentin, a flattened odontoblastic layer adjacent to irregular tertiary dentin, dentinal tubules with silver deposits to a depth of 1 mm and no bacteria, and a pulp with no significant inflammation. CONCLUSIONS: The use of silver diamine fluoride as an interim treatment of deep caries on vital carious primary teeth of children, leads to histologic changes that prevent pain and pulp deterioration, and most likely facilitate pulp healing. These unique findings expand the knowledge about the effect of SDF on the human dental tissues.

Cvek pulpotomy - revisited.

BACKGROUND/AIM: While some studies support the notion that the time elapsed from coronal fracture and treatment with Cvek pulpotomy in permanent teeth plays an important role in minimizing the possibility of pain and discomfort, microbial pulp invasion, and ensuring pulp and periodontal healing, others consider that neither time between the accident and treatment nor size of exposure is critical if the inflamed superficial pulp tissue is amputated to the level of a healthy pulp. This study compares published data in an attempt to assess whether the outcome of Cvek pulpotomies is affected by these factors. RESULTS AND CONCLUSIONS: Evidence in the literature suggests to treat a permanent tooth with a complicated crown fracture as soon as possible to diminish the possibility of pain and prevent necrosis and infection of the pulp. Delay of treatment by 9 days or less may have minimal effect on the outcome of Cvek pulpotomies. While the literature indicates that pulp exposures of 4 mm or less may have a good prognosis after a Cvek pulpotomy, the prognosis in teeth with pulp exposures of more than 4 mm has not yet been clarified. Although the literature is not conclusive regarding a difference in the outcomes of Cvek pulpotomies in teeth with open or closed apices, it appears that teeth with open apices have a better prognosis. The outcome of a Cvek pulpotomy may be compromised by a luxation injury that diminishes the tooth's blood supply and innervation. A good restoration that prevents bacterial penetration into the tooth is essential for the success of a Cvek pulpotomy.

The potential lifespan impact of gingivitis and periodontitis in children.

The prevalence of gingivitis in children can be similar to or greater than dental caries, but has received much less attention in understanding the long-term impact on overall health. Oral health providers must take into consideration that the clinical presentation of the gingivitis progression/severity in the primary dentition is only evident when the magnitude of the inflammatory cell infiltrate approximates the gingival surface reflected by inflamed tissues. Moreover despite its relatively benign clinical appearance, the establishment of chronic inflammation of the periodontal tissues in childhood may have the potential for local tissue destruction leading to periodontitis, and/or create an "at-risk" environment in the tissues that could adversely affect the health of these tissues across the lifespan. The present manuscript presents some fundamental information regarding the characteristics of chronic inflammation in gingival tissues of children and adolescents and speculates about the lifetime impact of gingival and periodontal infections in childhood on future oral and systemic health in the adult.

Gingival overgrowth in a child with arthrogryposis treated with a Er,Cr:YSGG laser: a case report.

The present manuscript reports a case of a 21/2 year old girl, diagnosed with arthrogryposis, presenting increasing gingival hyperplasia which was treated with Er,Cr:YSGG Laser. The patient was treated under general anesthesia by the Pediatric Dentistry and Periodontics departments. Er,Cr:YSGG laser G6 tip was used at 1.50 watts, 20 pps, 8% water and 11% air, which is recommended by the manufacturer. Scalpel and periodontal curettes were used to complement the laser. Tissue samples from the anterior maxilla, anterior mandible and palatal sites were formalin-fixed and submitted for evaluation. The samples biopsied revealed prominent hyperplasia of the fibrous connective tissue with areas of the epithelium exhibiting pseudoepitheliomatous hyperplasia. At 1 week and 3 months follow up, oral examination showed appropriate healing of gingival tissue. The use of Er,Cr:YSGG laser in the present case proved to be effective in the removal of large amounts of hyperplasic gingival tissue and resulted in fast heeling and mild discomfort.

Obesity in children: a challenge that pediatric dentistry should not ignore--review of the literature.

The link between childhood oral diseases and obesity is demonstrated by their increasing prevalence, potential cause and effect relationship, the significant deleterious effect on the child's present and future oral and systemic health, and the influence of obesity on conscious sedation. The purpose of this manuscript is to review the literature on the relationships between childhood oral diseases and obesity, and between obesity, breathing and conscious sedation. While some reports suggest a connection between caries and obesity others do not, and it is unclear if they correlate or they just coexist since they have common etiologic and/or facilitating factors. Deleterious effects of dental caries and obesity on the systemic condition are clear, may potentiate each other, and facilitate the development and progress of chronic or acute systemic conditions. Obesity may interfere with the possibility to sedate patients because of potential breathing problems, or modify the effect of the sedative agents. Health providers should be aware of the increasing challenge posed by the correlations between dental caries, obesity, oral and systemic diseases. Furthermore, pediatric dentistry should team with other health professions in order to cooperate in the prevention and treatment of these diseases.

Shear bond strength of one etch-and-rinse and five self-etching dental adhesives when used by six operators.

OBJECTIVE: To test the hypothesis that some single-bottle self-etching adhesives bond as well to enamel and dentin as a typical two-bottle etch-and-rinse adhesive. MATERIAL AND METHODS: Six operators used one two-bottle etch-and-rinse dentin adhesive (Scotchbond MP) and five all-in-one self-etching adhesives (iBond Gluma Inside, Clearfil S(3) Bond, iBond Experimental, Xeno IV, and G-BOND). Each operator carried out six bondings to enamel and six bondings to dentin with each adhesive. After 24 h of storage in water at 37 degrees C, bond strength was determined in shear. RESULTS: The pooled results of all the adhesives revealed no significant difference (p>0.05) in bond strength between dentin and enamel. However, there were significant differences (p<0.0001) between the different adhesives. The etch-and-rinse adhesive did better than the self-etching adhesives when substrate was not an issue (pooled enamel and dentin results). On comparing the performance of the different adhesives, it became clear that there were significant interactions (p<0.0001) between substrates and products. There were also significant differences (p<0.0001) between operators, and the interaction between operators and products was significant (p<0.0002). CONCLUSIONS: The tested etch-and-rinse adhesive did better than the tested self-etching adhesives. The shear bond strength results were also strongly affected by the operator as well as by the interaction between operator and used product. The pooled bond strength values of the different adhesives revealed no difference in bond strength to dentin versus enamel.

Educational, personal, and cultural attributes of dental students' humanitarian trips to Latin America.

This article evaluates the educational, personal, and cultural attributes that motivate or inhibit dental students' participation in humanitarian and educational trips to underserved communities in Latin America. Interviews, concentrating on students' expectations and experiences, were conducted with students who participated in the trips and with those who did not. A survey of a larger group of students (including those interviewed) was also conducted; the survey included demographic data, ethnic affiliation, cultural competence, motivators and inhibitors to attend trips, and trip attributes. One hundred and seventy-four students at one dental school completed the survey; the group interviews were conducted with twenty-three students who attended humanitarian and educational trips and nine students who did not. This research found that skill development, educational opportunity, and philanthropy were the most important motivators for trip participation. Cost and time commitments were the strongest inhibitors to participate. Exposure to infectious diseases, substandard working and living conditions, threat of crime, and language barriers were mostly considered as "not important." However, female dental students were more concerned than males about crime, living conditions, and infectious diseases during the trips. Cultural education, increased knowledge, cross-cultural professional relationships, increased self-confidence, and public health awareness were the most important attributes of the trips. This study indicates that the undergraduate humanitarian educational trips to underserved Latin American communities have a most significant personal, professional, and social impact on dental students.

First-year students' perceptions about pediatric dental behavior guidance techniques: the effect of education.

The purpose of this study was to evaluate the effect of a dental education component on dental students' perceptions toward behavior guidance techniques in pediatric dentistry. A questionnaire was completed by seventy-three first-year dental students, before and after a course on human development and behavior guidance techniques in pediatric dentistry. The acceptability of behavior guidance techniques and situations in pediatric dentistry was scored with a visual analog scale before and after the course, compared, and evaluated in relation to demographic data. After the course, statistically significant increases (ANOVA) in the acceptability of aversive behavior guidance (voice control, hand over mouth, and immobilization), sedation, general anesthesia, and modeling were found. Statistically significant decreases (ANOVA) in acceptability were found in mentioning the possibility of pain during treatment and with a parent being in the clinic or talking with the child during treatment. Female or married students, those who had previously received dental treatment, or those who had a dentist in the family showed statistically significant changes that indicated more empathy toward the children. We conclude that undergraduate dental education may have a significant short-term influence on dental students' perceptions of behavior guidance in pediatric dentistry.

Oral characteristics of children with attention-deficit hyperactivity disorder.

The purpose of this study was to compare the oral and demographic characteristics of children with attention-deficit hyperactivity disorder (ADHD) to those of a control group of children. A sample of 25 dental records of children medicated for ADHD was compared to 127 records of healthy children not receiving any medication. The children with ADHD had a statistically higher prevalence of toothache, bruxism, bleeding gums, and oral trauma histories than the control group (chi square, p < 0.05). The differences in other recorded oral characteristics and habits, such as plaque accumulation, gingival inflammation, calculus, oral hygiene compliance, dental caries experience, and unmet dental needs, were not statistically significant. The demographic characteristics such as age, gender, residence, ethnicity, income, and payment method were also not significantly different between the two groups. There is a need to develop and implement specific strategies for the early prevention and treatment of oral diseases in children with ADHD.

Congenital epulis of the newborn: a case report.

Congenital epulis of the newborn is a rare soft tissue manifestation that affects infants, involving predominantly the maxillary ridge. When identified, generally at birth, excisional biopsy is recommended to avoid feeding and respiratory disturbances. This article presents a case report of a female infant who was referred to an oral and maxillofacial surgery facility for removal of a fibrotic mass present on the mandibular alveolar ridge. Diagnosis and prompt intervention can prevent expected complications such as failure to thrive or respiratory difficulty. Pediatric and general dentists should be familiar with oral pathologies that may affect the newborn or infants so that early diagnosis and treatment can be accomplished.

Oral health and preterm delivery education: a new role for the pediatric dentist.

A variety of epidemiological, animal and intervention studies support a positive link between preterm delivery and the presence of periodontal disease in the pregnant women. Although the exact mechanism underlying this association is still unclear, evidence is accumulating that oral bacteria, and especially P gingivalis, can invade the placental tissues and trigger inflammatory responses which will result in release of effector molecules involved in preterm delivery. However, the medical profession has yet to assume a role in the education of the pregnant women about her oral health. We believe that the dental profession, including the pediatric dentist, should play an active role in transferring the current knowledge on this subject to the expecting mother in order to minimize the risks of preterm delivery.

Children's selection of posterior restorative materials.

This study evaluated children's preference for posterior restorations. After viewing photographs of amalgam, composite, colored compomer and stainless steel crowns, 100 children 5-12 years-old responded to a satisfaction survey. The influence of age, gender and ethnicity was assessed and statistically analyzed Composite resins were preferred the most and amalgam the least. Caucasians mostly selected composites while African Americans stainless steel crowns. Early interest in colored compomers was seen in young, males and Caucasians.

The relationship between oral and demographic characteristics of children with asthma.

The information from 291 children's dental charts was analyzed; 127 children had no mental or systemic diseases, 50 had asthma and 114 had other diseases. Children with systemic diseases in general and those with asthma had a higher prevalence of history of toothaches and higher plaque, calculus and caries indices than the healthy children. Children with systemic diseases in general and those with asthma in particular should be targeted for preventive dental services.

Shear bond strength of one 4th and two 7th generation bonding agents when used by operators with different bonding experience.

PURPOSE: To test the hypothesis that simpler-to-use dentin adhesives (7th-generation adhesives) perform better when used by inexperienced operators than do the more complex 4th-generation adhesives. MATERIALS AND METHODS: Six operators with no previous experience regarding dental adhesives, three residents in pediatric dentistry, and three experienced dentists used one 4th-generation dentin adhesive (MA) and two 7th-generation adhesives (MB and MC). With each adhesive, each operator performed 6 bondings to enamel and 6 bondings to dentin. After 24 h of storage in water at 37 degrees C, the shear bond strength was determined. RESULTS: The pooled results showed that the bond strength to dentin was higher (p < 0.05) than that to enamel (dentin mean value = 14.0 MPa, SD = 9.1 MPa; enamel mean value = 11.9 MPa, SD = 7.1 MPa), and that adhesive MA performed better (p < 0.05) than adhesives MB and MC (inexperienced operators = 16.2 +/- 10.9 MPa; residents in pedodontics = 12.0 +/- 6.8 MPa, and experienced operators = 10.7 +/- 4.8 MPa). Of the two 7th-generation adhesives, one performed better on enamel than on dentin, while the other 7th-generation adhesive performed better on dentin than on enamel. Regarding operators, there were large individual variations. The inexperienced bonders performed as well as the residents (p > 0.05), while the experienced operators performed best (p < 0.05). CONCLUSION: In general, the tested 4th-generation adhesive performed better than the 7th-generation adhesives. Even inexperienced operators performed better with the more difficult-to-use 4th-generation adhesives than with the 7th-generation adhesives. Dentin adhesion was stronger than enamel adhesion.

Permanent versus temporary restorations after emergency pulpotomies in primary molars.

PURPOSE: The purpose of this retrospective study was to determine if immediate placement of a stainless steel crown (SSC) after emergency pulpotomies in primary molars would result in a better outcome when compared to different temporary restorations. METHODS: Records of 94 emergency pulpotomies in primary molars performed at a university pediatric graduate dental clinic between July 2001 and June 2004 were analyzed. Inclusion criteria included: (1) teeth with a positive history of spontaneous or elicited pain; (2) deep caries with close approximation to the pulp; (3) absence of clinical and radiographic signs of pulpal degeneration; (4) abnormal mobility; or (5) swelling. Pulpotomized teeth were temporarily restored with a zinc oxide eugenol-based temporary restoration (IRM) covered with Ketac Molar or with a permanent restoration (SSC). The time interval between emergency and definitive treatment or recall, age, gender, tooth type, and arch were the variables analyzed in the study. Success was determined by record (progress notes and radiographs) verification of SSC placement in case of a temporary restoration and by confirmation of crown presence during recall exam. Data from emergency pulpotomies restored only with IRM was added to the study and included in the statistical analysis. RESULTS: Superior clinical success was obtained when emergency pulpotomies were restored with SSC (86%) when compared to IRM only (61%) or IRM and Ketac Molar combined (77%). Statistical significance was obtained in favor of SSC when survival analysis was performed (P<.001). No statistically significant difference was found for any of the other variables (P>.05). CONCLUSIONS: Immediate placement of an SSC tended to improve the chances for success when emergency pulpotomies are performed.

Pathophysiology, therapy, and oral implications of renal failure in children and adolescents: an update.

The objective of this manuscript was to describe the pathophysiology and the systemic and oral implications of chronic renal failure (CRF), end-stage renal failure (ESRF), and renal replacement therapy (RRT) in children and adolescents. Improvement in treatment modalities of CRF, ESRF, and RRT have resulted in an increase in survival, and better health in children and adolescents with renal failure. Therefore, dentists are expected to encounter an increasing number of patients with renal failure needing oral care. Renal failure leads to a state of intoxication known as uremia, which is associated with extra-renal multi-organ involvement. Oral findings frequently include: (1) excessive plaque accumulation; (2) gingivitis; (3) gingival overgrowth; and (4) enamel hypoplasia. Some cases develop periodontitis. It is hoped that the present review will lead to a better understanding of the systemic and oral abnormalities in children and adolescents with renal failure and provide guidance for their treatment and, ultimately, better treatment outcome.

The relationship between Porphyromonas gingivalis infection and local and systemic factors in children.

BACKGROUND: Porphyromonas gingivalis (P. gingivalis) is a major pathogen related to periodontitis. There are few reports on the prevalence and effect of P. gingivalis in children. The purpose of the present study was to describe in children the level of DNA-P gingivalis in subgingival plaque and the IgG serum reactivity to P. gingivalis (IgG-Pg), and examine their relationship to demographic, systemic, and oral variables. METHODS: Thirty-four children, aged 1.83 to 13.42 years, were included in the study; 16 with no systemic disease and 18 with systemic conditions. The demographic data for caries incidence, plaque and gingival indices, probing depth, and alveolar bone height were recorded. The IgG-Pg and DNA-Pg levels were determined by enzyme-linked immunosorbent assay and DNA-DNA hybridization, respectively. The relationships between the IgG-Pg and DNA-Pg values to the demographics, oral parameters, and systemic conditions were examined. RESULTS: IgG-Pg was evident in 53% of the children and DNA-Pg in 47%. IgG-Pg values significantly correlated positively with age, plaque index, and bone height. DNA-Pg values had statistically significant positive correlations with age. IgG-Pg and DNA-Pg values correlated with probing depth among children with systemic diseases. Neither the IgG-Pg nor the DNA-Pg values had a significant correlation to systemic conditions. Multiple regression analyses indicated that only age remained significantly related to IgG-Pg and DNA-Pg values. CONCLUSIONS: P. gingivalis can be found in significant levels in the plaque of young children and elicits an immune reaction that increases with age and may be related to incipient signs of periodontal disease. Plaque DNA-Pg and serum IgG-Pg levels correlate significantly.