The implication of integrating pediatric education into a pediatric dentistry course for undergraduate dental students.

Background/purpose: The separation of dentistry and medicine was initiated as a historical root. The purpose of this study was to evaluate the implication of integrating pediatric education into a pediatric dentistry course (so-called the integrated pediatric dentistry course in this study) for undergraduate dental students through students' perspectives. Materials and methods: A total of the 34 fifth-year dental students were invited to fill out the questionnaire for the integrated pediatric dentistry course survey after the class of integrated pediatric dentistry course. Results: Of the 34 dental students, all participated in the survey with a 100% valid response rate. The results showed that most of dental students found this integrated pediatric dentistry course to be helpful in improving their knowledge and clinical skills for pediatric dentistry, and knowledge about pediatrics related to dentistry. However, in comparison, the acquisition of clinical skills was less than that of knowledge for pediatric dentistry. Conclusion: We conclude that the integrated pediatric dentistry course improves dental students' knowledge and clinical skills about pediatric dentistry, and knowledge about pediatrics related to dentistry. Considering the effectiveness of this integrated pediatric dentistry course on students' knowledge and clinical skills, and positive attitude towards pediatric dentistry, this model shows promising for the further use in the dental education.

Retrospective survey of biopsied oral lesions in pediatric patients.

BACKGROUND/PURPOSE: Although the general profile of oral biopsies from Asian children has been reported, it was still worth examining whether there were racial and geographic variations in the categories and incidence of pediatric oral lesions. This retrospective study mainly evaluated the categories and incidence of biopsied oral lesions in Taiwanese pediatric patients. METHODS: Biopsy records of all oral lesions from pediatric patients, aged 0-14 years, in the files of the Department of Pathology, National Taiwan University Hospital from 1988 to 2007 were evaluated. The patients were divided into three age groups (0-5, 6-10, and 11-14 years), and the oral lesions were classified into four main categories: inflammatory and reactive, cystic, neoplastic, and other lesions. RESULTS: Of a total of 11,986 biopsied oral lesions, 797 (6.6%) were found in pediatric patients. The most common oral lesions were inflammatory and reactive (45.5%), followed by neoplastic (23.5%), cystic (22.2%), and other (8.8%) lesions. The majority of oral biopsies (47.3%) were taken from patients in the 11-14 years age group. Of the 187 oral neoplastic lesions, 178 (95%) were benign and nine (5%) were malignant, including two premalignant lesions. The maxilla (66 cases) and the mandible (61 cases) were the two most common sites for pediatric neoplastic lesions. The top five oral lesions in pediatric patients were mucous extravasation phenomenon (195 cases), dentigerous cyst (84 cases), odontoma (83 cases), radicular cyst (38 cases), and dental follicle (26 cases). CONCLUSION: The mucous extravasation phenomenon, odontoma, or dentigerous cyst was the most common inflammatory and reactive, neoplastic, or cystic lesion, respectively, in pediatric patients. The relatively high incidence of inflammatory and reactive lesions in pediatric patients implies the importance of stringent oral hygiene in children. Most oral neoplastic lesions in pediatric patients are benign, and malignant oral tumors rarely occur in pediatric patients.

Stimulation of glutathione depletion, ROS production and cell cycle arrest of dental pulp cells and gingival epithelial cells by HEMA.

2-Hydroxy-ethyl methacrylate (HEMA) is the major component released from resin-modified glass ionomer cements and dental adhesives. Human tissues mainly affected by HEMA are oral epithelium and dental pulp. We treated human gingival epithelial S-G cells and pulp fibroblasts (HPF) with various concentrations of HEMA, to evaluate its effects on cell growth, cell cycle progression, intracellular glutathione (GSH) level and reactive oxygen species (ROS) production. HEMA-induced growth inhibition in HPF and S-G cells in a dose-dependent manner, which may be partially explained by induction of cell cycle perturbation. G(2)/M phase arrest was noted after exposure of HPF to 5 and 10mm of HEMA, concomitant with glutathione depletion and ROS production. S-phase arrest occurred in S-G cells when treated with 2.5 and 5mm, while at 10mm a sub-G(0)/G(1) peak was noted, indicating the potential induction of apoptosis. GSH depletion was marked in S-G cells only at concentrations of 5 and 10mm, but excessive ROS production was noted at concentration of 1mm and rose with dose increase between 1 and 5mm, then lessened at 10mm. This suggested that the increase of ROS in S-G cells was not mainly caused by GSH depletion. These results helped to define the mechanism of the cytotoxicity caused by HEMA.

Dental anomalies in two patients with incontinentia pigmenti.

Incontinentia pigmenti (IP) is a rare X-linked dominant inherited disorder which has a variety of ectodermal aberrations. Skin hyperpigmentation is the most characteristic feature of IP. However, extracutaneous anomalies involving dentition, hair, eyes, and central nervous system are also found. The dental anomalies reported include peg-shaped or malformed teeth, hypodontia, delayed eruption, and impacted tooth. This report describes the dental anomalies in 2 IP patients who had the characteristic features of skin hyperpigmentation. One was a 13-year-old girl who had slender cone-shaped permanent anterior teeth, hypodontia, and delayed eruption of teeth which are characteristic dental anomalies in an IP patient. The other was a 10-year-old girl who only had 2 tulip-shaped maxillary permanent central incisors with shorter tapering roots but no congenital missing teeth or delayed eruption of teeth. Our findings suggest that IP may present a broad variation of dental anomalies individually. However, the characteristic finding of permanent anterior teeth with a longer crown and a shorter root found in both of our IP patients may be worthy of consideration in the differential diagnosis of IP.

Role of ALK5/Smad2/3 and MEK1/ERK Signaling in Transforming Growth Factor Beta 1-modulated Growth, Collagen Turnover, and Differentiation of Stem Cells from Apical Papilla of Human Tooth.

INTRODUCTION: Transforming growth factor ß1 (TGF-ß1) plays an important role in cell proliferation, matrix formation, and odontogenesis. This study investigated the effects of TGF-ß1 on stem cells from apical papilla (SCAPs) and its signaling by MEK/ERK and Smad2. METHODS: SCAPs were exposed to TGF-ß1 with/without pretreatment and coincubation by SB431542 (an ALK5/Smad 2/3 inhibitor) or U0126 (a MEK/ERK inhibitor). Cell growth was examined by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assay or direct counting of viable cells. Collagen content was determined by using the Sircol collagen assay (Biocolor Ltd, Newtownabbey, Northern Ireland). Cell differentiation was evaluated by measuring alkaline phosphatase (ALP) activity. Smad2 and ERK1/2 phosphorylation was analyzed by Western blotting or PathScan phospho-enzyme-linked immunosorbent assay (Cell Signaling Technology Inc, Danvers, MA). RESULTS: TGF-ß1 stimulated the growth and collagen content of cultured SCAPs. TGF-ß1 stimulated ERK1/2 and Smad2 phosphorylation within 60 minutes of exposure. Pretreatment by U0126 and SB431542 effectively prevented the TGF-ß1-induced cell growth and collagen content in SCAPs. TGF-ß1 stimulated ALP activity at lower concentrations (0.1-1 ng/mL) but down-regulated ALP at higher concentrations (>5 ng/mL). U0126 prevented 0.5 ng/mL TGF-ß1-induced ALP activity but showed little effect on 10 ng/mL TGF-ß1-induced decline of ALP in SCAPs. Interestingly, SB431542 attenuated both the stimulatory and inhibitory effects on ALP by TGF-ß1. CONCLUSIONS: TGF-ß1 may affect the proliferation, collagen turnover, and differentiation of SCAPs via differential activation of ALK5/Smad2 and MEK/ERK signaling. These results highlight the future use of TGF-ß1 and SCAP for engineering of pulpal regeneration and apexogenesis.

A continuous flow system for assessing fluoride release/uptake of fluoride-containing restorative materials.

OBJECTIVES: The aim of this study was to develop a continuous flow system to mimic the kinetics of salivary flow in the mouth and to study the fluoride (F) release/uptake characteristics of both a conventional (Fuji IX) and a resin-modified glass ionomer (Vitremer) in such system. METHODS: Five discs were made for each material. The disc was suspended in a drip chamber sustaining 2 ml of deionized water. The flow rate was controlled at 20 ml/h by an infusion pump. The F release in the drip chamber was assessed at designated time points for up to 6 days. The discs were subjected to 1 min exposures of 0.2% sodium fluoride (NaF); the F re-release was assessed for another 12 h. RESULTS: Following a brief initial burst of F release, the rate decreased rapidly. Vitremer reached a steady low after 8 h, while Fuji IX reached a steady low after 90 min. Cumulative F release was measured from both the effluence and the drip chamber and showed that Vitremer released and took up more F than Fuji IX, both before and after F treatment. Cumulative amounts of fluoride in the drip chamber were much less than that in the effluence. The daily release rate patterns from the two materials were parallel. However, the hourly release rate of Vitremer decreased more gradually than Fuji IX. After sodium fluoride (NaF) treatment, F can be recharged easily and re-released rapidly within 90 min. CONCLUSION: This study indicates that the continuous flow method can be used to assess F release/uptake of the material. This method may represent a closer model to in vivo conditions.

Root fracture of immature permanent incisors--a case report.

This 7-year-old girl experienced pain in her upper central incisors following a fall to the ground. Radiographic examination revealed immature upper central incisors with mid-root oblique and horizontal root fractures. Splinting was performed. When at 3 months, an electric pulp test was positive for both injured teeth, and after 5 months, the fracture lines had disappeared on the radiographs, the splint removed. After 2 years, clinical examination showed normal tooth color and position, with a positive response to the pulp test. Radiographs demonstrated continuous root development, although root canal narrowing was noted at the healed fracture sites.