Pulp aspects of traumatic dental injuries in primary incisors: Dark coronal discoloration.

Dark coronal discoloration is a common outcome of traumatic dental injuries in primary incisors. However, there are only a few research studies on the mechanism that causes dark discoloration, the condition of the pulp, and the preferred treatment of such teeth. This article is a summary of the author's research studies and personal experience regarding dark coronal discoloration of traumatized primary incisors.

Radiographic evidence of traumatic injuries to primary incisors without accompanying clinical signs.

BACKGROUND/AIMS: In epidemiological studies, traumatic dental injuries in children are usually determined from clinical signs or parents' reports. Radiographs are used in dental trauma centers but not in field surveys. The aim of this study was to evaluate the proportion of patients who present with radiographic evidence of trauma without any clinical signs of a history of TDI. METHODS: The prevalence of traumatic dental injuries was assessed from the records of 674 preschool children at their first visit to a private dental practice. Evidence of the history of traumatic dental injuries was based on clinical and radiographic signs. Clinical signs consisted of enamel fracture, crown fracture with dentin exposure (with or without pulp exposure), internal coronal discoloration, and the presence of a draining sinus. Radiographic signs were as follows: root fracture, pulp canal obliteration, tube-like mineralization, internal resorption, arrested dentin deposition, external inflammatory root resorption, and a periapical radiolucency. RESULTS: Of the 674 children, 408 (60.5%) presented with clinical evidence of traumatic dental injuries. This included 195 (28.9%) with enamel fracture as the sole sign. Seventeen (2.5%) had radiographic signs of traumatic dental injuries without any clinical evidence of trauma, increasing the prevalence of traumatic dental injuries by 2.5-63.0%. Fifteen of these were pulp canal obliteration, one root fracture, and one with arrested dentin deposition. Clinical signs of traumatic dental injuries without radiographic evidence of trauma were present in 275 (40.8%) patients. CONCLUSION: Traumatic dental injuries based on both clinical and radiographic evidence are more prevalent than when based on clinical examination only.

The association between traumatic dental injuries and atypical external root resorption in maxillary primary incisors.

Atypical root resorption (ARR), which is observed on radiographs of primary incisors, has been reported in the dental literature to result from digit sucking; thus ignoring any association between ARR and traumatic dental injuries (TDI). The purpose of this study was to evaluate and compare the contributions of sucking habits and TDI to external ARR in primary incisors. A history of dental trauma was assessed based on clinical and radiographic findings. Periapical radiographs of the premaxilla were evaluated for the presence of ARR. The presence or history of sucking habits was based on parents' report. Data were collected from files of 727 patients with a mean age of 52 months. Sixty-four children (8.8%) presented ARR in one or both central incisors. All 64 had experienced some type of TDI. Five hundred and forty-nine (76%) of the children had sucking habits; of them, 501 were pacifier-suckers and 48 digit suckers. Digit sucking was found in only 4 (6%) of the 64 children presenting ARR. These findings support the association of traumatic dental injury, and not of digit sucking, with ARR in primary incisors.

Premature loss of primary anterior teeth due to trauma--potential short- and long-term sequelae.

Traumatic dental injuries (TDIs) can result in the premature loss of primary anterior teeth due to an immediate avulsion, extraction later after the injury because of poor prognosis or late complications, or early exfoliation. There are a number of potential considerations or sequelae as a result of this premature loss that have been cited in the dental literature, which include esthetics, quality of life, eating, speech development, arch integrity (space loss), development and eruption of the permanent successors, and development of oral habits. This article provides a comprehensive review of the dental literature on the possible consequences of premature loss of maxillary primary incisors following TDI.

Replantation of avulsed primary incisors: a critical review of a controversial treatment.

Compared with the abundant literature on the replantation of avulsed permanent teeth, the literature on replantation of avulsed primary teeth is significantly more limited. A search of PubMed, using the terms: primary teeth, primary incisors, avulsion, exarticulation, replantation and reposition, and search in the reference list of the relevant articles, revealed 16 case reports of replantation of 31 primary incisors in 24 children. This article is a critical review of the arguments against replantation that have been presented in textbooks, review articles, and clinical guidelines.

Bilateral complicated crown fractures secondary to chin injury: a case report.

Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper.

Parents' ability to recall past injuries to maxillary primary incisors in their children.

AIM: To evaluate the ability of parents to recall past injuries to their children's maxillary primary incisors. MATERIALS AND METHODS: Clinical and radiographic trauma-related major and minor signs observed in the first dental visit of 727 preschool children were recorded. Major signs included crown fracture, coronal discoloration, internal resorption, pulp canal obliteration, swelling, fistula, and periapical lesion. Minor signs included enamel cracks, sensitivity to percussion, dull or metallic sound on percussion, increased mobility, and widened periodontal ligament. Children were divided into groups: CT = certainly traumatized (presenting with at least one major sign or a combination of three minor signs), PT = probably traumatized (presenting with one or two minor signs) and NT = not traumatized. Accompanying parents were asked to recall past injuries to their children's teeth. Possible replies were 'no', 'yes' and 'probably yes'. Disagreement when both parents were present was recorded as 'yes'. Crown fractures involving dentin, coronal discoloration, swelling and fistula were defined as 'observable signs of trauma'. RESULTS: One-hundred and eighteen children were accompanied by fathers, 411 by mothers and 198 by both. The CT group comprised 464 children; the PT group, 103; and the NT group, 160, with no statistically significant differences by gender. Parents' positive recall was similar for boys (33.3%) and girls (31.0%). Mothers recalled trauma in 32.6% and fathers in 27.1% of their children. Parents failed to recall trauma in 52.6% of the CT-group children and in 43.5% of the PT-group children. Parents failed to recall trauma in 37.6% of the children who had observable signs of trauma. CONCLUSIONS: Parents' recall of dental trauma occurring in their children's maxillary primary incisors was reliable in <50% of the cases.

Long-term follow up of root canal treated primary molars.

BACKGROUND: Root canal treatment (RCT) is commonly performed to preserve primary molars with an infected or necrotic pulp. AIM: This study evaluates the long-term effects of RCT in primary molars on the development and eruption of their permanent successors. METHODS: This is a retrospective study of treatment of pulpectomised primary molars in a public dental clinic. All teeth were treated by the same operator using the same material (Endoflas F.S.) and the same method. Records of 194 patients with 242 pulpectomised primary molars (124 in 97 boys and 118 in 97 girls) met the inclusion criteria. The children's age at the time of treatment ranged from 5 to 11 years (mean 6.72). Follow-up time ranged from 6 to 113 months (mean 33.5). RESULTS: Eight (3.3%) of the 242 primary molars presented a new radiolucent defect or enlargement of existing periapical radiolucency. Of the 106 molars followed until eruption of the permanent successor, none had radiographic pathological signs. Of 17 permanent teeth evaluated clinically, three were erupted into a rotated alignment, and one premolar presented hypocalcified defect in the enamel. CONCLUSIONS: Failure of root canal treatment in primary molars may be evident from development of new radiolucent defects or enlargement of existing defects. No relationship was found between RCT in the primary molars and the appearance of enamel defects or the ectopic eruption of following permanent teeth.

Parents' attitude toward their children's appearance in the case of esthetic defects of the anterior primary teeth.

PURPOSE: To evaluate parents' attitude toward esthetic defects of maxillary primary incisors and the association between various demographic parameters and the treatment parents chose for their children. METHODS: The study consisted of two parts: 1) a clinical examination of the child's primary incisors, and 2) a questionnaire for the accompanying parent. 362 parents who accompanied 294 children aged 1-6 years, participated in the study. They were divided in 2 groups: parents' accompanying children with esthetic defects (study group) and parents' of children without esthetic defects (control group). RESULTS: Significantly more parents in the study group (73%) recognized an esthetic problem in their child's incisors, compared to (17%) in the control group. Eighty seven percent (219 in the Study Group [85.20%] and 97 in the Control Group [92.4%]) advocated dental treatment to save a primary tooth even if the chances for success were only 50%. 35.9% rejected the idea of a prosthetic replacement for a lost primary incisor. The same percentage of parents (35.9%) answered that they "want it 'very much'" while the rest (28.2%) chose intermediate scores '2-3' on a scale of '0' (= not at all) to '5' (= yes! very much). CONCLUSION: Parents are interested in a conservative treatment for preserving esthetically damaged incisors, but will be less enthusiastic to replace extracted or missing teeth with an esthetic device.

Pulp Aspects of Traumatic Dental Injuries in Primary Incisors: Dark Coronal Discoloration.

Dark coronal discoloration is a common outcome of traumatic dental injuries in primary incisors. However, there are only a few research studies on the mechanism that causes dark discoloration, the condition of the pulp, and the preferred treatment of such teeth. This article is a summary of the author's research studies and personal experience regarding dark coronal discoloration of traumatized primary incisors.

Success rate of root canal treatment in primary molars.

OBJECTIVES: The purpose of the present retrospective large-scale study is to evaluate rate of success of root canal treatments in primary infected molars using Endoflas F.S as a filling material. METHODS: The study material consisted of 382 records of root canal treated primary molars of which 174 teeth with high quality radiographs and sufficient data comprised the 'study group'. The technique for root canal treatment in one visit is described. Treatment was considered success if clinically the tooth was asymptomatic and radiographs showed decrease or no change in pre-existing pathologic radiolucent defects. RESULTS: In the total pulpectomy group there was a statistically significant difference between mandibular teeth presented with a periapical lesion prior to the treatment compared to maxillary teeth. This difference was not significant in the study group. Decrease in post treatment radicular radiographic defects was statistically significant more in the maxilla compared to the mandible. The success rate of teeth restored with a permanent restoration (stainless steel crown or amalgam filling) was statistically significant higher than those teeth left with a temporary filling. There was no statistically significant difference between success rate and the extent of root canal filling material. Rate of success was not statistically different depending on pre-existing radiolucent area prior to RCT. CONCLUSIONS: Endoflas F.S. can be used as an alternative root canal filling material for primary teeth. One condition for success is the prevention of microleakage. A permanent restoration should be placed as soon as possible after clinical signs and symptoms of inflammation are eliminated.

Long-term evaluation of pulpotomy in primary molars using mineral trioxide aggregate or formocresol.

PURPOSE: The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). METHODS: Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). RESULTS: The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of the MTA group and in 52% of the FC group (total=55%). CONCLUSIONS: MTA showed a higher (though not statistically significant) long-term clinical and radiographic success rate than formocresol, and can be recommended as its replacement as, unlike FC, MTA does not induce undesirable responses.

Treatment of crown fractures with pulp exposure in primary incisors.

The treatment options of enamel dentin crown fractures with pulpal exposure in the primary dentition traditionally consist of direct pulp capping, pulpotomy, pulpectomy, or extraction. Many clinicians disagree on the most appropriate treatment, and individual preferences exist within dentistry. Partial pulpotomy, also known as the Cvek pulpotomy, is a mode of treatment which is widely used in the permanent dentition but less so in primary teeth. This conservative technique is described and its advantages over the others are presented. In addition, a report of a case with a 2-year follow-up is also included. The purposes of this article are: (1) to present the indications and contraindications of the various treatment modalities for primary incisors with complicated crown fractures; and (2) to suggest partial pulpotomy as a conservative and more appropriate approach for primary incisors with complicated crown fracture.

Success rate of formocresol pulpotomy in primary molars restored with stainless steel crown vs amalga.

PURPOSE: The purpose of this retrospective study was to compare the success rates of formocresol pulpotomy in primary molars restored with stainless steel crowns (SSC) to those restored with amalgam (AM). METHODS: Radiographs of pulpotomized primary molars restored with SSC or AM in the principal author's pediatric dentist practice were evaluated and defined as a "failure" when one or more of the following signs were present: internal (IR) or external (ER) root resorption and periapical (PR) or inter-radicular (IRR) radiolucency. Pulp canal obliteration was not regarded as failure. Three hundred and forty-one molars were available for follow-up evaluations ranging from 6 to 103 months. RESULTS: Forty-seven (14%) teeth were defined as "failure," with a rate of 13% (36/287) for teeth restored with SSC and 20% (11/54) for AM. This difference was not statistically significant (P>0.1). Failure rates of 2 surfaces AM was 23% (7/30), much higher than that of one surface AM (10%, 2/20). Most of the failed teeth presented more than one pathologic finding, with IR being the most frequently observed (36%), followed by ER (31%), IRR (22%) and PR (11%). Pulp canal obliteration was detected in 80% of the teeth, with similar rates in both groups. Failures were observed initially after a mean follow-up of 27 and 29 months in teeth restored with AM and SSC, respectively. CONCLUSIONS: Pulpotomized primary molars can be successfully restored with one surface amalgam if their natural exfoliation is expected within not more than two years.

The diagnostic value of lateral extraoral radiography for intruded maxillary primary incisors.

PURPOSE: The purpose of the study was to assess the contribution of a lateral extraoral radiograph for diagnosing the relation between the root of intruded maxillary primary incisors and their permanent successors. METHODS: Three pediatric dentists examined intruded primary teeth 0-7 days after injury. The relations between the primary and permanent teeth were assessed in three separate steps: 1) evaluation of clinical signs only; 2) evaluation of a periapical radiograph (no lateral radiograph); 3) evaluation of a lateral extraoral radiograph. The clinical and radiographic signs used to assess the relations were recorded. The lateral extraoral radiograph was regarded as contributory to diagnosis if the assessment after the third step differed significantly from that made after the first and second steps. Ninety-three evaluations of 53 intruded teeth in 37 children were available for analysis. RESULTS: The lateral extraoral radiograph was found valuable for assessment of the primary incisor's root alignment in only 5% (5/93) of the evaluations in which neither the clinical examination nor the periapical radiograph were contributory. Four of these five cases were in children less than 20 months old. In all other cases, the lateral radiograph was not contributory for two main reasons: It could not be evaluated due to overlap of multiple intruded teeth and/or when the teeth intruded were lateral incisors, and when the clinical and periapical radiographs were sufficient for diagnosis. CONCLUSIONS: Lateral extraoral radiographs should not be used routinely in cases of intrusion of primary incisors. The operator should base his or her diagnosis on clinical findings and examination of a periapical radiograph. The lateral extraoral radiograph should be taken only when its expected contribution to diagnosis can be confirmed, as in cases of children younger than 20 months.

Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients.

PURPOSE: The purpose of this study was to compare the effectiveness of midazolam (MDZ) alone to a combination of MDZ and hydroxyzine (MDZH) when sedating young children for dental treatment. METHODS: This was a prospective, double-blinded, crossover clinical study of young uncooperative children in need of at least 2 restorative visits. Twenty-eight children, ages 21 to 56 months, with a mean age of 36.6 months, participated in this study. The subjects were assigned randomly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment. The alternative drug regimen was administered at the second appointment. All subjects also received 50% nitrous oxide and were restrained with a papoose board. The child's behavior (quiet or crying, relaxed or moving) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child. At the conclusion of treatment, each session was evaluated for overall effectiveness. RESULTS: Regardless of the type of premedication, more patients exhibited quiet behavior at the beginning of treatment, with an increase in crying and movement toward the end of treatment. Regarding movement, a significant difference was observed during the first 20 minutes between the 2 regimens. MDZ showed more children exhibiting movement. During the first 30 minutes of treatment, more children cried in the MDZ group, while MDZH presented more children asleep or quiet. No significant differences were found in behavior as a function of the order the sedative regimens were given. No significant differences between the 2 regimens regarding overall behavior and success (t=0.655 at 27 degrees of freedom; P=.518) were found. CONCLUSIONS: The combination of hydroxyzine (3.7 mg/kg) with MDZ (0.3 mg/kg) administered 30 minutes before treatment resulted in safe and effective sedation for the dental treatment of young children. This combination's use might be more advantageous when compared to MDZ alone, resulting in less crying and movement during the first 30 and 20 minutes, respectively.

Pre-eruptive intracoronal radiolucent defect: a case of a nonprogressive lesion.

Pre-eruptive intracoronal resorption or defect is an unusual radiolucency located in the dentin, just beneath the dentin-enamel junction of unerupted teeth. The pathogenesis of the phenomenon is unclear. The present case with a radiolucency that has not changed in its dimension over a period of almost 7 years, until tooth eruption, raises a question about the progressive nature of the defect that is defined as "resorption." Resorption may not be the sole explanation for a pre-eruptive intracoronal radiolucent defect. The authors also challenge the hypothesis of "local pressure" as a prime cause for the defect. The authors conclude that, when dealing with pre-eruptive intracoronal radiolucency in permanent teeth, a conservative approach with radiographic follow-up is the recommended treatment if the lesion does not seem to endanger the pulp. Intervention can be postponed until after tooth eruption when treatment does not require surgical intervention.

Prevalence of gingival stippling in children.

Gingival stippling is a characteristic of the healthy attached gingiva and its diminution or loss has been considered as a sign of gingival disease. The clinician however, must take in consideration that its pattern and extent varies in different mouth areas, among persons and with age. Reports on the prevalence of stippling in children are few and inconsistent. Therefore, the purpose of the present study was to describe the prevalence of gingival stippling in children of various ages. Fifty-five high quality anterior oral color slides of children (25 girls and 30 boys) aged 1 to 10 years, were examined for the presence of stippling. The average age of the study population was 5.1 years (S. E. = 0.3). The overall prevalence of stippling was 56.4%. Analysis of the differences between boys and girls in age (t-test) or the prevalence of stippling (Chi square) did not indicate statistical significance (p>0.05). Stippling was evident from 3 years of age and thereafter, with no particular trend of change with age. Stippling was found in 47.2% of the maxillary areas, in 41.7% of the mandibular areas and in 26.1% in both arches of the same child. The differences in distribution of stippling by gender and arch were not statistically significant (Chi square, p>0.05). In conclusion, gingival stippling was found to be a normal characteristic in 56.3% of 3 to 10-year-old children, without significant differences in prevalence related to arch, gender or age.

Degree of root resorption after root canal treatment with iodoform-containing filling material in primary molars.

OBJECTIVE: To compare the degree of root resorption in endodontically treated primary molars with that of homologous teeth without root canal treatment. METHOD AND MATERIALS: A retrospective study was carried out comprising 105 records of children who had received root canal treatment in a primary molar. Mean age at the time of treatment was 7.0 ± 1.4 years. Inclusion criteria included one endodontically treated primary molar and a homologous primary molar with no root canal treatment on the other side of the mouth. All teeth were treated by the same operator in the same way using the same iodoform-containing root canal filling material. The degree of root resorption was compared by radiographic evaluation 12 or more months posttreatment. RESULTS: The degree of root resorption on the final follow-up radiograph in the endodontically treated primary molars was significantly higher (P < .05) than the degree of root resorption in the homologous teeth. The degree of root resorption was higher in boys than in girls. No statistical significance was found between the degree of root resorption and the age at the time of treatment in either the root canal-treated teeth or the homologous teeth. Follow-up radiographs demonstrated a higher degree of root resorption in the root canal treated teeth than in the homologous teeth, regardless of the type of treatment performed on the homologous side. CONCLUSION: Root canal treatment performed with iodoform-containing root canal filling material accelerates root resorption in root canal-treated primary molars compared with homologous teeth without endodontic treatment. Clinicians should be aware that endodontically treated teeth will probably shed before homologous ones that are not root canal treated.

Audiovisual video eyeglass distraction during dental treatment in children.

OBJECTIVE: To investigate the effect of audiovisual distraction (AVD) with video eyeglasses on the behavior of children undergoing dental restorative treatment and the satisfaction with this treatment as reported by children, parents, dental students, and experienced pediatric dentists. METHOD AND MATERIALS: During restorative dental treatment, 61 children wore wireless audiovisual eyeglasses with earphones, and 59 received dental treatment under nitrous oxide sedation. A Frankl behavior rating score was assigned to each child. After each treatment, a Houpt behavior rating score was recorded by an independent observer. A visual analogue scale (VAS) score was obtained from children who wore AVD eyeglasses, their parents, and the clinician. RESULTS: General behavior during the AVD sessions, as rated by the Houpt scales, was excellent (rating 6) for 70% of the children, very good (rating 5) for 19%, good (rating 4) for 6%, and fair, poor, or aborted for only 5%. VAS scores showed 85% of the children, including those with poor Frankl ratings, to be satisfied with the AVD eyeglasses. Satisfaction of parents and clinicians was also high. CONCLUSION: Audiovisual eyeglasses offer an effective distraction tool for the alleviation of the unpleasantness and distress that arises during dental restorative procedures.