Craniofacial and intraoral phenotype of Robinow syndrome forms.

Robinow syndrome (RS) is a rare genetic condition with two inheritance forms, autosomal dominant RS (DRS) and autosomal recessive RS (RRS). The characteristic features of this syndrome overlap in both inheritance forms, which make the clinical differential diagnosis difficult, especially in isolated cases. The objective of this study was to identify differences in the craniofacial and intraoral phenotype of patients with DRS and RRS. The characteristics and frequency of 13 facial and 13 intraoral clinical features associated with both DRS and RRS were assessed by direct dysmorphology examination and using a digital photographic analysis in 12 affected subjects. Although the phenotypic presentation varied and overlapped in the two forms of the syndrome, there were differences in the severity of the craniofacial and intraoral features. The craniofacial dysmorphology of RS was more severe in RRS. Nasal anomalies were the most frequent craniofacial features in both DRS and RRS. In contrast, intraoral features such as wide retromolar ridge, alveolar ridge deformation, malocclusion, dental crowding and hypodontia were more severe in patients with DRS. Overall, facial characteristics appeared less pronounced in adult subjects compared to younger subjects. Craniofacial and intraoral findings are highly variable in RS, with abnormalities of the intraoral structures being more prominent in the DRS form. We propose that the difference in the alveolar ridge deformation pattern and severity of other intraoral characteristics could enhance the differential diagnosis of the two forms of this syndrome.

The effects of a companion animal on distress in children undergoing dental procedures.

The purpose of our pilot study was to evaluate the effects of a companion animal (dog) on physiologic arousal and behavioral distress among children undergoing a dental procedure. A repeated measures experimental design was used to study 40 children between the ages of 7 and 11 years who were undergoing procedures in a pediatric dental clinic. Half the children had the dog present during the procedure and half did not. Data were obtained before, during, and after the procedure. Behavioral distress was measured using the Observational Scale of Behavioral Distress; procedures were videotaped. Physiologic arousal was measured using a YSI telethermometer taped to the child's index finger. Student's t-test and repeated measures analysis of variance were used to answer the research question. No significant differences in behavioral distress or physiologic arousal were found between experimental and control groups. Further analysis revealed that for children who initially verbalized distress on arrival at the clinic, the presence of the dog decreased physiologic arousal during the time the child was on the dental table waiting for the dentist to arrive. Further research should be conducted to verify the effect of a companion animal on initial stress experienced by children for whom the visit to the dentist is most stressful.

The Wand vs. traditional injection: a comparison of pain related behaviors.

PURPOSE: The purpose of this study was to evaluate the efficacy of a computerized anesthesia delivery system (e.g., Wand) compared to a traditional anesthesia administration, with respect to reducing disruptive pain related behavior during injections. METHODS: Subjects consisted of 62 patients between the ages of 5 and 13 requiring local anesthesia for dental restorations in the maxilla. Patients were randomly assigned to either the Wand or the traditional anesthetic delivery system. A palatal approach to the anterior and middle superior alveolar nerves and the anterior superior alveolar nerve was used with the Wand injections. Buccal infiltration and palatal injections were used for the traditional method. Pain behavior was observed and coded. Pain ratings were obtained. Subjects also rated their satisfaction with treatment. RESULTS: Results of chi-square tests found that the Wand injections produced significantly fewer patients who exhibited disruptive behavior during the initial 15 seconds of an injection when compared with those who received a traditional palatal injection. Wand patients were significantly less likely to cry, to exhibit disruptive body movements, and to require physical restraint. In contrast, there were no significant differences in disruptive behavior when comparing the Wand with the traditional buccal injection. Pain ratings showed no statistical difference between the Wand and the traditional injections. CONCLUSION: Wand injections can deliver proper anesthesia, utilizing one palatal injection site, while significantly reducing the likelihood of disruptive behaviors during the initial moments of an injection.

Caries resistance in enamel by laser irradiation and topical fluoride treatment.

PURPOSE: The purpose of this in vitro study was to compare caries resistance of sound human enamel following argon laser (AL) irradiation, as well as, combinations of topical fluoride foams and AL irradiation. METHODS AND MATERIALS: Thirty extracted human teeth were sectioned into four buccal windows and assigned to one of the following treatment groups: (1) no treatment/control; (2) low fluence (11.5 J/cm2) AL irradiation for 10 seconds; (3) 1.23% APF foam for 4 minutes followed by low fluence AL irradiation; (4) 2.0% NaF foam for 4 minutes followed by low fluence AL irradiation. Caries-like lesions were created by submerging the teeth in ten Cate solution (pH 4.5). Following a 96-hour exposure period, 100 microns longitudinal sections were prepared for polarized light evaluation. Visilog 5.1.1. image analysis software was used to obtain quantitative lesion depths. The Scheffe F-test was used to compare the lesion depths for each of the four treatment groups. RESULTS: Lesion depths were: 16.1 +/- 6 microns for control; 13.7 +/- 4 microns for AL irradiation alone; 12.1 +/- 4.3 microns for 1.23% APF foam before AL irradiation; and 11.4 +/- 5.9 microns for 2.0% NaF foam before AL irradiation. Significant difference (p < 0.05) was found between the control group and the 2.0% NaF foam before AL irradiation group. AL irradiation alone reduced lesion depth by 15% compared with the control lesion. When AL irradiation was combined with 1.23% APF foam treatment, lesion depth decreased by 25% compared with control lesions, and by 29% when combined with 2.0% NaF foam. CONCLUSION: Combining AL irradiation and 2.0% NaF foam treatment significantly enhances the resistance of sound enamel to an in vitro cariogenic challenge.

Confirmation of linkage of Van der Woude syndrome to chromosome 1q32: evidence of association with STR alleles suggests possible unique origin of the disease mutation.

Van der Woude syndrome (VWS) is an autosomal dominant craniofacial disorder with high penetrance and variable expression. Its clinical features are variably expressed, but include cleft lip and/or cleft palate, lip pits and hypodontia. All VWS families studied to date map the disease gene to a < 2 cM region of chromosome 1q32, with no evidence of locus heterogeneity. The aim of this study is to refine the localization of the VWS gene and to further assess possible heterogeneity. We analyzed four multiplex VWS families. All available members were clinically assessed and genotyped for 19 short tandem repeat markers on chromosome 1 in the VWS candidate gene region. We performed two-point and multipoint limit of detection (LOD) score analyses using a high penetrance autosomal dominant model. All families showed positive LOD scores without any recombination in the candidate region. The largest two-point LOD score was 5.87. Our assay method for short tandem repeat (STR) markers provided highly accurate size estimation of marker allele fragment sizes, and therefore enabled us to determine the specific alleles segregating with the VWS gene in each of our four families. We observed a striking pattern of STR allele sharing at several closely linked loci among our four Caucasian VWS families recruited at three different locations in the US. These results suggest the possibility of a unique origin for a mutation responsible for many or most cases of VWS.

Efficacy of a computerized local anesthesia device in pediatric dentistry.

PURPOSE: The purpose of this study was to evaluate the efficacy of a computerized anesthesia delivery system in reducing pain during injections when compared with a traditional delivery system (i.e., syringe). METHODS: Subjects consisted of 57 patients between the ages of 5 and 13 needing operative dentistry using local anesthesia. Patients were randomly assigned to either the computerized or traditional anesthesia delivery system. Inferior alveolar block injections, palatal, and buccal infiltrations were the only injections administered throughout this study. Pain behavior was videotaped and coded throughout the study. Pain perceptions were rated using a 10 point visual analogue rating scale. Subjects were also asked to rate their overall satisfaction and approval of the dentist and the treatment received. RESULTS: Results of multivariate analysis of variance indicated that there were no significant differences between the computerized and the traditional method of administering local anesthesia when comparing pain ratings and pain behavior. Average pain ratings for the computerized method were 4.5 while the average ratings for the traditional method were 3.6. In addition, all subjects reported overall satisfaction with their dental treatment and that they would be willing to return in the future. CONCLUSIONS: A computerized anesthesia injection method was found to be comparable to the traditional method of anesthesia injection.

The evaluation of child behavior during dental examination and treatment using predmedication and placebo.

The purpose of this study were to determine the association of scores on the North Carolina Behavior Rating Scale (NCBRS) to those of the Frankl scale during restorative visits; and to quantify and compare rated behavior of children during an oral examination and restorative visits involving either a placebo or a combination of chloral hydrate (CH) and hydroxyzine. Fifteen patients 21-37 months old participated in this institutionally approved study. The study was a double-blind, crossover design. Following an examination using a mirror, explorer, and prophylaxis cup, the child received either a placebo or a combination of chloral hydrate (CH) and hydroxyzine. Fifteen patients 21-37 months old participated in this institutionally approved study. The study was a double-blind, crossover design. Following an this institutionally approved study. The study was a double-blind, crossover design. Following an examination using a mirror, explorer, and prophylaxis cup, the child received either a placebo or a combination of chloral hydrate and hydroxyzine. The sequence was reversed at the next appointment. All exam and treatment visits were videotaped and analyzed using the NCBRS. In addition, all treatment visits were rated with the Frankl scale. The data were analyzed using a repeated ANOVA and correlation coefficients. The results showed a high interrater reliability (> 86% agreement) and a significant correlation between the NCBRS and Frankl scale (P < 0.001). No significant difference was found for the amount of disruptive behavior among oral examination, placebo, and medication visits (P < or = 0.097), although a consistent decrease in mean disruptive behavior for that order of visits was observed most frequently.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of stannous and sodium fluoride on coronal caries, root caries and bone loss in rice rats.

Sixty rice rats (Oryzomys palustris) were divided by littermate into 3 groups of 20 each. The 3 groups received either SnF2 (1000 parts/10(6) F), NaF (1000 parts/10(6] or double-distilled water (control). Test solutions were topically applied to molar teeth, twice daily, for 7 days. All rats were also provided with double-distilled drinking water and diet 2000 ad libitum. Experiments ended after 9 weeks. Alveolar bone loss, root and coronal caries were recorded and scored. SnF2 significantly reduced bone loss (p less than 0.05), but NaF did not. Root caries was significantly different in all 3 groups (p less than 0.05). SnF2 and NaF both reduced coronal caries significantly (p less than 0.05) in comparison to the control. However, the fluoride groups were not significantly different from each other. SnF2 may influence root caries via remineralization and an antimicrobial effect of the stannous ion.

Effect of calcium lactate in erosion and S. mutans in rats when added to Coca-Cola.

Thirty-six Sprague Dawley rats, 22 days of age, were divided randomly into three groups of 12 each and housed in a programmable feeder. The three experimental groups received either Coca-Cola (CC), Coca-Cola with calcium lactate (CC-CaL), or distilled water. The programmable feeder was set to deliver 17 equal volumes of fluid per day with each feeding period lasting between 80-90 min. All groups were given Diet MIT 305 in one premeasured amount per 24 hr period (ad libitum). The pH of the CC with calcium lactate was adjusted to match the CC without calcium lactate by the addition of citric and phosphoric acids. The test period lasted five weeks. Each week, the food and fluid consumed and the weight gain were measured. Erosion of the teeth was scored by the method of Restarski et al. (1945). ANOVA indicated that there was a significant difference in the amount of erosion among groups. A Newman-Keuls analysis showed that the mean erosion score of the CC group was significantly greater (P less than 0.05) than that of the CC-CaL and distilled water groups (54.2 +/- 0.12; 0.0275 +/- 0.0123; 0.132 +/- 0.070, respectively). There was no significant difference in erosion between the CC-CaL and distilled water groups. There was no difference in the amount of food and fluid consumed among the group of rats. In conclusion, calcium lactate added to CC resulted in significantly reduced tooth erosion in rats.

Dental abnormalities associated with campomelic syndrome: case report.

Campomelic syndrome is a rare autosomal recessive disease. It is characterized by short stature with angulation and bowing of the lower limbs, hypoplasia of the facial bones, and various other skeletal anomalies. The facies are unusually flat with micrognathia, frequent cleft palate, hypertelorism, and micro-ophthalmia. Most infants with this syndrome die from severe respiratory distress within the first hours or days of life. Those who survive infancy are mentally retarded. This case report concerns the dental treatment of a 13-year-old female with campomelic syndrome.

Oral complications in a patient with acute lymphocytic leukemia: a report of case.

Herpes viruses and Candida albicans are among the most common opportunistic pathogens infecting patients with neoplastic disease, especially those patients receiving cancer chemotherapy. Herpes virus infections have increased as treatment of oncological disease has become more aggressive and immunosuppression disorders have become more prevalent. Herpes simplex virus on the lips and mouth of a patient receiving chemotherapy can progress to multiple lesions in the mouth, larynx, and in rare instances can lead to pneumonitis and widely disseminated infection. The management and dental findings of a 13-year-old patient with acute lymphocytic leukemia are described.