Dental caries and dental developmental defects as adverse effects of antineoplastic treatment in childhood cancer survivors.

PURPOSE: To evaluate the prevalence of dental caries and dental developmental defects (DDD) in childhood cancer survivors (CCS) and identify disease and treatment-related risk factors. METHODS: CCS aged up to 21 years, diagnosed with a malignancy before the age of 10 years and in remission for at least one year were included. Data were collected from patients' medical records and through a clinical examination where presence of dental caries and prevalence of DDD were recorded. Fisher's exact test was used to assess possible correlations and multivariate regression analysis to determine risk factors for defect development. RESULTS: Seventy CCS with a mean chronological age of 11.2 years at the time of examination, mean age at cancer diagnosis of 4.17 years, and a mean post-treatment follow-up time of 5.48 years were included. Mean DMFT/dmft was 1.31, with 29% of survivors presenting with at least one carious lesion. Younger patients on the day of examination and patients treated with higher radiation dose, showed significantly higher prevalence of dental caries. The prevalence of DDD was 59%, with demarcated opacities being the defect most commonly observed (40%). Age at dental examination, diagnosis, age at diagnosis, and time that have elapsed since the end of treatment were the factors significantly affecting its prevalence. Regression analysis revealed that age at examination was the only factor significantly associated with the presence of coronal defects. CONCLUSION: A great number of CCS presented with at least one carious lesion or a DDD, with the prevalence being significantly associated with various disease-specific characteristics, but age at dental examination the only significant predictor.

Tooth-surface distribution of caries in Greek schoolchildren, using ICDAS-II index. A national pathfinder survey.

AIM: The objective of this cross-sectional nationwide study was to assess the caries status of Greek children, in regard to the severity and the distribution pattern of the lesions in the primary and permanent dentition at a tooth-surface level, based on ICDAS-II criteria. METHODS: Study Design: A national survey was conducted in 15 urban and 9 rural sites and about 50 subjects were examined at each location across the country. Caries data, based on ICDAS-II index, were recorded on 4,410 children aged 5, 12, and 15-years by 10 calibrated dentists. The rankings of the most affected tooth-surfaces, the most vulnerable teeth found cavitated, the right-left symmetry of caries stages and its pattern of distribution shown per jaw or dentition were determined by using descriptive statistics (SPSS v.20). CONCLUSION: Caries lesions were quite frequent in this school aged child population and the most common code of ICDAS-II observed was that of incipient enamel caries, mainly on the occlusal surfaces, indicative of the need for fissure sealant application. For those surfaces with ICDAS-II=3-6, dental care and intensive prevention programmes, both at home and office based, are needed.

Oral hygiene and periodontal condition of 12- and 15-year-old Greek adolescents. Socio-behavioural risk indicators, self- rated oral health and changes in 10 years.

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year-old Greek adolescents in relation to socio- demographic and behavioural indicators and identify national trends. MATERIALS AND METHODS: In a stratified cluster sample of 2,478 participants, the Simplified Debris Index (DI-S) and the Community Periodontal Index (CPI) were calculated. Socio- demographic/behavioural data were collected through structured questionnaires. Multivariate ordinary regression examined the effect of socio-behavioural indicators on oral hygiene and periodontal conditions. RESULTS: 51.7% of the 12-year-olds and 56.9% of the 15- year-olds had fair and good oral hygiene, respectively. Approximately 30% of the adolescents had healthy periodontium. Bleeding on probing was detected in 23.6% and 21.6% of the 12- and the 15-year-olds, accordingly. Calculus was found in 46.2% and 44.3% of the 12- and the 15-year-old groups, correspondingly. The prevalence of periodontal pockets ?4mm was 3.2%. Significantly higher DI-S scores were found among 12-year-olds who were males, had lower educated mothers or did not use dental floss and among adolescents who brushed their teeth

In vivo validation of Diagnodent and Vista proof devices vs ICDAS clinical criteria on incipient carious lesions in adults.

AIM: This study aimed to validate the in vivo performance of Diagnodent and Vista proof devices with ICDAS clinical criteria on incipient carious lesions in adults. METHODS: A total of 44 adult patients with 230 incipient occlusal caries took part in the present study. These patients were assessed for caries with ICDAS clinical criteria, and then they were examined with Diagnodent pen™ (DP) and Vista proof™ (VP) fluorescence devices. Sensitivity, specificity accuracy, and ICC agreement between devices with ICDAS criteria, which served as a gold standard, were evaluated. RESULTS: Regarding the caries diagnostic devices, sensitivity and specificity found 0,61 and 0,51 for DP, and 0,64 and 0,54 for VP, respectively. The different detection methods showed no differences in diagnostic capacity (Az values) each other, and ICC values with ICDAS criteria were calculated low. CONCLUSIONS: DP and VP do not contribute to incipient occlusal carious lesions' better detective ability compared with visual ICDAS clinical criteria. The DP and VP devices presented no differences in diagnostic ability and measured lesion depth concerning the visual examination.

Clinical Evaluation of Two Different Prevention Programs in Adults Depending on Their Caries Risk Profile: One-year Results.

The aim of this study was to investigate the management of incipient caries lesions in adults with two preventive protocols. A total of 44 adult patients with high, moderate and low caries risk with 516 incipient caries took part in the study. These patients were assessed for caries with International Caries Detection and Assessment System (ICDAS) criteria and were then divided into three groups depending on their caries risk profile: a high-risk group (group A), a moderate-risk group (group B), and a low-risk group (group C). Participants in each group were further divided randomly into two subgroups. In subgroups A1, B1, and C1, an intensive preventive protocol was applied, while in subgroups A2, B2, and C2, the protocol consisted only of instructions in oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000-ppm fluoride toothpaste, use of amorphous calcium phosphate-casein phosphopeptide, applications of sealants for occlusal lesions (ICDAS code 2), and minimal resin restorations for occlusal lesions (ICDAS code 3). There was no statistically significant difference in the number of lesions (baseline and after one year) in the high-risk and moderate-risk groups that received the intensive protocol (groups A1 and B1), while the control groups were statistically significant different (groups A2 and B2). In the low-risk group, there was no statistically significant difference in the number of lesions (groups C1 and C2). The two different preventive protocols in the high- and moderate-risk groups presented differences in effectiveness, while in the low-risk group, no significant difference was demonstrated.

Validation of fluorescence devices for evaluation of white spot lesions in orthodontic patients.

AIM: To clinically validate the fluorescence devices, DIAGNOdent Pen™ and Vista Proof™ for the evaluation of non-cavitated white spot lesions (WSL) in orthodontic patients and using direct visual examination after the brackets removal, as the gold standard. METHODS: The sample consisted of 31 patients, 13-28 years old, under fixed appliance orthodontic treatment. Teeth (N = 619) were evaluated with the brackets on, after cleaning and air drying, by direct, indirect visual examination and using the DIAGNOdent Pen™ device. After debonding with direct visual examination and the Vista Proof™ device. WSL were scored with the Gorelick Index for visual examination. The fluorescence devices were validated by calculating sensitivity, specificity and accuracy while ROC curves and area under the curve were used for comparison among the examination methods. RESULTS: Among the different diagnostic methods, visual examination recorded the highest degree of accuracy. The performance of the fluorescence devices was poor compared with that of the visual methods for mild WSL, while for more extended lesions no difference was found. A comparison between the validity of the two devices' showed no statistically significant difference. CONCLUSIONS: The validity of DIAGNOdent Pen™ and Vista Proof™ for the chairside diagnosis and quantification of non-cavitated WSL in orthodontic patients was moderate, and no better as compared to the visual diagnostic methods. The fluorescence devices performed similarly to the visual examination for more extended WSL and poorer for milder ones. Validity between the two devices did not differ.

Dental intrinsic green pigmentation from primary to mixed dentition: clinical and histological findings.

AIM: The aim of this report is to present a case of a child with green pigmentation of the primary dentition caused by bilirubin elevation due to choleostasis during neonatal life, and the 5-year follow-up. CASE REPORT: The case presented initially with bands of green pigmentation of all primary teeth in a pattern that followed the time of their calcification, with those formed earlier being more severely affected. Fading of the green pigmentation was detected during the follow-up, while erupted lower permanent incisors were normal. Histological findings of an exfoliated primary incisor showed a green line at the enamel-dentine junction with the external surface of the dentine showing a band of variable width and irregularly arranged tubules. CONCLUSION: Bilirubin green pigmentation of primary teeth follows a chronological pattern and its intensity fades with time. Overlying enamel in affected areas may appear thinner.

Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: a double-blind randomized controlled trial.

OBJECTIVES: To evaluate the effect of biannual fluoride varnish applications in preschool children as an adjunct to school-based oral health promotion and supervised tooth brushing with 1000ppm fluoride toothpaste. METHODS: 424 preschool children, 2-5 year of age, from 10 different pre schools in Athens were invited to this double-blind randomized controlled trial and 328 children completed the 2-year programme. All children received oral health education with hygiene instructions twice yearly and attended supervised tooth brushing once daily. The test group was treated with fluoride varnish (0.9% diflurosilane) biannually while the control group had placebo applications. The primary endpoints were caries prevalence and increment; secondary outcomes were gingival health, mutans streptococci growth and salivary buffer capacity. RESULTS: The groups were balanced at baseline and no significant differences in caries prevalence or increment were displayed between the groups after 1 and 2 years, respectively. There was a reduced number of new pre-cavitated enamel lesions during the second year of the study (p=0.05) but the decrease was not statistically significant. The secondary endpoints were unaffected by the varnish treatments. CONCLUSIONS: Under the present conditions, biannual fluoride varnish applications in preschool children did not show significant caries-preventive benefits when provided as an adjunct to school-based supervised tooth brushing with 1000ppm fluoride toothpaste. CLINICAL SIGNIFICANCE: In community based, caries prevention programmes, for high caries risk preschool children, a fluoride varnish may add little to caries prevention, when 1000ppm fluoride toothpaste is used daily.

Generalized pulp stones: report of a case with 6-year follow-up.

AIM: To present a mildly mentally retarded patient with generalized pulp stone formation and the six-year follow-up and to discuss the differential diagnosis of the case. SUMMARY: Pulp stones were radiographically detected in the pulp chamber of all permanent teeth in a 25-year-old woman with mild mental retardation who presented for endodontic treatment on tooth no 11 (FDI). The patient's medical, dental and family history was noncontributory. The pulp stone in the pulp chamber of tooth no 11 was removed during canal filing, and root canal treatment completed uneventfully. Six years later, the patient was re-evaluated and the pulp stones were unchanged radiographically. The patient's family history, facial phenotype and karyotype as well as the radiographic, laboratory and physical examination were not consistent with any of the known genetic syndromes associated with generalized pulp stones. Molecular analysis for the DSPP gene proved negative. The aetiology of this case remains unknown. KEY POINTS: Generalized pulp stones occur rarely; Such patients should be referred for genetic evaluation because pulp stones are mostly associated with genetic dentine defects; Pulp stones may hinder root canal treatment; Pulp stones may remain unchanged overtime.

Histological validation of a laser fluorescence device for occlusal caries detection in primary molars.

AIM: This was to validate in vitro a laser fluorescence device, DIAGNOdent 2095 - DD, on the detection of occlusal caries in primary molars using the histological examination as the gold standard and to compare the laser fluorescence findings to the results of the conventionally used diagnostic methods. STUDY DESIGN AND METHODS: 111 occlusal pits in 24 extracted primary molars were examined for caries by one trained operator (Intra-examiner Reliability K>0.83), using direct visual (DV), indirect visual (IDV), radiographic (XR) and fluorescence (DD) examinations and then the extent of caries was determined histologically. Sensitivity, specificity, accuracy and the area under the ROC curve - AUC were calculated for all methods, using the histological evaluation as the gold standard. STATISTICS: Differences between examination methods were estimated by pair-wise comparison of their respective AUC. RESULTS: DD's sensitivity for enamel and for dentine lesions respectively was 0.90 and 0.36, its specificity 0.36 and 0.91 and its accuracy 0.61 and 0.65. The DD device exhibited better sensitivity than specificity for enamel lesions and better specificity than sensitivity for lesions into dentine. The DD device was found to have the highest sensitivity for lesions into enamel, specificity and accuracy and as well as the largest AUC compared with all other methods. For lesions into dentine however, according to AUC values the DD was not statistically significant different from the other methods. CONCLUSION: Compared with the other methods, the DD had the highest validity for enamel caries while its validity for caries into dentine was not statistical different from the other methods.

Gingival fibromatosis and significant tooth eruption delay in an 11-year-old male: a 30-month follow-up.

This case report describes the dental management of an unusual case of idiopathic gingival fibromatosis with multiple impacted primary teeth, and the absence of eruption of permanent teeth, in an 11-year-old boy and at the 30-month follow-up. The patient presented with severely enlarged gingival tissues affecting both arches and multiple retained and non-erupted primary teeth. He had already been subjected to localized gingivectomies at the ages of 7 and 9 years. He had no known syndrome and there was no family history of any similar disorder. The patient was treated under general anaesthesia to remove the excessive gingival tissues using apically positioned flaps. During the surgical procedure, over-retained and unerupted impacted primary teeth were extracted in order to facilitate the eruption of the permanent successors. Two years postoperatively, there was no recurrence of the gingival enlargement. Overdentures were then constructed because none of the permanent teeth had yet erupted. Furthermore, pre-eruptive coronal resorption was detected radiographically affecting the crown of the unerupted 36. Thirty months postoperatively, no recurrence of gingival enlargement was seen, but the permanent teeth had still not erupted.

Subgingival foreign body embedment in a preschool child: management with three and a half years follow-up.

CASE REPORT: This is a case report of diagnosis and management of a foreign body embedded in the gingivae of a preschool child. A 3 year-old girl presented with pain, mobility and intraoral oedema of the upper left primary canine (#63). An angular, diffuse radiolucency on the mesial aspect of the primary canine was observed in the periapical radiograph and within this radiolucency, a linear radiopacity was noted in contact with the mesial surface of the root. A clinical diagnosis of severe localized periodontal involvement due to foreign body embedment was made. It was initially attempted unsuccessfully to remove the foreign body by subgingival root scaling and planning. The area was then surgically exposed. Upon flap elevation, a tubular plastic material similar to those used for the insulation of electric wires was found to encircle tightly the cervical area of the root of the primary canine, which was removed. Three months after the surgery, the gingiva of the affected tooth had attained its normal color but had started to recede for about 1 mm. One year post surgery, the gingival recession had progressed to 3 mm and a carious lesion had already developed at the denuded root surface. Three and a half years post surgery a mild inflammation of the buccal gingivae was apparent, but periodontal healing had occurred. CONCLUSION: The dentist must always consider the possibility of a foreign body embedment in the periodontal tissues of children and be familiar to the clinical signs and symptoms as well as the proper treatment procedures.

Clinical evaluation of a polyacid-modified resin composite (compomer) in Class II restorations of primary teeth: a two-year follow-up study.

PURPOSE: The aim of the study was to assess the clinical performance of a compomer restorative material (Dyract, DeTrey/Dentsply) for the restoration of Class II cavities, extended into dentin in primary teeth. METHODS: The sample of the study consisted of 25 patients with 68 restored cavities. The restorations were evaluated with the modified Ryge criteria at baseline and after 6, 12 and 24 months. Examination was clinical, radiographic, and observation of cast replicas under scanning electron microscope (SEM). RESULTS: After 24 months, 100% of the restorations were retained, 3% presented bulk fractures, and 6% developed secondary caries at cervical margins. After 24 months, there was a significant reduction in marginal integrity while there was only slight change in anatomic form. Proximal contact was defective in 6% of the restorations and 8% showed marginal discoloration. SEM evaluation revealed a generalized occlusal and scattered marginal wear with no marginal gaps. CONCLUSION: The compomer presented acceptable clinical performance in Class II restorations of primary teeth after 24 months in service.

Urinary catecholamine levels and gingivitis in children.

This study investigated the relationship between gingivitis and emotionally stressful states measured by the urinary catecholamines in children. Three-hundred and fourteen (314) children, boys and girls, aged 6 to 8 years were included in the study. Gingivitis was recorded by the gingival bleeding index and dental plaque by the plaque control record index. Proximal decayed surfaces, faulty restorations, and stainless steel crowns were diagnosed clinically and radiographically. Information concerning systemic and socioeconomic factors was collected by a questionnaire. A 24-hour urine sample was collected for each subject and analyzed by the HPLC technique to assay the catecholamine content. The multiple-regression analysis was carried out to test whether gingivitis was affected by the studied variables. The 95% probability was used. The results showed that epinephrine, norepinephrine, and dopamine did not have a significant association with gingival index. Dental plaque and proximal decayed surfaces significantly affected gingivitis. Of the socioeconomic factors, mother's education had a significant association with gingivitis when all factors were included in the analysis. The data suggest that emotionally stressful states may not increase the probability of developing gingivitis in children of this age.

[Fluoride poisoning: mechanism, symptoms and treatment]. / Deleteriase apo phthorioucha. Mechanismos, symptomatoligia kai antimetopise.

The use of fluorides in doses recommended by the International Dental Association is totally safe. Fluoride toxicity occurs only when these doses are exceeded. The human organism is capable of metabolizing fluoride when administered in low doses. Toxic doses though can cause signs and symptoms which vary from simple gastric disturbances to serious health problems or even death. The least fluoride dose which can cause signs and symptoms of fluoride poisoning is called possibly toxic dose. In the present paper the amount of 5 mgF-/kg is considered as the probably toxic dose of fluoride. In the case of accidental ingestion of a fluoride overdose the dentist should be also to calculate the amount of fluoride ingested. A simple method of calculating the amount of fluoride swallowed is presented in this paper. In addition the emergency treatment for fluoride overdoses is discussed. The danger of acute fluoride poisoning has increased lately, especially for children, due to the variety, pleasant taste smell and colour of fluoride products. Dentists should be able to estimate the toxic potential of fluoride in case of accidental poisoning and advise appropriate treatment.