Estimating age using permanent molars and third cervical vertebrae shape with a novel semi-automated method.

Estimating chronological age accurately in young adults is difficult and additional methods are required to increase the accuracy. This study explored a new semi-automated method to assess shape change of third cervical vertebra (C3) with age in the living; comparing this as a method to determine whether individuals could be categorised into being less than 18 years of age (<18), or at least 18 years of age (≥18) with tooth formation of the second and third mandibular molars (M2 and M3). The sample was panoramic and lateral skull radiographs of 174 dental patients (78 males, 96 females aged 15-22 years). Twelve variables were compared in two age categories: younger than 18 and at least 18 years of age in males and females separately using a t-test. Tooth formation of M2 and M3 was assessed. Mean values of eight variables of C3 in males and one variable in females were significantly different between the two age categories (p < 0.05). Results for males showed that the best age indicator for age ≥18 was the ratio between height and width of C3 and for females, the ratio between diagonals. Results for molars showed that M2 was mature in 69% of males and 83% of females, within the expected age range of 14-16 years. M3 was highly variable ranging from stages 6-14 for both; M3 was missing in 24% of males and 28% of females and mature in 14% of males and 15% of females. The conclusion was that shape change of C3 has potential as an additional method to group individuals <18 and ≥ 18 years of age.

How do foster carers manage the oral health of children in foster care? A qualitative study.

OBJECTIVES: This qualitative study explored how the foster family environment influenced children's oral health. It also aimed to better understand foster carers' oral health knowledge, attitudes and experiences of managing foster children's oral health behaviours and oral health care. METHODS: An interpretative phenomenological analysis (IPA) study design was used to recruit a purposive sample of foster carers in Tower Hamlets, United Kingdom, from a range of backgrounds (maximum variation sampling). Participants were aged 21 years and older and provided full-time foster care for children for a minimum of 1 year. The foster carers took part in focus groups that were audio-recorded and transcribed verbatim. Data analysis followed a five-step IPA process, which included reading the transcripts, note taking, identifying emerging themes, connecting related themes and writing up the final themes. Iterative data gathering and analysis continued to reach thematic saturation. RESULTS: Three focus groups were conducted, involving a total of 12 foster carers. Eight of the 12 participants had fostered children for more than 10 years and they were currently fostering 22 children aged five to 18 years old. Four themes emerged from within the context of the supportive and nurturing foster family environment that described how foster carers' responded to and managed the oral health of their foster children. Foster carers had adopted an oral health caregiving role, "in loco parentis" responding to the poor oral health of their vulnerable foster children. They were hypervigilant about establishing and monitoring children's oral health routines and taking their children to see a dentist; these were seen as an integral part of being good foster carers. They were knowledgeable about the causes of children's oral ill health, gained from their own dental experiences and from looking after their own children. Foster carers had experienced tensions while adopting this oral health caregiving role with dentists who had refused to see younger children. Foster carers had also experienced tensions with teenage foster children who questioned their parental authority and legitimate right to set rules about smoking and healthy eating. CONCLUSIONS: This is the first study to explore foster carers' oral health perspectives and the foster family environment within the oral health context. It highlights the unrecognized and important role that foster carers have in improving the oral health of vulnerable children. Further research is needed to explore the relationship between foster carers and dentists and to support the development of health and social care interventions to improve foster children's oral health.

A novel frameshift MSX1 mutation in a Saudi family with autosomal dominant premolar and third molar agenesis.

OBJECTIVES: In this study, the aim was to investigate a consanguineous Saudi family with non-syndromic premolars and third molars agenesis and to identify the causal mutation(s) using whole exome sequencing. DESIGN: Family phenotype and family pedigree were constructed from clinical and radiographic examinations. Whole exome sequencing was performed in two affected members of the Saudi family using the SureSelect Human all Exon 50 Mb kit (Agilent Technologies, Inc., Santa Clara, CA) and then sequenced on an Illumina HiSeq. SNP and indel calling were performed using samtools version 0.18 and were annotated using the software ANNOVAR. RESULTS: The family pedigree showed that the inheritance was autosomal dominant. Whole exome sequencing revealed that the affected members in this family were heterozygous with a novel frameshift mutation in exon 2 of the MSX1 gene, (NM_002448:c.750_751insACCGGCTGCC, p.F251PfsX92). CONCLUSIONS: The novel MSX1 frameshift mutation was linked to a family with moderate to severe tooth agenesis phenotype affecting second premolars and third molars in both arches. This expands the genotype-phenotype of MSX1 associated conditions.

Synthesis and characterizations of a fluoride-releasing dental restorative material.

The aim was to develop an obturating material which has the tendency to release fluoride and minimize interfaces with tooth. Nano-fluorapatite (nFA) powder was synthesized by sol-gel. The composite based on polyurethane (PU) was obtained by chemically binding the nFA (10, 15, 20%wt/wt) to the diisocyanate component by utilizing in-situ polymerization. The procedure involved stepwise addition of monomeric units of PU, and optimizing the reagent concentrations to synthesize composite. The structural, phase and morphological analysis of nFA was evaluated. The structural, fluoride release and in-vitro adhesion analysis with tooth structure of PU/nFA was conducted. For fluoride release analysis the samples were stored in artificial saliva and deionized water for periodical time intervals. Bond strength of composites was analyzed by push-out test. Chemical linkage was achieved between PU and nFA without intermediate coupling agent. The insignificant difference of fluoride release pattern was observed in artificial saliva and (p≥0.05) deionized water. The PU/nFA composite provided sustained release of fluoride over a long period of time. The composite showed more adhesion toward tooth structure with the increase in concentration of nFA. Bond strength of composite was in accordance with root canal filling material, hence, the material with anti-cariogenic properties can be used as an obturating material.

Structural and in vitro adhesion analysis of a novel covalently coupled bioactive composite.

The interfacial adhesion between a restorative composite and tooth is one of the major factors that determine the ultimate performance of composite restoration. A novel polyurethane (PU) composite material was prepared by chemically binding the nano-hydroxyapatite (nHA) to the diisocyanate component in the PU backbone by utilizing solvent polymerization. The procedure involved stepwise addition of monomeric units of the PU and optimizing the reagent concentrations. The resultant materials were characterized structurally (Raman Spectroscopy) and in vitro bioactive analysis was conducted in modified-simulated body fluid for periodical time intervals. The in vitro study evaluated the push-out bond strength of existing obturating material and novel covalently linked PU/nHA composites to dentin after long-term storage in deionized water and artificial saliva. Human extracted molar roots were filled with experimental samples and analyzed at predetermined time intervals. The shear bond strength of samples was measured and surface morphologies were evaluated. Covalent bond formation was achieved between PU and nHA without intermediate coupling agent. With the increase in concentration of nHA, the composite showed more bioactivity and adhesion toward tooth structure. Bond strength of this new composite were in accordance with obutrating material, therefore, the material can be used as an obturating material because of its direct adhesion with tooth structure.

The cost of treating children and adolescents with injuries to their permanent incisors at a dental hospital in the United Kingdom.

The aim was to estimate the total cost, including the direct costs (outpatient costs) and indirect costs (missed working day) of treating children and adolescents with traumatic injuries to their incisors. Factors such as the number of treatment visits and the success of outcome were also investigated. The sample was taken from patients who attended the dental trauma clinic at a London teaching hospital between 1990 and 2001. Eighty-one patients, with 111 traumatized incisors were included in this study. The mean age was 9.9 (SD = 2.33) years and the male:female ratio was 3:2. The median number of visits and median treatment duration were eight visits and 21 months, respectively. Sixty-two per cent of the patients lived >5 miles and 25% lived >10 miles from the hospital; 44% of the patients had uncomplicated and 56% had complicated trauma to their incisors. Accidental falls, falls involving a second person, sport-related injuries and road accidents accounted for 30, 22, 22 and 17% of the total injuries. For uncomplicated trauma, 97% of the patients had a successful outcome but this was reduced to 58% for complicated trauma. The average total cost of treating a patient with one traumatic injury was 856 pounds. The best predictor for higher number of visits and unsuccessful outcome was complicated trauma with odd ratios of 4.5 and 24 (95% CI 1.5-13.7 and 2.9-194.2), respectively. It was concluded that the indirect cost was a considerably large proportion (39%) of the total cost. More specialists in paediatric dentistry are needed to improve access to care locally and thus reducing the indirect travelling cost.