"Setting the scene in early childhood" - an MID approach for life.

This article presents a discussion paper for both consideration and implementation of Minimal Intervention Dentistry (MID) principles by the general dental practitioner. It argues that if these concepts can be adopted in early childhood by both the community and the profession, "Teeth for Life" can become a reality for all. Oral Health promoting behaviours can be nurtured and supported from infancy and developed into everyday living practice for a lifetime thereby maintaining an optimal quality of life. MID techniques have become more refined and supported by scientific research in the recent times and should be considered an essential clinical guideline for the future disease management.

Caries experience of children with cardiac conditions attending the Royal Children's Hospital of Melbourne.

BACKGROUND: Poor oral health in children with cardiac conditions can have negative effects on quality of life and increased risk of infective endocarditis. The aim of this study was to investigate the caries experience in children with cardiac conditions attending the Royal Children's Hospital, Melbourne. METHODS: Medical and dental records of 428 children aged <12 years were examined. Cardiac and other medical diagnoses, decayed, missing and filled surfaces/teeth were recorded and analysed. Children referred for reasons other than caries management (NRCM) was analysed separately to address confounding of referral reason on caries experience. RESULTS: Mean age of overall study population was 4.9 (SD 2.4) years, caries prevalence 52.1%, mean dmft 3.65 (SD 4.8), mean dmfs 6.19 (SD 11.3), enamel defects prevalence 29.2%. Mean age of NRCM group was 4.6 (SD 2.4) years, caries prevalence 37.5%, mean dmft 2.37 (SD 4.2), mean dmfs 4.22 (SD 9.4), enamel defects prevalence 23.0%. Untreated carious lesions accounted for 89.9% of caries experience. Caries experience was associated with low socio-economic status, absence of comorbidity and enamel defect presence. CONCLUSIONS: High disease levels were observed. Age, socio-economic status and enamel defects were associated with caries experience, not severity of cardiac diagnoses. Early referral for dental care and improved access should be facilitated.

Caries experience in preschool children referred for specialist dental care in hospital.

BACKGROUND: Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation. METHODS: A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures. RESULTS: Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 +/- 3.8 and mean dmfs of 27.1 +/- 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6). CONCLUSIONS: The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

Somatostatin antagonist analogue stimulates growth in rats.

The somatostatin antagonist analogue cyclo Ahep-Phe-D-Trp-Lys-Thr(Bzl) stimulates growth in young female rats, while somatostatin itself has only equivocal effects on inhibiting growth.

Microleakage of resin-modified glass ionomer cement restorations: an in vitro study.

Microleakage of two resin-modified glass ionomer cement (GIC) restorative materials was compared with that of two conventional GIC restorative materials. Forty-five noncarious extracted human molars were prepared with standardized Class V cavity outlines on the buccal and lingual surfaces. The occlusal margin was in enamel and the gingival margin was in dentin/cementum. All were restored according to the manufacturers' instructions. After thermocycling, 30 teeth were placed in 2% basic fuchsin dye for 24 h, sectioned and viewed with a stereomicroscope to assess microleakage. The other 15 teeth were sectioned, replicated and prepared for marginal gap evaluation using a SEM. Differences in microleakage scores between materials were compared using Kruskal-Wallis and Mann-Whitney U tests. One resin-modified GIC restorative material showed significantly less microleakage against enamel and dentin/cementum compared to the conventional GIC restorative (p < 0.01). Marginal gap formation for both resin-modified GIC restorations was limited to the axial wall of the restorations.

Mucopolysaccharidosis: MPS VI and associated delayed tooth eruption.

Eight cases of mucopolysaccharidosis Type VI (Maroteaux-Lamy syndrome) are reviewed and two cases are presented in detail. Developmental dental anomalies including unerupted and impacted permanent teeth and associated hyperplastic tooth follicles are seen frequently in MPS patients. The surgical implications and management are discussed. All patients reviewed had significant cardiovalvular disease. It is essential for the primary medical provider to establish early basic dental care and evaluation for delayed eruption of primary and permanent dentition. This will probably minimize the possibility of infective endocarditis and allow for early treatment of impacted teeth.

Gingival fibromatosis and Klippel-Trénaunay-Weber syndrome. Case report.

A case of a young male with the Klippel-Trénaunay-Weber syndrome is described. Typical features of hemihypertrophy, hemangiomata, macrodactyly, and macrocephaly were present. The most striking oral feature was generalized severe gingival hypertrophy confirmed histologically, ultrastructurally, and by collagen analysis. In the absence of other known systemic causes of gingival enlargement, a diagnosis of familial gingival fibromatosis in association with Klippel-Trénaunay-Weber-syndrome is concluded. The combination of gingival fibromatosis and Klippel-Trénaunay-Weber syndrome has not been reported to our knowledge, it is uncertain whether this occurrence is significant or coincidental.

Manipulation of the n-3 polyunsaturated fatty acid content of muscle and adipose tissue in lambs.

Fifty Suffolk-crossbred wether lambs, with an initial live weight of 29 +/- 2.1 kg, were allocated to one of five concentrate-based diets formulated to have a similar fatty acid content (60 g/kg DM), but containing either linseed oil (high in 18:3n-3); fish oil (high in 20:5n-3 and 22:6n-3); protected linseed and soybean (PLS; high in 18:2n-6 and 18:3n-3); fish oil and marine algae (fish/algae; high in 20:5n-3 and 22:6n-3); or PLS and algae (PLS/algae; high in 18:3n-3 and 22:6n-3). Lambs were slaughtered when they reached 40 kg. Growth performance and intake were similar (P > 0.35) among treatments. By contrast, gain:feed was higher (P < 0.05) in lambs fed the fish oil compared with the linseed oil or PLS/algae diets. Total fatty acid concentration (mg/100 g) in the neutral lipid of the longissimus muscle was not affected by treatment (P > 0.87) but was least (P < 0.05) in the phospholipid fraction in lambs fed the linseed oil diet. Lambs fed either diet containing marine algae contained the highest (P < 0.05) percentage of 22:6n-3 in the phospholipid (mean of 5.2%), 2.8-fold higher than in sheep fed the fish oil diet. In lambs fed the fish/algae diet, the percentage of 20:5n-3 was highest (P < 0.05), contributing some 8.7, 0.8, and 0.5% of the total fatty acids in the muscle phospholipid, neutral lipids, and adipose tissue, respectively. The percentage of 18:3n-3 in the phospholipid fraction of the LM was highest (P < 0.05) in lambs fed the linseed oil diet (6.9%), a value double that of sheep fed the PLS diet. By contrast, lambs fed the PLS diet had twice the percentage of 18:3n-3 in the muscle neutral lipids (3.8%) than those offered the linseed oil diet, and 5.5-fold greater than lambs fed the fish/algae treatment (P < 0.05), an effect that was similar in the adipose tissue. The percentage of 18:2n-6 was highest (P < 0.05) in lambs fed the PLS diet, where it contributed 33.7, 10.1, and 11.2% in the muscle phospholipid, neutral lipids, and adipose tissue, respectively. The highest (P < 0.05) muscle PUFA-to-saturated fatty acid (P:S) ratio was obtained in lambs fed the PLS diet (0.57), followed by the PLS/algae diet (0.46), and those fed the fish oil or linseed oil diets had the lowest ratios (0.19 and 0.26, respectively). The favorable P:S ratio of lambs fed the PLS/algae diet, in conjunction with the increased levels of 20:5n-3 and 22:6n-3, enhanced the nutritional qualities of lamb to more closely resemble what is recommended for the human diet.

The polyunsaturated fatty acid composition of beef and lamb liver.

The effect on liver fatty acids of two typical beef production systems, steers fed grass (grazing) and bulls fed concentrates, was investigated. Liver fatty acids were also studied in lambs grazing grass. Total fatty acid content of liver in the beef animals was not affected by production system, being 3.5% for grass and 3.7% for concentrates although carcasses of the latter animals were leaner. The percentages of the major non polyunsaturated fatty acids (PUFA) were also similar: (concentrates in parentheses) 18:0, 25.2% (25.1%); 16:0, 13.3% (14.5%); 18:1 12.6% (14.0%). Total liver PUFA contents were similar for the two production systems and much higher than in muscle from the same animals. All n-3 PUFA were present in greater amounts in liver from grass fed animals and n-6 PUFA were higher in concentrate fed animals: mg/100g liver, 18:3n-3 92 (32); 20:5 n-3, 151 (17); 22:5 n-3, 283 (108); 22:6 n-3, 83 (32); 18:2 n-6, 172 (444); 20:4 n-6, 194 (270). The P:S ratios were 0.20 (grass) and 0.32 (concentrates) and the n-6:n-3 ratios were 0.71 and 4.8, respectively. Livers from grass-fed lamb had a higher fat content, 4.9%, than the beef livers and a lower percentage of 18:0, (21%); but more 16:0, (16%) and 18:1 (21 %). Total PUFA content of lamb's liver resembled that of beef liver and the composition was similar to that of the steers fed grass. However the concentrations of 18:3 n-3 and 22:6 n-3 were higher in lamb and contributed to a lower n-6: n-3 ratio of 0.46 although the P:S ratio of 0.18 was similar to that in beef liver. Ruminant liver is potentially a good source of C20 and C22 PUFA in the human diet particularly from grass fed animals, with a highly desirable n-6:n-3 ratio and this may be more important nutritionally than the low P:S ratio since people can offset this elsewhere in the diet.

Fatty acid content and composition of UK beef and lamb muscle in relation to production system and implications for human nutrition.

Although ruminant meats normally have a low ratio of polyunsaturated fatty acids (PUFA) to saturated fatty acids (P:S ratio), the muscle contains a range of C(20) and C(22) PUFA of both the n-6 and n-3 series of potential significance in human nutrition. However, information on the amounts of these fatty acids in muscle and how they are modified by production system is limited In this study, the content and composition of fatty acids was determined in several muscles from beef steers fed grass (grazed) and bulls fed cereal concentrates. These are the two main types of beef production in the UK and Europe. Muscle fatty acids were also determined in lambs fed grass (grazed on pasture). The total fatty acid content of all muscles studied was less than 35 g kg(-1). The percentages in total fatty acids of all n-3 PUFA were higher in muscles from steers fed grass than from bulls fed concentrates whereas all n-6 PUFA were higher in the latter. The gluteobiceps muscle contained the largest amounts of fatty acids including PUFA and the m. longissimus dorsi the least amounts of PUFA in beef and lamb, and m. longissimus contained the lowest percentages of PUFA. Arachidonic acid was the major fatty acid in the C(20) + C(22) PUFA in beef from both production systems with twice as much in muscles from bulls fed concentrates. The P:S ratios were higher in the latter animals, range 0.21-0.34 compared with 0.08-0.13 in the steers fed grass. However, the n6:n-3 ratio was much less desirable in the bulls, 15.6-20.1 compared with 2.0-2.3 in the steers fed grass. These effects of production system in ruminants are larger than previously reported. Lamb muscle P:S ratios resembled those in grass-fed beef but the n-6:n-3 ratios were lower. The percentage of trans unsaturated 18:1 fatty acids was similar in both cattle production systems but lamb muscles contained twice as much as beef. Although the concentrations of the C(20) and C(22) PUFA are much lower than in fish, maintaining high n-3 levels in ruminant meats through grass feeding may be advantageous in human nutrition since meat is more widely consumed.

Fatty acid content and composition of english beef, lamb and pork at retail.

We have determined the fatty acid content and composition of retail samples of meat and assessed them with respect to UK dietary recommendations. Fifty beef sirloin steaks, pork chops and lamb chops were purchased from four supermarkets on separate occasions. The percentage of muscle (boneless basis) in the samples was 84.4 ± 4.3, 69.8 ± 7.7 and 78.9 ± 7.1 for beef, lamb and pork, respectively, with fatty acid contents of 3.84 ± 1.3, 4.73 ± 1.66 and 2.26 ± 0.7 g per 100 g muscle, respectively. Adipose tissue fatty acid contents were 70.0 ± 8.2, 70.6 ± 8.6 and 65.3 ± 9.4 g per 100 g tissue. A range of C20 and C22 polyunsaturated fatty acids (PUFA) was present in the muscle of all three species and pork adipose tissue but their concentrations in lamb and beef adipose tissue were too low to measure. The mean P:S ratios for beef, lamb and pork muscle were (adipose tissue values in parentheses): 0.11 (0.05); 0.15 (0.09) and 0.58 (0.61), and the n-6:n-3 ratios were 2.1 (2.3), 1.3 (1.4) and 7.2 (7.6). We conclude that the muscles of red meat species are a valuable source of PUFA, particularly the C20 and C22 n-3 fatty acids, in the human diet and that, considered as part of a varied diet, the low P:S ratio of the ruminant muscle, the high n-6:n-3 ratio of pork and the total fatty acid contents do not detract significantly from the nutritional value of lean meat.

Social and behavioural determinants of early childhood caries.

BACKGROUND: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. METHODS: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. RESULTS: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). CONCLUSIONS: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Dental caries experience of preschool children from the North Brisbane region.

BACKGROUND: To report the dental caries experience of preschool children within the north Brisbane region and to investigate the association between selected social and demographic variables and disease presence. METHODS: A cross-sectional sample of 2515 children aged four to six years was examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) and percentage caries free indices. A self-administered questionnaire obtained information regarding selected social and demographic variables. The data were analysed using the chi-square and one way analysis of variance procedures at the 5 per cent level of significance. RESULTS: Overall, 1668 (66.3 per cent) children were disease free at the examination and mean dmft was 1.4+/-2.77 and dmfs was 2.28+/-6.00. Dental caries occurred more frequently and severely in children from non-Caucasian background (p<0.000), family language other than English (p=0.001) and lower socio-economic status (p<0.000). CONCLUSIONS: Significant associations between child ethnicity, language spoken at home, socio-economic status and caries presence have been identified. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Shear bond strength of a resin composite to enamel etched with maleic or phosphoric acid.

The purpose of this study was to evaluate the effect of 10 per cent maleic and 37 per cent phosphoric acid on the shear bond strength of Z100 composite resin with Scotchbond Multi-Purpose adhesive to primary and permanent tooth enamel. Four groups of 20 teeth each were established: 1, permanent teeth, 10 per cent maleic acid etched for 15 seconds; 2, permanent teeth, 10 per cent maleic acid etched for 30 seconds; 3, permanent teeth, 37 per cent phosphoric acid etched for 15 seconds; 4, primary teeth, 10 per cent maleic acid etched for 15 seconds. Five teeth from each group were randomly assigned for SEM examination of the etched enamel surface. Scotchbond Multi-Purpose primer and adhesive were applied to the etched enamel surface of the remaining 15 teeth and cured following the manufacturer's instructions. Z100 composite resin was placed in a nylon cylinder and cured for two 40 second intervals. Following thermocycling, the specimens were sheared on an universal testing machine and debonded areas were examined visually with a stereo microscope and with SEM. The mean shear bond strengths in MPa were: 1, 17.00; 2, 14.58; 3, 14.66; 4, 11.18. ANOVA and Student-Newman-Keuls analyses revealed no statistically significant difference among the groups. SEM examination showed the majority of specimens fractured at the adhesive-resin interface.

Submandibular gland aplasia and progressive dental caries: a case report.

When severe caries occurs in mandibular permanent incisor teeth, the clinician should consider the possibility of associated submandibular gland aplasia or salivary hypofunction. Early diagnosis of submandibular gland disease is essential, as operative problems involving restoration of mandibular incisor teeth are considerable. Furthermore, progressive severe dental caries can present a dilemma for the clinician in affected individuals, despite intensive preventive and restorative therapy. A case report describing severe progressive dental caries and enamel demineralization of the permanent mandibular incisor teeth in a young girl is presented. Further investigation revealed absence of functional bilateral submandibular salivary glands contributing to the rapid breakdown of the teeth despite intensive preventive measures.

Congenital adrenal hyperplasia and enamel hypoplasia: case report.

A female with congenital adrenal hyperplasia and enamel defects involving the permanent maxillary incisors and all canines and premolars received composite veneer splint overlays under general anesthesia. Possible etiological factors involved in the formation of the enamel defects and overall case management is discussed.

Oral health of children with congenital cardiac diseases: a controlled study.

Congenital cardiac disease (CCD) is one of the most common developmental anomalies in children. Affected children require special care in dentistry because of their susceptibility to infective endocarditis from oral infections, yet little information is available on the oral health of children with CCD. The present study, which investigated 39 children with CCD and 33 healthy control siblings, showed that CCD children generally suffered poorer oral health. In patients with primary dentitions, 52% of CCD children had enamel hypoplasia, compared with only 23% in the control group. In addition, CCD children had significantly more teeth with untreated dental decay (mean dmft 4.2 vs. 2.3), and more endodontically treated teeth. Children with CCD also had less than optimal professional and home dental care. Only 31% had professional advice regarding increased preventive dental health behavior, and only 15% used fluoride supplements, although the children resided in a nonfluoridated area. Furthermore, significantly fewer CCD children had parental help with tooth brushing compared to control children. This study shows that children with CCD should be targeted for vigorous preventive dental care.

Neuropathological chewing: a dental management protocol and treatment appliances for pediatric patients.

Neuropathological chewing in hospitalized, comatose patients can occur from severe brain damage following a closed head injury, hypoxia, and septic shock. The dental management protocol developed by the Department of Dentistry at the Royal Children's Hospital, Melbourne, Australia, is presented. Treatment appliances utilizing a mandibular cast-silver cap splint with acrylic bite blocks and a maxillary mouthguard with acrylic bite blocks are discussed.

Dental health of children with cerebral palsy following sialodochoplasty.

Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as slalodochoplasties, are often performed for the control of drooling. These include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re-routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation. This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience-including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only-plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed. The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed-rank Test, P < 0.0001. This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries-protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre- and postsurgical preventive dental therapy.

Effects of replacing pork backfat with emulsified vegetable oil on fatty acid composition and quality of UK-style sausages.

Rapeseed and sunflower oil were used to replace pork backfat in UK-style sausages by incorporating the oils as pre-formed emulsions. Replacing the pork backfat emulsion with rapeseed emulsion at total fat content of about 12%, reduced total saturated fatty acid (SFA) composition from 38% to 14% (4.5 to 1.8 g/100 g), increased monounsaturated fatty acid (MUFA) composition from 45% to 59% and increased polyunsaturated fatty acid (PUFA) composition from 15% to 25%. Partial replacement of pork backfat with rapeseed at a fat content of about 20% reduced SFA from 38% to 24% (7.2 to 4.8 g/100 g). There were no significant differences in eating quality and overall liking other than slight differences in the attributes 'firmness' and 'particle size'. Improvement in the fatty acid composition was achieved without adversely affecting colour shelf life or lipid oxidation. The study suggests that a substantial reduction in SFA can be achieved by incorporating 'healthy' oils in UK-style sausages without adversely affecting eating quality or shelf life.