Type 1 Diabetes Mellitus (Juvenile Diabetes) - A Review for the Pediatric Oral Health Provider.

Objective: To describe the significance of type 1 diabetes mellitus (juvenile diabetes) to the pediatric oral health provider. Relevance: The oral health provider must be aware of type 1 diabetes mellitus (T1DM) characteristics, influence of on oral health, each patient pre-operative diabetic management, symptoms and treatment of hypo and hyper-glycemia, and the clinical implications before, during and after treatment of children with T1DM. Study design: A review of the scientific literature about the T1DM influence on dental development, caries prevalence, gingival and periodontal diseases, wound healing, salivary and taste dysfunction, oral infections, and the factors that must be taken in consideration before, during and after oral treatment of children with T1DM is presented. Conclusion: The increasing prevalence of T1DB in children strongly emphasizes the need for oral health providers to be aware of the complicacy of the treatment aimed to obtain and maintain acceptable blood glucose levels in diabetic children, the effect of diabetes on the oral cavity, the possible serious complications due to hypo- or hyper glycemia before, during and after oral treatments, the effect of stress on blood glucose levels, and the special behavioral interaction between the diabetic child, his/her family and the oral health providers.

Pediatric dentistry clinical education venues evaluation by pre and post-doctoral students.

OBJECTIVE: To evaluate dental students' perspectives about pre- and post-doctoral pediatric dentistry education venues. STUDY DESIGN: Surveys with visual analog scales (from 0 to 100) measuring the educational contribution of pediatric dentistry venues were conducted. The pre-doctoral venues included a 3rd year university twilight clinic (UTC), a 3rd year urban community based clinic (CBC) and 4th year mobile clinics (MCs). The post-doctoral venues included treatment of children under general anesthesia, oral sedations, a regular clinic (no sedations), seminars, journal club, case conferences and studding for the American Board of Pediatric Dentistry. RESULTS: Analyses of variance between the scores indicated that the 3rd year CBC score (68.2 ± 4.5) was statistically significant higher (p= .007) than the one for the 3rd year UTC score (44.9 ± 6.1). The 4th year students' MCs score (61.4 ± 4.0) was statistically significant higher than their retrospective scores for the 3rd year CBC (56.4 ± 4.4) or UTC (42.2 ± 4.9) scores (p= .03 and .004 respectively). Among the didactic or clinical post-doctoral venues, the regular clinic and the seminars received the highest scores (84.3 ± 1.7 and 71.6 ± 2.8 respectively). CONCLUSION: pre-doctoral community-based clinical education and post-doctoral regular university based clinic are considered by students to provide the main contribution to pediatric dental education.

Hyperbilirubinemic stain: location and extent in dental tissues.

OBJECTIVE: The purpose of the present manuscript is to describe the location and extent of hyperbilirubinemic stain in a primary molar of a 3-year-old who was diagnosed with cystic fibrosis shortly after birth, subsequently developed liver disease and hyperbilirubinemia, and received a liver transplant at age 10-months. STUDY DESIGN: Clinical and histological assessments were performed to evaluate the location and extent of hyperbilirubinemic stain in an extracted primary molar. RESULTS: The clinical image, and macroscopic and microscopic histological examinations of a primary molar showed hyperbilirubinemic staining of enamel and of the coronal dentin that developed between birth and when the liver transplant took place, irregular dentin tubules, and an irregular cementum-dentinal junction. CONCLUSIONS: The findings of the present manuscript indicate that hyperbilirubinemc staining of primary teeth affects dental hard tissues at the time of their calcification, and the clinical picture of the stain may be related to stained enamel and/or dentin, and underlying stained dentin visible through translucent unstained enamel.

Root surface characteristics of children teeth with periodontal diseases.

The present study examined the root surfaces of teeth from children with or without periodontal diseases and with or without systemic diseases. Light microscopy revealed that when compared to control teeth: teeth with chronic periodontitis had similar radicular histology; teeth from children with leukocyte adhesion deficiency, Down syndrome and aggressive periodontitis had narrower cementum areas; teeth from children with hypophosphatasia showed cementum aplasia. Cementum anomalies may facilitate the establishment and progress of periodontitis in children.

A clinical and histometric study of gingivitis associated with the human deciduous dentition.

This study examined the relationship between clinical indices and the histologic parameters associated with the gingiva of the human deciduous dentition. The plaque index, gingival swelling and color, probing depth, bleeding on probing, contact with adjacent teeth and the degree of root resorption of 58 deciduous teeth were recorded. The teeth were extracted with their surrounding gingiva and prepared for histologic examination. The area of epithelium and connective tissue with and without inflammatory cells was measured as well as the epithelial length from the gingival margin including the junctional epithelium. When these measurements were grouped according to the values of the clinical indices, nonmobile teeth were found to have less epithelium than those with mobility and gingiva with a healthy color had a significantly smaller inflammatory cell infiltrate than red gingiva. Bleeding and increased probing depth were not associated with the other clinical signs of inflammation. The amount of plaque did not correlate with the measures of clinical inflammation. The inflammatory cell infiltrate was present irrespective of whether the gingiva was clinically normal or not and the inflammation did not correlate with the amount of plaque.

Root surface characteristics of primary teeth from children with prepubertal periodontitis.

This study describes the histologic characteristics of root surfaces of primary teeth from children with prepubertal periodontitis (PP). Fifteen primary teeth from 4 children with PP, and 2 control primary teeth from 2 healthy children were examined. Light microscopy revealed normal root surfaces in the control teeth. In contrast, the PP specimens revealed bacteria inside dentin tubules or covering cementum, a cuticle, or resorbed dentin; normal, wider than normal, or hypoplastic cementum; resorption lacunae with various depths; aplastic root resorption; alternate resorption and repair; and active repair. No cementoclasts were found in the resorption lacunae. Scanning electron microscopy revealed intrabony and suprabony root areas, and a "plaque free zone" (PFZ). Colonies of filaments were evident at the cemento-enamel junction (CEJ). The suprabony root surfaces had resorption lacunae, isolated short rods, calculus, colonies of filaments, or colonies composed by an heterogeneous bacterial population. The coronal boundary of the PFZ was the border of a sheet-like structure, which included isolated rods or filaments. At the PFZ, isolated filaments and rods, and a fibril matrix were evident. The apical boundary of the PFZ consisted of bundles of soft tissue remnants or the insertion of the periodontal fibers. The intrabony surfaces were mostly covered by soft tissue, which included isolated filaments and short rods. Resorption lacunae with or without soft tissue were also evident in this area. Crystals of calcium oxalate dihydrate and erythrocytes in distinct forms were found at various root areas. The present findings are different from those previously reported for hypophosphatasia specimens.

Periodontitis associated with Papillon-Lefèvre syndrome.

The predominant subgingival microflora, host immune response, and genetic history of a 14-year-old girl with Papillon-Lefèvre Syndrome (PLS) are reported. The patient had high counts of Actinobacillus actinomycetemcomitans and surface translocating bacteria. She had significantly raised levels of antibodies to five of the bacterial species studied with the levels to A. actinomycetemcomitans remaining high after antibiotic therapy. The polymorphonuclear leukocytes (PMN) also released significantly increased amounts of O2 compared to controls. The data presented support a role for A. actinomycetemcomitans and PMN dysfunction in the pathogenesis of PLS.

Sequential manifestation of different forms of early-onset periodontitis. A case report.

Pathogenic bacteria constitute the primary extrinsic agent in the etiology of early onset periodontitis. However, the risk of developing periodontal disease is not equal for all individuals, suggesting host factors are involved in determining an individual's disease susceptibility. In this report, a case of an otherwise healthy female, who exhibited prepubertal periodontitis (PPP) at age 10, juvenile periodontitis (JP) at age 13, and rapidly progressive periodontitis (RPP) at age 29 years, is presented. Microbial, immunological, and genetic features of the case are presented. PPP, JP, and RPP are considered distinct disease entities, albeit with similar pathology and pathogenesis, yet all were manifest sequentially in the same individual. This report presents the idea that certain individuals are predisposed to early-onset periodontal diseases and the early identification of risk factors is important in the management of these individuals.

Periodontal health and disease in children and adolescents.

The prevention and treatment of periodontal diseases in children and adolescents are most desirable and the physician should be involved in the achievement of these goals. Furthermore, cooperation between the physician and the dentist may be imperative for the comprehensive treatment of some patients. One should be aware of the influence of the general growth and development of the periodontium in order to be able to differentiate between health and disease. Periodontal diseases in children and adolescents include chronic gingivitis, gingival recession, chronic periodontitis, prepubertal periodontitis, juvenile periodontitis, and cases with peculiar causes. The main cause for periodontal diseases is the microorganisms in the dental plaque. In addition, the systemic status of the individual may affect the response of the periodontal tissues and vice versa. The physician and dentist should cooperate with the purpose of providing comprehensive prevention, diagnosis, and treatment of periodontal diseases and systemic diseases.

Evaluation of quandrant dentistry in provision of dental care.

The chairtime required for a single Class I or Class II amalgam restoration at 163 sittings was compared with the chairtime required for 99 cases in which two restorations in a quandrant were treated at the same sitting. The "Quadrant Dentistry Efficiency Rate" was calculated and it was found that quadrant dentistry resulted in a saving of between 30% and 50% of chairtime. The individual speed of the three dentists treating the children did not greatly influence the percentage of chairtime saved.

Chairtime needed for an incremental dental care program for schoolchildren in Israel.

Chairtime needed to provide initial treatment to 80 children, 6 1/2 to 7 1/2 years of age, in an incremental care program was recorded. An average of 8.2 carious teeth with 14.0 carous surfaces required treatment. The clinical and radiographic examinations were concluded earlier and were not included in the chairtime recorded. One year after completion of the initial treatment, 51 of these children were reexamined to determine the maintenance treatment needs. These were found to be approximately one-third of the initial treatment needs. The average chairtime required for initial treatment was 2 hours and 37 min. It was estimated that for complete treatment, including examination and preventive measures, 3 hours per child would be required for initial treatment and 1 hour for maintenance care each following year.

Anterior open bite and gingival recession in children and adolescents.

Gingival recession is a manifestation of periodontal breakdown. Plaque microorganisms are the primary aetiological factor, but other secondary conditions are also associated with its presence. This study examined the hypothesis that localized gingival recession is more prevalent in open-bite cases. The study included 26 children with untreated anterior open bite and a matched control group. Clinical crown length, recession depth, oral habits and periodontal indices were recorded for each individual. Although the plaque index was not significantly different between the two groups, the open-bite group showed significantly greater clinical crown length and gingival inflammation. This may be attributed to increased virulence of dehydrated plaque and it is suggested that open bite may predispose to the development of localized gingival recession in the anterior segments of young individuals.

Non-surgical treatment of pseudo-recession in children and adolescents.

A case of a 7 year-old girl with gingival pseudo-recession at a mandibular permanent central incisor was successfully treated with a non-surgical approach. Patient compliance (oral hygiene), the location of the junctional epithelium in relation to the cemento-enamel junction (pseudo or true recession), the width of the buccal alveolar bone of the affected tooth, the potential for an increase in the width of the attached gingiva and tooth alignment should be taken into account when considering the type of treatment (surgical or not) of uneven buccal gingival margins in children and adolescents.

Clinical, radiographic, SEM evaluation and assessment of microleakage of Class II composite restorations.

The influence of incremental or bulk filling techniques, and reapplication of unfilled resin (impregnation) to the margins with an enamel bonding agent, on marginal adaptation was evaluated in Class II composite restorations by clinical, radiographic, scanning electron microscope (SEM) and dye penetration techniques. Cavities were prepared in 80 extracted permanent posterior teeth. All cavity walls were treated with polyacrylic acid for 10 seconds. The enamel was etched for 1 minute, rinsed, dried, and lined with Scotchbond. Forty cavities were filled by increments of P30 and 40 cavities in bulk. The margins of the restorations of 20 teeth in each group were re-etched for 30 seconds and Concise Enamel Bond reapplied. The clinical scores were excellent for all restorations. Radiographic examination showed twice as many bubbles in the incrementally filled restoration than in the group filled in bulk. In 53 teeth, a radiolucent area between the dentin and the restorative material was found. After sectioning, this area was found to correspond to a hard material. The SEM revealed excellent margins in the groups of teeth that were impregnated with an unfilled resin, whereas 13 teeth without impregnation showed defective margins. The dye penetration, as a test for marginal leakage, was minimal at the occlusal surface of all teeth. At the cervical surface, 10.5% of the impregnated teeth showed severe dye penetration compared to 18% of the nonimpregnated teeth. No correlation was found between dye penetration at the cervical surface and the thickness of the residual enamel in this area.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of alveolar bone loss adjacent to proximal caries in the primary molars and healing due to restoration of the teeth.

The frequency of alveolar bone loss adjacent to extensive proximal caries, and the effect of dental restorations on alveolar bone loss and healthy alveolar bone were examined in human primary molars. Proximal caries, contact loss, mesial drift and the presence of alveolar bone loss were recorded from 190 bite-wing radiographs from 60 boys and 46 girls. Proximal caries was evident in 297 quadrants. In 63.0% of quadrants, both primary molars had proximal caries. Contact loss was evident in 38.4% of the quadrants with proximal caries. Bone loss was found in 12.1% of the quadrants with proximal caries or 31.6% of those with contact loss. Analysis of variance for the presence of bone loss indicated statistically significant values (P less than 0.05) for one or two teeth with caries by quadrant, the presence or absence of contact loss, and age. A second examination was available for 41 children. Among these, eight out of the 36 bone defects disclosed at the first examination were present. At the second examination, after tooth restoration, healing of five bone defects was evident. These findings indicate a connection between the presence and treatment of extensive proximal caries and alveolar bone health in the primary dentition.

Growth and development considerations in the diagnosis of gingivitis and periodontitis in children.

Increasing information emphasize the relevance of the prevention, early diagnosis and early treatment of periodontal diseases in children. In order to avoid erroneous diagnosis and unnecessary treatments, the pediatric dentist is required to differentiate between pathologic processes and normal changes that take place in the periodontum with age. The present review outlines structural and functional changes of the periodontal structures, the establishment and maturation of the oral microflora and immune defense reactions to periodontal pathogens in children and adolescents. The age-related tendency to develop gingivitis, that is evident in children and adolescents, may be related to changes in the bacterial composition of the dental plaque, the inflammatory cell response, hormonal changes, morphological differences, tooth eruption and shedding. The hormonal influence on the gingival tissues and the composition of the dental plaque are of particular relevance during puberty. Large ranges for the prevalence of attachment loss, periodontitis or destructive periodontal disease in children and adolescents have been reported. The variance in values may be related to population characteristics, method of examination or diagnostic criteria that may include measurements of attachment loss and distances from the cementoenamel junction to the alveolar bone crest, both of which may be either physiological or pathological. The pediatric dentist should be able to diagnose gingival inflammation, attachment loss or distances from the cementoenamel junction to the alveolar crest which are out of proportion to the child's age and the amount of dental plaque. These may be indicative of a high susceptibility to periodontal diseases or reflect systemic conditions that affect the periodontum.

Radiographic assessment of the alveolar bone height in children and adolescents with familial dysautonomia.

PURPOSE: Familial dysautonomia (FD) is a progressive neuropathy, characterized by somatic and skeletal abnormalities, and by a variety of oral and diet disturbances. The purpose of the study was to assess the alveolar bone height at the molar areas of children and adolescents with FD. METHODS: The distance from the cemento-enamel junction (CEJ) to the alveolar bone crest (ABC) was measured on routine diagnostic bitewing radiographs of nine males and seven females with FD (mean age = 122 months) and in those of two matching groups (C1 = 119 months; C2 = 122 months). RESULTS: The mean values for the maxilla were significantly larger than those in the mandible. A positive significant correlation was found between the CEJ-ABC measurements of the primary and the permanent teeth, and between the CEJ-ABC measurements and age. The mean values per patient for the CEJ-ABC distances of the FD group were smaller than the control groups, but the difference was not statistically significant. The CEJ-ABC measurements in the primary and the permanent molars were smaller in the FD group, and in the premolars and permanent cuspids they were larger than those in the two control groups. These differences were not statistically significant. No differences were found between the FD and the control groups in the primary cuspids. CONCLUSIONS: The alveolar bone height of children and adolescent with familial dysautonomia does not differ from that of healthy controls.

Serum antibody levels to oral microorganisms in children and young adults with relation to the severity of gingival disease.

The purpose of this study was to describe and compare the IgG and IgM serum antibody levels to 10 microorganisms involved in periodontal diseases in children and young adults with no systemic disease, but with either minimal/none or severe gingival inflammation. Blood samples from 15 children and 14 young adults were collected. Seven children and nine adults had minimal or no gingival inflammation; the rest had severe gingivitis. Kruskal-Wallis H analysis indicated significant differences among the age groups in the IgM values for all microorganisms and for most organisms in the IgG values. The contrast coefficient matrix values between children and young adults were significant for all the microorganisms for the IgM values and for most of the organisms for the IgG values when the severity of the disease was not taken into consideration. However, when the severity of the disease was also considered, the contrast coefficient matrix values for most of the microorganisms were not significant for both the IgG and IgM values. Age had a more significant influence on the serum antibody levels than the severity of the disease, mostly in the IgM values.

The composition of subgingival microflora in two groups of children with and without primary dentition alveolar bone loss.

The is study examined the relationships between the microbial composition of the subgingival plaque, contact loss caused by caries and alveolar bone loss (ABL) in primary molars. The study included 10 children with contact loss in at least two sites, one with ABL and one without ABL, and 10 children without ABL with sites with or without contact loss. The microbial composition of subgingival plaque was examined by dark-field microscopy and by cultures of total anaerobic bacteria, Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg). Dark-field microscopy confirmed that spirochetes and motile rods may be part of the indigenous flora of the oral cavity. More spirochetes and motile rods were observed in sites with ABL than in control sites in the same subject and control subjects without ABL. Lower numbers of cocci were seen in sites with ABL than in sites in children without ABL, but a significant difference was not observed between sites with ABL and healthy sites within the same subjects. No significant differences in the dark-field values were evident in sites without ABL, with or without contact loss. Aa and Pg were found in children and sites with or without ABL. In sites with Aa, larger proportions of spirochetes, lower values of cocci, and more colonies of Pg were evident. No significant differences in anaerobic bacteria were evident between sites with or without contact loss or with or without ABL. ABL in the primary dentition was found to be related to the microbial composition of the subgingival plaque, but not related to contact loss per se.