Birth-Weight, Pregnancy Term, Pre-Natal and Natal Complications Related to Child's Dental Anomalies.

OBJECTIVES: This cross-sectional study was aimed at determining whether certain pre-natal and natal conditions can predict specific dental anomalies. The conditions observed were: low birth-weight, preterm birth, pre-natal & natal complications. The dental anomalies observed were: enamel defects, total number of decayed, missing and filled teeth (total DMFT), disturbances in the tooth shape and disturbances in the number of teeth. STUDY DESIGN: Out of more than 2000 medical files of children aged 2-17 years old which were reviewed, 300 files met the selection criteria. Information recorded from the files included: age, gender, health status (the ASA physical status classification system by the American Society of Anesthesiologists), birth week, birth weight, total DMFT, hypomineralization, abnormal tooth shape, abnormal number of teeth and hypoplasia. RESULTS: Twenty one children out of 300 (7%) were born after a high-risk pregnancy, 25 children (8.3%) were born after high-risk birth, 20 children (6.7%) were born preterm - before week 37, and 29 children (9.7%) were born with a low birth weight (LBW) - 2500 grams or less. A relationship between a preterm birth and LBW to hypomineralization was found. And a relationship between a preterm birth and high-risk pregnancy to abnormal number of teeth was found. No relationship was found between birth (normal/high-risk) and the other parameters inspected. CONCLUSION: Preterm birth and LBW may predict hypomineralization in both primary and permanent dentitions. Furthermore, the study demonstrated that preterm birth and high-risk pregnancy may predict abnormal number of teeth in both dentitions.

[Periodontal health during pregnancy and the dental health of the child].

Several studies have shown an association between local/systemic infections and preterm-low birth weight (PTLBW), and it might be an important part of the etiology. Oral Infections such as periodontitis may act as a distant reservoir of microbes, microbial products and inflammatory mediators. These might influence pregnancy and contribute to restriction of fetal growth and induction of early labor and PTB. Enamel formation of the primary teeth begins at 11-14 weeks of fetal life and is completed by the end of 3rd postnatal month. The initial phase consists of matrix formation, followed by calcification in utero. Since enamel is a stable structure, defects involving its matrix secretion and/or maturation of primary teeth can act as a permanent record of insults occurring pre- or perinatally. Any stressful event during pregnancy and birth may lead to metabolic changes in the formation of the enamel, resulting in clinically enamel defects. Severe infections occurring during amelogenesis may be associated with enamel hypoplasia. Babies born after maternal complications during pregnancy or babies who experience a traumatic birth must be considered to be at risk of developing Early Childhood Caries - ECC when exposed to excessive bottle nursing. Therefore oral healthcare should be kept during pregnancy.

Chemotherapy induced dental changes in a child with medulloblastoma: a case report.

We describe the dental findings and therapeutic management of a child aged three years and eight months with medulloblastoma treated by surgical resection at age eight months followed by 20 months of chemotherapy. Thin and short roots of the primary molars were observed, as were microdontia and anodontia of the premolars. The boy suffered from severe early childhood caries (ECC). Dental treatment was carried out under general anesthesia. Follow-up examinations at three, six and twelve months after the initial dental treatment revealed healthy gingival tissue and no new caries. The boy passed away before the next scheduled follow-up dental examination.

Candida, mutans streptococci, oral hygiene and caries in children.

OBJECTIVE: to test the association between Candida and mutans streptococci (ms), oral hygiene and caries levels and in children. METHODS: 22 boys and 12 girls (age 6 to 14.5 years) participated in the study. Each participant received a toothbrush, and was asked to brush his/her teeth after proper instructions. Dental caries and oral hygiene were recorded. Candida and ms levels were determined in saliva samples. RESULTS: Candida colonies were observed in 70.5% of the children. No association was found between Candida and caries or plaque and gingival indices. C. albicans-positive children demonstrated significantly higher brushing scores. CONCLUSIONS: Our findings may suggest that there is no clear association between Candida in saliva, and levels of cariogenic bacteria and caries risk in children.

Crown size asymmetry in males with fra (X) or Martin-Bell syndrome.

We measured the mesio-distal and bucco-lingual crown diameters of 13 males with the fra(X) or Martin-Bell syndrome. Fluctuating crown-size asymmetry was calculated and compared with values obtained in normal Caucasian children and also with a sample of 19 males with Down syndrome. A statistically significant increased asymmetry was found in the fra(X) males when compared to normal control individuals. In the maxilla, Down syndrome males showed a significantly higher tooth crown asymmetry than fra(X) males. (less than 0.02); in the mandible, no significant differences were found between the 2 groups. It is suggested that crown size asymmetry be included in the evaluation of fra(X) males.

Dental anxiety among patients undergoing endodontic treatment.

The purpose of this study was to evaluate the dental anxiety expressed among patients undergoing endodontic treatment with respect to some social and dental parameters. The dental records of 98 patients, 42 men and 56 women who were referred for root canal treatment to an endodontist, were examined. Patients completed a Dental Anxiety Scale (DAS). Dental experience, time of last visit to the dentist, and symptoms of tooth were recorded. The mean DAS scores were higher than scores reported in other countries (9.4 +/- 3.3). Women demonstrated higher dental anxiety than men. Patients with higher education demonstrated lower dental anxiety. No difference was found between patients experienced in endodontic treatment and those who were not, patients who suffered previous pain in the treated tooth and patients who did not. Women in their mid-thirties to mid-forties and men in their twenties expressed the highest DAS scores.

Effect of gutta-percha solvents on surface microhardness of IRM fillings.

Eighty identical samples of IRM were prepared and embedded in acrylic resin. The samples were polished, rinsed, and divided into experimental groups and controls, 10 specimens each. Each experimental group was treated for 1 or 5 min with one of the following gutta-percha solvents: chloroform, xylene, or halothane. Sterile saline was used as a control. Treatment consisted of pipetting each solvent onto the external IRM surface. The specimens were then sealed in plastic assay tubes for the corresponding exposure periods. At each time period, surface microhardness of the samples was measured using a mini-load hardness tester with a 500 g load for 20 s. It was found that xylene and halothane caused significant reduction in surface microhardness of IRM after 5 min (p < 0.01). Chloroform caused significant reduction in surface microhardness of IRM after 1 min of treatment (p < 0.01). Chloroform caused total dissolution after 5 min of treatment. Saline caused only minor and nonsignificant changes in surface microhardness of IRM.

Morphometric variables of developing primary mandibular second molars.

Morphometric variables of second primary molar crowns from birth to completion were examined and measured. An image analysing technique comprising a photographic camera, a monitor, a computer with appropriate software and a digital caliper was used. Strong correlations were found between the 'external' aspect of the crown (mesiobuccal cusp height, mesiodistal and buccolingual dimensions and perimeter), and between all the 'occlusal' measurements of the crown, i.e. all the intercusp distances. However, poor correlations were found between the external and internal measurements of the crown such as the mesiobuccal cusp height and mesiobuccal-mesiolingual cusp-tip distance. It was also found that the mesiobuccal cusp serves as the apex of two triangles, the one formed by mesial cusps, and one formed by the distal cusps. The cusps on the mesial portion of the crown (ML, DB) are on a similar radius from the MB cusp, and the cusps on the distal portion are on a similar radius from the MB cusp. The small sample is a limitation but the results suggest a separate and independent pattern and rate of development of the external and the occlusal morphological variables of the tooth crown. Further research is needed on larger samples.

Morphometric variables of developing primary maxillary first molar crowns in humans.

The following morphometric variables were examined in 18 primary maxillary first molars at various stages of development, collected from archaeological excavation sites in Israel: perimeters and areas from the occlusal view; buccolingual and mesiodistal dimensions and intercusp distances; the angle between the line joining the distobuccal, mesiobuccal and lingual cusps; and the height of the mesiobuccal cusp. An image-analysing technique comprising a photographic camera, a monitor, a computer with appropriate software and a digital caliper was used. Significant correlations were demonstrated between most variables. Teeth were divided into two groups according to their stage of development: stage one included all teeth at an early stage of development in which mesiobuccal cusp height was less than 5 mm; stage two included all teeth in later stages of development where mesiobuccal cusp height was greater than 5 mm. All external variables showed an increase in size between the two stages (while, among the internal ones, only the angle between the cusps showed a very small increase). The small sample is a limitation but the results suggest the following: (1) growth of the primary maxillary molar crown occurs with 'bursts' of development ; and (2) a change in the shape of the crown occurs during its formation where the mesiobuccal cusp moves buccally and distally, and the lingual cusp moves mesially.

Morphometric analysis of developing crowns of maxillary primary second molars and permanent first molars in humans.

The purpose of this study was firstly to characterize the changes occurring in size and form of the mineralizing maxillary second primary molar and first permanent molar crowns, and secondly to determine if similar changes in size and form characterize enamel apposition in the crowns of these teeth. Twenty-five primary second molars and 20 maxillary permanent first molars at various stages of development, found in archaeological excavations in Israel, were examined for a number of measured variables using image analyser software. Teeth were divided into two groups according to their stage of development: stage I included all teeth at an early stage of development in which mesiobuccal-cusp height was less than 5 mm for the primary molar and 5.9 mm for the permanent molar; stage 2 included all teeth in later stages of development where mesiobuccal-cusp height was greater than these values. In the primary molar, a significant increase was found between the two stages in almost all variables. Significant correlations were also found between all intercusp distances and the external variables. Strong correlations between height of the mesiobuccal cusp and all external and internal variables were noted in stage 1, but fewer in stage 2. In the permanent tooth, no increase was observed in intercusp distances and very few correlations were found between and among the variables. The results suggest that a change in the shape of the maxillary primary second molar occurs during formation, with the lingual cusp tips moving lingually and distally, and the distobuccal cusp tips moving distally. No change occurs in the shape of the maxillary permanent first molar during crown formation. Growth of the maxillary primary second and permanent first molar crowns occurs in 'bursts' of development.

A behavioural approach in the treatment of elderly patients: a new philosophy.

Complete denture prosthodontists are very well aware of the influence of psychological factors in the success of their treatment. Recently, a number of authors tried to ascertain some psychosocial criteria in the predictability of patients' satisfaction. Although special attention was paid to concerns of socio-demographic and educational status, it was demonstrated that there is little relationship between quality of dentures and patients' satisfaction, nor a relationship between satisfaction and anatomical conditions. The purpose of this paper is to give a better understanding of the behavioural problems of this treatment and offer some solutions. Educational programmes should be influenced by behavioural problems in the management of the elderly patient.

Dental anxiety among patients prior to different dental treatments.

The purpose of the present study was to evaluate dental anxiety among patients anticipating various dental treatments. One hundred and eighty patients who were scheduled for specific dental treatments at the School of Dental Medicine, the Hebrew University--Hadassah, Jerusalem, Israel participated in the study. Patients were anticipating one of the following dental procedures: scaling, filling, root canal therapy, preparation for crown, periodontal surgery or extraction. For each of the six dental treatments, 30 patients were selected at random. Dental Anxiety Scale (DAS) questionnaires were completed by the patients while waiting for their treatments. The results indicated that extraction caused the highest score, followed by scaling (though not significantly). Patients in the 35 to 49 year age group showed the highest total DAS scores. Women demonstrated higher total DAS scores than men. The relative influence of gender, type of treatment and age on the anxiety scores is demonstrated by using logistic regression, which revealed gender to have the strongest impact on the DAS scores, followed by the type of treatment and age.

Professional education and practice arrangements: are there gender differences among paediatric dentists in Israel?

AIM: To assess gender differences in professional education, practice setting and working arrangements among dentists in Israel, who primarily treat children. SUBJECTS: All 112 participants in the meeting of the Israeli Society of Dentistry for Children that was held in February 1999. METHODS: A questionnaire completed during the meeting. RESULTS: Seventy participants (63 per cent) completed the questionnaire and returned it. There were 43 females and 27 males. Less than half of the population were specialists (40 per cent of the females, 48 per cent of the males). No significant differences were found in the educational background and working in academia between females and males. With regard to practice arrangement, males significantly reported more frequently working in two clinics or more, than females (P = 0.049), and working in clinics with general practitioners (GPs) and specialists in various fields in dentistry, while more women reported working with either GPs or specialists (P = 0.007). In all other variables, no significant gender differences were found. The results of our study show that paediatric dentistry in Israel appears as a branch of the profession which shows great sexual equality of opportunity.

Treating dental phobic patients in the Israeli Defense Force.

The present study reports the results of the Israeli Defense Force clinic for dental phobic patients 14 months after its establishment. Thirty four soldiers (26 men, 8 women) attended the clinic, their ages ranged from 19 to 46 years. The patients were asked to complete Corah's Dental Anxiety Scale (DAS), prior to their first and each subsequent visit to the clinic. A full dental examination, including radiographs, was carried out on each patient, and the DMFT was recorded. The Tell, Show, Do, technique (21 patients), the use of nitrous oxide/oxygen sedation (5), behavioural relaxation techniques (4), and hypnosis (1) were used. Most patients required four sessions or more for treatment. The mean DAS total scores significantly decreased after each visit, as did the mean scores for each question. The mean DMFT, and the D component, were higher than the scores reported previously in Israeli soldiers, suggesting an association between dental phobia, avoidance of dental treatment and higher dental disease. Alleviating anxiety by rational explanation may not be sufficient in all phobic patients.

Response to nitrous-oxide and oxygen among dental phobic patients.

The present study evaluated the records of 27 patients (20 men, 7 women) who were treated under nitrous-oxide (N2O) and oxygen sedation due to extremely high dental anxiety. Corah's DAS and Kleinknecht's dental fear survey were completed by the patients. Patients who responded positively to the gas were categorised as N2O+ patients, whereas those who responded negatively were categorised as N2O- patients. A mean DAS score of 19.3 +/- 1.6 was observed for the entire population. No significant difference was found between N2O+ patients and N2O- patients in any DAS item, nor in the total scores (19.4 +/- 1.35 and 18.67 +/- 2.24 respectively). Only in answer to the question, 'Has fear of dental work ever caused you to cancel or not appear for an appointment?' were the scores of N2O- patients significantly higher than of N2O+ patients. No differences were found between patients who reported pain as the source for their dental anxiety and those who did not; between patients with gag reflex and those without, between patients who had never had any dental treatment and those who had, and between patients who required two or three appointments before administration of the gas with respect to successful treatment under N2O and oxygen sedation. Among the N2O- group, significantly more patients did not attend for two appointments or more. The results suggest that lack of keeping previous dental appointments may indicate patients' possible negative response to nitrous-oxide and oxygen sedation.

Apexification of wide-open apices in nonvital, immature permanent incisors: a case report.

Apexification is the accepted procedure to form an apical stop in nonvital teeth with incomplete root formation. A case is presented in which apexification with calcium hydroxide was performed on two permanent central incisors with immature roots and wide-open apices; treatment concluded with gutta-percha root canal restoration. Spontaneous apical seal had probably been initiated before the calcium hydroxide was inserted, but it was weak and nonhomogenous.

Bilateral transposition of maxillary canines and first premolars: case report.

Transposition of teeth is a rare phenomenon. A case of bilateral transposition of maxillary canines and first premolars in a 27-year-old man is described.

Tooth rotation and alveolar bone loss.

Tooth rotation and periodontal breakdown has not been thoroughly studied due to lack of quantitative tools. The purpose of the present study was to examine this correlation, with respect to alveolar bone loss, from direct observation of 17 skulls. A photograph of the mandibular occlusal plane was taken from a fixed reference point, and the midcentral fossa and the extreme mesial and distal points of each tooth were marked on the photograph. A computer program established the arch form of each mandibular from the midtooth landmarks. The angle between individual teeth and the arch (at any given point) was calculated. Bone loss, indicated by the distance of the bone crest from the cementoenamel junction, was measured at six reference points around each tooth with a caliper. A positive correlation, through weak, was found between increased tooth rotation and greater bone loss. Mean bone loss of teeth with rotation of 20 degrees and greater was 4.03 mm, while that of teeth with less than 20 degrees of rotation was 3.49 mm.

The relationship between cervical enamel projection and class II furcation defects in humans.

The purposes of the present study were to examine the frequency of cervical enamel projection in mandibular molars with class II furcation defects and to examine the response of these teeth to guided tissue regeneration procedures. Probing depth and vertical and horizontal periodontal attachment levels were recorded with a constant-force electronic periodontal probe. Following surgical exposure of the bifurcation and prior to membrane placement, the cervical enamel projection was examined and then graded clinically; photographs were taken to allow further examination of the bifurcation. An overall improvement in clinical parameters was observed in most sites. Cervical enamel projection was present in 82.1% of all molars examined. Grade II was the most prevalent (34.8%). Patients with any degree of cervical enamel projection demonstrated significantly higher mean probing depths at baseline than did patients without cervical enamel projection. Likewise, pretreatment probing attachment levels were higher in patients with some degree of cervical enamel projection. However, greater posttreatment horizontal and vertical attachment gains were observed in sites with a baseline cervical enamel projection.

One-year clinical evaluation of an anterior composite resin.

An anterior composite resin was evaluated in a clinical study of 93 Class III and Class IV restorations placed in patients aged 12 to 50 years. The restorations were evaluated at baseline, 6 months, and 1 year. Sixty-four (79%) of the 81 restorations examined at the 1-year recall were unchanged. Marginal discoloration and changes in surface appearance and marginal adaptation accounted for most of the changes. All changes appeared in patients younger than 14 years, which may indicate that the patients had problems in oral hygiene. Replicas of randomly selected restorations showed smooth surfaces and well-sealed margins with a smooth transition from restoration to enamel. Some restorations showed marginal breakdown and a pitted irregular surface.