Preventive dental care: the role of the pediatrician.

The pediatrician can assist the dental profession in preventing dental disease and maintaining the oral health of children. Pediatricians are urged to counsel parents in dietary and oral hygiene practices that will prevent dental caries and to refer patients for professional dental care when appropriate. Systemic fluoride supplements should be prescribed when needed but only after a careful review of requirements and daily consumption.

Dental development in precocious puberty.

One hundred and one children with precocious puberty were given an oral examination. Dental root development was assessed using panoramic radiographs. All mandibular canines, pre-molars, and molars which could be visualized without apparent distortion were included. The patients were grouped for analysis according to the etiology of their precocity, e.g., McCune-Albright syndrome, familial male, congenital adrenal hyperplasia, central nervous system lesions, and idiopathic precocious puberty. Dental development was significantly retarded relative to their chronological age in patients with idiopathic precocious puberty. However, no significant abnormal dental development was detected in any of the other groups. Individual oral-facial growth and development remain the primary considerations for timing orthodontic treatment.

Oral findings in anorexia nervosa and bulimia nervosa: a study of 47 cases.

These two clinically oriented articles deal with problems dentists are seeing more frequently. One hospital dental service sees an average of four to five patients weekly with eating disorders. The first article is a research study discussing problems found in 47 study participants with the eating disorders anorexia nervosa and bulimia nervosa. The second article describes a helpful technique for oral rehabilitation.

Oral effects of steroid therapy in a patient with systemic lupus erythematosus: report of case.

Steroids are used extensively in modern medicine and dentistry for their anti-inflammatory and immunosuppressive properties. However, this class of drugs can lead to adverse effects on other organs. In this case, developmental and functional disturbances of the primary and permanent dentition are seen. The patient's dental development and pharmacological history suggest prednisone as the offending agent.

Oral manifestations of AIDS: a study of 84 patients.

Early diagnosis of AIDS is vital in providing appropriate referral for medical care and counseling. Subtle intraoral signs and symptoms identified by the dental practitioner can aid in the diagnosis of the disease. Because the role of the practitioner in detection and treatment of AIDS patients is becoming greater, signs found in 84 patients are described.

Clinical evaluation of three acid-etch composite resin systems: two-year report.

One hundred fifty-seven fractured anterior teeth were restored with one of three acid-etch composite resin systems and were clinically and radiographically evaluated for 24 months. Of the three systems evaluated, the material activated by ultraviolet light provided the highest retention rate and clinical acceptance.

Oral manifestations of the Rieger syndrome: report of case.

The Rieger syndrome is a rare, autosomal dominant disorder. It is characterized by defects of the anterior chamber of the eyes as well as developmental malformations of the dentition. A case is described that shows classic findings with emphasis on dental management. Oral abnormalities in the pedigree may also suggest subtle manifestations of the syndrome. Recognition of the dental anomalies may result in early diagnosis of the syndrome and prevent progressive visual loss.

Bulimia nervosa. Its effect on salivary chemistry.

Erosion of the dental hard tissues and enlarged parotid and submandibular saliva glands are commonly associated with bulimia nervosa. In 15 patients and controls, no significant difference was detected in the concentrations of potassium, chloride, calcium, urea nitrogen or albumin. There was also no evidence of olfactory dysfunction.

Case review section of the American Board of Pediatric Dentistry: stumbling blocks and pitfalls.

The Directors of the American Board of Pediatric Dentistry are eager for eligible candidates to become Diplomates. It is important to the profession as well as to the individual that more of our colleagues become Board certified. Failure on a Section of the examination is distressing to us as well as to the candidate. Requirements for the Case Review Section are very specific and are intended to assist the candidate in preparing the cases. Carefully following the guidelines will minimize potential disappointment.

Oral manifestations associated with leukocyte adhesion deficiency: a five-year case study.

A five-year case study of a child with leukocyte adhesion deficiency is presented. The report describes the generalized progressive periodontitis and intraoral infections associated with both the primary and permanent dentition. The associated therapeutic challenges and largely unsuccessful treatment regimens utilized in the attempts to arrest the periodontal disease are described.

Career preferences of pediatric dentistry advanced education students.

A questionnaire addressing career preferences of pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. Men were in combined specialty programs significantly more than women (P < 0.05, chi-square) and U.S. citizen students were significantly older than non-citizens (P < 0.05, t-test). The collected data reflected differences in career preferences between men and women, and citizens and noncitizens. Women reported a significant preference for private practice, part-time associate and public health practice than did men. Although not significant, men declared equal preference for full-time private practice either solo or as an associate. Noncitizens were found to have a significant preference when compared to citizens for academic full- and part-time, hospital/institutional full- and part-time, research, full- and part-time positions, and for additional training.

Factors that affect career choices of pediatric dentistry advanced education students.

A questionnaire addressing factors that affect career choices by pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. The responses were analyzed for women and men and citizens and noncitizens. Concern for spouse career opportunities affected women's personal career decisions significantly more (P < 0.05) than it did for men. Women rated previous federal/military experience significantly less (P < 0.05) influential on their career choice than did men. Geographic preference when making career decisions was significantly more (P < 0.001) important to citizens than it was for noncitizens. Noncitizens assigned significantly higher (P < 0.001) ratings to an interest in teaching and research than did citizens. A preference for practicing with a parent or relative and previous federal/military experience affected career choices by noncitizens significantly more (P < 0.05) than they did citizens. This study suggests that numerous career-influencing factors in pediatric dentistry are perceived differently by women and men, and citizens and noncitizens.

Fluoride concentrations in whole saliva following use of fluoride tablets and a rinse.

This clinical investigation is comprised of two studies. The first monitored the oral clearance of fluoride following the use of an oral rinse and two types of tablets: one that was chewed, swished, and swallowed, and another that was allowed to dissolve undisturbed at a specific site in the oral vestibule. Fluoride from the rinse and tablets exhibited similar rapid clearance patterns with a mean concentration of 1.2 ppm or less within 1 hr and returned to baseline concentrations within 24 hr. Data from the second study indicated fluoride was distributed unevenly to various areas of the mouth from the slowly dissolving undisturbed tablet. Information concerning oral clearance of fluoride may be used to rationalize various treatment regimens.

Cystic fibrosis: a current review.

Cystic fibrosis (CF) is the most common severe genetic disorder seen in Caucasians. Defective exocrine gland secretions result in chronic diseases of the respiratory and gastrointestinal systems. However, the CF gene recently has been located and cloned. Currently, genetic technology allows identification of sibling carriers and antenatal diagnosis within families. Oral implications associated with CF include enamel hypoplasia and tooth discoloration, salivary gland involvement, reduced incidence of dental caries, reservoir for potentially pathogenic respiratory bacteria, mouth breathing, and anterior open bite associated with nasal and sinus obstruction. Continued efforts to improve early diagnosis and treatment of CF should increase life expectancy. Affected patients are expected to seek regular dental care more frequently as they learn to view the disease as manageable.

Pattern of permanent teeth present in individuals with ectodermal dysplasia and severe hypodontia suggests treatment with dental implants.

PURPOSE: The objective of this study was to assess the pattern of permanent teeth present in a self-selected sample of 17 female and 35 male patients with ectodermal dysplasia presenting for treatment with dental implants. METHODS: Mean age of sample: 18.7 years, age range: 5.9 to 60.9 years. Panoramic radiographs were examined independently by two investigators to determine the permanent teeth present. None of the sample reported extractions of permanent teeth prior to presenting for implants. RESULTS: Permanent teeth most likely to be present, reported as a percentage of the patient sample with that tooth, were: maxillary central incisors (42%), maxillary first molars (41%), mandibular first molars (39%), maxillary canines (22%), mandibular second molars (17%), maxillary second premolars (15%), and mandibular premolars (12%). Comparing dentition by quadrants, mandibular anterior teeth (canines and incisors) were least likely to be present. CONCLUSIONS: Results support previous findings that the maxillary central incisors, maxillary first molars, mandibular first molars, and maxillary canines are the most conserved teeth in hypodontia. Successful use of osseointegrated implants in the anterior mandibles of most of these patients suggests that habilitation of the mandible with dental implant-supported prostheses is a reasonable option.

Factors affecting the mobility of pediatric dentistry faculty.

PURPOSE: A questionnaire was used to develop a profile of current pediatric dentistry faculty to determine whether current faculty would consider relocating to accept another position in academia, and to identify what factors are most important to current full-time faculty when considering another faculty position. RESULTS: Responding males had a significantly higher mean age (49.3 years) than the females (39.3 years). A significantly greater proportion of women (87%) than men (66%) reported that they were prepared to move if offered an improved career opportunity. Both women and men ranked an improved opportunity for professional growth followed by salary increase as the highest rated factors in considering relocation. There was no statistical difference between women and men at the assistant professor level relative to the importance of academic promotion opportunity. However, women at the associate professor level ranked an opportunity for academic promotion statistically higher than did men.

Evaluation of the carbon dioxide laser on vital human primary pulp tissue.

PURPOSE: The purpose of this study was to evaluate the response of the human primary pulp to the carbon dioxide laser and formocresol for vital pulp therapy. METHODS: Fifteen healthy children with intact, caries-and-restoration-free, contralateral primary cuspids with at least two-thirds of the roots remaining who were scheduled for orthodontic extraction were randomly assigned to pulpotomy treatment with a carbon dioxide laser or formocresol. The treated teeth were clinically and radiographically evaluated at 28 and 90 days post-treatment prior to extraction. The extracted teeth were evaluated histologically for pulpal response. RESULTS: All teeth were asymptomatic and clinically normal at both observation periods. Internal root resorption was observed in one formocresol and two laser treated teeth. There was a significant inverse correlation between the laser energy applied to the pulp and the degree of inflammation at 28 days (P = .01) but not at 90 days (P = .27). CONCLUSION: Carbon dioxide laser treatment compared favorably to formocresol for pulpotomy in primary teeth.

A cost analysis of treating pediatric dental patients using general anesthesia versus conscious sedation.

PURPOSE: The purpose of this pilot study is to report a cost comparison of general anesthesia (GA) versus oral conscious sedation (CS) for the treatment of pediatric dental patients. METHODS: The study sample included 22 children whose parents/guardian selected GA care for their child. Selection criteria limited inclusion to healthy children (ASA I) ages 24-60 m.o. The subjects acted as their own comparison group to an estimation CS model. Models were developed to assess societal costs for treatment under GA and CS. Treatment rendered was equalized using the dental Relative Based Value Units Scale (RBVU). RESULTS: Ordinary Least Squares Regression analysis techniques showed the association of RBVU to the total societal costs of GA and CS to be significant (P < 0.01) with an adjusted R2 of .64 and .78 respectively. When regression lines were plotted, the intersection represented RBVU level at which societal costs of GA and CS were the same. CONCLUSION: Under the conditions of this pilot study, it is concluded that CS costs exceed GA costs at a RBVU level of 66.4, which would equate to more than three CS appointments.

In vitro evaluation of fluorescein for testing the permeability of white spots on tooth enamel.

This investigation demonstrates the reliability of fluorescein for detecting the permeability of incipient dental caries (white spots). Artificial white spots were created on the buccal surface of 12 human bicuspids by viscous lactic acid (pH 4). Permeability of these lesions was assessed and reassessed before and after 24 and 48 hr of acid challenge using two disclosants: sodium iodide and sodium fluorescein. Estimates obtained from both disclosants showed that the microvoid volume approximately doubled as the decalcification time doubled. The two disclosants exhibited good intraclass reliability and their scores were correlated (r = 0.69 to r = 0.91). However, only fluorescein disclosed the extent of porous white spot lesions. Thus, fluorescein should be considered when the objective is to detect the location and permeability of incipient lesions.

Oral manifestations of human immunodeficiency virus infection.

It is important that both physicians and dentists recognize the earliest signs of HIV infection in order that a timely diagnosis and patient referral can be made for counseling and treatment. Candidiasis, hairy leukoplakia, and Kaposi's sarcoma are the most common oral manifestations, but there are other important lesions as well. They include severe necrotizing periodontitis, bacterial and viral infections, lymphomas, and carcinomas. The various oral lesions seen in patients with the acquired immunodeficiency syndrome are reviewed and managements are discussed.