Influence of metabolic-linked early life factors on the eruption timing of the first primary tooth.

AIM: Early eruption of permanent teeth has been associated with childhood obesity and diabetes mellitus, suggesting links between tooth eruption and metabolic conditions. This longitudinal study aimed to identify pre-, peri- and postnatal factors with metabolic consequences during infancy that may affect the eruption timing of the first primary tooth (ETFT) in children from an ethnically heterogeneous population residing within the same community. MATERIAL AND METHODS: Participants were recruited (n = 1033) through the GUSTO (Growing Up in Singapore Towards healthy Outcomes) birth cohort (n = 1237). Oral examinations were performed at 3-month intervals from 6 to 18 months of age. Crude and adjusted analyses, with generalized linear modelling, were conducted to link ETFT to potential determinants occurring during pregnancy, delivery/birth and early infancy. RESULTS: Overall mean eruption age of the first primary tooth was 8.5 (SD 2.6) months. Earlier tooth eruption was significantly associated with infant's rate of weight gain during the first 3 months of life and increased maternal childbearing age. Compared to their Chinese counterparts, Malay and Indian children experienced significantly delayed tooth eruption by 1.2 and 1.7 months, respectively. CONCLUSIONS: Infant weight gain from birth to 3 months, ethnicity and maternal childbearing age were significant determinants of first tooth eruption timing. Early life influences can affect primary tooth development, possibly via metabolic pathways. CLINICAL RELEVANCE: Timing of tooth eruption is linked to general growth and metabolic function. Therefore, it has potential in forecasting oral and systemic conditions such as caries and obesity.

Orthodontists and the thyroid gland.

This paper questions the adequacy of orthodontists' full appreciation of the issues associated with the routine prescription of extra- oral radiography, particularly that related to a high risk of thyroid gland exposure to ionising radiation. There does not appear to be adequate application of the ALARA principle in the consileration of justifiable options to minimise the cumulative effects of radiation exposure in young patients.

Challenges and Long-Term Management of Patients with Craniofacial Clefts in Thailand.

OBJECTIVE: To report challenges and long-term management of patients with craniofacial clefts, treated at Srinagarind Hospital, Khon Kaen, Thailand. MATERIAL AND METHOD: Patients who were treated at Srinagarind Hospital, between 1993 and 2001. A review of data was performed including general information, classifications, photographs, radiographic findings, dental records, reconstructive surgeries, and long-term management. RESULTS: A total of 20 patients were recruited; six males and 14 females, grouped into six median, two paramedian and 12 oblique clefts. Age of the first treatment ranged from one to 39 years, age of the last follow-up ranged from 11 to 48 years and the range of follow-ups was 11 to 24 years. The reconstructive procedures included a variety of techniques of plastic surgery for soft tissue repairs and bone grafting for facial reconstructions. Four patients with median clefts and paramedian clefts died. One patient lost to follow-up. Fifteen patients were followed-up and the results were satisfying. CONCLUSION: Diagnosis, evaluation, and treatment of clefts and craniofacial deformities are complex. The proper management is challenging because of socioeconomic, cause difficulties in follow-ups according to the planned protocol. Other associated anomalies are important. Protocols with well-co-ordination of an interdisciplinary team in Craniofacial Center and continuing evaluation at appropriate schedule and age group until completion of facial growth are critical factors. Establishment of a foundation and comprehensive care model with families, local health professionals and school will benefit the most to this group of patients.

Surgery first orthognathic approach for skeletal Class III malocclusion corrections--a literature review.

Management for patients with skeletal Class III malocclusion is orthognathic surgery which involves both orthodontics and surgery. Nowadays, there are two approaches for orthognathic surgery: orthodontics-first and surgery-first approaches. The orthodontics-first approach, or presurgical orthodontics treatment, causes longer treatment time and worsens facial appearance before surgery compared with a surgery-first approach. Conversely, with the surgery-first approach or the surgery-first-orthognathic-approach (SFOA), correction can be resolved more rapidly. SFOA needs high level skill of orthodontist and surgeon and also needs good cooperation between them to accomplish best results. The purpose of this article is to review the concept, indications, contraindications, the stages of treatment and advantages, and disadvantages of SFOA.

Reverse-Transcription Loop-Mediated Isothermal Amplification Has High Accuracy for Detecting Severe Acute Respiratory Syndrome Coronavirus 2 in Saliva and Nasopharyngeal/Oropharyngeal Swabs from Asymptomatic and Symptomatic Individuals.

Previous studies have described reverse-transcription loop-mediated isothermal amplification (RT-LAMP) for the rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in nasopharyngeal/oropharyngeal swab and saliva samples. This multisite clinical evaluation describes the validation of an improved sample preparation method for extraction-free RT-LAMP and reports clinical performance of four RT-LAMP assay formats for SARS-CoV-2 detection. Direct RT-LAMP was performed on 559 swabs and 86,760 saliva samples and RNA RT-LAMP on extracted RNA from 12,619 swabs and 12,521 saliva samples from asymptomatic and symptomatic individuals across health care and community settings. For direct RT-LAMP, overall diagnostic sensitivity (DSe) was 70.35% (95% CI, 63.48%-76.60%) on swabs and 84.62% (95% CI, 79.50%-88.88%) on saliva, with diagnostic specificity of 100% (95% CI, 98.98%-100.00%) on swabs and 100% (95% CI, 99.72%-100.00%) on saliva, compared with quantitative RT-PCR (RT-qPCR); analyzing samples with RT-qPCR ORF1ab CT values of ≤25 and ≤33, DSe values were 100% (95% CI, 96.34%-100%) and 77.78% (95% CI, 70.99%-83.62%) for swabs, and 99.01% (95% CI, 94.61%-99.97%) and 87.61% (95% CI, 82.69%-91.54%) for saliva, respectively. For RNA RT-LAMP, overall DSe and diagnostic specificity were 96.06% (95% CI, 92.88%-98.12%) and 99.99% (95% CI, 99.95%-100%) for swabs, and 80.65% (95% CI, 73.54%-86.54%) and 99.99% (95% CI, 99.95%-100%) for saliva, respectively. These findings demonstrate that RT-LAMP is applicable to a variety of use cases, including frequent, interval-based direct RT-LAMP of saliva from asymptomatic individuals who may otherwise be missed using symptomatic testing alone.

New clinical method for alveolar bone graft evaluation in cleft patients: a pilot study.

The objective of this analytical cross-sectional study was to develop and test a new clinical evaluation method, using two sets of clinical criteria: (1) probing depth for teeth at either side of the grafted region and (2) residual defect at the central faciolingual region of the alveolar bone graft site, for assessing alveolar bone graft outcomes in patients with cleft of the lip and palate. Thirteen patients, 8 to 13 years old, with cleft lip and palate who underwent alveolar bone graft at Srinagarind Hospital and Faculty of Dentistry of Khon Kaen University were recruited into the study to test the agreement between two sets of data: (1) clinical examination scores and an expert's clinical judgment, (2) clinical and radiographic examination scores (Bergland and Chelsea scales). Study results showed that between the two criteria used in the new clinical method, reliability of the first criterion was higher than that of the second, .66 to 1.00 and .59 to .65, respectively. The reliability test for radiographic evaluation showed that the Chelsea scale had higher agreement than the Bergland, .80 to 1.00 and .64 to .86, respectively. Sensitivity, specificity, and likelihood ratio of the three proposed methods could not be concluded statistically due to the small sample size. In conclusion, even though the study sample was small, the method offers useful prospects as a supplement, if not an alternative, to overcome identified deficiencies of the Bergland and Chelsea scales and computed tomography scans, which raise concerns about radiation hazards and costs.

Prediction of final treatment for class III malocclusion of patients with oral clefts.

OBJECTIVE: To evaluate the value of predicted treatment plans interpreted from a previously developed Formula for Orthodontics and Surgery Prediction (FOSP) in patients with cleft lip and/or palate (CLP). MATERIAL AND METHOD: Orthodontic treatment records were collected of 105 non-syndromic CLP patients between the ages of 5 and 29 years, having Class III malocclusions of varying severity. Three cephalometric values from pre-treatment lateral cephalometric radiographs were determined for use with the FOSP. A receiver operating curve (ROC) was used to identify the optimal cut-off score for classifying predicted treatment needs, whether orthodontics alone or orthognathic surgery. The clinical merit of using the FOSP was determined by comparing predicted plans with actual treatments. RESULTS: The predictive value using a cut-off score of 0.6475 from the FOSP-for recommending the final treatment provided--was correctly classified for 79 subjects (75.2%). Sensitivity and specificity of the FOSP for prediction of the need for orthognathic surgery were 68.1% (52.9%-80.9%) and 81.0% (68.6%-90.1%), respectively. CONCLUSION: The FOSP can be used for early treatment prediction and counseling, and for more objectively specifying the type of orthodontic treatment for CLP patients. Other sources of information-such as evaluation of psychological and socioeconomic status, and patient's wishes-are still necessary for finalizing the treatment plan.

Early dental arch relationships as treatment outcome in children with complete unilateral cleft lip and palate in northeastern Thailand.

The objective of the present study was to evaluate the dental arch relationships of children with complete unilateral cleft lip and palate (UCLP) as an early surgical repair outcome in the Northeastern part of Thailand. The study used a 5-year study model of 46 complete UCLP, non consecutive, patients whose primary repair had been performed at Khon Kaen University. The outcome of dental arch relationships was assessed using the 5-Year-Olds' Index. Agreement of rating was assessed with weighted kappa statistics; both the intra- and inter-examiner agreements were high, indicating good reproducibility. The results indicated that the surgical outcome was graded as poor and very poor for 60% of patients and excellent, good, or fair for 40% of patients. This result was also poor compared with other overseas reports.

Revision rates of alveolar bone grafting in unilateral cleft lip and palate patients with and without orthodontic preparation.

The main purpose of the present study was to compare the revision rates of alveolar bone grafting in cleft lip and palate (CLP) patients with and without orthodontic preparation. The dental record of 101 patients with unilateral cleft lip and palate were examined. Details were recorded of general characteristic, the need for revision, intraoral condition prior to surgery, surgical procedure and the cause of revision. The revision rates were 11.9% and 20.6% in orthodontic preparation and non-orthodontic preparation groups, respectively. The Fisher's exact test showed that there was no difference in the revision rate between both groups. Intraoral conditions prior to grafting and different surgical procedures did not affect the success of alveolar bone grafting.

Preliminary optimisation of a simplified sample preparation method to permit direct detection of SARS-CoV-2 within saliva samples using reverse-transcription loop-mediated isothermal amplification (RT-LAMP).

We describe the optimisation of a simplified sample preparation method which permits rapid and direct detection of SARS-CoV-2 RNA within saliva, using reverse-transcription loop-mediated isothermal amplification (RT-LAMP). Treatment of saliva samples prior to RT-LAMP by dilution 1:1 in Mucolyse™, followed by dilution in 10 % (w/v) Chelex© 100 Resin and a 98 °C heat step for 2 min enabled detection of SARS-CoV-2 RNA in positive saliva samples. Using RT-LAMP, SARS-CoV-2 RNA was detected in as little as 05:43 min, with no amplification detected in 3097 real-time reverse transcription PCR (rRT-PCR) negative saliva samples from staff tested within a service evaluation study, or for other respiratory pathogens tested (n = 22). Saliva samples can be collected non-invasively, without the need for skilled staff and can be obtained from both healthcare and home settings. Critically, this approach overcomes the requirement for, and validation of, different swabs and the global bottleneck in obtaining access to extraction robots and reagents to enable molecular testing by rRT-PCR. Such testing opens the possibility of public health approaches for effective intervention during the COVID-19 pandemic through regular SARS-CoV-2 testing at a population scale, combined with isolation and contact tracing.

Diagnostic accuracy of loop-mediated isothermal amplification coupled to nanopore sequencing (LamPORE) for the detection of SARS-CoV-2 infection at scale in symptomatic and asymptomatic populations.

OBJECTIVES: Rapid, high throughput diagnostics are a valuable tool, allowing the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in populations so as to identify and isolate people with asymptomatic and symptomatic infections. Reagent shortages and restricted access to high throughput testing solutions have limited the effectiveness of conventional assays such as quantitative RT-PCR (RT-qPCR), particularly throughout the first months of the coronavirus disease 2019 pandemic. We investigated the use of LamPORE, where loop-mediated isothermal amplification (LAMP) is coupled to nanopore sequencing technology, for the detection of SARS-CoV-2 in symptomatic and asymptomatic populations. METHODS: In an asymptomatic prospective cohort, for 3 weeks in September 2020, health-care workers across four sites (Birmingham, Southampton, Basingstoke and Manchester) self-swabbed with nasopharyngeal swabs weekly and supplied a saliva specimen daily. These samples were tested for SARS-CoV-2 RNA using the Oxford Nanopore LamPORE system and a reference RT-qPCR assay on extracted sample RNA. A second retrospective cohort of 848 patients with influenza-like illness from March 2020 to June 2020 were similarly tested from nasopharyngeal swabs. RESULTS: In the asymptomatic cohort a total of 1200 participants supplied 23 427 samples (3966 swab, 19 461 saliva) over a 3-week period. The incidence of SARS-CoV-2 detection using LamPORE was 0.95%. Diagnostic sensitivity and specificity of LamPORE was >99.5% (decreasing to approximately 98% when clustered estimation was used) in both swab and saliva asymptomatic samples when compared with the reference RT-qPCR test. In the retrospective symptomatic cohort, the incidence was 13.4% and the sensitivity and specificity were 100%. CONCLUSIONS: LamPORE is a highly accurate methodology for the detection of SARS-CoV-2 in both symptomatic and asymptomatic population settings and can be used as an alternative to RT-qPCR.

Infant dietary patterns and early childhood caries in a multi-ethnic Asian cohort.

Dental caries, although preventable, remains one of the most prevalent chronic disease worldwide. Most studies focused on the relationship between sugar intake and caries. However, examining multidimensional dietary patterns is becoming increasingly important. Here, we examined the relationship between dietary patterns from ages 6 to 12 months and early childhood caries (ECC) at age 2 to 3-years. Infant dietary data was collected from caregivers and dietary pattern trajectories from 6 to 12 months derived. Oral examinations were carried out by trained calibrated dentists at ages 2 and 3 years. Associations between dietary pattern and ECC were estimated using generalized estimating equation. We found a 3.9 fold lower prevalence of decayed surfaces among children with high Guidelines dietary pattern scores at 6-months (IRR 0.26; CI [0.12-0.53]; p-value < 0.001) and 100% reduction of decayed surfaces with increased intakes of Guidelines dietary pattern foods from 6 to 12-month (IRR 2.4 × 10-4; CI [4.2 × 10-7-0.13]; p-value = 0.01). Suggesting that following the Guideline dietary pattern, which corresponds most closely to current World Health Organization weaning guidelines, at 6 months and an increase in pattern score between 6 and 12 months were protective against ECC development compared to Predominantly breastmilk, Easy-to-prepare foods and Noodles (in soup) and seafood dietary patterns.

Assisted eruption of impacted teeth into an alveolar bone graft in a patient with cleft lip and palate.

AIMS: To assist the eruption of impacted upper teeth into an alveolar bone graft in a patient with a unilateral cleft lip and palate. METHODS: An 8-year-old Thai boy with left unilateral complete cleft lip and palate had the chief complaint of anterior crossbite. He presented with a mild skeletal 3, dental Class III subdivision malocclusion, anterior crossbite, left unilateral posterior crossbite, moderate crowding in the upper arch with impaction of upper the left lateral incisor (tooth 22) and canine (tooth 23). In the first phase of treatment the posterior crossbite was corrected with a removable appliance with a 3-way screw. In the second phase the impacted teeth were surgically exposed, moved into the alveolar bone graft and the teeth aligned with fixed appliances. The upper left lateral incisor was extracted because of its questionable longevity. RESULTS: The orthodontic treatment resulted in normal overjet, overbite and an acceptable facial profile. A prosthesis replaced tooth 22. CONCLUSIONS: Forced eruption of impacted teeth can be carried out successfully in the cleft patients after an appropriate treatment plan has been formulated and following preparation of alveolar bone graft in the cleft site.

Clinical effects associated with miniscrews used as orthodontic anchorage.

AIMS: To measure the clinical effects associated with miniscrew anchorage used to retract the upper anterior teeth, specifically the positional changes associated with the miniscrews, the upper anterior teeth and the first upper molars. METHODS: This clinical trial included 13 patients. After orthodontic alignment, miniscrews were inserted in the maxillary zygomatic buttresses as anchorage for en masse retraction of the upper anterior teeth. Following premolar extractions, nickel-titanium closed coil springs, stretched between the miniscrews and upper archwire, were used for retraction. Three-dimensional changes in the upper anterior teeth, the upper first molars and the heads of the miniscrews were measured on study models taken before a 300 g force was applied and seven months later, or when retraction was completed if less than seven months. RESULTS: The mean duration of retraction was 5.23 months (SD: 1.74 months) with a range of three to seven months. The mean amount of anterior retraction was 3.82 +/- 1.64 mm (Range: 0.77-7.07 mm). Average movements of the miniscrew heads on the right side were 0.44 mm buccally, 0.38 mm forward and 0.54 mm downward, and on the left side 0.06 mm buccally, 0.41 mm forward and 0.50 mm downward. During the study period the right and left upper first molars moved mesially 0.70 +/- 0.46 mm (Range: 0.01-2.3 mm) and 0.76 +/- 0.47 mm (Range: 0.1-2.61 mm) respectively, although no force was applied to them. CONCLUSION: Miniscrews provide satisfactory anchorage for retraction of the upper anterior segment, but do not remain absolutely stationary under orthodontic loads. Because of coincidental mesial movement of the upper molars, there must be sufficient clearance mesial to the molars to avoid the molar roots contacting the miniscrews.

Stress responsiveness in adult life: influence of mother's diet in late pregnancy.

CONTEXT: Men and women whose mothers ate an unbalanced high-protein, low-carbohydrate diet in late pregnancy have raised blood pressure. We recently showed that they also have raised fasting plasma cortisol concentrations. Because raised fasting cortisol concentrations probably reflect a greater response to the stress of fasting and venesection, we suspected that this diet may have led to increased stress responsiveness in the adult offspring. OBJECTIVE: The aim was to determine whether an unbalanced high-protein diet during pregnancy is associated with increased cortisol secretion in response to psychological stress in the offspring. DESIGN AND PARTICIPANTS: Salivary cortisol concentrations were measured during a modified Trier Social Stress Test in 70 men and women aged 36.3 yr whose mothers had taken part in a dietary intervention in which they were advised to eat 1 pound (0.45 kg) of red meat daily during pregnancy and to avoid carbohydrate-rich foods. RESULTS: The offspring of women who reported greater consumption of meat and fish in the second half of pregnancy had higher cortisol concentrations during the Trier Test. Compared with the offspring of mothers who had reported eating no more than 13 meat/fish portions per week, the average cortisol concentrations were raised by 22% (95% confidence interval, 13 to 71%) and 46% (5 to 103%) in the offspring of those eating 14-16 and at least 17 portions per week, respectively. CONCLUSIONS: These findings provide the first human evidence that an unbalanced high protein maternal diet during late pregnancy leads to increased cortisol secretion in response to psychological stress in the offspring.

Treatment of skeletal 2 malocclusion using bone-plate anchorage. A case report.

OBJECTIVE: To report the treatment of a severe Class II division 1 malocclusion using bone-plate anchorage. METHODS: A 12 year-old Thai girl presented with a skeletal 2, Class II division 1 malocclusion. Following extraction of the maxillary first premolars and mandibular second premolars, the maxillary anterior teeth were retracted and the mandibular posterior teeth moved mesially. A miniplate with screws, placed in each zygomatic buttress, was used as absolute anchorage for coil springs to retract the maxillary anterior six teeth. RESULTS: After treatment, the patient presented with a normal overjet and overbite, a dental Class I relationship bilaterally and an improved facial profile.

Force-deflection characteristics of the fatigue-resistant device spring: an in vitro study.

AIM: The Forsus fatigue-resistant device spring is a 3-piece telescoping compression spring used for Class II correction. The aims of this study were: (1) to measure the mean force delivered at different amounts of deflection; (2) to determine and compare the mean stiffness between loading and unloading; and (3) to determine the resilience of the fatigue-resistant device springs. MATERIAL AND METHODS: Twelve fatigue-resistant device springs were tested with a universal testing machine and Winrcon software, with the load cell of 100 N, crosshead speed at 0.5 mm/second. Force-deflection data during loading and unloading were recorded at 2-mm intervals up to 12 mm compression. RESULTS: (1) The mean force-deflection loading and unloading curves generally were linear, with a small area of hysteresis; (2) the loading mean stiffness (19.4 g/mm) was significantly greater than the unloading mean stiffness (18 g/mm), although this is clinically insignificant; (3) fatigue-resistant device springs exhibited good resiliency. A calibrated table of force-deflection of fatigue-resistant device springs is presented for clinicians to select the appropriate length of the device for the particular orthodontic force needed.

Fetal growth and the adrenocortical response to psychological stress.

CONTEXT: Experimental studies in animals show that adverse prenatal environments lead to lifelong alterations in the activity of the hypothalamic-pituitary-adrenal axis, which mediates the stress response through secretion of glucocorticoid hormones. The extent to which such prenatal hypothalamic-pituitary-adrenal axis adaptations occur in humans is unknown. OBJECTIVE: The objective of the study was to determine whether smaller but otherwise healthy term babies are more likely to demonstrate increased glucocorticoid responses to psychological stress in childhood. DESIGN AND PARTICIPANTS: This was a cross-sectional study of 68 boys and 72 girls (aged 7-9 yr) who have been followed up since 12 wk gestation when their mothers took part in a study of healthy children born in Southampton, United Kingdom. MAIN OUTCOME MEASURE: Salivary cortisol responses to psychological stress were measured. RESULTS: In boys, birth weight was inversely related to salivary cortisol responses to stress (r = -0.56, P < 0.001) but not morning cortisol levels, whereas in girls, morning peak cortisol was inversely related to birth weight (r = -0.36, P < 0.05). These associations were independent of gestational age and potential confounding factors including obesity, social class, and educational achievement. CONCLUSIONS: This study suggests that processes occurring during fetal life, resulting in smaller newborns, have a lasting effect on adrenocortical responses to stress in boys and on basal adrenocortical activity in girls. Given the known associations between small alterations in adrenocortical activity and features of the metabolic syndrome such as raised blood pressure and glucose intolerance, these effects warrant further investigation of their potential impact on the future health of prepubertal children.

Miniplates and screws in treatment of skeletal Class III malocclusion with missing posterior teeth. A case report.

AIM: To describe the use of miniplates for temporary skeletal anchorage to distalise the entire lower dentition. METHODS: A 40 year-old woman presented with a skeletal Class III malocclusion and multiple missing maxillary and mandibular teeth. The treatment plan was to distalise the mandibular dentition. Two miniplates and screws in the mandibular retromolar region were used as temporary skeletal anchorage for Class I elastics. The entire lower dentition was distalised into a Class I incisor relationship with the miniplate and screw anchorage.