No consistent association found between dental caries and body mass index in children.

Data sourcesPubMed, Embase, the Cochrane Library and reference lists of identified studies.Study selectionObservational studies comparing dental caries and body mass index (BMI) where BMI was clearly defined were considered.Data extraction and synthesisTwo reviewers independently abstracted data using standard forms with study quality being assessed using a modified version of the Agency for Healthcare Research and Quality (AHRQ) methodology checklist for cross-sectional studies. The weighted mean differences and corresponding 95% confidence intervals for dental caries between children with abnormal weight and those with normal weight were analysed.ResultsFourteen cross-sectional studies including 43,860 children (boys: 23,299; girls: 20,561) were included. Only two studies were considered to be of high quality, eight of medium quality and four of low quality. Four main patterns of associations between dental caries and BMI were found: five studies showed no association, five studies found a positive association, three an inverse association and one found a U-shaped pattern, which meant that the deft score was significantly higher in underweight children and there was a higher DMFT score in overweight and obese children.ConclusionsThis meta-analysis showed no differences in dental caries between underweight and normal weight children. Further studies are recommended using suitable sample sizes, to unify the criteria for BMI categorisation and the dental caries index, and investigate the confounding factors that might influence dental caries and BMI.

Direct effects of mitochondrial dysfunction on poor bone health in Leigh syndrome.

Mitochondrial diseases are the result of aberrant mitochondrial function caused by mutations in either nuclear or mitochondrial DNA. Poor bone health has recently been suggested as a symptom of mitochondrial diseases; however, a direct link between decreased mitochondrial function and poor bone health in mitochondrial disease has not been demonstrated. In this study, stem cells from human exfoliated deciduous teeth (SHED) were isolated from a child with Leigh syndrome (LS), a mitochondrial disease, and the effects of decreased mitochondrial function on poor bone health were analyzed. Compared with control SHED, LS SHED displayed decreased osteoblastic differentiation and calcium mineralization. The intracellular and mitochondrial calcium levels were lower in LS SHED than in control SHED. Furthermore, the mitochondrial activity of LS SHED was decreased compared with control SHED both with and without osteoblastic differentiation. Our results indicate that decreased osteoblast differentiation potential and osteoblast function contribute to poor bone health in mitochondrial diseases.

Molar incisor hypomineralisation.

Data sourcesThe Medline and Embase databases and hand searches in the journals International Journal of Paediatric Dentistry and European Archives of Paediatric Dentistry.Study selectionEnglish language cohort and case-control studies.Data extraction and synthesisStudy selection was carried out independently by two reviewers with data abstraction being conducted by a single reviewer and checked by a second reviewer. Risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Adjusted (aOR) and unadjusted odds ratios (uOR), P-values and 95% confidence intervals (CI) were obtained from the studies. Meta-analysis was not conducted.ResultsTwenty-eight studies were included; 25 reported on MIH, three on hypomineralised second primary molars (HSPM). Nineteen of the studies were of cohort design (six prospective,13 retrospective) and nine were case controls. There was little evidence of an association between the most frequently investigated prenatal factors (smoking, maternal illness, maternal medication, maternal stress) and MIH. Similarly there was little evidence of an association between MIH and perinatal factors such as prematurity, low birth weight, caesarean delivery and birth complications. Early childhood illness, up to three or four years of age, was widely investigated, with six studies reporting a crude association. Associations between antibiotics, anti-asthma medication and breastfeeding were also evaluated. Only three studies looked at HSPM; one study suggested that maternal antibiotic use during pregnancy is unlikely to be associated with HSPM but maternal alcohol intake may be. Another study reported possible associations with a large number of factors, with perinatal factors and neonatal illness being most common, followed by prenatal factors.ConclusionsPrenatal and perinatal factors are infrequently associated with MIH. However, despite a lack of prospective studies, early childhood illness (in particular fever) appears to be associated with MIH. Further prospective studies that adjust for confounding based on biological principles, as well as genetic and epigenetic studies, are needed because the aetiology is likely to be multifactorial.

AN ERUPTION PATTERN OF DECIDUOUS TEETH IN CHILDREN BORN WITH FETAL MACROSOMIA DURING THE FIRST YEAR OF LIFE.

The paper aims at studying the effect of body overweight at birth on the dental health of 482 children in the Kharkiv City (Ukraine) during their first year of life over the 2001 and 2013 interval. The macrosomia set is comprised of the medical records of the children born with fetal macrosomia, and the normosimia set of the medical records of the children born with weight and height that correspond to the gestation age. The gestation age of all children is 37 to 42 weeks'. To determine the average time of first tooth eruption and deciduous teeth growth rate for each of the sets under study, we have used the hypothesis about a linear dependence between the number of erupted teeth and the age of the child. Processing statistical data is performed applying the multiple linear regression analysis. The reasons for macrosomia in the children are examined. The number of pregnancies and deliveries influence the likelihood of having a child with fetal macrosomia. A greater likelihood of having a child with fetal macrosomia in the older parents is not found. The correlation between the states of a child at birth (macrosomia/normosimia) and terms of deciduous tooth eruption (the delayed/timely/early eruption) expressed in a number of teeth at the age of one year is determined. The difference in the teeth growth rate between the boys and girls within the both sets are insignificant. The children born with macrosomia have a lower rate (approximately 0.1 tooth per month) of teeth growth and a greater spread in the number of teeth that erupt by a certain age.

Effect of a thin-neck pacifier on primary dentition: a randomized controlled trial.

OBJECTIVES: To evaluate changes in occlusal characteristics in the primary dentition that occur after introducing a thin-neck pacifier (TNP) to children with previously diagnosed pacifier-associated anterior open bite (AOB) and increased overjet. SETTING AND SAMPLE POPULATION: Department of Preventive and Pediatric Dentistry, Jena University Hospital, Germany. Subjects were 86 children (mean age 20.3 months) with a pacifier-associated open bite or overjet ≥2 mm. MATERIAL & METHODS: Randomized controlled trial. Subjects were randomly assigned: group I (n = 28), intervention group using a TNP; group II (n = 30), control group, using a conventional or physiological pacifier; and group III (n = 28), intervention group, Gold standard, weaned off pacifier. Participants were re-examined after 3, 6, 9 and 12 months by an operator, blinded for the treatment. RESULTS: After 12 months data for 63 children (mean age 33.1 months) were analyzed (I: n = 24; II: n = 22; III: n = 17). There was a significant difference between the groups regarding mean overjet (group I: 2.7 ± 0.5 mm, group II: 3.2 ± 0.7 mm, group III: 2.4 ± 0.5 mm, Kruskal-Wallis, p = 0.002) and AOB (group I: -1.2 ± 0.3 mm, group II: -2.2 ± 0.3 mm, group III: -0.8 ± 0.8 mm, Kruskal-Wallis, p < 0.001). The differences between group I and II regarding increased overjet (3.1 ± 0.2 mm vs. 3.6 ± 0.3 mm, Mann-Whitney, p < 0.001) and extent of AOB (-1.2 ± 0.3 mm vs. -2.2 ± 0.3 mm, Mann-Whitney, p < 0.001) were statistically significant. CONCLUSION: Use of TNP resulted in better clinical measurements for in overjet and overbite compared with the continuing use of conventional or physiological pacifiers.

Treatment considerations in hutchinson-gilford progeria syndrome: a case report.

Hutchinson-Guilford progeria syndrome is an extremely rare condition classified as one of the premature ageing syndromes. This case presents a 16-year-old Israeli female patient, suffering from a variant of Hutchinson-Guilford progeria with a history of treatment with oral biphosphnates. The patient presented with typical cranial and facial features of the syndrome including delayed teeth eruption and root development probably due to insufficient jaw growth and severs retrognatic position of the maxilla and mandible. Orthodontic treatment considerations are described along with those required in light of the previous treatment by oral biphosphonates.All primary teeth were extracted in three appointments while creating as minimal trauma as possible to the surrounding tissue and alveolar bone. For now, the patient refuses to begin the orthodontic treatment course. There are no limitations to conduct any dental procedures in progeria patients, however, extreme caution must be exercised during oral surgery due to the inelasticity of tissues and dermal atrophy. Orthodontic procedure commencement should be early enough to manage the delayed development and eruption of teeth. Patients taking oral biphosphonates should be advised of this potential complication. If orthodontic treatment is considered appropriate, plans should be assessed and modified to include compromises.

[Complex treatment approach for preschool children with impaired nasal breathing].

During the treatment of children with impaired nasal breathing (INB) cooperation of medical specialists is needed in order to reveal risk factors. The objective of the study was to prove the necessity of complex approach to the treatment of children with risk factors for INB. Multi-variant analysis of somatic and dental health of 170 children aged 4-6 was performed. The dental health was examined gradually in several steps, including physical examination. The following risk factors of antenatal and postnatal development of a child were revealed: genetic predisposition, complication of pregnancy, birth defects, somatic pathology, mastication dyspraxia, respiratory impairment, and various speech impediments. The following dentofacial anomalies prevailed: disorder of abrasion of primary dentition tubercle, development discord of cranio-facial area. The necessity of doctors' cooperation was proved during the treatment of children with impaired nasal breathing. Accurate execution of proposed treatment schemes allows eliminating risk factors promptly and decreasing the pathology severity.

Establishing the diagnostic criteria for eruption disorders based on genetic and clinical data.

INTRODUCTION: Proper diagnosis and management of eruption disturbances remains challenging but is critical to a functional occlusion. The objective of this study was to establish definitive criteria to differentiate and diagnose eruption disorders, specifically primary failure of eruption (PFE) and ankylosis. METHODS: Sixty-four affected persons were placed into 3 cohorts: PFE diagnosed through confirmed PTH1R mutation (n = 11), PFE diagnosed based on clinical criteria (n = 47), and ankylosis diagnosed based on clinical criteria (n = 6). These groups were assessed to identify clinical features that differentiate PFE and ankylosis. RESULTS: Ninety-three percent of the subjects in the genetic and clinical PFE cohorts combined (n = 58) and 100% in the genetic PFE cohort had at least 1 infraoccluded first permanent molar. Additionally, a novel functional PTH1R mutation, 1092delG, was identified and linked to PFE in the deciduous dentition. CONCLUSIONS: An infraoccluded, supracrestal first molar is a hallmark of PFE, often involving both arches in the permanent or deciduous dentition, and with unilateral or bilateral affection, infraoccluded second premolar or second molar, and multiple affected adjacent teeth. Our results further suggest that PFE and ankylosis might be clinically indistinguishable without knowledge of prior trauma, treatment history, genetic information, or obliteration of the periodontal ligament space.

Root resorption of primary molars without successor teeth. An experimental study in the beagle dog.

Tooth agenesis is a common craniofacial congenital malformation in humans, but little is known about the mechanisms of root resorption in this condition. The purpose of this study was to investigate the mechanisms of root resorption in primary molars without successors. An animal model without permanent tooth germs was established by surgery in beagles. The times of onset of primary molar root resorption, with and without successors, were compared. The distribution of immune cells, odontoclasts, and their activating factors were determined by histochemistry and immunohistochemistry. Root resorption of primary mandibular molars without successors began later than physiological resorption. In primary molars without permanent germs, odontoclasts and immune cells were present mainly in the apical pulp at the start of root resorption, whereas in control teeth receptor activator of nuclear factor-κB ligand (RANKL)-positive cells were found mainly in the region of the periodontal ligament. CD14(+) and CD3(+) cells were found in both the pulp and the periodontal ligament region. These results suggest that the dental pulp of primary molars, as well as immune cells, may play an important role in root resorption in primary molars without permanent tooth germs.

Hypoplastic root cementum and premature loss of primary teeth in Coffin-Lowry syndrome: a case report.

BACKGROUND: Coffin-Lowry syndrome (CLS) is a rare genetic disorder. The syndrome presents with psychomotor retardation, short stature, skeletal deformations, digit abnormalities, and distinctive facial features. Oral and dental findings in CLS are common and they include thick prominent lips, high palate, midline lingual furrow, hypodontia, microdontia, delayed eruption, and early tooth loss. Only one earlier case suggesting hypoplastic root cementum as cause for primary loss of teeth in CLS has been published. CASE REPORT: This case describes a 3-year-old boy with premature loss of primary incisors without preceding root resorption. In addition to the dental findings, the boy had several general signs and symptoms and the dental findings together with the other characteristics led to the clinical diagnosis of CLS, which later was genetically verified. Histological analysis of an extracted primary incisor showed hypoplastic root cementum. CONCLUSION: Hypoplastic root cementum may explain early tooth loss in CLS. As early loss of primary teeth is rare, especially when there is no previous root resorption, the individual is likely to seek dental care. Thus, the dentist may play an important role in assisting in the diagnosing of CLS.

Variant Carvajal syndrome with additional dental anomalies.

BACKGROUND: This paper aims to review the case of a girl who presented with a number of dental anomalies, in addition to unusual skin, nail and hair conditions. Tragically an undiagnosed cardiomyopathy caused unexpected sudden death. The case is discussed with reference to a number of dermatological and oral conditions which were considered as possible diagnoses. CASE REPORT: AW had been under long term dental care for prepubertal periodontitis, premature root resorption of primary teeth, soft tissue and dental anomalies, and angular cheilitis. Separately she had also been seen by several dermatologists with respect to palmar plantar keratosis, striae keratoderma, wiry hair and abnormal finger nails. Tragically the patient suffered a sudden unexpected death and the subsequent post mortem identified an undiagnosed dilated cardiomyopathy. CONCLUSION: The most likely diagnosis is that this case is a variant of Carvajal Syndrome with additional dental anomalies. To date we have been unable to identify mutations in the desoplakin gene. We aim to emphasise the importance of recognising these dental and dermatological signs when they present together as a potential risk factor for cardiac abnormalities.

Vertical alveolar growth in subjects with infraoccluded mandibular deciduous molars.

INTRODUCTION: Our objective was to compare vertical alveolar growth in areas adjacent to infraoccluded deciduous molars with growth in areas of deciduous molars and normal occlusion for a period of at least 1 year by using digital subtraction radiography. METHODS: This case-control study included 40 pairs of panoramic radiographs of growing patients with infraoccluded deciduous molars and 40 pairs of radiographs of patients without infraoccluded deciduous molars. One radiograph at baseline was obtained at diagnosis, and the other at least 1 year later. The subjects and the controls were matched according to chronologic age and time interval between the 2 radiographs. The 2 groups were compared with regard to vertical alveolar growth and vertical tooth movement. Measurements were assessed by using nonparametric tests (Mann-Whitney and Friedman) and a multiple comparison test. Significance was set at 5%. RESULTS: A statistically significant difference was observed between the groups with regard to vertical alveolar growth measured on the bone crest between the first permanent molars and second premolars. CONCLUSIONS: Vertical alveolar growth between the first permanent molar and the second premolar adjacent to the infraoccluded teeth was smaller than in areas adjacent to teeth with normal occlusion.

An evaluation of factors associated with persistent primary teeth.

The aim of the present study was to investigate the reasons for the persistence of primary teeth and also use panoramic radiography to determine the characteristics of persistence teeth. Four-hundred and twenty-six panoramic radiographies, which diagnosed one or more retained primary teeth, were selected from 100,577 panoramic radiographic image files from nine clinics and six different cities in Turkey. The selected radiographies were evaluated to determine the reasons for the persistence of primary teeth; furthermore, this study analyzed the characteristics of the retained primary teeth including tooth type, number, location, and root resorption, and whether, or not, the primary teeth showed evidence of pathological conditions, such as periodontal problems, caries, ankylosis, infra-occlusions, or tipping of the adjacent permanent teeth. Six hundred and seventy-seven retained primary teeth were determined in 426 patients (148 males and 278 females). Retained primary teeth were found most frequently in the mandible rather than the maxilla and the left side was more frequently affected than the right side. Level 1 was found as a most frequently encountered root resorption level. Within the limitation of the present study, the most common type of persistent primary teeth seen on the dental arch were mandibular primary second molars, followed by maxillary primary canines. The most frequent reason for the persistence was the congenital absence of successors to the primary teeth, followed by impaction of the successor teeth.

Eruption delay in a 47 XXY male: a case report.

BACKGROUND: The 47,XXY syndrome, or Klinefelter syndrome, though it is a rare occurrence, it is the most common sex choromosome disorder affecting male subjects. This syndrome is underdiagnosed and seldomly before puberty. In this case, diagnosis was made before birth, through chorion villus sampling. CASE REPORT: A 16 month-old Italian male with 47 XXY syndrome showed the absence of primary teeth, with a delay of about 8-10 months, whereas during the first 15 months of life the auxological development has been normal both in weight and height (about 50th percentile). We assumed that this delay may be linked with Klinefelter syndrome, as sexual chromosomes play an important role in the dental development.

Association between interdental plaque acidogenicity and caries risk at surface level: a cross sectional study in primary dentition.

BACKGROUND: In schoolchildren the most commonly decayed primary teeth are molars affecting proximal adjacent surfaces especially. AIM: To determine whether a more acidic plaque in response to sucrose challenge is detected in children with more carious lesions. DESIGN: Plaque pH measurements, using the microtouch technique, were carried out in interproximal spaces between primary molars, in 157 high caries risk children (314 sites and caries status of the 628 proximal surfaces recorded). The area under the curve (AUC(5.7) and AUC(6.2) ) was analyzed. RESULTS: The AUC(5.7) and the AUC(6.2) showed a statistically significant difference between plaque adjacent to proximal surfaces with or without caries. Differences for AUC(5.7) and AUC(6.2) were recorded between one decayed surface compared to two decayed surfaces (P<0.01) whereas a statistical significant difference was only observed for AUC(5.7) , when the areas under the curve were obtained near one decayed surface compared to two sound surfaces (P=0.04). CONCLUSIONS: The higher acidogenicity of the dental plaque found in presence of a proximal carious lesion in primary maxillary molars represents an additional risk factor for the adjacent surface. This finding may help clinicians in treatment decisions.

Nonsurgical treatment of a Class III patient with a lateral open-bite malocclusion.

A 15.3-year-old white girl with a skeletal Class III malocclusion and a severe lateral open bite was treated with conventional orthodontics and directional force mechanics and elastics. She had 5 congenitally missing premolars. The maxillary right canine was ectopically erupted and in contact with the maxillary right first molar. An Angle Class I molar relationship was achieved with canine protected occlusion and incisal guidance. A wrap-around retainer was placed on the maxillary arch and a lingual bonded retainer on the mandibular arch. Treatment time was 38 months.

Prevalence of systemic and local disturbances in infants during primary teeth eruption: a clinical study.

AIM: The purpose of this study was to find the correlations between local and systemic manifestations during primary teeth eruption and the eruption of various groups of teeth. MATERIALS AND METHODS: The infants selected for the study purpose were between 6 months to 3 years of age who had at least one erupting tooth. The study group consisted of 894 infants and other 550 infants served as a control group. Questionnaires were distributed to all parents and the data was collected. Chi square test was performed to analyse the information obtained between the two groups. There were 378 girls (42.2%) and 516 boys (57.7%) in the study group. The control group consisted of 195 girls (35.4%) and 355 boys (64.5%). RESULTS: The most common finding was gingival irritation 821 (95.9%) and the least common symptom observed in the study was running nose 234 (27.3%). The presence of fever diarrhea was seen in 101 (11.7%) infants. In the control group, 92.1% of the infants did not show any clinical manifestations. CONCLUSION: An association was found between primary teeth eruption and local and systemic manifestations. Most manifestations were found during eruption of the primary incisors.

Oral manifestation associated with multiple pituitary hormone deficiency and ectopic neurohypophysis.

Multiple pituitary hormone deficiency (MPHD) is the diminished secretion of all the hormones produced in the anterior lobe of the pituitary gland. The oral manifestation of this condition includes delayed eruption and prolonged retention of primary teeth, delayed formation and eruption of permanent teeth, delay in development and growth of the jaws, tendency towards development of deep bite and enamel disturbances. This paper reports the case of an adolescent patient with MPHD. Clinical examination revealed partial ankylosis and prolonged retention ofprimary second molars, primary maxillary canines and deep bite. Dental treatment included extraction of all molars with prolonged retention preceded by the necessary medical care with clinical and radiographic follow-up afterwards. The patient was also referred to an orthodontist for orthodontic treatment. Patients' medical condition should always be investigated by clinicians when faced with cases of delayed tooth eruption and bone development.

Loss of deciduous teeth--is timing important to the GDP?

UNLABELLED: On a daily basis, GDPs encounter patients with prematurely lost deciduous teeth or, conversely, deciduous teeth retained well past their accepted exfoliaton date. The timing of deciduous tooth loss impacts on many aspects of the developing occlusion. The aim of the article is both to describe this impact and also to set out guidelines which should assist the general dental practitioner in the decision of when to lose deciduous teeth. CLINICAL RELEVANCE: The timing of deciduous tooth loss is an important concept which, when outside the normal pattern, may have adverse or beneficial side-effects that general dental practitioners should fully understand.

Effects of fluoride dentifrice on remineralization of demineralized primary enamel.

This study was performed to compare the remineralizing effects of various concentrations of fluoride containing dentifrices against artificial demineralization of primary enamel. One hundred twenty primary incisors were partly covered with a nail varnish, leaving a 1 x 1 mm window, then placed in demineralizing solution for 96 hours to produce artificial carious lesions 60-100 microm in depth. They were assigned to 8 groups (A to H; n = 15). Groups A-D were exposed to a half pea-sized portion of dentifrice (0.16 g) and groups E-H were exposed to a pea-sized portion of dentifrice (0.32 g), both groups with fluoride concentrations of 0, 250, 500 and 1,000 ppm. The pH-cycling method was carried out for 7 days, then the teeth were cut through the lesions and examined under a polarized light microscope; photographs were taken and analyzed. Lesion depth was measured using a computerized method using the Image-Pro Plus Program. The results were analyzed using the One way ANOVA and LSD tests. The mean lesion depth in the 2 non-fluoridated control groups (A and E) were significantly deeper than in the fluoridated groups. There were no differences found between the half pea-sized and pea-sized dentifrice.