Dental, oral pH, orthodontic and salivary values in children with obstructive sleep apnea.

OBJECTIVES: Mouth breathing is a key feature of obstructive sleep apnea (OSA). The current study evaluated dental, salivary and orthodontic characteristics of children with OSA, and compared them to those of children without OSA. MATERIALS AND METHODS: Twenty-two children (mean age 5.3 years, 13 males) with OSA and 21 children without OSA who served as a control group (mean age 6.8 years, 11 males) underwent dental examinations. The OSA group was classified according to the apnea-hypopnea Index. Clinical examination included plaque index, gingival index, caries status, pH at 7 oral sites, salivary carries bacterial counts and inflammatory cytokine levels. Orthodontics measurements were calculated as the percentage of children with values in the normal range, in each group. RESULTS: The mean values of the decayed, missing and filled teeth (DMFT)/dmft index, the gingival index and the plaque index were higher in the OSA than the control group. Salivary Mutans streptococci and lactobacilli counts were significantly higher in the OSA than the control group; as were pH values in the hard and soft palate, and in the posterior and middle tongue. Significantly lower values were observed in the OSA than the control group for most of the orthodontic variables examined. Similarly, stratification of AHI according to severity shows the lowest values among those with mild OSA, and the highest among those with severe AHI. CONCLUSIONS: Compared to a control group, mouth breathing children with obstructive sleep apnea had differences in oral microbiota, greater acidity and poorer dental status. CLINICAL RELEVANCE: Clinicians should be aware of the various oral disturbances that may accompany OSA, and implement preventive measures.

Salivary biochemical variables in liver transplanted children and young adults.

PURPOSE: To investigate associations between levels of blood parameters used to monitor liver-transplanted children with their salivary levels, and compare the salivary parameters of transplant recipients with those of healthy controls. METHODS: Saliva and blood samples from 30 liver transplanted recipients, mean age 11.7 years and saliva from age and sex matched 27 healthy patients were analyzed using a standard complete blood count test. RESULTS: Uric acid and alkaline phosphatase levels correlated significantly between saliva and blood samples in the transplanted subjects. Median salivary sodium level was significantly lower and the median salivary potassium level significantly higher in transplant recipients compared with healthy subjects. No differences were found between the groups in salivary glucose, urea, chloride, total protein, albumin, calcium, phosphorus, uric acid, total bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), triglycerides, cholesterol, iron, transferrin, glutamic pyruvic transaminase (GPT) and gamma-glutamyltranspeptidase (GGT). CONCLUSION: Specific correlations of serum and salivary chemistry were found in liver transplant patients. Such information may lead to the development of noninvasive monitoring tools for this population.

Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment.

OBJECTIVE: To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists. STUDY DESIGN: During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists . RESULTS: No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures. CONCLUSION: Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

[Pediatric obstructive sleep apnea--an orthodontic perspective].

Sleep disturbed breathing in children, is a general term describing a wide range of respiratory disorders that occur during sleep, ranging from snoring to Obstructive Sleep apnea syndrome (OSAS). In recent years, the role of OSAS in a vast range of morbidities has been recognized, namely metabolic, neuro-cognitive and cardio-vascular disorders, thus emphasizing the importance of early detection. The recommended initial treatment for pediatric OSAS consists of surgical removal of adenoids and tonsils. However, today it is clear that there are other factors involved in the etiology of the syndrome. An association is believed to exist between the airway and craniofacial development and vice versa. The structure of the face and jaws has been shown to play an important role in the pathophysiology of OSAS, thus, the orthodontist plays a substantial role in the diagnosis and treatment of these children. Moreover, OSAS is believed to have a direct and indirect effect on oral health. Obstructive Sleep apnea syndrome is also common in adults, but is defined as a separate entity being different in terms of pathophysiology, clinical presentation and treatment. This paper reviews the pathophysiology, diagnosis, clinical implications and available treatment options for pediatric OSAS. Moreover, we will review the impact of the condition on the structures of the face, jaws, mouth and teeth and discuss the dentist's critical role in identifying and treating these problems.

Oral hygiene habits, dental home, and toothbrushing among immigrant and native low socioeconomic class populations.

UNLABELLED: About 45,000 people immigrated to Israel from Ethiopia over the last 30 years. The purpose of this study was to compare oral hygiene habits in preschool children from low socioeconomic neighborhoods offspring of immigrants from Ethiopia to offspring of native Israelis. METHOD: Parents of children attending 21 nursery schools were asked to respond anonymously to 7 questions about their children's visits to a dentist and toothbrushing habits. RESULTS: Parents of 719 children (382 Ethiopian and 337 native Israeli) responded. Of children aged 49-82 months, 15% offspring of Ethiopian and 25% of native Israelis were reported to have visited a dentist; and 45% and 65%, respectively, to brush their teeth at least once daily. More than 90% of children of both populations were reported to have toothbrushes. Of children aged 18-48 months, 28% of Ethiopian and 65% of native Israelis were reported to brush their teeth at least once daily. CONCLUSION: After more than 20 years residence in a new country, the dental home of an immigrant population was significantly different from that of the native population, of the same low socioeconomic neighborhoods. Discrepancies in parental responses highlight the importance of addressing information bias.

Premedication intake behavior--does it predict behavior during dental treatment?

OBJECTIVES: To investigate whether behavior during hydroxyzine administration predicts children's behavior during dental treatment and whether behavior during treatment is affected by the complexity of treatment. MATERIALS AND METHOD: 118 children aged 2 to 6.5 years old were treated under conscious sedation with oral premedication (3.7 mg/kg of hydroxyzine in a concentration of 50 mg/5 cc. hydroxyzine) and 50% nitrous oxide/oxygen sedation. Children were divided in two age groups: aged 2 to < or = 4 years old, and aged 4 > to 6 years old. Behavior during first examination; cooperation during premedication administration, cooperation during nitrous oxide nose-mask placement, behavior during dental treatment, treatment duration and complexity of treatment were recorded. RESULTS: More children in the older group took the premedication willingly (p = 0.026). Significant correlation (p = 0.002) between behavior during examination and nitrous oxide mask acceptance was found in the older age group. No correlation was found regarding the cooperation during premedication intake and behavior during treatment within and between age groups. No statistical differences within the groups and between the groups were found between complexity of treatment and behavior during treatment. CONCLUSIONS: Premedication intake is not a reliable predictive tool for behavior during treatment in children aged 2-6.5 years. Complexity of treatment does not influence behavior during treatment in children aged 2-6.5 years.

Mandibular block or maxillary infiltration: does it influence children's opposition to a subsequent dental visit?

PURPOSE: Local anesthesia by mandibular block or maxillary infiltration is commonly administered to children receiving dental treatment of primary molars. Discomfort, when presenting, most often involves the lower lip. The purpose of this study was to investigate whether children would be more opposed to attending a dental treatment following anesthesia by mandibular block than by maxillary infiltration. METHODS: Each of 102 children in two age groups: 3 to 5 years, and 6 to 9 years, received the two types of local anesthesia at dental appointments one week apart. Their opposition to attending a subsequent appointment was assessed by parent report. RESULTS: More adverse reactions were observed during and following anesthesia with mandibular block than with maxillary infiltration. Few of the children in either age group expressed opposition to attend a dental visit after receiving mandibular block or maxillary infiltration in the previous visit. CONCLUSIONS: Though more adverse reactions were observed in children following mandibular block than maxillary infiltration, this did not result in increased opposition to attend a subsequent dental appointment.

Sialochemistry and cortisol levels in patients with Sjogren's syndrome.

OBJECTIVES: (i) To determine whether salivary cortisol and electrolyte levels differ between patients with Sjogren's syndrome (SjS) and healthy individuals. (ii) To assess correlations between whole-saliva cortisol and some clinical manifestations in patients with SjS. METHODS: A total of 24 healthy women (mean age 49.3±9.8) served as controls (C) vis-à-vis 17 patients with SjS (mean age 55.5±15.7). Salivary cortisol concentration was determined, and sialochemistry analysis was performed. RESULTS: Significantly lower saliva flow rates and higher salivary chloride (Cl(-) ), potassium (K(+) ), and Ca(2+) levels were found in the SjS group. No significant differences or correlations were found in other parameters, including sodium (Na(+) ), magnesium (Mg(2+) ), phosphate ((-) ), urea (U), and salivary cortisol levels. CONCLUSION: Increased whole-salivary output of Cl(-) and K(+) in SjS may reflect release from apoptotic rests of acinar cells after secondary necrosis. Normal levels of salivary Na(+) , Mg(2+) , and (-) argue against concentration effect, deranged tubular function or cortisol (mineralocorticosteroid) effect as the cause for these findings. Increased salivary Ca(2+) levels probably reflect leakage of plasma Ca(2+) through the injured oral mucosa in SjS. In spite of disease-associated stress, salivary cortisol, a stress biomarker, was not increased, suggesting insufficient hypothalamus-pituitary-adrenal (HPA) axis response and/or local consumption of cortisol by lymphocyte infiltrates.

Calculus in a toddler with end-stage renal disease due to prune-belly syndrome.

Prune-belly syndrome is a congenital kidney and urinary tract anomaly which may lead to end-stage renal failure (ESRF). The present case describes an infant suffering from end-stage kidney disease due to prune-belly syndrome, undergoing chronic hemodialysis, with excessive calculus deposits which disappeared following kidney transplantation. Possible explanations are discussed. The first mechanism is associated with lack of oral function which may have caused pooling of saliva around the teeth enhancing precipitations of minerals. The second possible mechanism is associated with the child's uremic state. The third mechanism could be a disturbance in calcium-phosphor metabolism. It is possible that in the present case, the gastrostomy and the electrolyte disturbances characterizing ESRF had an additive effect.

Oral findings and periodontal status in children, adolescents and young adults suffering from renal failure.

AIM: Describe the oral condition of chronic renal failure and healthy subjects, and the relationship between oral variables, chronic renal failure (CRF) conditions, and their treatment. MATERIALS AND METHODS: Four renal failure groups: chronic renal disease (n=22); undergoing dialysis (n=22); after dialysis and transplant (n=21); and after transplant (n=32), and a healthy control (n=38) were examined. Caries, enamel hypoplasia, pulp obliteration, plaque index, gingival bleeding, recession, overgrowth and index, probing depths, attachment loss, renal treatments and their relations with the oral variables were analysed. RESULTS: The renal failure groups had higher gingival index (GI) and bleeding, probing depths, attachment loss, hypoplasia and obliteration and less caries, than the control. Plaque was higher in the dialysis and pre-dialysis (PD) groups. Overgrowth was evident after transplant. The PD group showed lower GI than other renal groups. Dialysis duration and end-stage renal failure significantly correlated with gingivitis, probing depth, attachment loss and enamel hypoplasia. Immuran correlated positively with probing depth, gingival recession and attachment loss. Normiten and Nifedipine had positive correlations with gingival overgrowth. CONCLUSIONS: CRF patients are characterized by pulp obliteration, gingival and periodontal diseases. Duration of end stage renal failure and type of systemic treatment have a significant influence on the oral condition.