Prevalence of oral soft tissue lesions in HIV-infected minority children treated with highly active antiretroviral therapies.

PURPOSE: This project studied the prevalence of oral soft tissue disease in HIV-infected children treated with highly active antiretroviral therapy (HAART). METHODS: Thirty-eight HIV-infected children participated in the study. Twenty-three of these patients were treated with HAART while 14 received exclusively reverse transcriptase inhibitors (RTI) and served as controls. The children were examined three times at approximately one-month intervals while their health history and laboratory data were abstracted from medical charts. Analyses were performed to determine differences in lesion prevalence between treatment groups as well as between lesion and no lesion groups with regard to immune differences. RESULTS: Thirty patients (79%) had oral lesions detected in at least one visit. There were no differences in specific lesion prevalence between HAART compared with RTI-treated children. However, a trend for more oral candidiasis in the latter group was observed. Subjects with oral soft tissue lesions had lower CD4 counts (P = 0.04) and percentage (P = 0.01) but similar viral loads when compared to patients without oral soft tissue disease. CONCLUSIONS: HAART does not appear to significantly affect oral soft tissue disease prevalence in HIV-infected children. Presence of lesions was associated with decreased immunity and may signal advancing disease.

Microleakage of compomer class V restorations: effect of load cycling, thermal cycling, and cavity shape differences.

STATEMENT OF PROBLEM: Microleakage is an important problem with direct filling restorations and an understanding of the factors that contribute to it is of critical importance. PURPOSE: This study investigated the effect of thermal and occlusal load cycling, and limited cavity preparation on microleakage of compomer Class V restorations in vitro. MATERIAL AND METHODS: Class V cavities were randomly prepared on the buccal and lingual surfaces of 32 recently extracted molars and premolars and restored with Dyract compomer restorative system as per the manufacturer's directions. Teeth were randomly assigned to 1 of 4 treatment groups with 8 teeth in each group: (I) thermocycling only; (II) load cycling only; (III) both thermocycling and load cycling; and (IV) no treatment. All teeth were then immersed in 2% basic fuchsin solution for 24 hours. Dye penetration was measured linearly using color photographic prints. ANOVA, comparisons between means, and correlation were used to analyze the results. RESULTS: Thermocycling and cavity preparation had a significant effect on microleakage, but load cycling did not. Occlusal margins leaked more than the gingival margins. CONCLUSION: Class V restorations demonstrated increased microleakage under the conditions of thermal cycling and nonretentive cavity design. More microleakage occurred at occlusal margins than at gingival margins. The effect of load cycling is complicated by considerations of the types of stresses applied and the restorative material response to such stresses.

An evaluation of intraoral lidocaine patches in reducing needle-insertion pain.

Intraoral lidocaine patches have recently been approved by the US Food and Drug Administration for the production of topical anesthesia before superficial dental procedures and for the reduction of pain associated with local anesthetic injections. The results of this 5-center clinical study showed that lidocaine patches were significantly more efficacious than matching placebo patches in reducing the pain associated with 25-gauge needle insertions to the level of bone in the maxillary premolar region. Anesthetic onset occurred within 5 minutes and was present for the entire 15-minute period that the patches were in contact with the oral mucosa. In addition, the patches were safe and well tolerated by study participants. Other potential clinical applications of this novel delivery system are also discussed in this article.

Fluoride uptake by proximal surfaces from professionally applied fluorides: an in vitro study.

This study was performed to examine the uptake of fluoride by mesial enamel surfaces of extracted teeth from different types of topical fluoride. Forty-eight extracted human molars and twelve premolars were randomly divided into four groups and mounted in twelve wax blocks with five teeth in proximal contact in each block. Each group was treated for four minutes with either 1.23 percent acidulated phosphofluoride conventional gel, thixotropic gel, or foam in lined trays, or 2 percent neutral sodium fluoride solution applied with a cotton tip applicator. Acid-etch biopsies were performed three times to indicate the amount of fluoride uptake at three different depths. The results demonstrated that there was a statistically significant increase in fluoride uptake in the surface layer with both gels and foam (1150, 1058 and 1120 ppm F), whereas there was an insignificant increase with the fluoride solution (27 ppm F). In the deepest layer, the thixotropic fluoride produced the greatest fluoride uptake (919 ppm F) in comparison with the uptake from conventional gel (383 ppm F), foam (297 ppm F), or solution (118 ppm F).

Analgesic efficacy and safety of an intraoral lidocaine patch.

The effectiveness of intraoral II-docaine patches was tested by asking participants to rate the pain experienced after insertions of a 25-gauge needle. Needlesticks were performed at baseline and at various time points after patch placement. Each needlestick included contact with the periosteum. Lidocaine patches achieved significantly better analgesia than the placebo within 2.5 to five minutes after placement. Drug-related side effects were minimal and venous blood levels of lidocaine were low, averaging 10 to 14 times less than those achieved with a typical injection of lidocaine plus epinephrine. The authors conclude that the lidocaine patches used in this study are effective and safe in reducing needle insertion pain in adults.

Effects of nitrous oxide on diazepam sedation of young children.

This study was performed to test the hypothesis that nitrous oxide augments the effects of diazepam sedation of young children by reducing crying and movement and improving the overall quality of sedation. Twenty-four children (mean age of 32 months) were sedated on two occasions with two different treatment regimens. All subjects received a standard oral dose of 0.5 mg/kg of diazepam with and without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for the first 20 min followed by 100% oxygen for the balance of the procedure and, during the second visit, the reverse regimen was used. All subjects were restrained in a Papoose Board (Olympic Medical, Seattle, WA) with an auxiliary head restraint. Successful sedation, as evidenced by lack of crying or movement that interrupted treatment, occurred in 83% of administrations. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted, local anesthesia was administered, and the rubber dam was placed. When the evaluation of the overall sedation was compared with and without nitrous oxide, it was better with nitrous oxide 56% of the time, worse 13% of the time, and the same in the remaining 31% of the comparisons. It is concluded that nitrous oxide may slightly augment the effect of diazepam sedation of young children, but it does not do so uniformly for all children receiving sedation.

Caries experience and cariogenic markers in HIV-positive children and their siblings.

The purpose of this cross-sectional, masked study was to compare the oral status of perinatally HIV-infected children with their uninfected siblings living in the same environment. A secondary purpose was to compare HIV-positive children for differences in oral health with respect to disease advancement. One hundred forty-seven children were examined in their homes and meeting places, using NIH criteria for caries diagnosis. Significant differences were found in the number of caries-free children (P < 0.05), past caries experience (P < 0.003), subsurface demineralizations (P < 0.0001), and caries-related bacteria (P < 0.05). However, differences in caries prevalence were not found in the 3- to 6-year-old subgroup. Caries prevalence (P < 0.001) and levels of caries-related flora in saliva were correlated to years since diagnosis (mutans streptococci P < 0.008, lactobacilli P < 0.02). Children with a more advanced disease stage had significantly more caries (P < 0.02). Among the HIV-infected children, the frequency of carbohydrate intake was clearly correlated to caries (P < 0.003) and to lactobacilli levels (P < 0.0001). It is concluded that children with perinatally acquired HIV are at greater risk for caries than their siblings, more so with advancing disease.

Oral soft tissue manifestations and CD4 lymphocyte counts in HIV-infected children.

This study investigated the prevalence of oral soft tissue lesions in children infected with HIV and the relationship of CD4 lymphocyte levels with the prevalence of those lesions. Sixty HIV-positive children enrolled in the Children's Hospital AIDS Program (age 5.8 +/- 3 years) were selected for study. Only five subjects (8%) had healthy gingiva and a low mean plaque index (22%). The remainder had gingivitis or periodontitis with relatively high plaque indices (47, 55, and 94%, respectively). A declining CD4 lymphocyte count (1357 to 35) was associated with an increasing severity of gingival disease.

Mercury release from dental amalgams: an in vitro study under controlled chewing and brushing in an artificial mouth.

The release of mercury vapor from class I amalgam restorations prepared in human molar teeth was studied during chewing simulations in an artificial mouth of a bi-axial servo-hydraulic mechanical test system. So that the total mercury released from the restoration over a fixed time could be determined, a closed chamber surrounded the envelope of chewing motion. In addition, the influence of sampling frequency on mercury release was corrected by the use of different sampling frequencies over a fixed time interval of mercury release measurement and extrapolation to zero sampling time. Thus, a combination of a closed environment and an extrapolation method to determine the mercury release under continuous sampling was used to determine the mercury released under normal breathing conditions. The measured mercury release rate data were used to calculate the potential daily mercury dose in a patient due to a single amalgam restoration, following the method previously outlined by Berglund. The mercury release from both a conventional and a high-copper amalgam was evaluated at different age intervals after the restoration was placed in the teeth. The results show that while the age of the amalgam and the amalgam type influence the extent of mercury release during the initial non-steady-state conditions, the steady-state value of mercury daily dose due to a single amalgam filling is 0.03 micrograms/day, which is well below the calculated threshold-limiting value (TLV) of 82.29 micrograms/day considered dangerous for occupational exposure in the United States.

Hypohidrotic ectodermal dysplasia: characteristics and treatment.

Hypohidrotic ectodermal dysplasia is a rare congenital disease that affects several ectodermal structures. The disease is usually transmitted as an X-linked recessive trait in which the gene is carried by the female and manifested in the male. Manifestations of the disease differ in severity and may involve teeth, skin, hair, nails, and sweat and sebaceous glands. Most affected children require extensive dental treatment to restore their appearance and help the development of a positive self-image.