Correlating spacing in the primary dentition and caries experience in preschool children.

PURPOSE: To evaluate the correlation between spacing in the primary dentition and caries experience. METHODS: One hundred seventy-four clinical records, including photographs during 2017-2019 were assessed for primate, generalised and interdental spaces. The mean of decayed, missing or filled teeth and surfaces (dmft and dmfs) were recorded to quantify the caries experience. Linear regression analyses were used to ascertain correlations between spacing and dental caries. The strength of the associations was quantified using odds ratio (OR) and 95% confidence interval (CI). RESULTS: Ninety-seven boys and 77 girls were included in the final analysis. Approximately 41% of children had primate space in all four quadrants, and 15% of children had no primate spaces in all four quadrants. 50% of children did not exhibit generalised spacing, while 39% of children showed interdental spacing. Children with no primate space had approximately five surfaces higher dmfs score compared to those with primate space in all four quadrants (95% CI - 9.27 to - 1.23; p < 0.05). Similarly, children with no primate space in the mandible had 6.12 surfaces higher dmfs score compared to those with primate space in the mandibular arch (95% CI - 10.07 to - 2.17; p < 0.05). CONCLUSIONS: Preschool children with no primate space exhibited a 50% increase in dmfs scores compared to children with primate space.

Health- and oral health-related quality of life among preschool children with autism spectrum disorders.

PURPOSE: To assess the health-related quality of life (HrQoL) and oral health-related quality of life (OHrQoL) of preschool children with autism spectrum disorders (ASD) and to determine the associated factors. METHODS: A case-control study of preschool children with and without ASD was undertaken. H&OHrQoL were assessed employing Pediatric Quality-of-Life Inventory Version 4.0 (PedsQL™ 4.0) and Early Childhood Oral Health Impact Scale (ECOHIS). Differences in PedsQL and ECOHIS scores were determined between groups and correlation between PedsQL and ECOHIS was explored. Regression analyses were conducted to determine key factors associated with H&OHrQoL. RESULTS: Parents of 510 children (253 cases and 257 controls) completed the H&OHrQoL questionnaire assessments. Significant difference in PedsQL (p < 0.001) and ECOHIS (p < 0.001) scores was apparent between children with and without ASD. There was a positive and weak correlation between PedsQL and ECOHIS scores (r = - 0.45, p < 0.01). In regression analyses, the presence of ASD was associated with an increased likelihood of having lower PedsQL (OR 0.10, 95% CI 0.06-0.15, p < 0.001) and higher ECOHIS scores (OR 2.34, 95% CI 1.60-3.42, p < 0.001). CONCLUSIONS: Differences in H&OHrQoL exist among preschool children with and without ASD. There was a significant but weak correlation between children's H&OHrQoL. Both H&OHrQoL were associated with autism spectrum disorders.

Root canal morphology of hypomineralised first permanent molars using micro-CT.

AIM: To investigate the root canal morphology of hypomineralised first permanent molars (FPMs) using micro-CT (µCT). METHODOLOGY: Twenty-four hypomineralised FPMs and five clinically sound FPMs were scanned using µCT and assessed using the following parameters: (i) root canal configuration, (ii) connecting canal frequency, (iii) enamel, dentin, and pulp volumes, (iv) cusp tip to pulp horn distance, root canal length, root canal width, and dentin thickness, and (v) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. A two-way repeated-measures analysis of variance was employed with the statistical significance set at p < 0.05. RESULTS: The frequency of accessory and connecting canals was higher in hypomineralised FPMs. Mesio-buccal cusp horn was found to be the closest to its corresponding cusp tip in both groups. There was no significant difference between the root lengths, dentine widths, and pulp space measurements of hypomineralised FPMs compared to clinically sound FPMs. The best angulation to access FPMs was straight-line radicular, along the pulp horn. CONCLUSIONS: This study illustrates some variations in the root canal morphology in hypomineralised FPMs compared to clinically sound FPMs. Future studies should focus on assessing these parameters in larger samples.

Oral health experiences of individuals with Rett syndrome: a retrospective study.

BACKGROUND: There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. METHODS: Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. RESULTS: The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46-16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94-0.97). CONCLUSIONS: Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.

Pre-maxillary hypohyperdontia: a report of two cases.

BACKGROUND: Hypodontia and hyperdontia are considered to be at opposite ends of the dental development spectrum. Nevertheless, these anomalies may occur concomitantly (hypohyperdontia). CASE REPORT: This clinical report describes two case of hypohyperdontia occurring exclusively in the premaxillary region, and the difficulties associated with its diagnosis and management. Following 24 months of follow-up examinations, Case 1 developed a sequential supernumerary tooth in the tooth 35 region. CONCLUSION: Cases of hypohyperdontia can occur exclusively in the premaxillary region and may be difficult to diagnose. Multidisciplinary treatment planning is essential to facilitate appropriate management, and long-term follow-up is necessary as sequential supernumerary teeth may develop.

Tooth mineral density of different types of hypomineralised molars: a micro-CT analysis.

AIM: This study sought to evaluate the tooth mineral density (TMD) for the different lesion types in hypomineralised first permanent molars (FPMs) and compare them to unaffected enamel in clinically sound FPMs. DESIGN: Eighteen FPMs with varying degrees of hypomineralised enamel were grouped into brown, yellow/creamy and white lesion types. Micro-CT was used to determine the TMD for each lesion type, and for unaffected enamel at different locations in the outer, middle, and inner-third of the enamel. RESULTS: The average TMD for brown, yellow/creamy, white and unaffected enamel was 1.79, 2.21, 2.43 and 2.46 g/cm3, respectively. Brown and yellow/creamy lesions exhibited a statistically significant difference when compared to white lesions and unaffected enamel. However, no statistical difference was evident in TMD between white lesions and unaffected enamel. The TMD increased from the outer-third to inner-third for brown and yellow/creamy lesions (p < 0.05), while in white lesions and unaffected enamel, the TMD decreased from the outer-third to inner-third (p < 0.05). CONCLUSION: TMD was lowest for brown lesions followed by yellow/creamy lesions while the TMD for white lesions was similar to unaffected enamel.

New treatments for serious conditions: ethical implications.

Approval of Spinraza (nusinersen) for treatment of spinal muscular atrophy prompts consideration of a number of ethical issues that arise whenever a new treatment is proposed for a serious condition, especially one that is rare and can devastatingly affect children. Patients, families, clinicians, researchers, institutions and policymakers all must take account of the ways that newly available treatments affect informed and shared decision-making about therapeutic and research options. The issues to consider include: addressing what is still uncertain and unknown; the possibility that potential benefits will be exaggerated and potential harms underemphasized in the media, by advocacy organizations, and in consent forms and processes; the high cost of many novel drugs and biologics; the effects of including conditions of variable phenotype in state-mandated newborn screening panels; and how new treatments can change the standard of care, altering what is and is not known about a disorder and posing challenges for decision-making at both individual and policy levels. The good news that Spinraza brings thus requires additional attention to its ethical and policy implications, to improve counseling and shared decision-making about treatment and research options for patients and all involved in their care.

Is there sufficient evidence to support an optimum time for the extraction of first permanent molars?

AIM: To evaluate whether the literature contains evidence, of an appropriate quality, to support the fundamental belief that there is an "optimal time" for extraction of FPMs with a poor prognosis. METHODS: A comprehensive search, limited to human studies, was performed using five databases. PICO based inclusion and exclusion criteria were employed to facilitate article selection. Three independent reviewers assessed the quality of included studies using STROBE and GRADE criteria. RESULTS: Initially, 56 articles were selected, of which 9 were included for final assessments. None of the included studies obtained moderate or high GRADE level rating and neither did they meet all of the STROBE requirements with only one study satisfying 95%, and another study satisfying 73%, of the requirements. The inter-observer agreement was excellent. CONCLUSION: There is no scientific evidence, of an appropriate quality, to support the "optimal time" for extraction of FPMs with a poor prognosis.

Bilateral supplemental maxillary central incisors with double-tooth like appearance.

BACKGROUND: Supplemental teeth refer to extra teeth that resemble the normal tooth series. Bilateral supplemental central incisors in a healthy individual are rare and bilateral supplemental incisors with double-tooth like appearance are exceptionally rare and has not been previously reported in the dental literature. CASE REPORT: This clinical report describes an 8-year old healthy Indian boy referred for the management of delayed eruption of his permanent maxillary incisor teeth. Following clinical and radiographic examination the two supplemental incisors closer to the midline were extracted under local analgesia and both of them exhibited double-tooth like appearance. CONCLUSIONS: The present case refutes the conventional wisdom that "supplemental teeth are usually smaller than the normal tooth type they resemble and occur distal to the normal tooth series", illustrates that the unusual can occur and that the clinician should be aware of such variations.

Reliability of horizontal and vertical tube shift techniques in the localisation of supernumerary teeth.

AIM: To assess the reliability of the vertical tube shift technique (VTST) and horizontal tube shift technique (HTST) for the localisation of unerupted supernumerary teeth (ST) in the anterior region of the maxilla. METHODS: A convenience sample of 83 patients who attended a major teaching hospital because of unerupted ST was selected. Only non-syndromic patients with ST and who had complete clinical and radiographic and surgical records were included in the study. Ten examiners independently rated the paired set of radiographs for each technique. Chi-square test, paired t test and kappa statistics were employed to assess the intra- and inter-examiner reliability. RESULTS: Paired sets of 1660 radiographs (830 pairs for each technique) were available for the analysis. The overall sensitivity for VTST and HTST was 80.6 and 72.1% respectively, with slight inter-examiner and good intra-examiner reliability. Statistically significant differences were evident between the two localisation techniques (p < 0.05). CONCLUSIONS: Localisation of unerupted ST using VTST was more successful than HTST in the anterior region of the maxilla.

Hypodontia of all primary canines.

BACKGROUND: Several hypotheses have been proposed to explain hypodontia of the various tooth types with evolutionary and anatomic models. Hypodontia of all primary canines in a healthy individual is exceptionally rare and has not been previously reported in the dental literature. CASE REPORT: This clinical report describes a 4-year-old southern Chinese female with the congenital absence of the primary canines in all quadrants. Furthermore, all of the permanent tooth germs excluding the third molars were evident on a panoramic radiograph and were developing consistent with the subject's chronological age. CONCLUSION: This case serves as an excellent example to refute the conventional wisdom that "all primary canines can never go missing" and that all of the currently proposed hypotheses to explain hypodontia have limitations.

Remineralizing potential of CPP-ACP applied for 1 min in vitro.

AIM: To evaluate (1) the remineralizing potential of Tooth Mousse(®) (TM) on artificial carious lesions, when applied for 1 min, and (2) the benefit of a fluoridated dentifrice prior to TM application. METHODS: Demineralisation caries-like lesions 120-200 µm deep were produced by placing molars in demineralizing solution for 96 h, sections 100-150 µm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or fluoridated dentifrice (1000 ppm) (Group B), or TM (Group C), or a fluoridated dentifrice followed by TM (Group D) then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. RESULTS: Application of TM in isolation (Group C) for 1 min resulted in significant increase in lesion depth (LD), however, an increase in mineral content deposition (V max) was not significant. Post treatment LD increases were greatest in Group A, then Group C and Group B respectively. A decrease in LD (by 19.9 %) was noted only after fluoridated dentifrice and TM (Group D) were applied consecutively for 1 min each (p < 0.05). Mineral content deposition was also greatest in this group (Group D) and both V max and LD changes were statistically significant when compared to other groups. CONCLUSIONS: TM alone failed to remineralize carious lesions when applied for 1 min. However, remineralization occurred after a prior application of a fluoridated dentifrice.

Systematic Review and Meta-Analysis of Randomized Clinical Trials on Chemomechanical Caries Removal.

OBJECTIVES: The aim of this review was to assess the methodologies used in previously published prospective randomized clinical trials on chemomechanical caries removal and to conduct a meta-analysis to quantify the differences in the excavation time between chemomechanical and conventional caries removal methods. METHODS: An electronic search was performed using Scopus, PubMed, EBSCO host, and Cochrane Library databases. The following categories were excluded during the assessment process: non-English studies published before 2000, animal studies, review articles, laboratory studies, case reports, and nonrandomized or retrospective clinical trials. The methodologies of the selected clinical trials were assessed. Furthermore, the reviewed clinical trials were subjected to meta-analysis for quantifying the differences in excavation time between the chemomechanical and the conventional caries removal techniques. RESULTS: Only 19 randomized clinical trials fit the inclusion criteria of this systematic review. None of the 19 reviewed trials completely fulfilled Delphi's ideal criteria for quality assessment of randomized clinical trials. The meta-analysis results revealed that the shortest mean excavation time was recorded for rotary caries excavation (2.99±0.001 minutes), followed by the enzyme-based chemomechanical caries removal method (6.36±0.08 minutes) and the the hand excavation method (atraumatic restorative technique; 6.98±0.17 minutes). The longest caries excavation time was recorded for the sodium hypochlorite-based chemomechanical caries removal method (8.12±0.02 minutes). CONCLUSIONS: It was found that none of the current reviewed trials fulfilled all the ideal requirements of clinical trials. Furthermore, the current scientific evidence shows that the sodium hypochlorite-based (Carisolv) chemomechanical caries removal method was more time consuming when compared to the enzyme-based (Papacarie) chemomechanical and the conventional caries removal methods. Further prospective randomized controlled clinical trials evaluating the long-term follow-up of papain-treated permanent teeth are needed.

The relationship between oral hygiene status and obesity among preschool children in Hong Kong.

OBJECTIVES: To explore the association between oral hygiene status and obesity among preschool children in Hong Kong. METHODS: Three hundred and twenty-four 5-year-old children in Hong Kong were recruited. Their oral hygiene status was recorded using visible plaque index (VPI). Body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were measured to assess general adiposity (weight/height ratio, W/H; body mass index, BMI), central adiposity (WC; waist/hip ratio, WHR) and peripheral adiposity (TRSKF). The relationships between VPI and W/H, BMI, WC, WHR and TRSKF were examined in bivariate and regression analyses. RESULTS: Fifty-six per cent of the children were considered to have high VPI (VPI ≥ 65.0%). Logistic regression analyses identified that W/H z-score (OR = 1.28, 95% CI = 1.01-1.61) and WC z-score (OR = 1.25, 95% CI = 1.00-1.58) were associated with high VPI. No association was found after adjusted for socio-demographic status (P > 0.05). CONCLUSION: Oral hygiene status was not associated with obesity among 5-year-old children in Hong Kong after controlling for socio-demographic factors.

Association between dental caries and adiposity status (general, central, and peripheral adiposity) in 12-year-old children.

BACKGROUND/AIMS: To investigate the cross-sectional relationship between dental caries experience and adiposity status (general, central, and peripheral adiposity) in 12-year-old children in Hong Kong. METHODS: A random sample of 668 12-year-old students was recruited. Clinical assessment for dental caries (DMFT) was conducted using WHO criteria. Anthropometric measurements for body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were performed to assess general adiposity (weight-height ratio, body mass index); central adiposity (WC; waist-hip ratio, WHR), and peripheral adiposity (TRSKF). Associations between adiposity indices and dental caries experience [prevalence DMFT > 0, 'high' experience (DMFT ≥ SiC Index value) and 'very high' experience (DMFT ≥ SiC10 Index value)] were examined in bivariate and multivariate regression analyses. RESULTS: The response rate was 76.9% (n = 514/668). Regression analyses (adjusted for oral hygiene practice, snacking habits, and socio-demographic factors) identified that WHR z score was associated with 'high' dental caries experience (OR 1.33, 95% CI 1.05, 1.70, p = 0.02), and that WHR z score was associated with 'very high' dental caries experience (OR 1.52, 95% CI 1.10, 2.11, p = 0.01). TRSKF z score was associated with 'very high' dental caries experience (OR 1.47, 95% CI 1.10, 1.96, p = 0.01). CONCLUSIONS: In a population-based sample of 12-year-old children in Hong Kong, dental caries experience was associated with adiposity. Central and peripheral, but not general adiposity was associated with dental caries experience.

Aetiology of supernumerary teeth: a literature review.

BACKGROUND: Supernumerary teeth are teeth, or tooth-like structures that have either erupted or remain unerupted in addition to the 20 primary and 32 permanent teeth. AIMS: This paper attempts to (a) provide an overview of the proposed hypotheses and the current understanding of the aetiology of supernumerary teeth, and (b) review the published cases of supernumerary teeth occurring in families. REVIEW: No studies have been able to distinguish between different aetiologies for the different locations of supernumerary teeth, while, from a developmental or molecular perspective, the proposed hypotheses may be plausible and explains the origin of different types of supernumerary teeth. CONCLUSION: The only clearly evident feature, based on the existing published reports, is that it is logical to state that supernumerary teeth have a genetic component in their aetiology.

Chemical, morphological and microhardness changes of dentine after chemomechanical caries removal.

BACKGROUND: This study compared the chemical, morphological and microhardness changes in carious dentine following application of NaOCl-based (Carisolv), papain-based (Papacarie) chemomechanical caries removal agents with conventional rotary method. METHODS: Thirty-two carious and eight non-carious human permanent molars were used. The carious molars were randomly distributed into four groups: Group 1 (positive control) - molars were left without caries removal; Group 2 - caries excavated with rotary method; Group 3 - caries excavated with Carisolv; Group 4 - caries excavated with Papacarie. Group 5 (negative control) consisted of eight sound molars. After caries excavation, all specimens were prepared for chemical, morphological analysis and Vickers hardness testing. RESULTS: EDX analysis showed no significant difference in Ca wt%, P wt% and Ca/P ratio among Groups 2 to 5. Vickers hardness of dentine from Groups 3 and 4 was significantly lower (p < 0.05) than for Groups 2 and 5. The use of Papacarie resulted in a dentine surface without smear layer and patent tubules, while Carisolv resulted in a dentine surface exhibiting two patterns: (1) the presence of smear layer or (2) patent tubules with partial smear layer formation. CONCLUSIONS: Papain-based (Papacarie) chemomechanical caries removal method is a reliable alternative to conventional rotary and NaOCl-based (Carisolv) caries removal.

Primary failure of eruption or severe infra-occlusion: a misdiagnosis?

BACKGROUND: The literature considers primary failure of eruption (PFE) and infra-occlusion as two separate clinical entities and there are no clearly identified signs and symptoms that aid to facilitate a definitive diagnosis between these two conditions. Therefore, it is the purpose of this report to illustrate a case to emphasise the potential for misdiagnosis when categorising these conditions as two separate clinical entities. CASE REPORT: A 5-year-old Chinese boy was referred for the management of an unerupted primary mandibular left second molar tooth (75). Intra-oral examination revealed a primary dentition, with a PFE of tooth 75. He was scheduled for surgical removal of tooth 75 and placement of a space maintainer. Following improvements in the position of tooth 75 in the subsequent visits, the surgical option was disregarded and eventually tooth 75 erupted and exfoliated despite apparent mechanical obstructions. FOLLOW-UP: During the 6-year follow-up period, tooth 75 moved mesially resorbing the distal root of tooth 74 which was later extracted to facilitate the eruption of tooth 75; which then underwent normal exfoliation. CONCLUSION: While the present case could indicate the unpredictability of infra-occluded teeth, it is postulated that infra-occluded teeth erupt to the occlusal plane and then remain static due to mechanical obstructions, while the adjacent teeth accompany the growing alveolar bone. Conversely, teeth with PFE do not erupt and the mechanical obstructions are secondary factors. Therefore, the patient's age, at the time of diagnosis, may lead to the diagnosis of infra-occlusion; but it could have been PFE.

Talon cusp affecting primary dentition in two siblings: a case report.

The term talon cusp refers to a rare developmental dental anomaly characterized by a cusp-like structure projecting from the cingulum area or cement-enamel junction. This condition can occur in the maxillary and mandibular arches of the primary and permanent dentitions. The purpose of this paper is to report on the presence of talon cusps in the primary dentition of two southern Chinese siblings. The 4 years and 2 months old girl had a talon cusp on her maxillary right primary central incisor, while her 2 years and 9 months old brother had bilateral talon cusps on the maxillary primary central incisors. The presence of this rare dental anomaly in two siblings has scarcely been reported in the literature and this may provide further evidence of a hereditary etiology.