Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders.

PURPOSE: The Picture Exchange Communication System (PECS) is a communication system for children with autism spectrum disorders (ASD). The aim of this study was to assess the effect of a PECS-based tooth-brushing programme on gingival health in children with ASD and assess parents' perception of PECS. METHODS: This was a prospective interventional study. Using PECS as a pictures/cards series showing a structured tooth-brushing method, 37 children with ASD (31 males, 6 females) (average age 9.49 ± 4.10, 4-16 years) and their parents/caregivers were trained on tooth-brushing twice, 2 weeks apart. Data collected after examinations (baseline, 3, 6-months) included gingival and plaque indices (GI, PI) and two questionnaires (baseline, 6-months) for demographic data and parents' perception of PECS including difficulty rating (easy, hard, very hard) and PECS usefulness. RESULTS: Most children with ASD had language abilities (64.9%) and prior PECS use (67.6%). Both GI and PI significantly dropped between baseline and both re-evaluations, (P < 0.001). Age, among studied factors, significantly affected PI only at all stages (P < 0.001). Most parents/caregivers (75.7%) rated PECS as hard, but useful (100%). Age and PECS prior use significantly affected PECS difficulty rating (P = 0.000 and 0.031, respectively), while sex did not (P > 0.05). CONCLUSION: PECS though rated as hard was useful in improving gingival health in children with ASD.

Changes in occlusal bite force following placement of preformed metal crowns on primary molars in 4-6 years old children: a 6 months' follow-up pilot study.

AIM: To evaluate the occlusal bite force (OBF) changes 6 months after placement of preformed metal crowns PMCs on primary molars in children. METHOD: Twenty-two subjects (aged 5.08 ± 0.92 years) participated and completed OBF records. Each patient received eight PMCs on their primary molars. OBF was recorded using a battery-operated portable type of OBF gauge at different time intervals: before placement, 1 week-, 1 month-, 2 months-, 3 months-, and 6 months after PMCs placement (T0-T5). A second group consisted of 22 caries-free children matched for age and gender were selected as a control sample and received no dental treatment. OBF was recorded in these subjects at T0 and T5 (6 months after). RESULTS: OBF was reduced the first week after placement of PMCs. However, the OBF was restored and reached its original value at T4. At the 6-month recall visit (T5), maximum occlusal bite force (MOBF) was 148% and 136% of pre-treatment value on right and left sides, respectively. The mean MOBF difference between T5 and T0 was statistically significant (70.83N and 54.67N on the right and left sides respectively, p < 0.000). CONCLUSION: OBF decreased 1 week after placement of PMC restoration and started to increase after 1 month reaching 136-140% of its original value after 6 months.

Effect of CPP-ACP or a Potassium Nitrate Sodium Fluoride Dentifrice on Enamel Erosion Prevention.

AIM: To investigate in situ/ex vivo the effect of remineralizing agents in the prevention of dental erosion in permanent and primary teeth. STUDY DESIGN: A randomized, controlled, double-blind study with crossover design with three treatment phases: Control, ProNamel® and Tooth Mousse™. Twenty adults and children wore removable palatal appliances containing two insets of permanent and primary human enamel and used the corresponding assigned toothpaste twice daily for 10 days. The enamel samples were then removed, mounted on acrylic bases and acid-challenged in demineralizing solution. Enamel surface microhardness (SµH) was measured pre and post acid challenge. Data were analyzed using two-way ANOVA and Tukey's post hoc test (P < 0.05). RESULTS: The mean SµH values (Vicker's unit) prior to acid challenge were: Permanent teeth (Control 366.16 ± 12.28, ProNamel® 372.18 ± 14.75, Tooth Mousse™ 370.19 ± 11.88) and Primary teeth (Control 325.31± 11.90, ProNamel® 327.34 ± 9.90, Tooth Mousse™ 331.63 ± 10.55). Following the acid challenge, the mean %ΔSµH (±SD) were: Permanent (79.72 ± 1.59, 66.52 ± 2.45, 60.13 ± 4.98) and Primary (81.09 ± 2.90, 76.50 ± 3.13, 69.02 ± 4.23). CONCLUSION: The application of remineralizing agents reduced the significantly softening by acidic attack of enamel especially in the permanent dentition.

Maxillary and mandibular arch forms in the primary dentition stage.

OBJECTIVE: To determine the most common maxillary and mandibular arch form and size in primary dentition stage. MATERIAL AND METHODS: Four hundred thirty five preschool children were included in this study with an age range of 3.5-5.5 years old. Dental casts were digitized and landmarks for the measurements were identified and marked on each model. Ten points were determined on the dental arch. Measurements of the x and y coordinates of the 10 points of each dental cast image were plotted on a computer software to obtain the polynomial function that best describes the curve corresponding to the dental arch form. RESULTS: Three arch forms were observed; square, oval and tapered. The most common arch form observed in the primary dentition was the oval form (52%) followed by the square and tapered arch forms (29% and 19%, respectively). Gender differences were not detected. In the maxilla, the most common arch form was the oval (58.4%) arch whereas the square arch form (46.7%) was the most common in the mandible. The medium size arch form was the most common size in both mandible (83%) and maxilla (71.5%) and for the total sample (77%). Differences in arch form size distribution were detected (P<0.000). Small size arch form was more common in females compared to males in the maxilla and total sample (P<0.000). Intercanine width was significantly smaller in the tapered arch form compared to oval arch form (P=0.048). In both arches, intercanine and intermolar widths were significantly larger in males compared to females. CONCLUSIONS: The most common arch forms in the maxilla and mandible were the medium sized oval and square forms, respectively. Intercanine width was the smallest in the tapered arch form. Intercanine and intermolar widths were affected by gender.

Effectiveness of a lower lingual arch as a space holding device.

The aims of this study were to evaluate the effectiveness of a lower lingual holding arch (LLHA) in maintaining arch length, and to compare the effectiveness of two LLHAs made of two different gauges (0.9 and 1.25 mm) of stainless steel (SS) wire. The sample comprised 44 subjects (24 males and 20 females) who for various reasons attended orthodontic clinics at Jordan University of Science and Technology Dental Teaching Center. The subjects were randomly divided into two treatment groups. The first group contained 20 subjects (12 males/8 females, average age 10.76 ± 0.75 years). The LLHA used in this group was made of 0.9 mm SS wire. The second group comprised 24 subjects (12 males/12 females, average age 10.57 ± 0.54 years). The LLHA used in this group was made of 1.25 mm SS wire. The third group consisted of 23 subjects (15 males/8 females, average age 10.63 ± 0.66 years) who served as the control. The records consisted of lateral cephalograms, dental pantomograms, and study casts. Paired t-test, analysis of variance, and chi-square tests were used to determine whether significant differences existed between the groups. In both treatment groups, the lower incisors proclined and moved forward, and space loss of the lower primary second molar occurred. The LLHA made of 0.9 mm SS was superior to that made of 1.25 mm SS in terms of arch length preservation.

Missense mutation of the EDA gene in a Jordanian family with X-linked hypohidrotic ectodermal dysplasia: phenotypic appearance and speech problems.

Mutations in the EDA gene are responsible for X-linked hypohidrotic ectodermal dysplasia, the most common form of ectodermal dysplasia. Males show a severe form of this disease, while females often manifest mild to moderate symptoms. We identified a missense mutation (c.463C>T) in the EDA gene in a Jordanian family, using direct DNA sequencing. This mutation leads to an amino acid change of arginine to cysteine in the extracellular domain of ectodysplasin-A, a protein encoded by the EDA gene. The phenotype of a severely affected 11-year-old boy with this mutation included heat intolerance, sparse hair (hypotrichosis), absence of 17 teeth (oligodontia), speech problems, and damaged eccrine glands, resulting in reduced sweating (anhidrosis). Both the mother (40 years old) and the sister (10 years old) were carriers with mild to moderate symptoms of this disease, while the father was healthy. This detailed description of the phenotype caused by this missense mutation could be useful for prenatal diagnosis.

Challenging parents' myths regarding their children's teething.

OBJECTIVES: The aims of this study were to (i) investigate the parental beliefs about teething signs and symptoms, (ii) investigate the parents' practices used to alleviate teething troubles and (iii) provide an educational basis for dental healthcare providers to better educate parents on this subject. METHODS: A cross-sectional survey was conducted in a random sample of 1500 parents attending Maternity and Child Health Care Centers. The self-administered questionnaire contained three sections: Section I surveyed parents' and their children's demographic characteristics, Section II aimed to assess the general knowledge and beliefs of parents regarding their children's teething. Section III aimed at investigating the practices that the parents would do to manage teething problems and relieve pain. The analysis of data was carried out using spss computer software. Descriptive statistics and Chi-squared test were utilized. RESULTS: Almost 75% of the participants incorrectly attributed fever, diarrhoea and sleep disturbances to teething, and more than 50% believed systemic symptoms are not related to the process. More than 50% of the participants allowed their children to bite on chilled objects, (76.1%) used systemic analgesics and (65.6%) rubbed the gums with topical analgesics to relieve the symptoms associated with teething. CONCLUSIONS: This study shows a common lack of knowledge about teething among parents. Parents should be better educated about the teething process and the proper management of teething troubles by the dental health care providers.

Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries.

AIM: To prospectively compare the clinical success rate of partial pulpotomy treatment in permanent molars using calcium hydroxide (CH) and mineral trioxide aggregates (MTA) as pulp dressing agents. METHODS: Restorable permanent first molars (64) with carious pulp exposures were randomly assigned to two groups; CH and MTA. A standardized operative procedure was followed in both groups. Following isolation and caries removal, the exposed superficial pulp tissue layers were removed with a sterile flame shape diamond bur to a depth of 2-4 mm. Bleeding was controlled and pulp dressed with either a paste of non-setting Ca(OH)2 followed by a setting layer of Ca(OH)2, or with grey MTA. The dressing materials in both groups were then covered with a layer of light cured glass ionomer cement. The teeth were either restored using amalgam, or where grossly carious with preformed metal crowns. Patients were scheduled for follow-up at 3, 6, 12 months and annually thereafter. RESULTS: There were 34 patients (17 males and 17 females) with 51 teeth available for evaluation. The age of patients at the time of restoration ranged between 6.8 to 13.3 years (mean of 10.3 +/- 1.8 years). The follow-up period ranged from 25.4 to 45.6 months with an average of 34.8 +/- 4.4 months. There was no statistically significant difference in the success rate of teeth treated with CH (91%) in comparison to teeth treated with MTA (93%). Radiographically, a hard tissue barrier under CH was noticed in 12 (55%) teeth compared with 18 (64%) teeth under MTA (p=0.4). CONCLUSIONS: MTA has clinical success rate comparable to CH as a pulp dressing material for partial pulpotomy in permanent molars with carious exposures.

Learning priorities and attitudes towards computer-assisted learning of general medical practitioners, general dental practitioners and dental hygienists.

OBJECTIVES: The objectives of this survey were to assess the attitudes and learning priorities of general medical practitioners (GMPs), general dental practitioners (GDPs), and dental hygienists (DHs) working at Jordan University of Science and Technology (JUST), Irbid, Jordan in relation to post-graduate education, to gather information on their attitudes and skills in using computers and computer-assisted learning (CAL) and to see whether the material in this form is acceptable to participate as a means of teaching. METHODS: Data for this study was gathered via a questionnaire distributed to 63 health professionals including GMPs, general dental practitioners and DHs (mean age 24.79 +/- 2.69 years) working at JUST. RESULTS: Of the 63 participants, 80% of the participants have home computers, 38% have office computers at work and only 25% have both home and office computers. Approximately 53% of the participants had their first CAL experience at home. Seventy-three of the participants indicated that connection to Internet is necessary for their work. Seventy-one of the participants were interested in the possibility of using CAL to further improve and increase their medical knowledge. The most important topic for doctors was 'learning about new techniques which may supersede those in current use', for DHs it was 'improve knowledge or skill in radiology', and for dentists it was 'reinforcement of well established techniques commonly used in dental practice'. CONCLUSIONS: It is necessary for practicing health care professionals to update themselves by taking continuous education courses after graduation more conveniently via CAL methods.

Arsenical necrosis of the jaws.

After a brief historical review of the use of arsenic in dental practice two cases of arsenical necrosis of the jaws, affecting the maxilla and mandible respectively, are reported. Both patients were treated conservatively over an extended period with excellent results. It is concluded that there is no justification, whatsoever, for the use of arsenic in modern dental practice and that, although prolonged, conservative treatment of chemical necrosis of the jaws is preferable to more radical treatment.