Revascularization outcomes: a prospective analysis of 16 consecutive cases.

INTRODUCTION: Recent reviews lament the lack of evidence on the efficacy of regenerative procedures to induce further root maturation despite claims of a paradigm shift in the way infected, necrotic immature teeth with arrested root development can be endodontically treated. The majority of reports are either case series or successful case reports where nonstandardized images may make interpretation uncertain. METHODS: This prospective clinical study reports on preliminary outcomes of regenerative endodontic procedures carried out on 16 teeth, 3 mandibular premolars and 13 traumatized central incisors, after 18-month reviews. Qualitative analysis of resolution of periapical radiolucencies and apical closure was undertaken. Quantitative analysis compared preoperative and recall radiographs by using a geometrical imaging program that calculated percentage changes in root length and dentin wall thickness. RESULTS: Qualitative assessment showed 90.3% resolution of the periapical radiolucency. Apical closure was assessed as incomplete in 47.2% and complete apical closure in 19.4% of cases. Quantitative assessment showed change in root length varying from -2.7% to 25.3% and change for root dentin thickness of -1.9% to 72.6%. CONCLUSIONS: Patterns of continued root maturogenesis were variable at 18-month review. Reviews at 36 months showed continued root maturogenesis for 2 cases. Quantitative analysis can control for changes in angulation but may introduce other measurement errors. However, not all anterior teeth were suitable for TurboReg assessment because overlapping of the cementoenamel junctions and/or further eruption of teeth often precluded stable landmark positioning. Discoloration of the crown was a common consequence, with unaesthetic results in 10 of the 16 cases.

Marfan syndrome: a review of the literature and case report.

Marfan syndrome (MFS) is a connective tissue disorder of variable inheritance that affects multiple organ systems. Cardiovascular, ocular, and skeletal abnormalities are cardinal features of the syndrome. Orofacially, MFS patients typically exhibit skeletal class II malocclusion, dolichofacial growth pattern, mandibular retrognathia, malar hypoplasia, high arched palate, dental crowding, and root anomalies. The purpose of this paper is to provide a review of the literature, as well as describe an 11-year-old female with MFS diagnosed at the age of 10.5 years. This report emphasizes the orofacial findings in MFS and highlights particularities of dental treatment when social deficits and intellectual disabilities are also implicated.

A randomised, controlled clinical trial comparing chlorhexidine gel and low-dose fluoride toothpaste to prevent early childhood caries.

OBJECTIVES. This randomised, controlled trial compared the effectiveness of 0.12% chlorhexidine (CHX) gel and 304% fluoride toothpaste to prevent early childhood caries (ECC) in a birth cohort by 24 months. METHODS. The participants were randomised to receive either (i) twice daily toothbrushing with toothpaste and once daily 0.12% CHX gel (n = 110) or (ii) twice daily toothbrushing with toothpaste only (study controls) (n = 89). The primary outcome measured was caries incidence and the secondary outcome was percentage of children with mutans streptococci (MS). All mothers were contacted by telephone at 6, 12, and 18 months. At 24 months, all children were examined at a community dental clinic. RESULTS. At 24 months, the caries prevalence was 5% (3/61) in the CHX and 7% (4/58) in the controls (P = 0.7). There were no differences in percentages of MS-positive children between the CHX and control groups (54%vs 53%). Only 20% applied the CHX gel once daily and 80% less than once daily. CONCLUSIONS. Toothbrushing using 304% fluoride toothpaste with or without the application of chlorhexidine gel (0.12%) reduces ECC from 23% found in the general community to 5-7%. The lack of effect with chlorhexidine is likely to be due to low compliance.

A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries.

BACKGROUND: Home visits (HV) provide excellent opportunities for health promotion. AIM: This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months. DESIGN: A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age-matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic. RESULTS: At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02). CONCLUSIONS: Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.

A randomized controlled trial of a 10 percent CPP-ACP cream to reduce mutans streptococci colonization.

PURPOSE: The purpose of this study was to investigate the effectiveness of a 10 percent casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream to reduce mutans streptococci (MS) colonization and prevent early childhood caries. METHODS: The cohort was randomized at mean age of 11 days old to receive once-daily CPP-ACP cream (n=102) or no product (comparison group; n=89) from the time of first tooth eruption. All mothers were contacted by telephone at six, 12, and 18 months and advised to brush their children's teeth twice daily with low-dose fluoride toothpaste. At 24 months, all children were examined at a community clinic. RESULTS: At 24 months old, one out of 65 (2 percent) children in the CPP-ACP group had caries vs. four out of 58 (seven percent) in the comparison group (difference not statistically significant). There were fewer MS-positive children in the CPP-ACP group (26 percent) vs. the comparison group (47 percent; P=.02). A dose-response effect of CPP-ACP usage on MS was observed, where MS was present in eight percent of regular CPP-ACP users, 28 percent of irregular users, and 47 percent of non-users (P<.02). CONCLUSIONS: CPP-ACP reduced the percentages of mutans streptococci-positive 24-month-old children, although it did not reduce caries prevalence.

Congenital aplasia of the major salivary glands: literature review and case report.

Congenital aplasia of the major salivary glands is rare, and there have been few cases of the condition reported to date. In many cases, absence of the salivary glands is associated with syndromes involving the ectodermal tissues. The xerostomia encountered in affected children is usually associated with increased risk for caries and infections of the soft tissues. The purpose of this paper was to describe the case of a 10-year-old boy with bilateral aplasia of the submandibular and parotid salivary glands and the preventive and restorative treatment rendered. This case study demonstrates the importance of timely diagnosis of this condition in order to prevent the serious oral complications from xerostomia.

Comparison of enamel defects in the primary and permanent dentitions of children from a low-fluoride District in Australia.

PURPOSE: The purpose of this study was to compare developmental defects of enamel (DDE) in the primary and permanent dentitions of children from a low-fluoride district. METHODS: A total of 517 healthy schoolchildren were examined using the modified DDE criteria. RESULTS: The prevalence of DDE in the primary and permanent dentition was 25% and 58%, respectively (P<.001). The mean number of teeth with enamel opacity per subject was approximately threefold compared to that affected by enamel hypoplasia (3.1±3.8 vs 0.8±1.4, P<.001 in the primary dentition and 3.6±4.7 vs 1.2±2.2, P<.001 in the permanent dentition). Demarcated opacities (83%) were predominant compared to diffuse opacities (17%), while missing enamel was the most common type of enamel hypoplasia (50%), followed by grooves (31%) and enamel pits (19%) (P=.04). In the permanent dentition, diffuse and demarcated opacities were equally frequent, while enamel grooves were the commonest type of hypoplasia (52%), followed by missing enamel (35%) and enamel pits (5%; P<.001). CONCLUSIONS: In a low-fluoride community, developmental defects of enamel were twice as common in the permanent dentition vs the primary dentition. In the primary dentition, the predominant defects were demarcated opacities and missing enamel, while in the permanent dentition, the defects were more variable.

Enamel hypoplasia in the primary dentition of monozygotic and dizygotic twins compared with singleton controls.

BACKGROUND: The study of enamel hypoplasia (EH) and opacity in twins provides insights into the contribution of genetic and environmental factors in the expression of enamel defects. AIM: This study examined prevalence and site concordance of EH and opacity in the primary dentition of 2- to 4-year-old twins and singleton controls to assess the relative contribution of genetics and the environment to the aetiology of these defects. DESIGN: The study sample consisted of 88 twin children and 40 singletons aged 2-4 years of age. Medical histories were obtained and the children examined for enamel defects. RESULTS: The prevalence of EH by teeth was 21% in monozygotic twins (MZ), 22% in dizygotic twins (DZ), and 15% in singleton controls. Twins showed a higher prevalence of EH compared with singletons (P < 0.05). Factors contributing to increase EH in twins were neonatal complications including intubation. There were no significant differences in site concordance of EH within the MZ twin pairs compared with DZ twin pairs when only presence of EH was considered, whereas a greater concordance was noted between MZ twin pairs compared with DZ twin pairs when both presence and absence of EH were considered. CONCLUSIONS: The results suggest that both genetic and environmental factors contribute to observed variation of EH, although it is likely that environmental factors exert a greater influence.

A controlled study of dental erosion in 2- to 4-year-old twins.

BACKGROUND: Dental erosion (DE) in children is a significant oral health issue and has become a focus for research in clinical paediatric dentistry. AIM: This study investigated DE in the primary dentition of 2- to 4-year-old twin and singleton children with regard to the genetic, medical and dietary factors associated with the condition. DESIGN: The 128 subjects consisted of 88 twin children (31 monozygous, 50 dizygous, 7 unknown zygosity) and singletons (n = 40) aged 2-4 years. Medical, dental, and dietary histories were obtained. The children were examined for DE using a modified index. RESULTS: The prevalence of DE by subject affected was 77% in monozygotic twins (MZ), 74% in dizygotic twins (DZ), and 75% in singleton controls (P > 0.1). Of the teeth scored, 12% had mild, 10% moderate, and 1% severe lesions, and DE was more severe in the older age group (P < 0.05). Concordance rates for erosion lesions in MZ and DZ co-twins were not statistically significant. CONCLUSIONS: The prevalence of DE and the concordance of erosion lesions were similar between MZ and DZ twins and singleton children, suggesting that the contribution of genetic factors to DE is negligible.

A case-control study of dental development in Hypodontic and Hyperdontic children.

PURPOSE: The purpose of this study was to investigate the rate of dental development in children with nonsyndromic hypodontia and nonsyndromic hyperdontia compared to age- and gender-matched controls. METHODS: Dental age assessment was performed using orthopantomograms on 115 children (63 girls, 52 boys) with hypodontia and 61 children (22 girls, 39 boys) with hyperdontia and compared with 176 normal controls, case-matched for gender and age. RESULTS: Both girls and boys with hypodontia showed a significant delay in dental development compared to case controls. The mean differences between dental age and chronological age in hypodontia girls and boys were -0.1+/-1.5 years and -0.1+/-1.2 years, respectively, compared to 1.0+/-1.0 years and 0.8+/-0.8 years in the case controls, respectively (P<.001 for both boys and girls). The delay in dental development was accentuated during puberty. By contrast, no significant differences were observed between hyperdontic children and case controls. CONCLUSIONS: Nonsyndromic hypodontia children experience delayed dental development, whereas nonsyndromic hyperdontia children have similar rotes of dental development compared to normal children. These findings have implications for management of dental growth and development in children with agenesis of the teeth and supernumerary teeth.

Taurodontism in children with hypodontia and supernumerary teeth: a case control study.

PURPOSE: The aim of the present investigation was to compare the prevalence of taurodontism in the permanent mandibular first molars of nonsyndromic children with hypodontia and supernumerary teeth with age- and gender-matched controls. METHODS: The crown-body root ratios of the permanent first molars were determined from orthopantomograms of 83 children with hypodontia (> or =1 missing teeth) and 37 children with supernumerary teeth (> or =1 extra teeth) compared with normal case controls. RESULTS: In children with hypodontia, only girls showed a significantly higher tendency for taurodontism compared to case controls (P=.003), while boys with hypodontia showed a similar prevalence of taurodontism as controls (P=.83). Children with multiple missing teeth were significantly more susceptible to taurodontism than children with a single missing tooth (P=.004). By contrast, the prevalence of taurodontism in children with supernumerary teeth was not significantly different from that of controls. CONCLUSIONS: Compared to normal case controls, children with nonsyndromic hypodontia are more likely to show taurodontism of the permanent first molar teeth whereas children with nonsyndromic supernumerary teeth are not.

Oral Streptococcus species in pre-term and full-term children - a longitudinal study.

BACKGROUND: Despite high clinical significance, the microbiology of the dental biofilm in young children remains poorly understood. AIM: The aim of this longitudinal study was to investigate five Streptoccocus species commonly found in the oral biofilm of children, namely Streptococcus mutans, Streptococcus sobrinus, Streptococcus mitis, Streptococcus sanguinis, and Streptococcus salivarius to determine their relative numbers in caries-free pre-term children, and age-matched full-term controls. DESIGN: Plaque and saliva samples were obtained from 15 pre-term children and 15 age-matched controls at ages 3, 6, 12, 18, and 24 months. A quantitative real-time PCR technique was used to determine the numbers of five species of Streptococcus using probes and primers specific for each bacterial species. RESULTS: All species of Streptococcus generally increased from ages 3 to 24 months. The relative ratios of the bacteria remained fairly constant at all ages studied (P > 0.1). There were no significant differences in numbers of all Streptococcus species between pre-term children and full-term controls at all the ages investigated between. CONCLUSION: The results show that the relative numbers of S. mutans, S. sobrinus, S. mitis, S. sanguinis, and S. salivarius remain relatively constant from 3 to 24 months of age in caries-free pre- and full-term children.

Common dental conditions associated with dental erosion in schoolchildren in Australia.

PURPOSE: The purpose of the investigation was to determine factors associated with dental erosion in a group of schoolchildren in Queensland, Australia. METHODS: Dental examinations were carried out on 714 children aged 5.5 to 14.6 years from 8 randomly selected Australian schools. A total of 3,165 primary and 2,976 permanent teeth were scored for dental erosion using a modified erosion index. Dental caries experience was determined from clinical examination and bitewing radiographs. Enamel defects were recorded using the developmental defects of enamel index. RESULTS: There were 225 children (32%) who exhibited no erosion and 489 (68%) who had erosion of at least one tooth. Erosion was found in 78% of subjects with primary teeth and 25% of subjects with permanent teeth (P<.001). Children with erosion in the primary and permanent dentition were more likely to have: (1) a lower socioeconomic status (primary dentition, P<.001 and permanent dentition (P<.001); (2) enamel hypoplasia in permanent dentition (P=.001); (3) dental caries in the primary dentition (P=.001); and (4) permanent dentition (P=.002). CONCLUSIONS: In Australian schoolchildren, the prevalence of dental erosion in the primary dentition is approximately 3 times greater than in the permanent dentition. Dental erosion is strongly associated with caries experience and enamel hypoplasia.