A retrospective study of root canal therapy in non-vital primary molars.

AIM: This study was performed to assess the clinical and radiographic success rates of a formocresol and zinc oxide eugenol (ZOE) primary molar root canal therapy (RCT) technique. The effects of this treatment on the permanent successors and on exfoliation times were also investigated. MATERIALS AND METHODS: Study design: the retrospective study included 161 patients with 211 primary molars treated by RCT by a single operator in a private paediatric dental office in the Toronto area. Data were coded and entered into a Microsoft Excel database and analysis undertaken using SPSS software. Predominantly non-parametric tests were used to evaluate statistical differences (p < 0.05). RESULTS: A clinical success rate of 90% (190/211) and a radiographic success rate of 77.3% (136/176) were obtained. Following RCT in a primary molar, enamel defects were found in 6.8% (7/103) of premolars, all of which occurred in first premolars, and in patients treated at a mean age of 54.1 months (p < 0.005). Treated molars exfoliated on average 7.6 months sooner than contralateral teeth (p < 0.005). CONCLUSION: This formocresol and ZOE RCT is a viable treatment for necrotic primary molars and yielded very high clinical and acceptable radiographic success rates.

Clinical management of avulsed permanent incisors using Emdogain: initial report of an investigation.

The enamel matrix derivative Emdogain was recently approved for clinical use in a number of countries, including Canada. It has been shown to stimulate regeneration of periodontal ligament following periodontal surgery in adults. This paper reviews pertinent clinical and laboratory studies of Emdogain and describes the protocol and methods used for a longitudinal outcome study of replantation of avulsed permanent incisors in children and adolescents. Application of these methods is described in an illustrative case report of Emdogain use. This paper is meant to inform clinicians and guide those who are instituting similar investigations.

Hospital-based dental care for persons with disabilities: a study of patient selection criteria.

The objective of this investigation was to generate a medical and dental profile of patients attending the Mount Sinai Hospital Dental Program for Persons with Disabilities, to determine if certain selected criteria could identify patients likely to require dental care in that setting. The need for dental care under general anesthesia was used as the prime indicator that care should be provided in a hospital setting. A retrospective review of all the charts of the patients enrolled in this hospital program was undertaken. Results indicated that patients who were treated in this hospital-based dental program had the following characteristics: moderate to profound mental retardation (39.5%), moderate to severe behavioral problems (31.1%), and/or a history of seizure activity (29.1%). Behavioral criteria appear to be the predominant reason for the provision of hospital-based dental care for persons with disabilities.

Down's syndrome and Alzheimer's disease.

Individuals with Down's syndrome (DS) who live to be 40 years of age will demonstrate neuropathological changes that are consistent with Alzheimer's disease (AD). Due to modern medical intervention, we are now observing an aging DS population. Middle-aged Down's syndrome adults are actually considered to be "very old," and it is not uncommon to observe a progressive loss of cognitive function and a decline in the ability to perform daily tasks consistent with that seen in Alzheimer's disease. At this stage, the DS individual will not be able to perform daily preventive dental care and may be unable to cooperate for professional dental care. Clinicians who care for DS adults must be aware of this problem when preparing their dental treatment plans, which must emphasize preventive care prior to the onset of dementia and the maintenance of that program during their patients' cognitive decline. In the latter stages of AD, it may be necessary to extract all the remaining teeth due to the inability of the individual or care giver to provide adequate oral hygiene to prevent dental caries or periodontal disease.

Symptomatic benign migratory glossitis: report of two cases and literature review.

Benign migratory glossitis (geographic tongue) is a common clinical finding in routine pediatric dentistry. The condition usually discovered on routine clinical examination, appearing as an asymptomatic, ulcer-like region on the dorsum of the tongue. The lesion may recur at different sites on the tongue, creating a migratory appearance, and in many cases, will resolve completely. The presentation of symptomatic geographic tongue in children is rare. This article presents two cases of symptomatic geographic tongue. Both children presented with a chief complaint of significant oral pain which was affecting daily activity, eating, and sleeping. Both patients presented with a classical clinical presentation of ulcer-like regions on the dorsum of the tongue in which the filiform papillae were denuded. Successful management was achieved with topical and systemic antihistamine. The clinician should be aware that this condition may be symptomatic in children.

A transition space maintainer for the adolescent dentition: a case report.

Premature loss of teeth in posterior segments of the primary, mixed or permanent dentition may lead to space loss in an anterior-posterior dimension. This article illustrates how a simple, aesthetic and effective space maintainer can be used to prevent space loss in the permanent dentition.

Facial swelling and asymmetry in children: systematic diagnosis and review.

This paper reviews a systematic approach which can be used to determine the diagnosis of a child who presents with a facial swelling or asymmetry. Once the most likely diagnosis is formulated then appropriate treatment can be initiated. Examples of some of the more common facial swellings within the listed differential diagnostic categories are also presented.

Dental care for the handicapped.

The family physician/pediatrician who sees the newborn handicapped infant is the health-care professional who can best influence the parent concerning the general health-care needs of the child. The realization that dental disease is preventable and need not further compromise the child's health is of major importance. Too often dental care is not considered important until an emergency arises, and then panic follows. This paper will delineate some of the basic principles involved in providing dental treatment for the disabled and the importance of an early referral so that a sound preventive program can be instituted. This approach will minimize the need for emergency visits and will help to establish a solid rapport with the parents/guardian and the handicapped child.

Bilateral mandibular hamartomas and familial natal teeth.

The case of a newborn girl with two mandibular incisor natal teeth and bilateral mandibular odontogenic harmartomas is presented. The hamartomas were evident as pedunculated masses on the posterior mandibular gum pads. The natal teeth were extracted at birth, and the hamartomas were excised at 5 months of age. Microscopic investigation of the hamartoma demonstrated the presence of all odontogenic tissues with the exception of an enamel organ. In addition, there was a strong family history of natal teeth, which may suggest a hereditary basis for the development of the odontogenic hamartoma.

Infant oral health care.

The family physician/pediatrician who sees a child from birth as part of the well-baby visit program is in the best position to identify early dental problems and to educate the family about early oral preventive health care. Since children under three years of age are not seen routinely by dentists, they are at risk of developing dental disease. This paper briefly covers the areas of infant oral pathology, early preventive care, teething, suckling habits, and dental trauma in the toddler. The physician will then be in a better position to recommend to parents when they should seek dental advice and treatment for their young children.

An immunocytochemical study of the human odontoblast process using antibodies against tubulin, actin, and vimentin.

An immunofluorescence technique was applied at the light microscope level to human third molar coronal dentin in order to localize the intracellular components tubulin, vimentin, and actin. Third molars were split immediately upon extraction, and immersed in periodate-lysine-paraformaldehyde fixative. The crowns were demineralized, dehydrated, and wax-embedded, and 6-micron sections were prepared. The sections were post-fixed in -20 degrees C acetone, and then incubated with monoclonal mouse anti-tubulin, anti-vimentin, or anti-actin antibodies, followed by fluorescein-conjugated sheep anti-mouse immunoglobulins. Intratubular immunofluorescence labeling for tubulin and vimentin was very similar in pattern and intensity and extended to the dentino-enamel junction. In contrast, the actin labeling appeared less intense and more punctate, and was located primarily in the pulpal half of the crown, although some labeling was detectable up to the dentino-enamel junction. The presence of tubulin-, vimentin-, and actin-containing structures extending to the dentino-enamel junction supports the hypothesis that the odontoblast process does extend to the dentino-enamel junction in the human, and is in agreement with earlier studies of rat molars.

A combined scanning electron microscopy and immunofluorescence study demonstrating that the odontoblast process extends to the dentinoenamel junction in human teeth.

The extent of the odontoblast cell process has been the subject of controversy for many years. Using SEM we have examined the extent and morphology of the process on dentine surfaces of human teeth which were partially demineralized and collagenase digested. Third molars were extracted and split; the dentine surface was demineralized, digested by bacterial collagenase, fixed with glutaraldehyde, postfixed in osmium tetroxide, and prepared for SEM investigation. The SEM study revealed the presence of many processlike structures which extended from the odontoblast cell bodies up to the dentinoenamel junction (DEJ). These processes demonstrated lateral and terminal branching and some of them terminated in distended spheres. We have also applied an immunofluorescence technique at the light microscope level to these exposed dentinal surfaces to localize the intracellular microtubules. For this, a second series of third molars was processed in the same manner as for the SEM up to the fixation stage. Teeth were then fixed in periodate-lysine-paraformaldehyde, postfixed in -20 degrees C acetone, and then incubated with affinity-purified rabbit antitubulin antibodies, followed by fluorescein-conjugated goat antirabbit IgGs. Intratubular immunofluorescence labelling for tubulin was evident from the odontoblast cell bodies up to the DEJ. The presence of the tubulin-containing structures extending to the DEJ supports the hypothesis that the structures observed with the SEM are odontoblast processes and that the odontoblast processes do extend to the DEJ.