Type 1 Diabetes Mellitus (Juvenile Diabetes) - A Review for the Pediatric Oral Health Provider.

Objective: To describe the significance of type 1 diabetes mellitus (juvenile diabetes) to the pediatric oral health provider. Relevance: The oral health provider must be aware of type 1 diabetes mellitus (T1DM) characteristics, influence of on oral health, each patient pre-operative diabetic management, symptoms and treatment of hypo and hyper-glycemia, and the clinical implications before, during and after treatment of children with T1DM. Study design: A review of the scientific literature about the T1DM influence on dental development, caries prevalence, gingival and periodontal diseases, wound healing, salivary and taste dysfunction, oral infections, and the factors that must be taken in consideration before, during and after oral treatment of children with T1DM is presented. Conclusion: The increasing prevalence of T1DB in children strongly emphasizes the need for oral health providers to be aware of the complicacy of the treatment aimed to obtain and maintain acceptable blood glucose levels in diabetic children, the effect of diabetes on the oral cavity, the possible serious complications due to hypo- or hyper glycemia before, during and after oral treatments, the effect of stress on blood glucose levels, and the special behavioral interaction between the diabetic child, his/her family and the oral health providers.

Pediatric dentistry clinical education venues evaluation by pre and post-doctoral students.

OBJECTIVE: To evaluate dental students' perspectives about pre- and post-doctoral pediatric dentistry education venues. STUDY DESIGN: Surveys with visual analog scales (from 0 to 100) measuring the educational contribution of pediatric dentistry venues were conducted. The pre-doctoral venues included a 3rd year university twilight clinic (UTC), a 3rd year urban community based clinic (CBC) and 4th year mobile clinics (MCs). The post-doctoral venues included treatment of children under general anesthesia, oral sedations, a regular clinic (no sedations), seminars, journal club, case conferences and studding for the American Board of Pediatric Dentistry. RESULTS: Analyses of variance between the scores indicated that the 3rd year CBC score (68.2 ± 4.5) was statistically significant higher (p= .007) than the one for the 3rd year UTC score (44.9 ± 6.1). The 4th year students' MCs score (61.4 ± 4.0) was statistically significant higher than their retrospective scores for the 3rd year CBC (56.4 ± 4.4) or UTC (42.2 ± 4.9) scores (p= .03 and .004 respectively). Among the didactic or clinical post-doctoral venues, the regular clinic and the seminars received the highest scores (84.3 ± 1.7 and 71.6 ± 2.8 respectively). CONCLUSION: pre-doctoral community-based clinical education and post-doctoral regular university based clinic are considered by students to provide the main contribution to pediatric dental education.

Local inflammatory markers and systemic endotoxin in aggressive periodontitis.

While much research has focused on local and systemic factors contributing to periodontal disease, little is known regarding mechanisms linking these factors. We have previously reported a systemic hyper-inflammatory response to bacterial endotoxin in localized aggressive periodontitis (LAP). The objectives of this study were to delineate cyto/chemokines in gingival crevicular fluid (GCF) and evaluate systemic levels of endotoxin associated with LAP. Clinical parameters, GCF, and peripheral blood were collected from: 34 LAP, 10 healthy siblings, and nine healthy unrelated control individuals. Cyto/chemokines were quantified in GCF, systemic endotoxin levels were quantified in plasma, and correlation analysis was performed among all parameters. Nine mediators were elevated in LAP diseased sites as compared with healthy sites (TNFα, INFγ, IL1ß, IL2, IL6, IL10, Il12p40, GMCSF, and MIP1α, p < 0.001), while MCP1, IL4, and IL8 were elevated in healthy sites (p < 0.01). Four- to five-fold-higher endotoxin levels were detected in LAP plasma compared with that from healthy participants (p < 0.0001), which correlated with all clinical parameters and most cyto/chemokines analyzed. In conclusion, higher systemic levels of endotoxin were found in LAP, which correlates with an exacerbated local inflammatory response and clinical signs of disease. (Clinicaltrials.gov number, NCT01330719).

Hyperbilirubinemic stain: location and extent in dental tissues.

OBJECTIVE: The purpose of the present manuscript is to describe the location and extent of hyperbilirubinemic stain in a primary molar of a 3-year-old who was diagnosed with cystic fibrosis shortly after birth, subsequently developed liver disease and hyperbilirubinemia, and received a liver transplant at age 10-months. STUDY DESIGN: Clinical and histological assessments were performed to evaluate the location and extent of hyperbilirubinemic stain in an extracted primary molar. RESULTS: The clinical image, and macroscopic and microscopic histological examinations of a primary molar showed hyperbilirubinemic staining of enamel and of the coronal dentin that developed between birth and when the liver transplant took place, irregular dentin tubules, and an irregular cementum-dentinal junction. CONCLUSIONS: The findings of the present manuscript indicate that hyperbilirubinemc staining of primary teeth affects dental hard tissues at the time of their calcification, and the clinical picture of the stain may be related to stained enamel and/or dentin, and underlying stained dentin visible through translucent unstained enamel.

Hyper-responsive phenotype in localized aggressive periodontitis.

The 'hyper-responsive' trait is an increased inflammatory response upon stimulation of innate immune receptors. Our objective was to determine if a hyper-reactive trait is present in a cohort diagnosed with aggressive periodontitis (LAgP). Peripheral blood was collected from 30 LAgP, 10 healthy unrelated, and 10 healthy sibling participants and stimulated with lipopolysaccharide (LPS) from E. coli and P. gingivalis. Cyto/chemokine response profiles were evaluated and analyzed by ANOVA. Elevated levels of pro-inflammatory cyto/chemokines were detected in E. coli and P. gingivalis LPS-stimulated LAgP cultures when compared with those of healthy unrelated control individuals. Periodontally healthy siblings presented with attenuated hyper-inflammatory cyto/chemokine profiles. Regression analysis demonstrated the hyper-reactive trait to be concomitant expression of pro-inflammatory cyto/chemokines and an absence of anti-inflammatory mediator expression. Our findings demonstrate hyper-responsive trait in a LAgP cohort, along with an attenuated hyper-responsiveness in healthy siblings, which can be induced in response to multiple TLR ligations.

Root surface characteristics of children teeth with periodontal diseases.

The present study examined the root surfaces of teeth from children with or without periodontal diseases and with or without systemic diseases. Light microscopy revealed that when compared to control teeth: teeth with chronic periodontitis had similar radicular histology; teeth from children with leukocyte adhesion deficiency, Down syndrome and aggressive periodontitis had narrower cementum areas; teeth from children with hypophosphatasia showed cementum aplasia. Cementum anomalies may facilitate the establishment and progress of periodontitis in children.

Oral findings and periodontal status in children, adolescents and young adults suffering from renal failure.

AIM: Describe the oral condition of chronic renal failure and healthy subjects, and the relationship between oral variables, chronic renal failure (CRF) conditions, and their treatment. MATERIALS AND METHODS: Four renal failure groups: chronic renal disease (n=22); undergoing dialysis (n=22); after dialysis and transplant (n=21); and after transplant (n=32), and a healthy control (n=38) were examined. Caries, enamel hypoplasia, pulp obliteration, plaque index, gingival bleeding, recession, overgrowth and index, probing depths, attachment loss, renal treatments and their relations with the oral variables were analysed. RESULTS: The renal failure groups had higher gingival index (GI) and bleeding, probing depths, attachment loss, hypoplasia and obliteration and less caries, than the control. Plaque was higher in the dialysis and pre-dialysis (PD) groups. Overgrowth was evident after transplant. The PD group showed lower GI than other renal groups. Dialysis duration and end-stage renal failure significantly correlated with gingivitis, probing depth, attachment loss and enamel hypoplasia. Immuran correlated positively with probing depth, gingival recession and attachment loss. Normiten and Nifedipine had positive correlations with gingival overgrowth. CONCLUSIONS: CRF patients are characterized by pulp obliteration, gingival and periodontal diseases. Duration of end stage renal failure and type of systemic treatment have a significant influence on the oral condition.

Oral diagnosis of Behcet disease in an eleven-year old girl and the non-surgical treatment of her gingival overgrowth caused by Cyclosporine.

A case of an eleven-year old girl with Behcet disease is presented. Non-surgical treatment of gingival overgrowth caused by the use of Cyclosporine was successfully treated. This case emphasizes the need for cooperation between the medical and dental professionals and the responsibility of dental professionals to lead the diagnosis of systemic diseases like Behcet.

Radiographic assessment of the alveolar bone height in children and adolescents with familial dysautonomia.

PURPOSE: Familial dysautonomia (FD) is a progressive neuropathy, characterized by somatic and skeletal abnormalities, and by a variety of oral and diet disturbances. The purpose of the study was to assess the alveolar bone height at the molar areas of children and adolescents with FD. METHODS: The distance from the cemento-enamel junction (CEJ) to the alveolar bone crest (ABC) was measured on routine diagnostic bitewing radiographs of nine males and seven females with FD (mean age = 122 months) and in those of two matching groups (C1 = 119 months; C2 = 122 months). RESULTS: The mean values for the maxilla were significantly larger than those in the mandible. A positive significant correlation was found between the CEJ-ABC measurements of the primary and the permanent teeth, and between the CEJ-ABC measurements and age. The mean values per patient for the CEJ-ABC distances of the FD group were smaller than the control groups, but the difference was not statistically significant. The CEJ-ABC measurements in the primary and the permanent molars were smaller in the FD group, and in the premolars and permanent cuspids they were larger than those in the two control groups. These differences were not statistically significant. No differences were found between the FD and the control groups in the primary cuspids. CONCLUSIONS: The alveolar bone height of children and adolescent with familial dysautonomia does not differ from that of healthy controls.

The use of imagery suggestions during administration of local anesthetic in pediatric dental patients.

The aim of this study was to evaluate the effects of suggestion before and during the administration of local anesthesia to children. These effects were then observed and correlated with social, behavioral and dentally related variables. Eighty children between the ages of three and sixteen years and who required at least one injection of local anesthesia were monitored. Retrospective examinations of their dental records provided the information regarding the behavior and dental treatment histories of the patients. All other data were provided through observation during the dental treatment phase. During the first treatment session, before the injection, each child was asked to select a favorite, pleasant memory or image. Where children had difficulty in identifying an image, one was proposed by the dentist. After an image had been chosen, the patients were asked to concentrate on the image and to visualize it during the procedure. The majority of children had chosen their own images, and significantly visualized the same images throughout the injection procedures. Image selection and visualization had no association with gender, age, the parent's assessment of the child's behavior, previous dental experience, behavior (both past and present) or, management techniques (both past and present). We conclude that imaging techniques may be successfully utilized in the administration of local anesthesia to young children (from three years of age) in an effort to mitigate untoward, pain-related stress.

Histomorphologic changes in the gingiva and pulp of overretained primary teeth.

This study examined the influence of overretention on the tissues of human primary teeth. The range of overretention was two to thirty-two years. Light microscopy and computerized morphometry were utilized for histologic assessment of twenty-five sites of twenty-one teeth. Dentinoclasts were found on the resorbing root surface of nine teeth; polymorphonuclear leucocytes were found in the pulp of fourteen teeth; and monocytes were present in all pulps. The apical and coronal ends of the junctional epithelium were apical to the cemento-enamel junction in eighteen and fourteen teeth, respectively. Significant correlations were found between the extent of overretention and gingival height, the length of the junctional epithelium and the extent of apical migration of the junctional epithelium. Present and previous findings indicate that odontoclastic activity in the pulp is reduced with overretention; and while at the beginning of overretention there is a lower percentage of pulps with polymorphonuclear leucocytes in the pulp, with an extended period of overretention an increase in this percentage takes place.

Cholinsalicylate gel induced oral lesion: report of case.

Salicylic acid and its derivatives are extensively used medications for the treatment of systemic and local diseases. However, injudicious use of aspirin as well as other derivatives of salicylic acid, may cause systemic and oral complications such as mucosal burns and oral ulcers. In children, topical administration of these drugs, even in small dosages, may cause adverse reactions. This report shows a case of an 8 year old boy with G6PD deficiency, who had a mucosal burn caused by application of a cholinsalicylate paste. Three days later, the child developed oral ulcers, malaise and fever. The present case is characteristic of the enigmatic nature of the etiology and diagnosis of oral lesions, and the possible connection between cholinsalicylate systemic absorption and hemolytic anemia is discussed.

Growth and development considerations in the diagnosis of gingivitis and periodontitis in children.

Increasing information emphasize the relevance of the prevention, early diagnosis and early treatment of periodontal diseases in children. In order to avoid erroneous diagnosis and unnecessary treatments, the pediatric dentist is required to differentiate between pathologic processes and normal changes that take place in the periodontum with age. The present review outlines structural and functional changes of the periodontal structures, the establishment and maturation of the oral microflora and immune defense reactions to periodontal pathogens in children and adolescents. The age-related tendency to develop gingivitis, that is evident in children and adolescents, may be related to changes in the bacterial composition of the dental plaque, the inflammatory cell response, hormonal changes, morphological differences, tooth eruption and shedding. The hormonal influence on the gingival tissues and the composition of the dental plaque are of particular relevance during puberty. Large ranges for the prevalence of attachment loss, periodontitis or destructive periodontal disease in children and adolescents have been reported. The variance in values may be related to population characteristics, method of examination or diagnostic criteria that may include measurements of attachment loss and distances from the cementoenamel junction to the alveolar bone crest, both of which may be either physiological or pathological. The pediatric dentist should be able to diagnose gingival inflammation, attachment loss or distances from the cementoenamel junction to the alveolar crest which are out of proportion to the child's age and the amount of dental plaque. These may be indicative of a high susceptibility to periodontal diseases or reflect systemic conditions that affect the periodontum.

Root surface characteristics of primary teeth from children with prepubertal periodontitis.

This study describes the histologic characteristics of root surfaces of primary teeth from children with prepubertal periodontitis (PP). Fifteen primary teeth from 4 children with PP, and 2 control primary teeth from 2 healthy children were examined. Light microscopy revealed normal root surfaces in the control teeth. In contrast, the PP specimens revealed bacteria inside dentin tubules or covering cementum, a cuticle, or resorbed dentin; normal, wider than normal, or hypoplastic cementum; resorption lacunae with various depths; aplastic root resorption; alternate resorption and repair; and active repair. No cementoclasts were found in the resorption lacunae. Scanning electron microscopy revealed intrabony and suprabony root areas, and a "plaque free zone" (PFZ). Colonies of filaments were evident at the cemento-enamel junction (CEJ). The suprabony root surfaces had resorption lacunae, isolated short rods, calculus, colonies of filaments, or colonies composed by an heterogeneous bacterial population. The coronal boundary of the PFZ was the border of a sheet-like structure, which included isolated rods or filaments. At the PFZ, isolated filaments and rods, and a fibril matrix were evident. The apical boundary of the PFZ consisted of bundles of soft tissue remnants or the insertion of the periodontal fibers. The intrabony surfaces were mostly covered by soft tissue, which included isolated filaments and short rods. Resorption lacunae with or without soft tissue were also evident in this area. Crystals of calcium oxalate dihydrate and erythrocytes in distinct forms were found at various root areas. The present findings are different from those previously reported for hypophosphatasia specimens.

Prevalence of marginal alveolar bone loss in children.

Previous studies have indicated that the prevalence of marginal alveolar bone loss (MABL) in several populations, but not yet in the Mexican children. Therefore, the present study examined the prevalence of MABL in a group of Mexican children. The characteristics of the proximal surfaces and the status of the adjacent alveolar bone, were recorded at 1307 sites from 209 diagnostic bite-wing radiographs, from 115 children. MABL was found in the radiographs of 7.8% of the children or 1.5% of the sites. The present prevalence finding is relatively low when compared to previous studies on children attending dental clinics. MABL was found already in 4-year-old children, confirming previous studies, which indicate the possibility of early onset of periodontitis in children.

Treatment trends during a thirteen-year period in a student pediatric dentistry clinic.

This manuscript reports the treatment trends in a pediatric dentistry clinic from 1980 to 1992 and discusses their implication in clinical teaching. Analysis of the records of the senior year pediatric dentistry students indicated: no significant change with time in the patients/student ratio, the number of preformed crowns, pulpotomies, and pulpectomies by student or by patient; a significant decrease in the number of one-surface and > or = 2-surface restorations by student and by patient; a significant increase in the number of pit-and-fissure sealants and preventive resin restorations by student and by patient. During the thirteen-year period, the students performed an average of 7.3 one-surface; 12.9 > or = 2-surface restorations; 5.5 preformed crowns; 6.4 pit-and-fissure sealants; 2.4 pulpotomies. There was a significant increase with time in the number of students who performed pit-and-fissure sealants.

Possible autosomal-dominant inheritance of prepubertal periodontitis in an extended kindred.

This study presents the clinical findings and the distribution of prepubertal periodontitis in an extended family with high prevalence of this entity. The expression of surface markers and adhesion molecules on peripheral lymphocytes were also studied. Approximately 50% of the children in this family suffered from prepubertal periodontitis. All the affected children were otherwise healthy. 2 identical twins were similarly, but not identically, affected. Detailed laboratory tests and analysis of lymphocyte surface marker expression, including CD18, were all within the normal levels. Both localized and generalized forms of prepubertal periodontitis were found. The high prevalence of prepubertal periodontitis in the 2 branches of this family, and the fact that identical twins were similarly affected, suggest a strong genetic predisposition for prepubertal periodontitis. The family pedigree is consistent with an autosomal-dominant mode of transmission. The coexistence of localized and generalized forms of the disease in sibs suggests the same genetic etiology for both entities with variability in disease expression. This variability in disease expression is further supported by the fact that 2 identical twins were not identically affected.