Relationship between the TAS2R38 and TAS1R2 polymorphisms and the dental status in obese children.

BACKGROUND: The sweet taste and bitter taste genes are thought to have an influence on obesity and caries, which are chronic diseases. OBJECTIVES: The aim of the study was to investigate the effects of the polymorphisms of TAS2R38 (the bitter taste gene) and TAS1R2 (the sweet taste gene), which are the most important members of the taste gene family, on the dental status of obese and normal-weight children. MATERIAL AND METHODS: The study included 78 healthy children and 100 children diagnosed with obesity (5-16 years old). The anthropometric measurements and dental status of the children were evaluated. The decayed, missing and filled permanent/primary teeth (DMFT/dmft) index was determined using the standard methods recommended by the World Health Organization (WHO). Blood samples were collected from all subjects and were analyzed via the polymerase chain reaction (PCR) test, with the use of specific primers for the genetic analysis. Five single-nucleotide polymorphisms (SNPs) of the TAS2R38 and TAS1R2 genes were investigated. The truncated Poisson and truncated negative binomial modeling approaches were used with regard to the data. RESULTS: The DMFT/dmft scores were low in obese children and high in children who did not sense the bitter taste (non-tasters). While obese non-taster children had increased DMFT/dmft scores, normalweight non-taster children had decreased DMFT/dmft scores. CONCLUSIONS: The alanine, valine and isoleucine (AVI) as well as proline, alanine and valine (PAV) haplotypes of the TAS2R38 gene are associated with the DMFT/dmft index and obesity. This study showed that the DMFT/dmft scores were decreased in obese children. According to the haplotype analysis of the TAS2R38 gene, the DMFT/dmft scores were increased in non-tasters. When differentiating obese nontasters and control non-tasters, DMFT/dmft increased in obese non-taster patients, while it decreased in control non-taster patients.

Evaluation of the effects of different remineralisation agents on initial enamel lesions by scanning electron microscope and energy-distributed X-ray analysis.

BACKGROUND: This study compared the ability of four remineralization agents to restore demineralised enamel lesions in permanent human incisors. METHODS: In total, 40 teeth were included in the study. Two samples were obtained from each tooth. The 80 samples were divided into 10 groups (n = 8 per group). The right halves of the teeth were controls solely subjected to demineralisation and stored in artificial saliva for the duration of the experiment. The left halves of the teeth were remineralised using a 5% NaF-containing fluoride varnish (GC MI varnish; GC Corp.), a toothpaste containing casein phosphopeptide and amorphous calcium (GC tooth mousse; GC Corp.), a water-soluble remineralisation paste containing fluoride, hydroxyapatite, xylitol (Remin Pro; Voco), and ROCS remineralising gel containing Ca, magnesium(Mg) and phosphate (P). After 21 days of remineralisation, scanning electron microscopy and energy-dispersive X-ray (EDX) assessments were performed, and the results were analysed using one-way analysis of variance. RESULTS: EDX analysis showed that the ROCS medical remineralising gel had the lowest Ca/P ratio among the groups (P = .04). Compared with the control groups, the Remin Pro and ROCS medical remineralising gel treatments produced significantly higher Ca/P ratios (P = .014 and P = .025). These results were statistically significant, and P-value <.05 was accepted for statistical significance. CONCLUSIONS: The group treated with a fluoride-free, xylitol-containing ROCS medical remineralising gel had the lowest Ca/P ratio. Compared with the control groups, Remin Pro and ROCS remineralising gel appeared effective for repairing initial enamel lesions.

Effect of Interproximal Caries in Primary Molars on Clinical Parameters and Levels of Some Biochemical Markers in Gingival Crevicular Fluid.

This study aims to investigate the relationship between dental caries and periodontal health by examining the clinical parameters and levels of some biochemical markers in the gingival crevicular fluid (GCF) of the teeth. In 22 children, 22 maxillary primary canine teeth and a pair of primary molars in a total of 38 quadrants were examined. The control group (C) consisted of children who had at least 1 caries-free primary maxillary canine. The test group (T) consisted of children who had a pair of primary molars where the interproximal contact was lost due to the caries in the same quadrant. Their primary molars were restored with compomer. The teeth were evaluated based on clinical values (plaque index, gingival index, and probing depth) and biochemical values in GCF before (C0, T0) and after a 6-month treatment (C1, T1). While total amounts of interleukin-1 beta and vascular endothelial growth factor in GCF in T0 were significantly higher than in C0 (P < 0.001), osteocalcin was statistically insignificant (P > 0.05). Clinic parameters in T0 were significantly higher than in C0 and T1. Also these parameters in C0 were higher than in C1 (P < 0.01). Clinical and biochemical parameters in GCF in the teeth with interproximal caries might show symptoms of periodontitis.

Evaluation of Mineral Content and Photon Interaction Parameters of Dental Enamel After Phosphoric Acid and Er:YAG Laser Treatment.

OBJECTIVE: The purpose of this study was to evaluate the effects of laser and acid etching on the mineral content and photon interaction parameters of dental enamel in human teeth. BACKGROUND DATA: The composition of dental enamel may vary, especially at the surface, depending on the reactions that occur during dental treatment. MATERIALS AND METHODS: Forty maxillary premolars were divided randomly into 2 groups of 20 teeth. In the first group, half of teeth crowns were etched by using 37% phosphoric acid; in the second group, half of teeth crowns were etched by using an erbium:yttrium-aluminum-garnet (Er:YAG) laser. The remaining half crowns in each group were used as untreated controls. We characterized the calcium (Ca), phosphorus (P), magnesium (Mg), sodium (Na), and potassium (K) contents in each specimen by using wavelength dispersive X-ray fluorescence spectrometry. The total atomic cross-section ([Formula: see text]), effective atomic number ([Formula: see text]), and electron density (Ne) of the tooth samples were determined at photon energies of 22.1, 25, 59.5, and 88 keV by using a narrow beam transmission method. Data were analyzed statistically by using the Mann-Whitney U test. RESULTS: The mineral contents after Er:YAG laser and phosphoric acid etching did not differ significantly (p > 0.05), and no significant variation in [Formula: see text], [Formula: see text], or Ne was observed. CONCLUSIONS: Therefore, we conclude that the Er:YAG laser and phosphoric acid systems used in this study did not affect mineral composition or photon interaction parameters of dental enamel.

Clinical Comparative Study of the Effects of Helicobacter Pylori Colonization on Oral Health in Children.

OBJECTIVE: To isolate Helicobacter pylori (HP) from the dental plaque of a selected group of children and to compare the oral and salivary findings of patients with those of a healthy control group. METHODS: A total of 70 children aged 5-15 years were included in this study. An intraoral examination was performed for each patient, and dental plaque and saliva specimens were collected for analysis. Oral health conditions, nutritional habits, tooth brushing frequency, saliva pH levels, flow velocity, and buffering capacities were noted. The Kruskal-Wallis test was used for comparison of the DMFT and dft index. The significance level was set at p=0.05. RESULTS: The prevalence of HP in dental plaque was higher in study group than controls (p<0.05). There were no significant differences between groups with respect to DMFT and dft scores, nutritional habits, tooth brushing frequency, saliva pH level or flow velocity (p>0.05). Meanwhile, the buffering capacity of saliva was lower in HP gastritis patients (p<0.05). CONCLUSION: There was a high prevalence of HP in dental plaque; thus, the oral cavity may be an important reservoir for HP. Good oral hygiene could be a positive contributor to the treatment of gastritis.

Carbonic Anhydrase VI Gene Polymorphism rs2274327 Relationship Between Salivary Parameters and Dental-Oral Health Status in Children.

The aim of this study was to research carbonic anhydrase (CA) VI one single-nucleotide polymorphism (SNP) and its potential association with dental-oral health status (dental caries, Plaque Index (PI) and Gingival Index (GI)) and salivary parameters (salivary buffering capacity, salivary flow rate (SFR)) in children. A total of 178 children were divided into two groups: non-carious (n = 70, 34 boys and 36 girls) and carious (n = 108, 47 boys and 61 girls). The clinical evaluations were performed according to the decayed, missing, and filled teeth (dmft/DMFT) index by a specialist. Clinical parameters including PI, GI, and simplified oral hygiene index (OHI-S) were recorded. Salivary pH (SpH) was measured using pH paper. Blood samples and unstimulated whole saliva were collected, and SFR was calculated. The CA VI rs2274327 polymorphism was determined by a LightSNiP assay on the realtime PCR system. The frequencies of rs2274327 were not significant between groups (p > 0.05). There was a positive correlation between OHI-S and SpH in the carious and non-carious groups (p < 0.05). There was no correlation among the SNPs' frequencies and OHI-S, PI, GI, SFR, and SpH (p > 0.05). CA VI SNP (rs2274327) had no statistically significant association with OHI-S, PI, GI, SFR, and SpH in the children.

Oral health status in epileptic children.

BACKGROUND: The aim of the present study was to evaluate the oral hygiene status and dental treatment requirements in children with epilepsy. METHODS: The treatment group consisted of 211 children with epilepsy (120 boys and 91 girls, 4-15 years old, mean age 7.85 + or - 2.98 years). The control group consisted of healthy children, matched by age and gender. Clinical features of the patients were obtained from hospital records. Clinical examinations were conducted, under standard light, using a plane buccal mirror, a dental probe and air drying to evaluate caries experience and to record the periodontal health of each child. Statistical analysis was performed using chi(2) test, Fisher exact test and anova. RESULTS: The number of decayed and missing teeth, the degree of abrasion and periodontal indexes were significantly worse in patients with epilepsy, compared to the control group (P < 0.001). Gingival enlargement was documented in 42% of patients on valproate monotherapy compared to only in 16% of patients on phenobarbital. Dental caries and halitosis were the most common oral disorders. Generalized tonic-clonic seizures often cause minor oral injuries and traumatized anterior teeth. CONCLUSIONS: Epileptic children are at an increased risk of developing caries and gingivitis compared with healthy subjects.

Traumatic injuries to permanent teeth in Turkish children, Ankara.

The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6-12 years (mean age: 8.91 +/- 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls (P = 0.019), whereas there was no difference in gender (P = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer (P < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8-10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.

Finite element stress analysis of short-post core and over restorations prepared with different restorative materials.

The present study was conducted to determine the effect on the distribution of stress with the use of short-post cores and over restorations composed of different materials. The restorative materials used were namely two different composite resin materials (Valux Plus and Tetric Flow), a polyacid-modified resin material (Dyract AP), and a woven polyethylene fiber combination (Ribbond Fiber + Bonding agent + Tetric Flow). Finite element analysis (FEA) was used to develop a model for the maxillary primary anterior teeth. A masticatory force of 100 N was applied at 148 degrees to the incisal edge of the palatal surface of the crown model. Stress distributions and stress values were compared using von Mises criteria. The tooth model was assumed to be isotropic, homogeneous, elastic, and asymmetrical. It was observed that the highest stress usually occurred in the cervical area of the tooth when Tetric Flow was used as the short-post core and over restoration material. The same maximum stress value was also obtained when Ribbond fiber + Tetric Flow material was used for the short-post core. The results of FEA showed that the mechanical properties and elastic modulus of the restorative material influenced the stresses generated in enamel, dentin, and restoration when short-post core restorations were loaded incisally. Resin-based restorative materials with higher elastic moduli were found to be unsuitable as short-post core materials in endodontically treated maxillary primary anterior teeth.

The repair of preveneered posterior stainless steel crowns.

PURPOSE: This study's purposes were to determine the shear bond strength (SBS) for and to perform dye penetration (microleakage) and scanning electron microscopy (SEM) evaluations of preveneered posterior stainless steel crowns (SSCs) that were repaired using 2 different materials. METHODS: Twenty-two crowns were used. They were stored in artificial saliva for 30 days and then thermocycled. A force was applied on the crowns' occlusal surfaces until the original veneer material appeared to be fractured. The fracture types and S8S values were recorded. The crowns were then repaired using Panavia opaque cement and Tetric Flow or Monoopaque and Tetric Flow. Twenty of the repaired crowns were subjected to dye penetration and SBS tests, and the remaining 2 were evaluated using SEM. RESULTS: Statistical analysis revealed no statistically significant differences in the results of either the S8S or the dye penetration test (P = .58 and P = 38, respectively). A statistically significant difference was found between original and repaired crowns regarding fracture extent (P = .02), but not failure type (P = .08). SEM evaluation showed that there was no observable gap at the interface of the original or repaired materials and the stainless steel base. CONCLUSION: Preveneered posterior stainless steel crowns may be repaired using either repair material types tested here.

Re-eruption of an intruded immature permanent incisor with necrotic pulp: a case report.

Intrusive luxation is a serious dental injury that causes damage to the pulp and supporting structures of a tooth because of its dislocation into the alveolar process. This paper presents the case of the re-eruption of a severely intruded immature permanent incisor with a crown-root fracture. A 9-year-old boy was referred to the clinic 1 day after a fall. Clinical and radiographic examinations revealed intrusive luxation of the immature left permanent incisor and a crown-root fracture without pulp exposure. Palatal gingivectomy was done 2 weeks later to facilitate re-eruption. Root canal therapy with intracanal calcium hydroxide paste was initiated during the first month owing to severe spontaneous pain. Six months later, the tooth re-erupted to a normal position, after which root canal obturation and a final esthetic restoration were done. The present case demonstrates the possibility of obtaining re-eruption of intruded immature permanent teeth with interim medication (calcium hydroxide) in the root canal.

Evaluation of root canal dentin after Nd:YAG laser irradiation and treatment with five different irrigation solutions: a preliminary study.

This study evaluated in vitro any changes in the morphology and mineral content of root canal dentin after treatments with Nd:YAG laser irradiation and 5 different irrigation solutions. The groups of extracted single-rooted human teeth were exposed to sterile saline solution, 5.25% NaOCl, 3% H2O2, 15% ethylenediaminetetraacetic acid, 2% chlorhexidine gluconate, and Nd:YAG laser irradiation. All prepared teeth were bisected longitudinally; half of each tooth was used for wavelength dispersive x-ray fluorescence spectrometry analysis to assess the mineral content. The other half was studied by using scanning electron microscopy to analyze the surface of the dentin. The results showed that the calcium level and calcium/phosphorus ratio decreased significantly with the NaOCl irrigation solutions (p < .05), suggesting the presence of changes at molecular level. Significant differences among the test groups were also observed in the scanning electron microscopy evaluation (p < .05). The lowest scores for root cleaning were obtained by using ethylenediaminetetraacetic acid followed by Nd:YAG laser treatment.

Performance of laser fluorescence for residual caries detection in primary teeth.

OBJECTIVES: The aim of this study was to evaluate the performance of a visual-tactile examination and a laser fluorescence device for detecting residual dentinal caries after carious dentin removal with bur excavation, hand excavation and chemomechanical excavation (Carisolv()]. METHODS: Thirty extracted coronal caries primary second molars were used. The caries infected dentin has been removed. A blinded examiner checked all cavities for residual caries using a visual-tactile examination and laser fluorescence. Then the teeth were sectioned through the prepared cavities and the two halves of each tooth were processed for light microscopy and Scanning Electron Microscopy (SEM). The presence or absence of residual caries was verified using polarized light microscopy as the gold standard. The cavity floor dentin after removing carious dentin was examined using SEM. RESULTS: In among all groups a significant difference is determined between visual-tactile examination and laser fluorescence (P<.05). There was an agreement between laser fluorescence or visual-tactile examination and histological gold standard (P>.05). In addition, SEM images of the surfaces with the caries removed have shown that a vast majority of the tubule openings is observed to be open in the samples of the Carisolv group in opposition to the other groups. CONCLUSIONS: The laser fluorescence system could be effective in checking the removal by other methods, such as bur or Carisolv and avoid excessive removal of the sound dentin.

Clinical evaluation of chemomechanical and mechanical caries removal: status of the restorations at 3, 6, 9 and 12 months.

In this study, the clinical efficacy of Carisolvtrade mark system and the hand excavation method in the removal of occlusal dentine caries of primary molar teeth was evaluated. Both Carisolv system and hand excavation method were applied for the removal of caries on different teeth of the same children. After the removal of the caries, Dyract AP materials were used to restore the teeth. The clinical follow-up was made every 3 months within a year. The clinical evaluations of restorations were carried out in accordance with US Public Health Service (USPHS) criteria. To determine whether there was any statistical difference between the groups, chi-square analysis was used. During both excavation methods, pain occurrence and the need for anesthesia and the time spent were all recorded. The time spent for the removal of caries in Carisolv system and in hand excavation method was 9.03+/-4.14 min (mean+/-SD) and 7.34+/-3.41 min (mean+/-SD), respectively (P>0.05). At the end of 1 year, differences between Carisolv and hand excavation groups in terms of marginal adaptation and secondary caries were found to be statistically insignificant (P>0.05). During the removal of caries, certain children complained about pain both in Carisolv system and hand excavation method (7.1 and 35.7%, respectively). As a result, it can be argued that Carisolv system is effective in the removal of caries and causes minimum level pain occurrence. Compared to hand excavation, Carisolv system seems to be a promising restorative approach to remove occlusal caries in primary molar teeth. Studies of longer duration are needed to confirm these findings.

Co-expression of cyclooxygenase-2 and vascular endothelial growth factor in inflamed human pulp: an immunohistochemical study.

Recent data from the medical literature indicates that cyclooxygenase-2 (COX-2) plays a key role in the production of vascular endothelial growth factor (VEGF), a glycoprotein that has the ability to increase the permeability of blood vessels and to induce angiogenesis. This study was undertaken to investigate the immunohistological co-expression of COX-2 and VEGF in inflamed human pulp, in conjunction with the expression of CD34, a transmembrane glycoprotein expressed in endothelial cells. Pulp tissue of extracted carious human third molars with a recent history of spontaneous pain were collected and processed for immunostaining of COX-2, VEGF, and CD34 using the biotin-streptoavidin method. Healthy pulp samples served as controls. COX-2 expression was not observed in healthy pulps, whereas all inflamed pulps demonstrated COX-2-expressing cells. Similarly, VEGF was not expressed in normal pulp tissue, but was strongly positive in inflamed pulps. CD34 was expressed in the endothelium of both normal and inflamed pulp tissues. Co-expression of COX-2 and VEGF in all consecutive sections of inflamed pulps could be suggestive of a possible release of VEGF via a COX-2-dependent pathway.

Primary canine and molar relationships in centric occlusion in three to six year-old Turkish children: a cross-sectional study.

This cross-sectional study aimed to evaluate the primary canine and the primary molar relationship in 205 (90 girls and 115 boys) three to six year-old Turkish children with the primary dentition in centric occlusion according to gender and age. In terms of the molar relationship, Class I was represented by 88.29% of all children who agreed to participate in the study, followed by Class II (7.31%), and Class III (4.4%). In terms of the canine relationship, Class I was represented by 87.8% of the sample, followed by Class II (7.8%), and Class III (4.4%). A statistically significant difference was found between age and both the canine and molar relationships (p<0.005), and a positive correlation was confirmed among them. However, the difference and correlation between the gender and the canine and molar relationships were not significant.

Evaluation of stainless steel crowns cemented with glass-ionomer and resin-modified glass-ionomer luting cements.

PURPOSE: To evaluate in vitro and in vivo conditions of stainless steel crowns (SSC) cemented using one luting glass-ionomer cement (Aqua Meron) and one luting resin-modified glass-ionomer cement (Vitremer). METHODS: In the in vitro part of this study, retentive properties of SSCs cemented using Aqua Meron and Vitremer on extracted primary first molars were tested. In addition, two specimens of each group were used to evaluate the tooth hard tissue-cement, within the cement itself, cement-SSC, and tooth hard tissue-cement-SSC under scanning electron microscope (SEM). In the in vivo part of this study, 152 SSCs were placed on the first or second primary molars of 86 children, and cemented using either Aqua Meron or Vitremer. The crowns were examined for retention. In addition, the clinical views of the crowns were recorded with an intraoral camera. RESULTS: No significant difference was found between the mean retentive forces of Aqua Meron and Vitremer (P> 0.05). SSCs cemented with Aqua Meron and Vitremer had an average lifespan of 26.44 and 24.07 months respectively. Only one (0.66%) of 152 SSCs was lost from the Aqua Meron group during post-cementation periods. Nineteen of the 152 SSCs (12.5%) had dents or perforations.

The influence of various conditioner agents on the interdiffusion zone and microleakage of a glass lonomer cement with a high viscosity in primary teeth.

The smear layer, which occurs during cavity preparation procedures, does not constitute a stable substructure in the bond of restorative material to dental hard tissues. Depending on the dissolution of this material in the course of time, microleakage occurs between the tooth and restorative material. This study evaluated the effects of different conditioner agents (Fuji Cavity Conditioner, 10% maleic acid, 35% phosphoric acid and 3% hydrogen peroxide) on Fuji IX microleakage, Fuji IX-enamel and Fuji IX-dentin combination in Class I cavities prepared to standards having the dimensions of 4x3x2 mm3 in extracted primary molars. The restorations were then subjected to thermocycling procedures and soaked in the 0.5% basic-fuchsin dye for 24 hours. Some sections were taken, parallel to the long axis of the tooth in a mesio-distal direction, and evaluated under a stereo-microscope for leakage. Also, two samples of Fuji IX-enamel and dentin combinations were chosen randomly from each group for evaluation in scanning electron microscopy (SEM). The distribution of microleakage occurred as follows: Control Group > Hydrogen Peroxide > 10% Maleic acid > Fuji Cavity Conditioner = Phosphoric acid. The difference between microleakage scores obtained from the groups was statistically significant (p<0.05). The SEM evaluation revealed a close interface connection in all groups except for the control and hydrogen peroxide groups in the Fuji IX-enamel combination. In the Fuji IX-dentin combination, however, a close interface connection was observed except in the control group. In conclusion, the application of conditioner agents to Class I cavities restored with glass ionomer cement with a high viscosity in vitro either diminishes or completely eliminates microleakage.

Clinical evaluation of simple fixed space maintainers bonded with flow composite resin.

The aim of this study was to evaluate the clinical performance of simple fixed space maintainers bonded by using a flow composite resin (Tetric Flow) to prevent space resulting from early extracted primary teeth. For that reason, 64 fixed space maintainers (34 in the lower jaw and 30 in the upper jaw) were applied to 45 patients. The patients followed up for 12 to 18 months. Survival rate, prevention ability of that space, and whether damage to the abutment teeth occurred were evaluated. Five percent of space maintainers were determined to be unsuccessful at the end of the control period. During this period, loss of space among the abutment teeth was found to be statistically insignificant (P > .05). Finally, it was observed that the use of simple fixed space maintainers was successful due to operator experience and the choosing of favorable patient groups.

Gingival enlargement in children treated with antiepileptics.

This study was conducted to determine the occurrence, severity, and risk factors of gingival enlargement in children treated with valproate and other nonvalproate antiepileptic drugs. A cross-sectional study was carried out in which data obtained from 68 epileptic children under treatment were compared with those from 50 controls. A structured questionnaire was used to collect data on patients' demographics, dental and oral hygiene practices, and medication history. Gingival enlargement, gingival index, plaque index, and probing depth were measured to assess periodontal health. The chi-square and Fisher exact tests were used in statistical analysis. In case of significance, a detailed chi-square analysis was carried out to determine the origin of the difference. Patients in both the valproate and nonvalproate groups showed significantly higher gingival enlargement, gingival index, plaque scores, and pocketing (P < .001 and P < .01, respectively) than the control group. In the valproate group, the duration of the treatment had a significant effect on gingival enlargement (P < .001) but not on gingival index, plaque index, and probing depth values (P > .05). Toothbrushing was most frequent in the control group (P = .000) and more frequent in the valproate group than the nonvalproate group (P = .024). Our study showed significant differences regarding gingival enlargement in children treated with valproate. These findings illustrate that epileptic children on valproate are at risk of periodontal problems.