Weighing in on pediatric obesity: Weight screening at the dental visit.

BACKGROUND AND OVERVIEW: Pediatric obesity is a public health concern requiring an interprofessional approach to care. Weight screening in the dental office can promote healthy behaviors to improve weight and oral health status and reduce systemic and oral health risks. CONCLUSIONS: Oral health care professionals can perform weight screenings quickly. Routine weight screening of pediatric patients and early intervention through education and referral of patients to a registered dietitian nutritionist and a physician for more in-depth evaluation may help reduce disease risk. PRACTICAL IMPLICATIONS: Oral health care professionals can measure a patient's height and weight and can easily calculate body mass index percentile according to a patient's age and sex to detect weight status that does not fall within the normal range. Oral health care professionals should refer patients who are underweight, overweight, or obese to a registered dietitian nutritionist and the patient's physician for follow-up.

Pulp and plaque microbiotas of children with severe early childhood caries.

BACKGROUND AND OBJECTIVE: Bacterial invasion into pulps of primary teeth can lead to infection and premature tooth loss in children. This pilot study aimed to explore whether the microbiota of carious exposures of dental pulps resembles that of carious dentin or that of infected root canals. DESIGN: Children with severe early childhood caries were studied. Children were consented and extent of caries, plaque, and gingivitis measured. Bacteria were sampled from carious lesion biofilms and vital carious exposures of pulps, and processed by anaerobic culture. Isolates were characterized from partial sequences of the 16S rRNA gene and identified by comparison with taxa in the Human Oral Microbiome Database (http://www.HOMD.org). The microbiotas of carious lesions and dental pulps were compared using univariate and multivariate approaches. RESULTS: The microbiota of cariously exposed pulps was similar in composition to that of carious lesion biofilms except that fewer species/taxa were identified from pulps. The major taxa identified belonged to the phyla Firmicutes (mainly streptococci) and Actinobacteria (mainly Actinomyces species). Actinomyces and Selenomonas species were associated with carious lesions whereas Veillonella species, particularly Veillonella dispar was associated with pulps. Other bacteria detected in pulps included Streptococcus mutans, Parascardovia denticolens, Bifidobacterium longum, and several Lactobacillus and Actinomyces species. By principal, component analysis pulp microbiotas grouped together, whereas those in caries biofilms were widely dispersed. CONCLUSIONS: We conclude that the microbiota of cariously exposed vital primary pulps is composed of a subset of species associated with carious lesions. Vital primary pulps had a dominant Firmicutes and Actinobacteria microbiota which contrasts with reports of endodontic infections which can harbor a gram-negative microbiota. The microbiota of exposed primary pulps may provide insight into bacterial species at the forefront of caries invasion in dentinal lesions that can invade into the pulp and the nature of species that need suppressing for successful pulp therapy.

Enhanced removal of Enterococcus faecalis biofilms in the root canal using sodium hypochlorite plus photon-induced photoacoustic streaming: an in vitro study.

OBJECTIVE: The purpose of this study was to determine the effectiveness of laser-activated irrigation by photon-induced photoacoustic streaming (PIPS) using Er:YAG laser energy in decontaminating heavily colonized root canal systems in vitro. MATERIALS AND METHODS: Extracted single-rooted human teeth (n=60) were mechanically and chemically prepared, sterilized, inoculated with Enterococcus faecalis for 3 weeks, and randomly assigned to four groups (n=15): Group I (control, no decontamination), Group II (PIPS+6% NaOCl), Group III (PIPS+saline), and Group IV (6% NaOCl). PIPS settings were all preset to 50 µsec pulse, 20 mJ, 15 Hz, for an average power of 0.3 W. After decontamination, the remaining live microbes from all specimens were collected and recovered via plate counting of the colony-forming units (CFUs). Randomized root canal surfaces were examined with scanning electron microscopy and confocal laser microscopy. Mean variance and Dunnett's t test (post-hoc test) comparisons were used to compare mean scores for the three groups with the control group. RESULTS: The CFU analysis showed the following measurements (mean±SE): Group I (control), 336.8±1.8; Group II (PIPS+NaOCl), 0.27±0.21; Group III (PIPS+saline), 225.0±21; and Group IV (NaOCl), 46.9±20.29. Group II had significantly lower CFUs than any other groups (p<0.05). Both imaging analyses confirmed levels of remaining bacteria on examined root surfaces. CONCLUSIONS: The use of the PIPS system along with NaOCl showed the most efficient eradication of the bacterial biofilm. It appears that laser-activated irrigation (LAI) utilizing PIPS may enhance the disinfection of the root canal system.

Aciduric microbiota and mutans streptococci in severe and recurrent severe early childhood caries.

PURPOSE: Severe early childhood caries (ECC) results from bacterial acid production in an acidic environment. The purpose of this study was to determine Streptococcus mutans, Streptococcus sobrinus, and acid-tolerant counts in severe early childhood caries. METHODS: Two- to 6-year-olds with severe-ECC (N=77) or who were caries-free (N=40) were examined. Plaque samples from teeth and the tongue were cultured anaerobically on blood, acid, and S. mutans selective agars. Severe-ECC children were monitored post-treatment for recurrent caries. RESULTS: Severe-ECC and caries-free children were balanced by household income and education level. Carious lesions were observed in 75% maxillary incisors and >80% molars in severe-ECC. At baseline, S. mutans, and S. sobrinus counts and proportions of S mutans were higher in severe-ECC than caries-free children. Acid and blood counts were elevated only in anterior samples of severe-ECC children. Baseline counts of S. sobrinus, but not S. mutans, were higher in children with recurrent compared with no recurrent caries. S. mutans counts were lower following treatment than pretreatment, particularly for children without caries recurrence. Other counts did not differ between before and after therapy. CONCLUSIONS: Severe and recurrent early childhood caries was better explained by mutans streptococci than the aciduric microbiota. Streptococcus mutans did not predict children with recurrent caries.

Behaviour guidance in dental treatment of patients with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder - not otherwise specified (PDD-NOS) and Asperger syndrome. AIMS: To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization. DESIGN: The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used. RESULTS: Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution. CONCLUSIONS: Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified.

The caries experience and behavior of dental patients with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. The authors conducted a study to evaluate the demographics, caries experience and behavior of patients with ASD and compare these characteristics with those of patients without ASD (unaffected patients). METHODS: The authors reviewed patients' charts and identified a group of 395 patients with ASD and a group of 386 unaffected patients. They obtained the following patient data for analysis: primary diagnosis, age, sex, residence (home versus institution or group home), presence of seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behavior or pica), medications, caries prevalence, caries severity and behavior. RESULTS: The ASD group had a male:female ratio of 4:1, and patients had a diagnosis of autism, pervasive developmental disorder-not otherwise specified or Asperger syndrome. Sex distribution was equal in the unaffected group, which was younger and had a higher decayed, missing and filled teeth (DMFT) score than did the ASD group. When the authors controlled for age and sex, they noted a statistically significant association between ASD and dental caries prevalence. A significantly higher percentage of patients with ASD than unaffected patients were uncooperative and required dental treatment to take place under general anesthesia. Caries prevalence and severity in patients with ASD were not associated with institutionalization, presence of seizure disorder or additional diagnosis. CONCLUSIONS: People with ASD were more likely to be caries-free and had lower DMFT scores than did their unaffected peers. Significantly more patients with ASD than unaffected patients were uncooperative and required general anesthesia to undergo dental treatment.

Prevalence of bruxism in children receiving treatment for attention deficit hyperactivity disorder: a pilot study.

The objective of this study was to evaluate reported bruxism among children affected by attention deficit hyperactivity disorder (ADHD). Thirty children diagnosed with ADHD and 30 healthy age and gender matched controls participated in the study. All subjects were examined for dental attrition, and the parents were asked for signs and symptoms of bruxism in their children using a questionnaire. Prevalence of oral parafunction was evaluated comparing ADHD children taking medications, ADHD children not taking medications, and controls. Subjects affected by ADHD and pharmacologically treated showed higher occurrence of bruxism compared to subjects affected by ADHD not taking medicines and controls; and within the ADHD group taking medications, CNS-stimulants have been associated with such side effect more frequently than the other drugs.

Microbial profile on metallic and ceramic bracket materials.

The placement of orthodontic appliances creates a favorable environment for the accumulation of a microbiota and food residues, which, in time, may cause caries or exacerbate any pre-existing periodontal disease. The purpose of the present study was to compare the total bacterial counts present on metallic and ceramic orthodontic brackets in order to clarify which bracket type has a higher plaque retaining capacity and to determine the levels of Streptococcus mutans and Lactobacillus spp on both types of brackets. Thirty-two metallic brackets and 24 ceramic brackets were collected from orthodontic patients at the day of debonding. Two brackets were collected from each patient; one from a maxillary central incisor and another from a maxillary second premolar. Sixteen patients who used metallic brackets and 12 patients who used ceramic brackets were sampled. Bacterial populations were studied using "checkerboard" DNA-DNA hybridization, which uses DNA probes to identify species in complex microbial samples. The significance of differences between groups was determined using the Mann-Whitney U-test. Results showed no significant differences between metallic and ceramic brackets with respect to the caries-inducing S mutans and L acidophilus spp counts. Mean counts of 8 of 35 additional species differed significantly between metallic and ceramic brackets with no obvious pattern favoring one bracket type over the other. This study showed higher mean counts of Treponema denticola, Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ss vincentii, Streptococcus anginosus, and Eubacterium nodatum on metallic brackets while higher counts of Eikenella corrodens, Campylobacter showae, and Selenomonas noxia were found on ceramic brackets.

Dental findings associated with the malformations of CHARGE.

The acronym CHARGE refers to a non-random clustering of congenital malformations whose cause remains unknown. To date, the dental features of CHARGE association are not well known. A brief review of the literature and a case in a 10-year old boy with the CHARGE association are presented. The patient had multiple dental anomalies including congenital absence of teeth, ectopic eruption, submergence of primary molars and an odontogenic fibroma associated with an impacted permanent molar.

Caries-risk factors for Hispanic children affected by early childhood caries.

PURPOSE: The purpose of this study was to examine factors associated with early childhood caries (ECC) and to develop a profile of risk factors for Hispanic families affected by this condition. METHODS: Sixty Hispanic families with at least 1 child affected by ECC and 60 Hispanic families without any affected children were included in the study. Data was collected using a parent-completed questionnaire which gathered information about family demographics, dental care and hygiene practices, and feeding practices of the children. RESULTS: Parents in families without ECC were significantly more likely to have visited the dentist recently and the children were less likely to sleep while feeding compared to families with an ECC-affected child. Within families affected by ECC, siblings with ECC were significantly more likely to use the bottle and to sleep while feeding compared with their siblings without ECC. Fifty-five percent of the subject families had more than 1 child affected by ECC. However, odds ratios did not indicate an increased risk of ECC among younger siblings in the presence of affected older siblings. CONCLUSIONS: The current study, while supporting the long-held belief that feeding practices influence the susceptibility and course of ECC, demonstrates the role of other nonfeeding practices.