Oral health experiences of individuals with Rett syndrome: a retrospective study.

BACKGROUND: There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. METHODS: Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. RESULTS: The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46-16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94-0.97). CONCLUSIONS: Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.

New treatments for serious conditions: ethical implications.

Approval of Spinraza (nusinersen) for treatment of spinal muscular atrophy prompts consideration of a number of ethical issues that arise whenever a new treatment is proposed for a serious condition, especially one that is rare and can devastatingly affect children. Patients, families, clinicians, researchers, institutions and policymakers all must take account of the ways that newly available treatments affect informed and shared decision-making about therapeutic and research options. The issues to consider include: addressing what is still uncertain and unknown; the possibility that potential benefits will be exaggerated and potential harms underemphasized in the media, by advocacy organizations, and in consent forms and processes; the high cost of many novel drugs and biologics; the effects of including conditions of variable phenotype in state-mandated newborn screening panels; and how new treatments can change the standard of care, altering what is and is not known about a disorder and posing challenges for decision-making at both individual and policy levels. The good news that Spinraza brings thus requires additional attention to its ethical and policy implications, to improve counseling and shared decision-making about treatment and research options for patients and all involved in their care.

Association between dental caries and adiposity status (general, central, and peripheral adiposity) in 12-year-old children.

BACKGROUND/AIMS: To investigate the cross-sectional relationship between dental caries experience and adiposity status (general, central, and peripheral adiposity) in 12-year-old children in Hong Kong. METHODS: A random sample of 668 12-year-old students was recruited. Clinical assessment for dental caries (DMFT) was conducted using WHO criteria. Anthropometric measurements for body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were performed to assess general adiposity (weight-height ratio, body mass index); central adiposity (WC; waist-hip ratio, WHR), and peripheral adiposity (TRSKF). Associations between adiposity indices and dental caries experience [prevalence DMFT > 0, 'high' experience (DMFT ≥ SiC Index value) and 'very high' experience (DMFT ≥ SiC10 Index value)] were examined in bivariate and multivariate regression analyses. RESULTS: The response rate was 76.9% (n = 514/668). Regression analyses (adjusted for oral hygiene practice, snacking habits, and socio-demographic factors) identified that WHR z score was associated with 'high' dental caries experience (OR 1.33, 95% CI 1.05, 1.70, p = 0.02), and that WHR z score was associated with 'very high' dental caries experience (OR 1.52, 95% CI 1.10, 2.11, p = 0.01). TRSKF z score was associated with 'very high' dental caries experience (OR 1.47, 95% CI 1.10, 1.96, p = 0.01). CONCLUSIONS: In a population-based sample of 12-year-old children in Hong Kong, dental caries experience was associated with adiposity. Central and peripheral, but not general adiposity was associated with dental caries experience.

The relationship between oral hygiene status and obesity among preschool children in Hong Kong.

OBJECTIVES: To explore the association between oral hygiene status and obesity among preschool children in Hong Kong. METHODS: Three hundred and twenty-four 5-year-old children in Hong Kong were recruited. Their oral hygiene status was recorded using visible plaque index (VPI). Body height, body weight, waist circumference (WC), hip circumference and triceps skinfold thickness (TRSKF) were measured to assess general adiposity (weight/height ratio, W/H; body mass index, BMI), central adiposity (WC; waist/hip ratio, WHR) and peripheral adiposity (TRSKF). The relationships between VPI and W/H, BMI, WC, WHR and TRSKF were examined in bivariate and regression analyses. RESULTS: Fifty-six per cent of the children were considered to have high VPI (VPI ≥ 65.0%). Logistic regression analyses identified that W/H z-score (OR = 1.28, 95% CI = 1.01-1.61) and WC z-score (OR = 1.25, 95% CI = 1.00-1.58) were associated with high VPI. No association was found after adjusted for socio-demographic status (P > 0.05). CONCLUSION: Oral hygiene status was not associated with obesity among 5-year-old children in Hong Kong after controlling for socio-demographic factors.

Is there sufficient evidence to support the long-term efficacy of mineral trioxide aggregate (MTA) for endodontic therapy in primary teeth?

Several papers have been published to illustrate the effectiveness of mineral trioxide aggregate (MTA) as a pulpotomy medicament. Most of these reports do not offer a critical assessment on the data quality. Therefore, this review evaluated whether the currently available evidence is of an appropriate quality to support the long-term effectiveness of MTA as a pulpotomy medicament in primary molars using a standardized assessment criterion. A comprehensive literature search of human clinical outcome studies, which employed MTA as a pulpotomy medicament in primary teeth, was conducted using the MEDLINE database. Two independent observers rated these articles using the standardized assessment criteria. Furthermore, based on the initial sample mentioned in the individual studies and the sample included for the final analysis, the drop-out rates were calculated. Twenty-two studies were included for quality assessment with an excellent interobserver agreement. None of the 22 studies obtained grade A, four studies attained grade B1, five were graded B2 and 13 received grade C. Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament. Furthermore, given the low quality of data, it is highly desirable to establish standard requisites for conducting and reporting on pulp therapy studies in primary teeth so as to benefit both researchers and clinicians to produce high-quality studies that are comparable and to prevent the misuse of clinical material and resources.

Oral health-related quality of life in Hong Kong preschool children.

OBJECTIVES: To assess the impact of early childhood caries (ECC) on the quality of life in a population of preschool children and their families in Hong Kong. METHODS: A random sample of 1,296 Chinese preschool children participated in the survey and were subjected to an oral examination for their ECC status by 2 trained examiners. The parents were asked to respond to the Early Childhood Oral Health Impact Scale (ECOHIS) and an extra set of questions concerning their sociodemographic background. RESULTS: The final data analysis included 1,261 children with a mean (±SD) age of 3.9 ± 0.66 years. The prevalence figures for ECC and severe ECC were 19.9 and 15.2%, respectively. Decayed teeth were found in 34.3% of the children while only 5.2% had filled teeth. The mean (±SD) dmft in this group of children was 1.5 ± 2.98. Higher ECOHIS scores were found in parents with lower education or income level, or with children who were born in mainland China (p < 0.05), or with children who had decayed, missing, or filled teeth (p < 0.001). In multiple regression analyses, decayed teeth and filled teeth in primary dentition were the better predictors (p < 0.001) of the ECOHIS score among the various parent and child characteristics collected in this survey. CONCLUSIONS: The findings of this study showed that parents of young children with dental caries experience perceived that both the children and other family members had poorer quality of life.

Ingestion of fluoride from dentifrices by young children and fluorosis of the teeth--a literature review.

UNLABELLED: The ADA recommends the use of fluoridated dentifrices as soon as the primary teeth erupt, so as to reduce the incidence of dental caries. However young children can ingest a significant amount of dentifrice during normal toothbrushing; this is a potential problem because the permanent teeth are at risk from fluorosis for the first seven years of life. AIMS: the objective of this paper was to review the literature on the role of fluoride dentifrices in causing dental fluorosis. SEARCH STRATEGY: a search for literature was performed using MEDLINE, OVID with the key words fluorosis, dentifrice, ingestion, and children. The search was limited to English language publications. Subsequently, 31 articles were retrieved, additional relevant articles were collected from the references cited in the initially identified papers. Ultimately, 96 articles were retrieved for review. CONCLUSIONS: Fluoride, should be used with caution so that the benefits out-way the adverse affects. Oral health care providers need to systematically assess individual tooth brushing habits and emphasize the advantages of early use of a fluoridated dentifrice whilst still meeting the need for the prudent use of small quantities of dentifrice. Dentifrices with a low concentration of fluoride may be appropriate for young children who are considered to be at low caries risk and the risk of fluorosis is minimal for children who ingest this dentifrice; nevertheless, it appears that more research is still required on the therapeutic effects of fluoride dentifrices which contain fluoride at a low concentration.

Correlating spacing in the primary dentition and caries experience in preschool children.

PURPOSE: To evaluate the correlation between spacing in the primary dentition and caries experience. METHODS: One hundred seventy-four clinical records, including photographs during 2017-2019 were assessed for primate, generalised and interdental spaces. The mean of decayed, missing or filled teeth and surfaces (dmft and dmfs) were recorded to quantify the caries experience. Linear regression analyses were used to ascertain correlations between spacing and dental caries. The strength of the associations was quantified using odds ratio (OR) and 95% confidence interval (CI). RESULTS: Ninety-seven boys and 77 girls were included in the final analysis. Approximately 41% of children had primate space in all four quadrants, and 15% of children had no primate spaces in all four quadrants. 50% of children did not exhibit generalised spacing, while 39% of children showed interdental spacing. Children with no primate space had approximately five surfaces higher dmfs score compared to those with primate space in all four quadrants (95% CI - 9.27 to - 1.23; p < 0.05). Similarly, children with no primate space in the mandible had 6.12 surfaces higher dmfs score compared to those with primate space in the mandibular arch (95% CI - 10.07 to - 2.17; p < 0.05). CONCLUSIONS: Preschool children with no primate space exhibited a 50% increase in dmfs scores compared to children with primate space.

Health- and oral health-related quality of life among preschool children with autism spectrum disorders.

PURPOSE: To assess the health-related quality of life (HrQoL) and oral health-related quality of life (OHrQoL) of preschool children with autism spectrum disorders (ASD) and to determine the associated factors. METHODS: A case-control study of preschool children with and without ASD was undertaken. H&OHrQoL were assessed employing Pediatric Quality-of-Life Inventory Version 4.0 (PedsQL™ 4.0) and Early Childhood Oral Health Impact Scale (ECOHIS). Differences in PedsQL and ECOHIS scores were determined between groups and correlation between PedsQL and ECOHIS was explored. Regression analyses were conducted to determine key factors associated with H&OHrQoL. RESULTS: Parents of 510 children (253 cases and 257 controls) completed the H&OHrQoL questionnaire assessments. Significant difference in PedsQL (p < 0.001) and ECOHIS (p < 0.001) scores was apparent between children with and without ASD. There was a positive and weak correlation between PedsQL and ECOHIS scores (r = - 0.45, p < 0.01). In regression analyses, the presence of ASD was associated with an increased likelihood of having lower PedsQL (OR 0.10, 95% CI 0.06-0.15, p < 0.001) and higher ECOHIS scores (OR 2.34, 95% CI 1.60-3.42, p < 0.001). CONCLUSIONS: Differences in H&OHrQoL exist among preschool children with and without ASD. There was a significant but weak correlation between children's H&OHrQoL. Both H&OHrQoL were associated with autism spectrum disorders.

Root canal morphology of hypomineralised first permanent molars using micro-CT.

AIM: To investigate the root canal morphology of hypomineralised first permanent molars (FPMs) using micro-CT (µCT). METHODOLOGY: Twenty-four hypomineralised FPMs and five clinically sound FPMs were scanned using µCT and assessed using the following parameters: (i) root canal configuration, (ii) connecting canal frequency, (iii) enamel, dentin, and pulp volumes, (iv) cusp tip to pulp horn distance, root canal length, root canal width, and dentin thickness, and (v) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. A two-way repeated-measures analysis of variance was employed with the statistical significance set at p < 0.05. RESULTS: The frequency of accessory and connecting canals was higher in hypomineralised FPMs. Mesio-buccal cusp horn was found to be the closest to its corresponding cusp tip in both groups. There was no significant difference between the root lengths, dentine widths, and pulp space measurements of hypomineralised FPMs compared to clinically sound FPMs. The best angulation to access FPMs was straight-line radicular, along the pulp horn. CONCLUSIONS: This study illustrates some variations in the root canal morphology in hypomineralised FPMs compared to clinically sound FPMs. Future studies should focus on assessing these parameters in larger samples.

Effect of temperature on water sorption and solubility of dental adhesive resins.

OBJECTIVE: This study examined the effect of temperature on water sorption and solubility characteristics of four commercial dental adhesives. The null hypothesis tested was that temperature has no effect on the water sorption and solubility characteristics of these adhesives. METHODS: The tested materials were: three-step etch-and-rinse (All-Bond 2, AB), two-step etch-and-rinse (One-Step, OS), two-step self-etch (Clearfil SE Bond, SE) and one-step self-etch (Clearfil S3 Bond, S3) adhesives. Seven resin disks (6mm in diameterx1mm in thickness) were prepared from each tested material and were stored in deionized water at 23 degrees C, 37 degrees C and 55 degrees C. Water sorption and solubility of the resin disks were measured before and after water immersion and desiccation following two consecutive sorption and desorption cycles. The water sorption and solubility values obtained were analyzed using two-way ANOVA and Tukey's multiple comparison tests. The relationships between maximum water sorption, solubility and kinetics of water diffusion with temperature were evaluated by means of Pearson correlation statistic. RESULTS: OS exhibited the highest water sorption and solubility values in the second sorption-desorption cycle at 55 degrees C (p<0.001). This is followed by S3, SE and AB with no significant difference between SE and AB. Significant positive correlations were observed between maximum water sorption (r=0.307, p<0.01), solubility (r=0.244, p<0.05), water sorption (r=0.651, p<0.001) and desorption (r=0.733, p<0.001) diffusion coefficients (obtained using Fick's law of diffusion) with temperature in the second cycle. SIGNIFICANCE: High temperatures increased water sorption of simplified adhesives. Such water sorption may contribute to the failure of resin-dentin bonds.

Chlorhexidine release and water sorption characteristics of chlorhexidine-incorporated hydrophobic/hydrophilic resins.

OBJECTIVES: The aim of this study was to evaluate chlorhexidine release from unfilled non-solvated methacrylate-based resins of increasing hydrophilicity and to examine relationships among Hoy's solubility parameters, water sorption, solubility and the rate of chlorhexidine release. METHODS: Resin discs were prepared from light-cured, experimental resin blends (R1, R2, R3, R4 and R5) containing 0.0, 0.2, 1.0 and 2.0 wt.% chlorhexidine diacetate (CDA). Discs were immersed in distilled water at 37 degrees C, and mass changes were recorded at different periods. Spectral measurements were made to follow change in optical densities of storage solution to examine chlorhexidine release kinetics. After a 28-day period, water sorption, solubility, and the cumulative chlorhexidine release were obtained. Additionally, antibacterial study was performed by observing the presence of inhibition zone against Streptococcus mutans. RESULTS: The most hydrophilic resin (R5) exhibited the highest chlorhexidine release rate. The most hydrophobic resin (R1) exhibited the lowest rate. However, no inhibition zone was produced by any specimens stored in water for 2 weeks. The addition of CDA increased solubility significantly but had no effect on water sorption. Significant positive correlations were seen between water sorption and the cumulative chlorhexidine release. SIGNIFICANCE: Chlorhexidine release from resins may be related to water-induced swelling, which in turn is enhanced by the hydrophilicity of cured polymer matrix.

The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study.

BACKGROUND: The aims of this study were to investigate the efficacy of CPP-ACP containing Tooth Mousse on the remineralization of enamel lesions and to compare its efficacy to that of a fluoride-containing toothpaste. METHODS: Permanent teeth were placed in demineralizing solution for 96 hours to produce artificial caries-like lesions 120-200 microm in depth. They were sectioned into 100-150 microm thick samples and randomly assigned to five groups: for Group A, a fluoridated toothpaste (1100 ppm) was used as a positive control and in Group B, a non-fluoridated toothpaste was used as a negative control. Tooth Mousse containing CPP-ACP was tested by three different means: as a toothpaste (Group C); as a topical coating (Group D); and (Group E) as a topical coating after treating the sections with the same fluoridated toothpaste as in Group A. RESULTS: The lesion depth decreased significantly by 7 per cent in Group A, 10.1 per cent in Groups C and D, and 13.1 per cent in Group E (Paired t- test, p < 0.05), while in Group B the lesion depth increased significantly by 23 per cent. CONCLUSIONS: Based on the data obtained, CPP-ACP containing Tooth Mousse remineralized initial enamel lesions and it showed a higher remineralizing potential when applied as a topical coating after the use of a fluoridated toothpaste.

A catalogue of anomalies and traits of the primary dentition of southern Chinese.

Variation in size, form and morphology of the teeth result in anomalies such as macrodontia, microdontia, hyperdontia, hypodontia, double tooth, taurodontism and dens in dente. While traits that may occur more commonly in certain ethnic groups may be considered to be specific to that population. The characteristics of these anomalies and traits are presented along with the prevalence figures for their occurrence in primary dentition of southern Chinese.

Pre-maxillary hypohyperdontia: a report of two cases.

BACKGROUND: Hypodontia and hyperdontia are considered to be at opposite ends of the dental development spectrum. Nevertheless, these anomalies may occur concomitantly (hypohyperdontia). CASE REPORT: This clinical report describes two case of hypohyperdontia occurring exclusively in the premaxillary region, and the difficulties associated with its diagnosis and management. Following 24 months of follow-up examinations, Case 1 developed a sequential supernumerary tooth in the tooth 35 region. CONCLUSION: Cases of hypohyperdontia can occur exclusively in the premaxillary region and may be difficult to diagnose. Multidisciplinary treatment planning is essential to facilitate appropriate management, and long-term follow-up is necessary as sequential supernumerary teeth may develop.

Technique sensitivity associated with air-drying of HEMA-free, single-bottle, one-step self-etch adhesives.

OBJECTIVES: This study examined the effect of air-drying on bond strength to dentin and nanoleakage in resin-dentin interfaces using HEMA-free one-step self-etch adhesives. METHODS: Twelve teeth had their occlusal dentin exposed and split in half. In the group of G-BOND (GB), the adhesive was dried gently or vigorously on each slit half tooth, and then light-cured. In the group of the experimental adhesive (EX), three coats of adhesive were dried using a single air-drying process prior to light-curing or dried after each of three coats of adhesive before light-curing. The split specimens were built-up with resin composite and then subjected to microtensile bond strength testing and TEM examination. RESULTS: GB showed significantly higher bond strength after vigorous drying than after gentle drying. Three teeth of from EX group showed higher bond strength after triple drying than after single drying, while two teeth showed no significant difference. Droplets were revealed in the adhesive layer after gentle drying with GB, and silver deposits existed along the interfaces in all groups. SIGNIFICANCE: The bonding quality to dentin may be improved by using an accelerated air-drying technique; although it is impossible to remove intrinsic dentin moisture that is drawn upwards from dentin tubules.

Effects of child formula dentifrices on artificial caries like lesions using in vitro pH-cycling: preliminary results.

AIM: To compare the remineralisation effects of different child dentifrices on primary teeth. DESIGN: In vitro single-section technique and pH-cycling model. METHODS: Primary teeth were painted with nail varnish, leaving a 1 mm wide window before placing in demineralising solution for 96hr to produce artificial carious lesions 150-200 microm deep. Teeth were longitudinally cut into approximately 100-150 microm thick sections and assigned to three groups (n = 7). Sections in Group A were exposed to Perioe Children's Toothpaste (LG, Korea), Group B to Colgate Pokemon (Colgate-Palmolive, Thailand) and Group C to Vicco (Vicco Laboratories, India). Polarised light microscopy and microradiography was used to evaluate lesion depth, before and after 7 days pH cycle. RESULTS: Mean lesion depths in Groups A and C increased by 11% and 14% respectively, while Group B demonstrated a lesion reduction of 3%. Comparisons using ANOVA and Student-Newman-Keuls tests showed that Groups A and C were significantly different from Group B (p < 0.05), but there was no significant difference between Groups A and C. CONCLUSIONS: Based on the data obtained, Colgate Pokemon remineralised initial carious lesions. In addition, when compared to Colgate Pokemon, Perioe Children's Toothpaste failed to show 'healing' efficacy even though it is claimed to contain fluoride.

Effects of dentifrices on artificial caries like lesions: an in vitro pH cycling study.

AIM: To evaluate remineralising effects of three dentifrices, Vicco by Vicco Labs, India, Perioe Cavity Care by LG Care, Korea and Colgate Total by Colgate-Palmolive, Thailand on artificial caries like lesions. DESIGN: In vitro single-section and pH cycling model. METHODS: Extracted third molars were painted with nail varnish, leaving 1 mm wide windows before placing demineralising solution for 96h to produce artificial carious lesions 150-200 miocrom deep. Teeth were then cut longitudinally into 100-150 microm thick sections and randomly assigned to three groups. Polarised light microscopy and microradiography were used to evaluate lesion depth, before and after the 10 day pH cycle. Sections in Group A were treated with Vicco by Vicco Labs, India (-ve control), Group B were treated with Perioe Cavity Care by LG Care, Korea and Group C were treated with Colgate Total by Colgate-Palmolive, Thailand. RESULTS: Mean lesion depths in Groups B and C reduced by 7% and 12% respectively, whereas lesion depth increased by 13% in Group A. Comparisons made among groups using ANOVA and Student-Newman-Keuls tests showed that three groups were significantly different from each other (p < 0.05). CONCLUSIONS: Perioe Cavity Care and Colgate Total remineralised initial carious lesions. However, the remineralising potential of Colgate Total was higher than that of Perioe Cavity Care.

Tooth mineral density of different types of hypomineralised molars: a micro-CT analysis.

AIM: This study sought to evaluate the tooth mineral density (TMD) for the different lesion types in hypomineralised first permanent molars (FPMs) and compare them to unaffected enamel in clinically sound FPMs. DESIGN: Eighteen FPMs with varying degrees of hypomineralised enamel were grouped into brown, yellow/creamy and white lesion types. Micro-CT was used to determine the TMD for each lesion type, and for unaffected enamel at different locations in the outer, middle, and inner-third of the enamel. RESULTS: The average TMD for brown, yellow/creamy, white and unaffected enamel was 1.79, 2.21, 2.43 and 2.46 g/cm3, respectively. Brown and yellow/creamy lesions exhibited a statistically significant difference when compared to white lesions and unaffected enamel. However, no statistical difference was evident in TMD between white lesions and unaffected enamel. The TMD increased from the outer-third to inner-third for brown and yellow/creamy lesions (p < 0.05), while in white lesions and unaffected enamel, the TMD decreased from the outer-third to inner-third (p < 0.05). CONCLUSION: TMD was lowest for brown lesions followed by yellow/creamy lesions while the TMD for white lesions was similar to unaffected enamel.