Symptom-orientated oral hygiene for children after heart transplantation: Effectiveness of a standardized prophylactic program.

Children with CHD, especially heart-transplanted patients, are predisposed to have caries lesions, gingivitis and other oral findings like gingival hyperplasia. The aim of the study was the implementation of a specific oral hygiene program in these patients and its effect on the improvement of oral health, especially gingival overgrowth. For this, we used a newly developed systematic GHI to evaluate and describe this gingival alteration. Thirty-three children, aged 6 to 15 years with cardiac transplants (9 girls, 24 boys), were examined and introduced into a specific oral hygiene program. Each child showed evidence of gingival hyperplasia. They were randomly divided into three groups with the following oral care measurements: Group ZZ tooth brushing, Group ZZS tooth brushing and mouth rinsing, Group ZZSS tooth brushing, mouth rinsing and the use of an additional single and sulcus toothbrush. A significant decline of all oral health parameters could be proven in all groups. Gingival hyperplasia (GHI) improved as well as plaque accumulation (QHI). The children who used in addition to toothbrushing rinsing solutions and/or additional miniature toothbrushes showed better parameters of the gingival hygiene indexes from the baseline examination until the end of the study. The results show that any infant with cardiac transplant has to be introduced into an individualized oral hygiene program underlining the need of comprehensive dental care in cooperation with pediatric cardiology.

Caries-, Candida- and Candida antigen/antibody frequency in children after heart transplantation and children with congenital heart disease.

The aim of this study was to determine the incidence of oral/intestinal Candida colonization and Candida-antigen/antibody in immunosuppressed children after HTx (group III, n = 31), in children with CHD (group II, n = 24) and in children with healthy hearts (comparison group, group I, n = 23) aged 2-16 yr according to their dental status between 2004 and 2007. Candida species in saliva, dental plaque, carious lesions and stool were detected with Sabouraud-/CHROMagar and Auxacolor system. Candida-specific-antigen/antibody assays were used for serological diagnosis. Dental status was determined on the basis of the DMF/dmf(T/t)-index. We found significant group differences in fecal Candida colonization (p = 0.027). In relation to dental status, oral Candida colonization increased within group III from 28.5% [DMF/dmf(T/t) = 0] to 66.7% [DMF/dmf(T/t) > or = 1] up to 100.0% [D/d(T/t) > or = 1], similar in groups I and II. Candida-mannan-antigen was determined to be positive in 16.1% (HTx), 5.5% (CHD) and 13.0% (comparison group). We show correlation between oral Candida colonization and (carious) dental status. We assume that high oral Candida and their descending/resorption through the gastrointestinal tract may lead to serologic Candida accumulation or rather candidiasis. Therefore, healthy oral cavity (especially before/after HTx) is an important precondition to prevent Candida infections.

Prevalence and severity of molar incisor hypomineralization in a region of Germany -- a brief communication.

OBJECTIVES: Molar incisor hypomineralization (MIH) is a developmental disturbance concerning permanent incisors and first permanent molars. The aim of this study was to ascertain the frequency of MIH in the region of central Hesse, Germany. METHODS: 1,022 children aged 6 to 12 years were surveyed during routine school-based dental examinations, which were conducted by the regional public health department. Symptoms of MIH were recorded and a DMF-T evaluation was carried out. RESULTS: Approximately 6 percent (5.9 percent) of all examined children showed at least one ill-structured first permanent molar in terms of MIH. Furthermore, 57.9 percent of these children with hypomineralized first molars also showed changes in the enamel structure of the permanent incisors. Altogether, children with MIH showed a significantly higher DMF-T value for permanent teeth than children without MIH. CONCLUSIONS: A carefully managed recall program for children affected by MIH is essential with regard to the increasing importance of preventive and restorative measures.

Microbial contamination of toothbrushes with different principles of filament anchoring.

BACKGROUND: The retention and growth of cariogenic microorganisms on toothbrushes pose a threat of recontamination. The authors to studied three species of oral microorganisms found at different places on toothbrush filaments. METHODS: The authors tested on patients 30 toothbrushes each of three different toothbrush types made by a single manufacturer. The toothbrushes were divided into three groups by type of construction: staple-set tufting (toothbrush A); in-mold tufting (toothbrush B); individual in-mold placement of filaments (toothbrush C). Subjects used the toothbrushes once under standardized conditions; the authors subsequently examined the brushes for the presence of Streptococcus mutans, lactobacilli and Candida species. The inspection was carried out at three time intervals after use. RESULTS: S. mutans was retained to the highest degree, followed by lactobacilli and finally by C. albicans. The authors found that the number of microorganisms on toothbrush types A and B did not reveal a significant difference either on examination immediately after use or after the toothbrushes had been dried for two hours or eight hours. The technique of individual in-mold placement of filaments made retention of microorganisms more difficult. The difference between the number of germs retained on toothbrush types A and C, as well as that between the number of germs retained on types B and C, was significant or even highly significant. CONCLUSIONS: The results show that toothbrushes made with the technique of individual in-mold placement of filaments appear to retain the least amount of microbial material. CLINICAL IMPLICATIONS: Owing to the fact that toothbrushes always are a possible source of microbial reinfection, the arrangement of the filaments within the head of the toothbrush is of great importance with regard to hygiene.

Bilateral triplicated primary central incisors: clinical course and therapy.

Uncommon developmental abnormalities such as fused or geminated teeth are of interest for the clinical problems associated with them. A rare case of fusion between maxillary primary central and lateral incisors and a supplemental incisor occurring bilaterally is presented. The patient was a 4-year-old Thai boy. Intraoral examination revealed an abscess and fistula in the region of the fused teeth as a result of periapical osteolysis. Access cavities were prepared as acute procedures. Because of the unpromising prognosis, surgical removal of the teeth was inevitable. For functional, esthetic, and phonetic rehabilitation, an acrylic denture was incorporated.

Exposed human pulp caused by trauma and/or caries in primary dentition: a histological evaluation.

The aim of this study was to compare the pulpal reactions after exposure due to trauma and/or caries and to suggest the appropriate treatment options for the management of pulp, in the light of the histological findings in the primary teeth. Fifteen primary maxillary incisors with pulpal exposure were examined with light microscope in a blind study. After the histological evaluation, teeth were divided into three groups for the etiological factors due to the exposure according to the patient's files: trauma group, caries group and caries and trauma group. The inflammatory infiltration was diminished from the pulp chamber towards the apical third of the root canal in all of the examined teeth. Teeth in the trauma group presented fewer inflammatory cells in the root canal in comparison with other groups. It was concluded that the teeth with traumatic pulp exposure were considered as more likely to respond positively to pulpotomy technique. Pulpectomy or extraction seemed to be indicated for the decayed or decayed and traumatically injured teeth.

Concomitant oral findings in children after cardiac transplant.

Heart transplantations have been performed in the Centre for Paediatric Heart Surgery at the Justus Liebig University in Giessen (Germany) since 1988. For further consultation and therapy, some affected children subsequently present at the Polyclinic for Paediatric Dentistry. In all these cases problematic oral findings were diagnosed. It was the aim of this study to describe the different findings and to create a concept for avoiding them in the future. Altogether, 10 children with cardiac transplants (three girls, seven boys) were examined and, where necessary, treated. At the time they first presented, they were between 23 and 119 months old (average = 72.2) and had all been operated on (organ transplant) in the first 6 months of life. Each child showed evidence of gingival hyperplasia in the area of the front teeth, which was because of ongoing immunosuppression. In three patients, reactive mucosal caps avoided the age-related penetration of a permanent incisor in the upper jaw. In addition, the primary teeth of six children were affected by caries; in two of these cases, the damage was because of the nursing-bottle syndrome. The results show that any infant with cardiac transplant has to be subjected to careful dental examination and offered comprehensive medical care in cooperation with the competent centre for child cardiac surgery. Furthermore, the parents of such children should be informed prior to transplantation about the possibility of subsequent findings and how these findings can be either avoided or, if necessary, adequately treated.

Quality of bristle end-rounding on replaceable heads of powered toothbrushes.

OBJECTIVES: The aim of this study was to evaluate the geometry and the quality of bristle tip-rounding using 14 different heads from powered toothbrushes. MATERIAL AND METHODS: Six powered toothbrushes for children and eight for juveniles and adults were included. Five replaceable heads of each product were randomly selected. Of each sample, 35 bristles were used for examination. This resulted in 175 bristles from each product being evaluated. The quality of end-rounding was assessed by scanning electron microscopy at an original magnification x 80 in two categories of acceptable and five categories of unacceptable rounding according to Silverstone & Featherstone (1988). RESULTS: The portion of acceptable end-rounding varied strongly between the products (18.9-94.3%). There were significant differences regarding the products for children (p<0.001) and for adults (p<0.001) with respect to end-rounding quality. Only one product achieved more than 90% and eight products had between 68% and 86% acceptable end-rounding. Two products for children and one for adults had less than 25% acceptable end-rounding. CONCLUSION: A high standard of bristle tip-rounding is an important feature with respect to the safety of powered toothbrushes. Those products with a greater portion of unacceptably rounded bristles might cause more harm to oral soft tissues during use. The end-rounding quality of some of the products should be improved.

Fluoride concentration and pH of iced tea products.

The objective of this study was to determine the fluoride concentration and pH of 44 iced tea samples and hence to assess the possible role of these beverages as systemic fluoride source as well as their potential cariogenic and erosive character. Ten tea samples were available as a granular instant powder, and 34 as ready-to-drink liquid products. The iced teas contained different types of sugar alone or in combination with maltodextrin, glucose syrup and noncaloric sweeteners. In one product, only acesulfame and aspartame were established. All samples contained lemon juice or citric acid as an additive. The pH ranged from 4.04 to 2.63 and the titrated amount of base to pH 7.0 from 0.75 to 2.39 mmol NaOH/50 ml. The fluoride concentrations measured were <0.6 ppm in 14 products, 0.6-1.0 ppm in 10 products, 1.1-1.5 ppm in 16 products, 1.6-2.0 ppm in 2, and >2.0 ppm in another 2 products. In conclusion, most of the iced teas studied contained considerable fluoride concentrations. If infants ingest larger amounts of them because of their sweet taste, there is a risk of uncontrolled overdosing as a result of additional fluoride intake from other sources at the same time. Furthermore, the majority of the products revealed a highly cariogenic character and finally, all the iced teas appear to be acidic enough to cause dental erosion if these refreshments were excessively consumed from nursing bottles.