Hypodontia and retention of third molars in Norwegian medieval skeletons: dental radiography in osteoarchaeology.

OBJECTIVES: The objective of the present study is to compare the prevalence of third molar hypodontia in matched medieval and modern Norwegian sample with the aim to examine whether there are secular changes in dental anomalies. A second objective is to determine the level of primary retention of third molar in the medieval sample. MATERIAL AND METHODS: The medieval material consisted of 130 adult skulls, hypodontia of third molars was determined using radiography and compared to findings with panoramic film images of 400 15-year-old individuals from a contemporary Norwegian epidemiological study. RESULTS: Among 130 medieval skulls, hypodontia of third molar was found in 36 skulls (27.7%), and in the contemporary sample, hypodontia of third molar was found in 69 individuals (17.2%). Female predominance, although not statistically significant, was observed both in the medieval and in the contemporary group. The third molars showed absence in the mandible (21.5%) more often than the maxilla in the medieval sample, and in both jaws (11.2%) in the contemporary material. In the medieval sample, only 7.7% of the individuals had at least one retained third molar. CONCLUSION: No increase in the frequency of third molar hypodontia was found from the medieval period until today. The frequency of retained third molars seems to have increased from the medieval period to modern times. The use of radiographic examination in addition to macroscopic inspection can give us a better understanding of the aetiology on a number of conditions in human skeletal remains.

Eighteen-Year Follow-Up of 160 Consecutive Individuals Born With Unilateral Cleft Lip or Cleft Lip and Alveolus Treated by the Oslo Cleft Lip and Palate Team.

OBJECTIVE: Describe patients born with unilateral cleft lip with or without cleft alveolus (CL±A) in relation to cleft severity and laterality, gender, associated anomalies and syndromes, number and type of lip- and nose operations, and time of alveolar bone graft (ABG) treatment in relation to dental status in cleft area. MATERIALS AND METHODS: Patients included 220 children born with unilateral CL±A, born between 1988 and 1997 referred to the Oslo Cleft Lip and Palate Team. The data were collected retrospectively. All patients were followed up until 18 years of age. RESULTS: Among all CL±A, 3.6% had recognized syndromes, 6.8% had associated anomalies, and in 89.6% CL±A was the only malformation. CL±A was more common, but not more severe, on the left side. Among the 160 individuals with CL±A without syndromes and associated anomalies, 66.9% had an isolated soft tissue CL, and 33.1% were diagnosed with a CL alveolus (CL+A). Male predominance was observed. Children with CL+A had more severe soft tissue clefts of the lip and underwent more lip and nose surgeries than children born with CL. The time of ABG was found to be at a younger age when the patient had a lateral incisor in the cleft area than when this tooth was missing. CONCLUSION: Findings provide a reference for morphologic variations in CL±A, and insight into the surgical burden of care until the age of 18 years.

Best Practices for the Diagnosis and Evaluation of Infants With Robin Sequence: A Clinical Consensus Report.

IMPORTANCE: Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and upper airway obstruction. Currently, no consensus exists regarding the diagnosis and evaluation of children with RS. An international, multidisciplinary consensus group was formed to begin to overcome this limitation. OBJECTIVE: To report a consensus-derived set of best practices for the diagnosis and evaluation of infants with RS as a starting point for defining standards and management. EVIDENCE REVIEW: Based on a literature review and expert opinion, a clinical consensus report was generated. FINDINGS: Because RS can occur as an isolated condition or as part of a syndrome or multiple-anomaly disorder, the diagnostic process for each newborn may differ. Micrognathia is hypothesized as the initiating event, but the diagnosis of micrognathia is subjective. Glossoptosis and upper airway compromise complete the primary characteristics of RS. It can be difficult to judge the severity of tongue base airway obstruction, and the possibility of multilevel obstruction exists. The initial assessment of the clinical features and severity of respiratory distress is important and has practical implications. Signs of upper airway obstruction can be intermittent and are more likely to be present when the infant is asleep. Therefore, sleep studies are recommended. Feeding problems are common and may be exacerbated by the presence of a cleft palate. The clinical features and their severity can vary widely and ultimately dictate the required investigations and treatments. CONCLUSIONS AND RELEVANCE: Agreed-on recommendations for the initial evaluation of RS and clinical descriptors are provided in this consensus report. Researchers and clinicians will ideally use uniform definitions and comparable assessments. Prospective studies and the standard application of validated assessments are needed to build an evidence base guiding standards of care for infants and children with RS.