How to predict the timing of eruption of mandibular second premolars

Objective:To evaluate the relationship between the stages of dental formation and the timing of eruption of mandibular second premolars.Materials and Methods:The sample comprised panoramic radiographs of 25 children, 7 to 12 years old, observed by space supervision during development of dentition. The initial radiograph (T1) was taken in the mixed dentition period and the progress radiograph (T2) close to the eruption of mandibular second premolars. The stages of dental formation were determined by the proportion between crown length and total length (CL/TL) as well by the Simpson and Kunos index. Average values between right and left sides (35, 45) were correlated to the time elapsed until dental eruption (T2-T1). Statistical analysis was performed by Pearson correlation analysis.Results:The proportion CL/TL presented higher correlation index with time to eruption than the Simpson and Kunos index. The linear regression equation for prediction of timing of eruption showed high coefficient of determination, low deviation, and good accuracy. According to survival analysis, mean deviation at 95% confidence level was between 3.6 and 6.4 months. There was no difference in contralateral measurements, with high intraclass correlation coefficient for both CL/TL proportion and Simpson and Kunos index.Conclusions:More advanced stages of dental formation indicate less time until dental eruption. The strong correlation with crown length/total length proportion (CL/TL) provides a linear regression equation for prediction of the timing of eruption of mandibular second premolars.     

Survey of dental treatments for pediatric patients referred to the pediatric dental clinic of a dental school hospital

This survey was conducted to clarify which dental treatments in children are regarded as difficult by general dentistry practitioners. The subjects were 615 children who first visited Tokyo Dental College Chiba Hospital from January 1995 to August 1999 with reference letters. There were 615 children in the study; 571 (92.8%) came from Chiba City where our hospital is located and the 11 regions surrounding Chiba City. The prime reasons for referral in the order of frequency were treatments of dental caries, malalignment/malocclusion, traumatized teeth, supernumerary teeth, retarded eruption/impacted teeth, abnormal direction of erupted teeth, congenitally missing teeth, prolonged retention of deciduous teeth, and abnormal frenulum. Patients with dental caries or traumatized teeth in the deciduous dentition period and those with malalignment/malocclusion, supernumerary teeth, or retarded eruption/impacted teeth in the mixed dentition period were often referred to medical organizations specializing in pediatric dentistry because of the difficulties in controlling the patients' behavior and in providing adequate treatment. The information about pediatric dental treatments considered difficult by general dentists revealed by this survey appears to be useful and needs to be incorporated in the programs for clinical training of undergraduate students and education of postgraduate students.     

乳牙深龋的间接牙髓治疗

乳牙是人类的第一副牙齿,其正常萌出建并行使生理功能对儿童的身心发育具有重要意义。乳牙龋病是儿童慢性疾病之首,是儿童口腔医学临床最常见的疾病之一。根据世界卫生组织调查数据显示,世界范围内60%~90%的学龄儿童患有龋病。乳牙龋病在我国具有患龋率高,就诊率低下的特点,如不及时治疗,可导致牙体组织缺损、生理间隙丢失、牙髓和根尖周病变及颌面间隙感染,严重者可致乳牙早失并伴发牙列畸形及后续恒牙萌出障碍等不良结果,影响儿童口腔健康及身心发育。因此,对深龋乳牙采取积极有效的治疗措施对保存必要乳牙及其牙髓活力,恢复正常生理功能,维持牙列完整性,诱导后续恒牙正常萌出建具有重要意义。本文从目前深龋乳牙间接牙髓治疗的研究认识现状出发,通过文献资料收集整理,对间接牙髓治疗、间接盖髓术、暂时性保髓充填、部分去龋法、分步去龋法和非创伤性修复治疗等相关概念进行了对比分析,阐明了乳牙间接牙髓治疗的技术内涵和治疗意义,对乳牙深龋的临床治疗路径完善提供了理论依据。     

Primary dentition unilateral crossbite in relation to functional lateralities

PURPOSE: The aim of this study was to explore primary dentition unilateral crossbite malocclusion prevalences in functionally true right-sided and nonright-sided children, with the latter having 1 or more left-sided or indeterminate functions (eye, hand, foot). METHODS: The transversal relationship of the primary teeth was determined from dental casts of 1,835 young African American (60%) and Caucasian (40%) children in a cross-sectional sample at a mean age of 8.5 years. Hand, foot, and eye preferences (right, left, or indeterminate) were recorded at the age of 4 years during the same collaborative perinatal study. The prevalences of left and right crossbites were compared between true right-sided and mixed or completely nonright-sided children using chi-square analysis. RESULTS: Unilateral crossbite occurred in 140 cases with a complete set of laterality tests: 65 were right-sided and 75 left-sided. True right-sided children had more bilaterally symmetric occlusions and less crossbite on the right side than those having nonright-sidedness in their functions, with the differences being statistically significant (P<.01). CONCLUSIONS: These results point to anatomical relationships between the structures supporting the occlusion, the asymmetric neurocranium, and the cranial base. This suggests variable unilateral compensatory growth after unbalanced fetal asymmetry, modified by sidedness and the growth-stimulating effects of early lateralized functions and oral habits.     

Common dental conditions associated with dental erosion in schoolchildren in Australia

PURPOSE: The purpose of the investigation was to determine factors associated with dental erosion in a group of schoolchildren in Queensland, Australia. METHODS: Dental examinations were carried out on 714 children aged 5.5 to 14.6 years from 8 randomly selected Australian schools. A total of 3,165 primary and 2,976 permanent teeth were scored for dental erosion using a modified erosion index. Dental caries experience was determined from clinical examination and bitewing radiographs. Enamel defects were recorded using the developmental defects of enamel index. RESULTS: There were 225 children (32%) who exhibited no erosion and 489 (68%) who had erosion of at least one tooth. Erosion was found in 78% of subjects with primary teeth and 25% of subjects with permanent teeth (P<.001). Children with erosion in the primary and permanent dentition were more likely to have: (1) a lower socioeconomic status (primary dentition, P<.001 and permanent dentition (P<.001); (2) enamel hypoplasia in permanent dentition (P=.001); (3) dental caries in the primary dentition (P=.001); and (4) permanent dentition (P=.002). CONCLUSIONS: In Australian schoolchildren, the prevalence of dental erosion in the primary dentition is approximately 3 times greater than in the permanent dentition. Dental erosion is strongly associated with caries experience and enamel hypoplasia.     

Management of children with autism spectrum disorder in the dental setting: Concerns,behavioural approaches and recommendations

Objectives: This article reviews the present literature on the issues encountered while coping with children with autistic spectrum disorder from the dental perspective. The autistic patient profile and external factors affecting the oral health status of this patient population are discussed upon the existing body of evidence. Material and Methods: The MEDLINE database was searched using the terms ‘Autistic Disorder’, ‘Behaviour Control/methods’, ‘Child’, ‘Dental care for disabled’, ‘Education’, ‘Oral Health’, and ‘Pediatric Dentistry’ to locate related articles published up to January 2013. Results: Most of the relevant studies indicate poor oral hygiene whereas they are inconclusive regarding the caries incidence in autistic individuals. Undergraduate dental education appears to determine the competence of dental professionals to treat developmentally disabled children and account partly for compromised access to dental care. Dental management of an autistic child requires in-depth understanding of the background of the autism and available behavioural guidance theories. The dental professional should be flexible to modify the treatment approach according to the individual patient needs. Key words:Autism spectrum disorder, dental management, children.     

Radiographic assessment of dental anomalies in patients with ectopic maxillary canines

Background.  The aetiology of palatally and labially located ectopic maxillary canines is multifactorial. Accordingly, early prediction of this eruptional disturbance is in most cases not possible.
Aim.  The purpose of this study was to analyse dental deviations in cases with either palatal or labial ectopic canines.
Design.  Panoramic and intra-oral radiographs from 50 patients with palatally located (38 females and 12 males) and 19 patients with labially located ectopic canines (11 females and 8 males), aged 10 years, 2 months–18 years, 1 month, were analysed. Dental deviations registered were crown and root malformations, agenesis, and eruption deviations. Registrations were performed in the maxillary incisor field and in the dentition in general.
Results.  The study documented that palatally as well as labially located ectopic canines can occur in dentitions without other dental deviations. Dental deviations occurred in approximately two-thirds of all cases, more often in females and in cases with palatally located canines. More than half of the females with palatally located canines had deviations in the maxillary incisors and in the dentition in general.
Conclusion.  Dental deviations may be considered a risk factor for maxillary canine ectopia. Early identification of patients at risk and appropriate interceptive treatment may reduce ectopic eruption of maxillary canines.     

Infraposition or infraocclusion– Is it time to rename?

Dental infraposition and dental infraocclusion, hereinafter referred to as infraposition and infraocclusion respectively, are terms that are often used interchangeably. This can be noted in the International Association of Dental Traumatology guidelines for the management of traumatic dental injuries, where infraocclusion is listed as an injury-specific outcome following avulsion of permanent teeth. Infraposition and infraocclusion are terms that have been used in the dental literature to describe teeth that interfere with the normal eruption and development of the permanent dentition. While teeth described in this manner share certain clinical characteristics that give rise to these terms being used interchangeably within the dental traumatology field, this may not necessarily be correct and may be confusing. The aim of this short communication is to start a discussion in the dental trauma community regarding the need for a more adequate term, particularly in relation to replanted teeth.     

Delayed eruption of permanent teeth in hyperimmunoglobulinemia E recurrent infection syndrome

OBJECTIVE: To determine the incidence of abnormal tooth eruption in patients with hyperimmunoglobulinemia E (hyper-IgE) syndrome. STUDY DESIGN: This study evaluated 34 individuals with hyper-IgE syndrome (age range, 2-40 years). A comprehensive dental history and a head and neck evaluation were performed on all patients. Dental age was assessed in patients younger than 17 years by 2 methods: (1) clinical assessment of tooth eruption and (2) a radiographic method. Relationships between the chronologic age, dental developmental age, and age at tooth eruption were determined. Other oral or dental anomalies were recorded. RESULTS: Of patients older than 7 years, 75% reported problems with permanent tooth eruption, as evidenced by retained primary teeth or the need for elective extractions of primary teeth to allow eruption of permanent teeth. None of the patients experienced problems with eruption of primary teeth. Eruption of the first and second permanent molars also occurred on time. Dental maturity scores were established for 14 patients 17 years of age or younger. In each case, the difference between chronologic age and the estimated dental developmental age was less than 12 months; however, we found a significant discrepancy between the chronologic age and the mean age of tooth eruption in 80% of these patients when using a particular set of standardized values. Persistence of Hertwig's epithelial root sheath was observed on histologic examination. Chronic multifocal oral candidiasis was a consistent feature in patients with hyper-IgE recurrent infection syndrome. Other oral anomalies were also noted. CONCLUSION: We confirmed that a disorder of tooth eruption is part of the hyper-IgE syndrome. This problem occurs because of delayed primary tooth exfoliation rather than a developmental delay in the formation of the permanent dentition. The persistence of Hertwig's epithelial root sheath is unusual and may be associated with the lack of resorption of the primary teeth. Dentists should be aware of this feature of hyper-IgE syndrome because timely intervention will allow normal eruption to occur.     

Prevalence of dental abscess in a population of children with vitamin D-resistant rickets.

A population of patients with vitamin D-resistant rickets whose present ages range from 4 to 22 years was examined to determine the prevalence of dental abscess associated with that condition. For those patients affected with abscesses in the primary dentition, four associated factors were examined: 1) the age at onset of the first abscess; 2) the tooth/teeth most commonly involved; 3) whether or not other teeth were involved over time; and 4) the order of occurrence of multiple abscesses. Six of 24 patients (25%) were affected with abscesses of the primary dentition; all had multiple abscesses. Males were more commonly involved than females. The sequence of involvement generally followed the pattern of tooth eruption; however, dental treatment in susceptible individuals shortened the time between eruption and abscess. Medication dose and measurement of radiographs were not reliable predictors of the occurrence of abscesses in this population; however, the results indicate that one abscess is a predictor of future abscesses for that patient.     

Oral features and dental health in Hurler Syndrome following hematopoietic stem cell transplantation

International Journal of Paediatric Dentistry 2010; 20: 322–329 Background. Hurler Syndrome is associated with a deficiency of a specific lysosomal enzyme involved in the degradation of glycosaminoglycans. Hematopoietic stem cell transplantation (HSCT) in early infancy is undertaken to help prevent the accumulation of glycosaminoglycans and improve organ function. Aim. To investigate the oral features and dental health of patients with Hurler Syndrome who have undergone successful HSCT. Materials and methods. Twenty‐five patients (median age 8.6 years) post‐HSCT (mean age 9.4 months) underwent oral assessment (mean of 7.5 years post‐HSCT). Results. Dental development was delayed. Numerous occlusal anomalies were noted including: open‐bite, class III skeletal base, dental spacing, primary molar infra‐occlusion and ectopic tooth eruption. Dental anomalies included hypodontia, microdontia, enamel defects, thin tapering canine crowns, pointed molar cusps, bulbous molar crowns and molar taurodontism. Tooth roots were usually short/blunted/spindle‐like in permanent molars. The prevalence of dental caries was low in the permanent dentition (mean DMFT 0.7) but high in the primary dentition (mean dmft 2.4). Oral hygiene instruction with plaque and or calculus removal was indicated in 71% of those that were dentate. Conclusion. Patients with Hurler Syndrome post‐HSCT are likely to have delayed dental development, a malocclusion, and dental anomalies, particularly hypodontia and microdontia.     

The effectiveness of routine dental checks: a systematic review of the evidence base

AIMS: To systematically review the effectiveness of routine dental checks of different recall frequencies in adults and children. METHODS: Search methods included electronic bibliographic databases up to March 2001, relevant internet sites, citation checking and contact with experts and professional dental bodies. Inclusion criteria: (1) Study design: any; (2) Population: deciduous, mixed and permanent dentition; (3) Intervention: 'Routine dental check': 'clinical examination, advice, charting (including monitoring of periodontal status) and report' as defined in the NHS Executive General Dental Service Statement of Dental Remuneration; (4) Comparator: no routine dental check or routine dental check(s) of different recall frequency; (5) Primary outcomes: caries, periodontal disease, quality of life, oral cancer. RESULTS: Twenty eight studies were identified for the review. Studies were poorly reported and clinically heterogenous which restricted comparison between studies and limited generalisability to the UK situation. There was no consistency across multiple studies in the direction of effect of different dental check frequencies on measures of caries in deciduous mixed or permanent dentition, periodontal disease or oral cancer in permanent dentition. No studies were identified linking empirical measures of quality of life associated with oral health and dental check frequency. CONCLUSIONS: There is no existing high quality evidence to support or refute the practice of encouraging six-monthly dental checks in adults and children.     

Association Between Socioeconomic Factors and Dental Erosion in Brazilian Schoolchildren

Objective: The aim of this study was to evaluate if a higher socioeconomic status is a potential risk factor for dental erosion in 6‐ to 12‐year‐old Brazilian schoolchildren. Methods: A sample of 983 children was drawn from 36 schools. A questionnaire was applied to determine socioeconomic background. Clinical exams for dental erosion were carried out by one trained and calibrated examiner considering location, severity, and surface area affected. Chi‐square tests and multivariate analysis were carried out. Results: Dental erosion was detected in 196 children (19.9 percent). From this total, 61.8 percent of the lesions were found in the primary dentition and 38.2 percent in the permanent dentition. The palatal surface was the most affected. Higher prevalence was observed in males (P = 0.005). Dental erosion was more prevalent in private school children than in public school children (P = 0.029). Also, dental erosion was prevalent in children from families with higher income (21.3 percent) than in children from low‐income families (13.5 percent) without significant difference (P > 0.05). A higher prevalence of erosion was observed in those children whose parents had a high education level (22.7 percent, P = 0.05). Conclusions: The data suggest a high prevalence of dental erosion across this age span. Dental erosion seems to occur most often in primary dentition of boys who attended private schools and whose mothers have a high educational status.     

How much reduction of the dental arch is functionally acceptable for the ageing patient?

Dental care should be aimed at the preservation of a natural functioning dentition for life, within the available resources. In general, preference should be given to dentitions comprising complete dental arches or 14 occluding pairs of teeth. However, in many subjects--such as the elderly--this goal might be neither attainable nor necessary. In these cases, dental care should be aimed at preserving the strategic parts of the dental arch, which are the front and premolar regions (the so-called ultimate occlusal preservation target). Clinical observation as well as research findings indicate that elderly people can function at an acceptable level with a reduced dentition consisting of 10 or even fewer occluding pairs. The minimum size of a functional dental arch differs between individuals and depends on local and systemic factors. Important indicators are the age, the (periodontal) quality of the remaining dentition, the spatial relationship between the lower and upper teeth, the occlusal activity and the adaptive capacity. Dental health care systems should implement guidelines to concentrate the available resources primarily on the strategic regions of the dental arch, especially in high-risk groups. These guidelines should be based on research results. The main objective of this paper is to contribute to defining an acceptable oral status for elderly subjects.     

Total antioxidant capacity of saliva and dental caries

Objective: Dental caries is one of the most common infectious diseases worldwide. Saliva has many functions in the oral cavity and is the first line defense against dental caries. Oxidative stress can affect initiation and progression of many inflammatory and infectious diseases such as dental caries. Thus the aim of this study was to evaluate the relationship between total antioxidant capacity (TAC) of saliva and dental caries. Study Design: 100 healthy high school students (50 female and 50 male) with age range of 15 -17 years were randomly selected, divided to four groups. Unstimulated whole saliva specimens were collected at the morning. TAC of saliva was evaluated by spectrophotometric assay. Statistical comparisons were performed using Student’s t-test, by SPSS 13. Results: The level of TAC was significantly higher in the saliva of caries active group relative to the caries free subjects. Statistical analysis for male and female groups showed a statistically significant reduction of TAC level in female group. Conclusion: TAC was higher in caries active group. Thus this result showed that total antioxidant capacity may influence in dental caries and activity can be measured by salivary factors and this may be helpful in preventive dentistry. Key words:Dental caries, saliva, total antioxidant capacity.     

Investigation of the prevalence of impacted third molars and the effects of eruption level and angulation on caries development by panoramic radiographs

Background This study is aimed to determine the prevalence of impacted third molars and to investigate the effects of their eruption level and angulation on caries formation in the distal of the adjacent tooth.Material and Methods This cross-sectional study was conducted on panoramic radiographs of 38481 patients who were admitted to the Trakya University, Faculty of Dentistry. The panoramic radiographs of 7998 patients with at least one impacted third molar were included. Third molars were classified according to Winter’s classification and Pell and Gregory’s classification. The frequency of caries in partially impacted third molars and adjacent second molars was determined. The chi-square tests were used to determine potential associations between the third molars'' level of eruption, angulation, and caries development.Results The study group consisted of 4423 females (55.3%) and 3575 males (44.7%) with a mean age of 36.3±13.4 years. The prevalence of the third molar impaction rate was 23%. The impaction pattern of partially erupted third molars was characterized by an eruption level of A with the vertical position in both jaws. Partially erupted and vertically placed maxillary third molars in the level of position A caused more caries in the adjacent tooth and mesioangularly located partially erupted mandibular third molars were associated with more caries in the adjacent tooth.Conclusions The angulation and eruption level of partially erupted third molars should be carefully examined. The prophylactic extraction of vertically and mesioangularly located third molars, especially with an eruption level of position A can be suggested to eliminate the related complications and risk of caries. Key words:Dental caries, digital radiography, impacted tooth, panoramic radiography, third molar.     

Longitudinal evaluation of caries patterns form the primary to the mixed dentition

The purpose of this study was to develop a model describing the sites and patterns of dental caries in the mixed dentition for children with one of five caries experiences in the primary dentition. Dental records were used from 317 children followed an average of 7.8 years in private pediatric dental offices to assess specific caries experiences in children from early primary dentition to middle or late mixed dentition. Eighty-four per cent of the children who were caries-free in the primary dentition remained so in the mixed dentition. Children with the pit and fissure caries pattern in the primary dentition were more likely to develop smooth surface caries of primary teeth in the mixed dentition (32%) than caries-free children (14%, X2 = 5.6;P less than 0.05). For children with molar-approximal lesions in the primary dentition, 57% developed lesions on additional molar-approximal surfaces in the primary teeth in the mixed dentition. Children with the faciolingual pattern (baby bottle tooth decay) were at the highest risk of any group for developing additional carious lesions. The model could serve as a basis for a prospective study.     

Quality of data gathered with International Caries Detection and Assessment System (ICDAS) assessment and dentists’ perceptions of completion of dental records

Background: The FDI World Dental Federation is engaged in a global consultation process to assess the potential challenges and impacts of the introduction of a preventive model to existing systems for caries management. Objectives: The aims of this study were to evaluate the quality of dental disease data collected with the International Caries Detection and Assessment System (ICDAS) index and dentists’ perceptions with regard to the collection of data using the ‘European Global Oral Health Indicators Development’ (EGOHID) survey methods, and to estimate the mean time required for completion of the dental records according to the practitioners’ perceptions. Materials and method: The data – 2877 clinical examinations and 2877 individual assessments – were collected in 2008 using a network of 146 sentinel dentists in eight European countries. A clinical survey was completed for each participant and the dentist gave a detailed assessment of each patient investigated. Results: This study shows that practitioners’ perceptions have an impact on the mean time required to complete the dental record. Mistakes originate from dentists’ attempts to simplify the completion of many boxes. This results in a larger number of missing data than of error codes. These missing data have an effect on the time required for information collection. Conclusion: The quality of the data collected will allow the establishment of recommendations based on this method.Key words: Dental caries management, dentists’ perception, European Global Oral Health Indicators Development, information collection, International Caries Detection and Assessment System, oral health surveillance, quality of data, sentinel dentists     

Assessment of Skeletal and Dental Maturity Levels for a given Chronological Age among Indian Children

Aim: The aim of this study was to evaluate the maturity levels of the individual by comparing the correlation between dental, skeletal and the chronological ages. Materials and methods: Intraoral periapical radiographs of the complete right side of the dentition and posteroanterior radiographs of the hand and wrist were obtained from 260 subjects, ranged from 3 to 15 years of age. Evaluation of handwrist roentgenograms for skeletal age and intraoral roentgenograms for dental age was done. Results: The findings of present study indicated that participated children were skeletally and dentally, retarded in maturation as compared with the standards except at 3 and 6 years of age. The girls were found to be skeletally more advanced than boys at all ages except 7 and 10 years of age. The dental maturity is more for girls than that of boys. Conclusion: No significant correlation was found among skeletal age, dental age and chronological age. Dental age and skeletal age was found to be correlated at 6, 10 and 11 years in boys and 6 and 9 years of age in girls. Clinical significance: The results of this study could enhance the diagnosis and treatment planning in orthodontics and other dental disciplines. Keywords: Dental age, Skeletal age, Growth. How to cite this article: Murthy KK, Srinivas CN, Varalakshmi, Kumar CV, Krishnaveni M. Assessment of Skeletal and Dental Maturity Levels for a given Chronological Age among Indian Children. J Contemp Dent Pract 2012;13(3):310-315. Source of support: Nil Conflict of interest: None declared.     

Oral conditions in renal disorders and treatment considerations – A review for pediatric dentist

This article reviews the current understanding of the oral and dental aspects of chronic renal disease (CRD). A PubMed literature search was performed and all relevant studies were assessed. As the number of people suffering from CRD increases worldwide, dentists are expected to encounter more patients with CRD who need oral care. In children, CRD can elicit a wide spectrum of oral manifestations in the hard and soft tissues. Bleeding, altered drug metabolism, impaired immune function, and an increased risk of dentally induced bacterial endocarditis are some important features that require attention. Dental management of patients with CRD requires that clinicians appreciate that multiple systems can be affected by the disease. Dentists should consult with nephrologists regarding the specific precautions required for each patient. Medical treatments in these patients may need to be postponed due to an unfavorable oral health status or potential risk of life-threatening infection after surgery. Improving oral hygiene and performing necessary dental and oral treatment before hemodialysis or transplantation may prevent endocarditis and septicemia in these patients. Hence, treatment plans should be formulated to restore the patient’s dentition and protect them from potentially severe infections of dental origin.