Dental disease indices and caries related oral microflora in children with phenylketonuria

The purpose of this study was to investigate the dental caries, plaque and gingivitis indices and caries related oral flora in children with classic phenylketonuria. Forty-one children at The Great Ormond Street Hospital for Children and controls were included in the study. The main findings were: No significant difference in the decayed, missing and filled surfaces of the primary and permanent teeth between the phenylketonuria children and the controls. A significantly greater mean plaque score for the control children compared with the phenylketonuria children (p < 0.01) for the permanent teeth only. A significantly greater number of white opacities in the permanent teeth of the phenylketonuria group compared with the control group (p < 0.02). No significant differences in the caries related microflora.     

The dental health and caries-related microflora in children with craniosynostosis.

OBJECTIVE: To compare levels of dental caries, bacterial dental plaque, gingivitis, enamel defects, and caries-related microflora in children with and without craniosynostosis. STUDY GROUP: Fifty-seven children with craniosynostosis and their matched controls. OUTCOME MEASURES: The decayed, missing, and filled teeth and surfaces in both the deciduous (dmfs and dmft) and the permanent dentition (DMFS and DMFT). The plaque and gingivitis scores and developmental enamel defects were also recorded. The caries-related microflora was sampled using an alginate swab and the prevalence of Streptococcus mutans and Lactobacillus and Candida species were recorded. RESULTS: The dmfs (p <.02) and dmft (p <.01) were significantly greater in the control children. The plaque score for the deciduous dentition only (p <.02) and also the gingivitis score for the permanent teeth only (p <.008) in the craniosynostosis group were significantly greater. The total aerobic bacterial count (p <.004), anaerobic count (p <.002), and Candida count (p <.05) were significantly greater in the control group. The proportion of S. mutans both as a percentage of the total anaerobic count (p <.04) and the total streptococcal count (p <.05) was significantly greater in the control group.     

Dental management of a patient with glycogen storage disease type I

Patients with glycogen storage disease type I (GSD I) have varied medical problems, including a bleeding diathesis characterized by a prolonged bleeding time. A case of a patient with GSD I having a history of medical problems, some of which were related to oral and dental bleeding, was presented. The patient was cariesfree and had generalized moderate to severe periodontal breakdown. A treatment regimen in a hospital setting, using cryoprecipitate and aminocaproic acid, permitted dental care and control of oral bleeding and associated complications.     

Dental findings in a child with glycogen storage disease type IA.

Glycogen storage disease type I, also known von Gierke's disease, is a rare, severe autosomal recessive disorder due to a defect in liver, kidney, and intestinal mucosa. The existence of delayed development of the dentition, increased incidence of dental caries, taurodontism, and prolonged bleeding following dental procedures should lead clinicians to consider type I glycogen storage disease. A 10-year-old boy with glycogen storage disease type I whose condition was first diagnosed when he was 4 years of age, was referred to the clinic for multiple caries and evaluation of delayed tooth eruption. On physical examination, the patient was cooperative, with short stature, protuberant abdomen, and growth retardation. Laboratory findings indicated that blood levels of pyruvate, triglycerate, uric acid, and cholesterol were elevated. Intraorally delayed mixed dentition was evident, and approximal caries were found in teeth 55, 54, 52, 51, 61, 62, 65, 74, 84, and 85. The most significant radiographic finding was consistent with taurodontism of the molar teeth. Lateral and posteroanterior cephalometric films showed that dimensions of the craniofacial complex were strongly reduced. Evaluation of the patient's dental age was approximately 6 years.     

Dental health indices and caries associated microflora in children with unilateral cleft lip and palate.

OBJECTIVE: To investigate the dental health and caries related microflora of children with unilateral cleft lip and palate. STUDY GROUP: Sixty children with unilateral cleft lip and palate and matched controls. OUTCOME MEASURES: The decayed, missing, and filled teeth and surfaces in both the deciduous and permanent dentitions. The presence of developmental defects and plaque and gingivitis scores were also recorded. Plaque was collected from 25 of the children and their matched controls from three different sites, which were (1) the first approximal site distal to the cleft, (2) a contralateral anterior site, and (3) a remote site. It was cultured for Streptococcus mutans and lactobacilli. Plaque was collected from two sites in the matched controls. RESULTS: There was no significant difference in the caries, plaque, and gingivitis scores between the children with cleft palate and the controls. A greater number of enamel opacities were recorded in the control group, and there was a higher prevalence of enamel discoloration in the children with cleft lip and palate. There was no significant difference in the proportion of S. mutans or lactobacilli at the cleft site, compared with the unaffected site in the study group, although there was an anterior-posterior gradient in the proportion of S. mutans. There was no significant association between the stagnation area at the cleft site and the bacteria associated with dental caries.     

Dental disease and caries related microflora in children with dystrophic epidermolysis bullosa.

PURPOSE: The purpose of this study was to investigate dental caries, bacterial dental plaque, gingivitis and caries related oral microflora in children with predominantly autosomal recessive Dystrophic Epidermolysis Bullosa (DEB). METHODS: Thirty children with DEB from The Great Ormond Street Hospital for Children and 31 control children matched for age, gender and ethnicity were included in the study. RESULTS: The main findings were: 1. A significantly greater mean dmft in the DEB children (p < 0.05). 2. A significantly greater mean plaque score for the DEB children for both the primary (p < 0.001) and permanent teeth (p < 0.02) compared with the control children. 3. A significantly greater mean gingivitis score for the DEB children for both the primary (p < 0.002) and permanent teeth (p < 0.0001) compared with the control children. 4. A significantly greater salivary total anaerobic count for the control children compared with the DEB children (p < 0.001). CONCLUSIONS: The results reflect the difficulties that children with DEB have with basic oral hygiene procedures combined with slow oral clearance.     

Dental enamel defects in children with coeliac disease

OBJECTIVE: The aim of this study was to investigate whether Dutch children with proven coeliac disease show specific dental enamel defects, and to asses whether children with the same gastrointestinal complaints, but proved no-coeliac disease, lack these specific dental enamel defects. MATERIALS AND METHODS: Eighty-one children (53 coeliac patients and 28 control subjects) were examined during the period 2003-2004 in the Oral Surgery Outpatient Clinic of the Academic Medical Centre in Amsterdam. RESULT: Twenty-nine (55%) coeliac patients had enamel defects against 5 (18%) control subjects. In the coeliac disease group, the enamel defects were diagnosed as specific in 20 (38%) children, compared with 1 (4%) in the control group. Statistical analysis showed significantly more specific enamel defects in children with coeliac disease than in children in the control group (chi(2) = 12.62, d.f. = 2, P = 0.002). CONCLUSION: This study showed significantly more specific enamel defects in Dutch children with coeliac disease as compared with children in the control group. Dentists could play an important role in recognizing patients with coeliac disease.     

Delayed dental age in hepatorenal glycogen storage disease

The dental findings in three patients with hepatorenal glycogen storage disease are described. In two cases, dental maturation and tooth eruption were considerably delayed. In the third case, dental maturation and tooth eruption are normal, possibly because of newer treatment methods of this disease.     

On dental caries and caries-related factors in children and teenagers

Dental caries is still a common disease among children and adolescents. The aims of the present thesis were therefore: 1) to investigate the approximal caries prevalence in posterior teeth in 15-year-olds, 2) to study past caries experience in the primary dentition in relation to future caries development and need for treatment, 3) to investigate factors during early childhood which are associated with caries development later in life, and 4) to study the association between age-specific body mass index (isoBMI) and approximal caries status in 15-year-olds. Paper I has a retrospective design and the analyses were based on record data from a randomly selected sample. Papers II, III and IV are based on radiographic analyses of posterior teeth in 15-year-olds followed longitudinally from 1 to 15 years of age. The data for these studies were selected from examinations, interviews and questionnaires from early childhood and school health care records at 15 years (isoBMI values). The result showed that the approximal caries prevalence in 15-year-olds is underestimated in official caries data, since initial caries lesions are not included in these statistics. Two thirds of all 15-year-olds had approximal caries and initial caries constituted 86% of the total number of caries lesions. There was a strong relationship between caries in early childhood and approximal caries prevalence in the posterior teeth at 15 years of age. Children with caries experience at 6 years received significantly more treatment in the primary dentition during the period from 7 to 12 years compared with children who were caries free at the same age. Further, it was pointed out that parents' attitudes to dental health and psychosocial factors during early childhood have an effect on approximal caries in 15-year-olds. Additionally, plaque on primary incisors at 1 year of age and infrequent toothbrushing at 3 years of age were associated with a high caries experience at 15 years. It was also demonstrated that adolescents with overweight and obesity had a significantly higher approximal caries prevalence than those of normal weight. Furthermore, it was shown that children's unfavourable snacking habits at 1 and 3 years of age were associated with approximal caries at 15 years. The main conclusions from this thesis are that: 1) epidemiologicalcaries data should include initial caries lesions on approximal tooth surfaces, in order to show the actual caries prevalence, 2) there is a strong relationship between caries in early childhood and approximal caries prevalence in the posterior teeth at 15 years of age, 3) the psychosocial environment in which children live during their childhood has an impact on dental health later in life, 4) good oral hygiene habits including the use of fluoride toothpaste, established in early childhood, provide a foundation for good dental health in adolescence, and 5) future preventive programmes should include, at a multidisciplinary level, strategies to prevent and reduce both dental caries and obesity at an early age.     

Dental and occlusal characteristics of children with neuromuscular disease

Seventy-nine pediatric patients with neuromuscular diseases were examined for dental and occlusal characteristics. Fifty-six patients suffered from primary muscle disease (myopathies) including 43 with Duchenne's muscular dystrophy. The neuromuscular disorders in 19 patients were of neuropathic origin, while four were caused by a fault in the neuromuscular junction. Posterior crossbites occurred more often in the myopathies (57%) as compared with the neurogenic dystrophies (14%) (P less than 0.003). Although not statistically significant, the prevalence of open bite was also higher in the combined myopathies (21%) as compared with neurogenic disorders (9%). The Duchenne patients exhibited a statistically significant delay in dental emergence (1.06 years), unlike the other myopathies (0.31 years) and the neurogenic disorders groups (-0.03 years). This study emphasizes the influence of muscular environment on dental development in general. The dentition may be more affected in muscular dystrophies stemming from degenerative or inflammatory muscle damage than in those originating from nerve malfunction or disorder of the neuromuscular junction.     

Oral manifestations in glycogen storage disease type 1b

Glycogen storage disease type 1b is a rare metabolic disorder which affects the transport system of glucose-6-phosphatase metabolism. As a result, hepatomegaly, failure to thrive, renal dysfunction and recurrent infections occur in affected patients. In this paper, the oral complications in three children with glycogen storage disease type 1b are discussed. Oral ulcers were a common rinding, probably due to severe neutropenia and impaired neutrophil migration which characterises the onset of this rare disorder.     

Oral complications in type 1B glycogen storage disease

A case of type 1b glycogen storage disease (GSD) in which neutropenia and neutrophil dysfunction were prominent features is described. Oral complications included rapidly progressive periodontal disease and recurrent mucosal ulceration.     

Unusual oral manifestations and evolution in glycogen storage disease type Ib

Glycogen storage disease type Ib is a rare inherited metabolic disorder that is caused by a deficiency of glucose-6-phosphate translocase with consequent accumulation of glycogen. The purpose of this study is to report a case affected by glycogen storage disease type Ib in which unusual oral findings were evident and to review the pertinent literature. The disease presents with failure to thrive, hepatomegaly, hypoglycemia, hyperlacticacidemia, neutropenia, and neutrophilic dysfunction causing increased susceptibility to recurrent infections. Common intraoral manifestations are dental caries, gingivitis, periodontal disease, delayed dental maturation and eruption, oral bleeding diathesis, and oral ulcers. Conversely, unusual oral lesions were observed in this case as hyperplastic-hypertrophic gingiva and giant cell granulomatous epulis. The treatment with granulocyte colony-stimulating factor markedly increased the neutrophil counts and reduced the frequency of infections and inflammations. Proper evaluation of the patient's oral condition, a program of preventive measures, and suitable medical consultation are important to minimize and avoid long-term complications.     

A long-term effect of caries-related factors in initially caries-free children

Aim.  The aim of this study was to examine the rate and pattern of early childhood caries development in caries-free children based on their dental plaque accumulations, salivary Streptococcus mutans levels, maternal sharing, oral hygiene, and feeding attitudes at baseline and at 24-month follow-up period.
Design.  A total of 92 children, aged between 15 to 35 months, comprised the study group. The children's dental examinations were first carried out at baseline, and 56 of them were re-examined 24 months later to determine the changes in dental status. The mothers were also interviewed at each examination based on a prepared questionnaire.
Results.  The prevalence of caries incidence was 45% at 24-month evaluation period among initially caries-free children. The new caries formation was mostly observed on occlusal and aproximal surfaces of maxillary molars (28% and 26%) followed by mesial, distal and buccal surfaces of anterior teeth, respectively. Significant correlations between dental caries formation and maternal sharing, S. mutans levels, and plaque scores were found.
Conclusion.  The results indicated that early S. mutans colonization, high plaque accumulation, and maternal sharing were important factors on a child's caries development.     

Dental health and treatment in a group of children with congenital heart disease

PURPOSES: The purposes of this study were to: (1) determine the prevalence of dental caries and developmental enamel defects in children with congenital heart (CHD) disease; and (2) evaluate previous dental treatment. METHODS: One hundred and seventy-six 2- to 16-year-old children were examined during their outpatient cardiology appointment. The study group consisted of 86 CHD children. Sixty healthy children formed the control group. RESULTS: Mean dmft and DMFT scores were 1.57 (+/- 3.01 SD) and 0.77 (+/- 1.42) for the study group and 1.81 (+/- 3.64) and 0.38 (+/- 1.16) for the control group, respectively. Eight out of 86 CHD children and 5 out of 60 healthy children had enamel defects on their permanent teeth. No significant differences were demonstrated between the 2 groups. The care index for primary teeth was 10% for the study group and 3% for the control group. In permanent dentition, the care index was 30% and 16%, respectively CONCLUSIONS: Children with and without congenital heart disease had similar levels of dental disease. The care index for primary teeth was higher in CHD children, although the overall level was very low.     

Prevalence of dental caries and caries-related risk factors in premature and term children

This study evaluated the prevalence of enamel defects and dental caries and their risk factors on primary and permanent dentitions of prematurely-born children and term children. Eighty children were examined, 40 born prematurely (G1) and 40 born term (G2), in the age group between 5 and 10 years. The demographic variables, medical history and oral health behaviors were recorded on a questionnaire. The teeth were examined for presence of deficiencies of the enamel and caries that were registered. The caries were registered, focusing on the indices dmft (decayed, missing, and filled primary teeth) and DMFT (decayed, missing, and filled permanent teeth). The results showed that 75% of the total sample had enamel defects. The logistic regression model showed that other risk factors such as per capita family income, educational level, dietary and hygiene habits, fluoride exposure, trauma, and diseases had no correlation with enamel defects and caries. A smaller value of total DMFT (0.95) was found in the group of premature children in comparison to the term children (2.07) p = 0.0164. There was no difference concerning the permanent dentition between the two groups (p = 0.9926). One concludes that prematurity can't be a predisposing factor for the presence of dental caries.     

An intraoral nighttime feeding attachment for patients with glycogen storage disease, types I and III

A simple type of attachment that any dentist can construct for patients with glycogen storage disease, types I and III, has been used successfully. The main benefit of this attachment is that the patient no longer needs a nasogastric tube at night, thus avoiding a great deal of discomfort and irritation. Although this procedure cannot be considered a cure, it is a new, important aid in treatment of these patients and a help to their parents.