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1.

Objective

This study aimed to radiographically assess the prevalence and location of accessory foramina in the human mandible using helical computed tomography (CT) images and three-dimensional reconstructions.

Methods

Helical CT images from 24 males and 22 females aged 66–88 years (mean age: 73.7 ± 5.3 years) were observed. Each image was assessed in the three anatomical planes, and three-dimensional reconstructions were performed with Amira 5.6 software.

Results

All subjects (n = 46) presented at least one accessory foramina. A lingual foramen was the most frequently observed foramen and present in 96 % (n = 44) of subjects. Mandibular anterior nutrient canals were clearly observed in 72 % (n = 33) of subjects (71 %, n = 17, of males; 73 %, n = 16, of females). A retromolar foramen was present in 17 % (n = 8) of subjects (21 %, n = 5, of males; 14 %, n = 3, of females). A double mental foramen (DMF) was present in only one subject (2 %). Fifty percent (n = 23) of subjects presented one or more inferior retromental foramen (IRF). No significant correlations were observed between prevalences of accessory foramina and sex.

Conclusions

The lingual foramen can be considered a constant finding, and mandibular anterior nutrient canal foramina and IRF were present in the majority of subjects. Retromolar foramina and DMF were less common but can be associated with anesthetic failures and oral surgery complications. Three-dimensional reconstructions provided better understanding of the locations of foramina and their interrelations with the anatomy of the jaw.
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2.

Purpose

This retrospective study investigated the relationship between the degree of neurosensory disturbance (NSD) and mandibular movement distance after sagittal split ramus osteotomy (SSRO) and assessed sensory recovery.

Methods

Lower lip hypoesthesia was evaluated at 1 week, 1 month, and 2 months after SSRO in 38 patients categorized according to the distance of mandibular movement: S group (0–7 mm; n = 17, 4 males and 13 females) and L group (7–14 mm; n = 21, 7 males, 14 females). Symptoms were evaluated by visual analog scale (VAS), tactile-threshold (SW) test, static 2-point discrimination (s-2PD) test, and current perception threshold (CPT) test.

Results

The two groups did not differ significantly in gender and age. The Aβ fiber results of the CPT test differed significantly between the groups at 1 week and 1 month postsurgery (P < 0.05). There were no significant differences between the groups throughout the period in terms of VAS, SW, s-2PD, Aδ fiber, and C fiber of CPT.

Conclusions

Post-SSRO, the incidence of NSD in terms of tactile sensation may be greater in the L group early postoperatively. This may assist surgeons in explaining postoperative hypoesthesia to patients preoperatively.
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3.

Objectives

The purpose of the present study was to radiographically evaluate the prevalence and characteristics of palatogingival grooves (PGs) in maxillary anterior teeth on cone-beam computed tomography (CBCT) to better understand the nature of these defects.

Methods

The CBCT examinations of 993 teeth (330 canines, 315 lateral incisors, 348 central incisors) in 191 patients (87 males, 104 females; age range 16–80 years) were evaluated retrospectively. The diagnosis and radiographic condition of PGs were obtained by consensus among all observers. Verification of PGs was achieved from the patients’ clinical records, which were stored in a database after their clinical evaluation. Differences in age, sex, occurrence, and location were evaluated by the Chi-square test. The level of significance was set at p < 0.05.

Results

Among the 993 teeth examined, nine PGs were observed in seven lateral incisors and two central incisors in eight patients (four males and four females). There was one bilateral case in the lateral incisors. The frequencies of PG occurrence and affected patients were 0.90 and 4.18%, respectively, without significance for sex and location (p > 0.05).

Conclusions

PGs were a relatively infrequent anomaly of teeth in this population, but when present, clinicians should understand the clinical features of these root variations.
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4.

Objective

We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.

Study design

The study design is a case series with chart review.

Setting

The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.

Subjects and methods

The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.

Results

Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).

Conclusions

Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.

Level of evidence

Level of evidence is a 4 case series.
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5.

Objective

In order to determine rates of metastasis and efficacy of elective superficial parotidectomy, we examine parotid specimens in patients with temporal region cutaneous squamous cell carcinoma treated with local excision and ipsilateral parotidectomy.

Study design

This paper is a retrospective review.

Setting

This study was conducted at a private tertiary referral practice in Fort Worth, Texas, from 1998 to 2013.

Subjects and methods

Ninety-three patients between ages 27 and 98 with primary squamous cell carcinoma of the temporal region greater than or equal to 2 cm were included in this study. Subjects had no evidence of adenopathy or parotid involvement on exam or imaging. Patients were treated with local excision and ipsilateral parotidectomy. The primary tumor was studied for vascular involvement and perineural invasion while the parotid specimen was analyzed for occult cancer. Patients were post-operatively followed for a minimum of three years.

Results

Twenty-three (24.7 %) parotid samples were found to harbor occult malignancy. Of these, nine (39.1 %) patients had vascular involvement of the primary tumor and 14 (60.8 %) had perineural invasion. Thirteen out of 58 affected males and 10 out of 35 affected females were found to have intraparotid node positivity. Vascular involvement (p?=?0.0004) and perineural invasion (p?=?0.0001) in the primary malignancy were found to be greater in patients with positive specimen. Sex was not statistically significant.

Conclusions

In patients with cutaneous squamous cell carcinoma of the temporal region at least 2 cm in size, elective superficial parotidectomy may be a beneficial part of treatment, especially in primary tumors showing perineural and/or vascular involvement.

Level of evidence

Level 2b (retrospective cohort)
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6.

Objectives

Cone-beam computed tomography (CBCT) has been widely used in many fields of dentistry. However, little is known about the accuracy of CBCT for evaluation of periodontal status. The objective of this study was to compare and correlate periodontal assessments among CBCT, clinical attachment loss (CAL) measurement, and periapical (PA)/bitewing (BW) radiography.

Methods

Eighty patients (28 males, 52 females; age range, 19–84 years) from the University of Texas School of Dentistry at Houston were evaluated retrospectively. Measurements were taken on the central incisors, canines, and first molars of the right maxilla and left mandible. CAL was extracted from periodontal charts. The radiographic distance from the cementum–enamel junction (CEJ) to the alveolar crest was measured for tooth mesial and distal sites on PA/BW and CBCT images using MiPacs software and Anatomage Invivo software, respectively. One-way ANOVA and Pearson analysis were performed for statistical analyses.

Results

The CEJ–crest distances for CBCT, PA/BW, and CAL were 2.56 ± 0.12, 2.04 ± 0.12, and 2.08 ± 0.17 mm (mean ± SD), respectively. CBCT exhibited larger values than the other two methods (p < 0.05). There were highly significant positive correlations among CBCT, PA/BW, and CAL measurements at all examined sites (p < 0.001). The Pearson correlation coefficient was higher for CBCT with CAL relative to PA/BW with CAL, but the difference was not significant (r = 0.64 and r = 0.55, respectively, p > 0.05).

Conclusions

This study validates the suitability of CBCT for periodontal assessment. Further studies are necessary to optimize the measurement methodology with CBCT.
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7.

Objective

With respect to the unknown aetiology of molar incisor hypomineralisation (MIH), it is unclear whether this phenomenon was overlooked in the last century as a result of a high number of caries in children or if this developmental disorder was not present until then. Therefore, this study determined the presence of MIH in historical dentitions and teeth.

Materials and methods

Dental remains from late medieval (n = 191, twelfth–sixteenth century, Regensburg, Germany), post-medieval (n = 33, sixteenth–eighteenth century, Passau, Germany) and modern age archaeological skeletal series (n = 99, nineteenth–twentieth century, Altdorf, Germany) were examined for MIH. In addition, linear enamel hypoplasia (LEH), diffuse opacities, hypoplasia and Turner’s teeth were documented.

Results

MIH-related demarcated opacities or enamel breakdowns were found in only 15 (0.4 %) of the 3891 examined permanent teeth. Ten cases (3.1 %) from a total of 323 dentitions were classified as having MIH. In contrast, 98 individuals (30.3 %) showed LEH. Other enamel disorders were recorded in 64 individuals (19.8 %).

Conclusion

With respect to the low number of affected dentitions and teeth, MIH most likely did not exist or was at least rarely present in the investigated archaeological case series.

Clinical relevance

This study supports the hypothesis that MIH may be linked to contemporary living conditions or other health-related factors.
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8.

Background

Odontogenic infections range from peripheral abscess to superficial and deep infections leading to severe infections in head and neck region. This study was aimed to assess bacterial isolates responsible for orofacial infection of odontogenic origin and their drug susceptibility patterns so as to provide better perceptive for the management of odontogenic infections.

Methods

The study was made in a selected cohort of patients, irrespective of age and gender having moderate and severe orofacial infections of odontogenic origin admitted to Yenepoya University Hospital. Pus samples were collected and identification of bacteria was performed by 16S rRNA gene sequencing. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method.

Result

A total of 37 study subjects were included, with bacterial isolation rate of 31 (83.7 %). The mean age presented of all patients was 40.62. Of all, 24 (64.9 %) were males. Staphylococcus aureus, Enterobacter claocae subsp. dissolvens, Klebsiella quasipneumoniae subsp. similipneumoniae, Staphylococcus aureus subsp. anaerobius and Klebsiella pneumoniae subsp. ozaenae were the most prevalent isolates. Result showed that 58.6 % of the isolates were resistant to gentamicin, 52.5 % for ampicillin, 51.3 % for piperacillin; least resistant being 18.9 % for azithromycin.

Conclusion

High prevalence of bacterial isolates was found, Staphylococcus aureus being the dominant. Most of the bacteria were resistant to different classes of antibiotics. Appropriate antibiotics should be given based on the bacterial isolates, culture sensitivity and clinical course of the disease.
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9.

Objective

Micro-neurosurgical repair is considered in permanent nerve damage but the outcome is unpredictable. We examined if histopathologic parameters of traumatic neuromas have a prognostic value for recovery in relation to lingual nerve micro-neurosurgery.

Materials and methods

Retrospective case study on neurosensory recovery after micro-neurosurgery. Outcome variables were as follows: pain perception, two-point discrimination, and sum score of perception, before and 12 months after micro-neurosurgery. Predictive histopathology variables included size, nerve tissue, and inflammation. Statistics are as follows: logistic and correlation analyses (P < 0.05).

Results

Sixty-five patients with lingual nerve damage were included in the study. Improved two-point discrimination was associated with small size of resected tissue (P = 0.0275). No normal appearing distal nerve tissue was associated with improved sum score of perception (P = 0.0185), higher final sum score of perception value (P = 0.0475) and final pain perception (P = 0.0324). Foreign body reaction was associated with no final pain perception (P = 0.0492).

Conclusions

Small size, absence of distal nerve tissue, and no foreign body reaction were associated with improvement of the neurosensory functions.

Clinical relevance

Histological parameters of the traumatic neuromas in routine preparation appeared to have some prognostic value for neurosensory functions as improvement of the neurosensory functions was associated with small size of resected tissue, no distal normal appearing nerve tissue, and no foreign body reaction.
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10.

Objectives

This study evaluated the effects of combined topical sodium fluoride and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) paste application on root surface conditions in cancer patients undergoing head and neck radiotherapy.

Patients and methods

Nineteen patients undergoing conventional external radiotherapy in head and neck cancer were enrolled and divided into CPP-ACP (topical sodium fluoride/daily CPP-ACP paste application) and Non-CPP-ACP (topical fluoride application alone) groups. Chronological root surface texture changes were prospectively investigated for 1 year.

Results

The mean radiation dose of the parotid gland did not differ significantly between the CPP-ACP and Non-CPP-ACP groups. From baseline to 6 and 6–12 months, the CPP-ACP group had significantly better root surface textures than those in the Non-CPP-ACP group (p = 0.001 and p < 0.001, respectively). The hard surface numbers in the CPP-ACP group increased from 347 to 350 in 12 months. The respective soft lesion incidence rates from baseline to 6, 6–12, and baseline to 12 months were significantly lower in the CPP-ACP group than those in the Non-CPP-ACP group (per patient: p = 0.038, p = 0.038, and p = 0.029; per root surface: p = 0.026, p < 0.001, and p < 0.001).

Conclusions

The present results suggest that dental management with a combination of topical sodium fluoride and CPP-ACP paste application can control root surface caries more effectively than topical sodium fluoride alone in patients undergoing head and neck radiotherapy.
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11.

Objective

The aim of this study was to evaluate alterations in condylar positioning through submentovertex projection (Hirtz Radiographic Technique) in patients who underwent orthognathic surgery for maxillary advancement and mandibular setback with stable internal fixation.

Methods

A prospective longitudinal clinical study of 40 surgical patients presenting dentofacial deformity admitted in the Oral and Maxillofacial Surgery Department of Federal University of Paraná (UFPR) in the period between March 2013 and December 2015. We performed two submentovertex digital radiographs, one 7 days before surgery and the other one 30 days after the procedure. Cephalometric tracings were made using Radiocef® Studio 2 Software and measured the intercondylar and condylar angles (right and left).

Results

There was a decrease in the intercondylar angle (p < 0.001) and an increase in condylar angles both the right and the left side (p < 0.001) when compared with the pre and postoperative period. There was a larger increase in condylar angle on the right side in males (p = 0.007).

Conclusion

There is a tendency of decreasing of the intercondylar angle after orthognathic surgery, regardless of the alteration in the condylar angles, creating a new position of the condyle in the glenoid fossa. Patients with asymmetry may present greater alterations in the positioning of the opposite condylar to the deviation of the mandibular midline.
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12.

Objectives

The aim of this study was to evaluate the localization, angulation, and resorption features of maxillary impacted canines on cone-beam computed tomography (CBCT).

Methods

This retrospective study examined the CBCT scans of 140 maxillary impacted canines in 102 patients (43 males, 59 females; mean age: 16.25 ± 6.31 years). The following impacted canine-related parameters were analyzed on the CBCT images: impaction side; location; root resorption levels of adjacent teeth; occlusal plane and midline distances of impacted canines; and angulations of impacted canines to midline, lateral incisor, and occlusal plane.

Results

Bilateral canine impaction was found in 38 subjects, and unilateral canine impaction was present in 64 subjects. Severe resorption was found in 14 canines. There were no significant differences between the occlusal plane and midline distances to the impacted canine cusp tip and root apex (p > 0.05). The midline angulation of right maxillary impacted canines was significantly higher than that of left maxillary impacted canines (p < 0.05), while the occlusal plane angulation of left maxillary impacted canines was significantly higher than that of right maxillary impacted canines (p < 0.05).

Conclusions

Maxillary canine impaction was more frequently seen in female subjects than in male subjects. Lateral incisors were more frequently affected than first premolars, and slight resorption was more frequently seen in adjacent teeth. CBCT assessment of maxillary impacted canines can provide accurate measurements of angular, linear, and resorption parameters.
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13.
14.

Objectives

To evaluate the change in masticatory efficiency and quality of life of patients treated with mandibular Kennedy class I removable partial dentures (RPDs) and maxillary complete dentures at the Department of Dentistry of the Federal University of Rio Grande do Norte.

Materials and methods

A total of 33 Kennedy class I patients were rehabilitated with maxillary complete dentures, and mandibular RPDs were selected for this non-randomized prospective intervention study. The patients had a mean age of 59.1 years. Masticatory efficiency was evaluated by colorimetric assay using fuchsin capsules. The measurements were conducted at baseline and 2 and 6 months after prosthesis insertion. Quality of life was evaluated using the Oral Health Impact Profile (OHIP-14) at baseline and 6 months after denture insertion. The Kolmogorov-Smirnov normality test was applied. Masticatory efficiency was evaluated by repeated measures ANOVA. Oral health-related quality of life was compared using the paired t test.

Results

There was no statistically significant difference in masticatory efficiency after denture insertion (p?=?0.101). Significant differences were found (p?=?0.010) for oral health-related quality of life. A significant improvement in psychological discomfort (p?<?0.01) and psychological disability (p?<?0.01) was observed. Mean difference value (95 % confidence interval) was 6.8 (3.8 to 9.7) points, reflecting a low impact of oral health on quality of life, considering the 0–56 range of variation of the OHIP-14 and a Cohen’s d of 1.13.

Conclusion

According to the results of the present study, rehabilitation with Kennedy class I RPDs and complete dentures did not influence masticatory efficiency but improved oral health-related quality of life.

Clinical relevance

The association between the patient’s quality of life and the masticatory efficiency is important for treatment predictability.
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15.

Background

Osteosarcomas of head and neck region have unique biology and exhibit a clinical behavior and natural history that is distinct from osteosarcomas of the trunk and extremities. Our understanding of this malignant bone tumor is largely based on data from single institutions or compiled from registries, and hence the clinical practice guidelines seem confusing and conflicting.

Aims and Objectives

To analyze the demographic profile, disease characteristics and survival outcomes of osteosarcoma of head and neck region.

Materials and Methods

Retrospective analysis of the patients treated for osteosarcoma of head and neck region with curative intent in the period between the years 2001–2013 at a tertiary cancer center from South India.

Results

A total of 14 patients were treated in the said period with a mean age of 37 years. The most common site was mandible (n = 9 patients) followed by maxilla (n = 4) and paranasal sinuses (n = 1). Conventional osteoblastic variant of OS was the most common histological variant (n = 8) followed by the chondroblastic variant (n = 5). The median disease-free survival was 41.7 months, whereas the median overall survival of our patient cohort was 47.6 months. A formal analysis of various prognostic factors showed only postoperative margin positivity to be the single important factor affecting the survival outcomes.

Conclusion

Head and neck osteosarcoma that most commonly afflicts the jaw bones occurs in the fourth decade of life. Despite being a small series, our study does highlight the importance of achieving a margin-negative resection as a part of the multimodality treatment of head and neck osteosarcomas. Considering the relative paucity of data, there is a need for multi-institutional collaborative studies to refine the therapeutic strategies for the management of patients with head and neck osteosarcomas.
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16.

Objectives

The current study investigated the association between VDR EcoRV (rs4516035), FokI (rs2228570), ApaI (rs7975232) and TaqI (rs731236), CYP27B1 (rs4646536), CYP24A1 (rs2296241), and MTHFR (rs1801133) gene polymorphisms and risk of oral lichen planus (OLP) occurrence.

Materials and methods

The study group consisted of 65 oral lichen planus patients and 100 healthy blood donors in the control group. Single nucleotide polymorphisms were genotyped by real time PCR or PCR-restriction fragment length polymorphism (RFLP) method.

Results

Heterozygous as well as mutated genotype of vitamin D receptor (VDR) FokI (rs2228570) polymorphism was associated with increased oral lichen planus risk in comparison with wild type genotype (odds ratio (OR) = 3.877, p = 0.017, OR = 38.153, p = 0.001, respectively). A significantly decreased OLP risk was observed for heterozygous genotype of rs2296241 polymorphism in CYP24A1 gene compared with the wild type form (OR = 0.314, p = 0.012). VDR gene polymorphisms ApaI and TaqI were in linkage disequilibrium (D’ = 0.71, r 2 = 0.22). Identified haplotype AT was associated with decreased OLP risk (OR = 0.592, p = 0.047).

Conclusion

Our results highlight the possible important role of VDR FokI (rs2228570) and CYP24A1 rs2296241 gene polymorphisms for oral lichen planus susceptibility.

Clinical relevance

Identification of new molecular biomarkers could potentially contribute to determination of individuals with OLP predisposition.
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17.
18.

Objectives

To evaluate the marginal and internal fit of CAD/CAM-generated frameworks for 4-unit, fixed dental prostheses (FDPs) from zirconia (Z) and cobalt-chromium alloy (C) made with conventional (CI) and digital impressions (DI).

Materials and methods

A titanium model was digitized with an intraoral scanner (DI, LAVA? C.O.S.; 3M ESPE; Seefeld, Germany; n = 12). Additionally, 12 conventional impressions were taken, and referring plaster casts were digitized by a laboratory-scanner (CI, LAVA? Scan ST; 3M ESPE; n = 12). Frameworks were fabricated (3M ESPE) from cobalt-chromium (DI-C, n = 12; CI-C, n = 12) and zirconia (DI-Z, n = 12; CI-Z, n = 12) from the same datasets. A replica technique was applied to measure the accuracy. The Mann–Whitney U statistical test was applied to detect statistical differences between each material and methodology groups in terms of fit.

Results

Frameworks from DI-C (median 19.07 μm) showed significantly better marginal fit than CI-C (median 64.64 μm, p < 0.001). Frameworks from DI-Z (median 52.50 μm) showed significantly better marginal fit than CI-Z (median 72.94 μm, p = 0.001). Additionally, frameworks from DI-C showed a significantly better marginal fit than DI-Z (p < 0.001).

Conclusions

CI and DI led to a clinically acceptable marginal fit of 4-unit FDPs from cobalt-chromium and zirconia. DI leads to better marginal fit of the cobalt-chromium frameworks; however, no effect on zirconia was found.

Clinical relevance

The results indicate that DI is suitable for fabricating 4-unit, cobalt-chromium and zirconia frameworks with regard to fit requirements.
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19.

Background

This study was aimed to investigate the prevalence of dental anxiety in a population of patients with Borderline Intellectual Functioning (BIF) and patients with mild and moderate intellectual disability (ID), and how dental anxiety correlated with their age and gender.

Methods

The sample was made of 700 patients, 287 females and 413 males, 6-to-47 years old, either with borderline intellectual functioning or mild/moderate intellectual disabilities. All patients were administered the Dental Anxiety Scale to assess their level of dental anxiety.

Results

Moderate Anxiety was the most prevalent dental anxiety category for patients with intellectual borderline functioning (15.56 %) and mild intellectual disabilities(18.79 %), while Severe Anxiety was the most prevalent category for patients with moderate intellectual disabilities(21 %). Overall, a statistically significant difference (p?<?0.001) between the three groups (BIF, Mild-ID and Moderate-ID) was found. Also, the correlation analysis between participants’ age and dental anxiety was statistically significant (p?<?0.001); indeed, dental anxiety turned out to decrease with the increasing of the age. Moreover, the analysis between gender and dental anxiety was found to be significant as well (p?<?0.001), where higher prevalence of dental anxiety was found in females.

Conclusions

To our knowledge, this is the first study on dental anxiety carried out in the field of intellectual disability. Results show that the higher the level of intellectual disability – and consequently the lower the cognitive functioning – the higher the percentage and the severity of dental anxiety.
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20.

Aim

This longitudinal study aimed to investigate the prevalence of teething-related pain and fever and the early-life factors that may affect the risk of experiencing these disturbances within the first 1.5 years of life.

Materials and methods

Participants were recruited (n = 1033) through the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 1237). Interviews were performed tri-monthly regarding the prevalence of teething pain and fever in children from 6 to 18 months of age. Crude and multivariable analyses were conducted using Poisson-log regression models.

Results

Prevalence rates for teething pain and fever were 35.5 and 49.9 % respectively. Multivariable Poisson regression analysis showed maternal second-hand tobacco smoke (SHS) exposure to increase the risk of both pain (mean ratio = 1.35; p = 0.006) and fever (mean ratio = 1.22; p = 0.025), whereas SHS exposure plus active smoking further increased risk of teething pain in the children (mean ratio = 1.89; p = 0.029). Delivery via Caesarean section increased risk of teething pain (mean ratio = 1.27; p = 0.033), while prenatal plasma vitamin D insufficiency lowered such a risk (mean ratio = 0.62; p = 0.012). Compared to Chinese infants, Indian babies exhibited lower risk of teething pain and fever (both p ≤ 0.001).

Conclusions

Early-life factors such as tobacco smoke exposure and vitamin insufficiency during pregnancy, ethnicity and childbirth via Caesarean section may significantly affect the child’s susceptibility to teething-related pain and fever.

Clinical relevance

Knowledge of prevalence and risk factors of teething disturbances may better equip primary caregivers and healthcare professionals to accurately detect teething-related local and/or systemic signs/symptoms and effectively facilitate tobacco cessation among pregnant women.
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