Stuttering prevalence among patients at risk for velopharyngeal inadequacy: a preliminary investigation

The purpose of the present investigation was to provide preliminary information concerning the prevalence of stuttering among patients manifesting structural abnormalities of the velopharyngeal complex. Certain theoretical considerations suggested, a priori, that the prevalence of stuttering might be higher among these patients, although unsubstantiated clinical impressions indicated that the opposite was true. A retrospective study of 534 patients uncovered one individual whose speech was characterized by stuttering. This prevalence rate of 1.87 per 1,000 did not differ significantly from the 7 per 1,000 prevalence rate that would be expected in the general population. However, the lack of statistical significance may have resulted from the small sample size. Additional information from other craniofacial centers is needed to address this issue adequately. The theoretical implications of these initial findings are explored.     

A comparison of the sialochemistry,oral pH,and oral health status of down syndrome children to healthy children

International Journal of Paediatric Dentistry 2010; 20: 235–241 Background: The aetiology of low caries incidence in Down syndrome (DS) children is not entirely clear. Aim. To compare sialochemistry and oral mucosal pH between Down syndrome children with caries (DS‐Ca) and caries free (DS‐CaF), and healthy children with caries (C‐Ca) and caries free (C‐CaF). Design. The study group comprised 70 children with DS (mean age 4.41 ± 1.9 years); 32 healthy children (mean age 9.22 ± 2.7 years) served as control. Groups were further subdivided according to caries status: DS‐Ca, DS‐CaF, C‐Ca and C‐CaF. Sialochemistry analysis included calcium (Ca), sodium (Na), potassium (K), and chloride (Cl). Mucosal pH, plaque and gingival indices (PI and GI), and caries status were recorded. Results. DMFT/dmft were significantly lower in the DS group. Cl and Ca levels were significantly higher in the DS‐Ca compared to the C‐Ca and the C‐CaF children. Na and K were significantly higher in DS‐Ca group compared to DS‐CaF group. PI and GI were significantly higher in DS‐C children compared to DS‐CaF children. Conclusions. DS may manifest itself in the salivary glands. Consequently, different electrolyte salivary environment may form, leading to lower caries rates among DS children.     

Serum antibody response to Actinobacillus actinomycetemcomitans in Down's syndrome

Persons with Down's syndrome (DS) are susceptible to severe and precocious periodontal disease. Several organisms have been implicated in the etiology of periodontal disease, including Actinobacillus actinomycetemcomitans (Aa). It is unknown whether circulating antibodies correlate with the severity of periodontal disease in DS. This study determined the circulating antibody titers to Aa in sera of DS and normal patients. Eleven DS patients with periodontal disease (pocket depth > 4 mm), five DS patients with gingivitis (inflammation and pocket depth < 3 mm), and 10 non-DS healthy subjects had blood drawn and analyzed for antibody response to Aa. Conventional enzyme-linked immunosorbent assay (ELISA) with goat anti-human IgG was performed for Aa-reactive serum diluted 1:200 to 1:12,800. Geometric mean titer was calculated, and significant differences were noted between the control group and the DS groups (p = 0.05), with the DS periodontal group having the highest response, followed by the DS gingivitis and normal controls, respectively. The DS groups were not significantly different. DS patients may exhibit a higher Aa antibody response, due to the presence of the organism, previous exposure, or in proportion to the extent of their periodontal condition .     

Carboxylic acids and pH of denture plaque in patients with denture stomatitis

Denture stomatitis (DS) is the commonest form of oral Candida infection. Although it has been suggested that the acidic conditions prevailing beneath maxillary dentures may potentiate palatal inflammation associated with DS, little is known about the pH and carboxylic acids of denture plaque in subjects with and without the disease. Therefore, qualitative and quantitative analyses of short-chain carboxylic acids and pH of maxillary denture plaque of ten patients and nine controls were performed. Gram-stained smears of plaque revealed numerous yeasts in the DS plaque while yeasts were absent in control plaque. Acetate, lactate, propionate, succinate, formate and pyruvate were present in descending order of concentration in all plaque samples. DS plaque was more acidic and contained significantly lower concentrations of lactate ions than control plaque. These results imply that the carboxylic acids produced by the microflora of denture plaque may be aetiologically involved in the pathogenesis of denture stomatitis.     

Periodontal disease in Down''s syndrome: a review

Cross-sectional as well as longitudinal studies indicate that the prevalence of periodontal disease in persons with Down's syndrome (DS) under the age of 30 years is extremely high. It is even noted in the deciduous dentition. The progression of the disease is rapid, especially in the younger age groups. Severe periodontal breakdown with horizontal bone loss is often present in the lower anteriors. The large amount of plaque and calculus alone cannot explain the severity of periodontal disease in DS persons. Many contributing factors are reported. Abnormal capillary morphology, disorders in connective tissue and anatomical aspects of teeth are some of those considered to be of influence. Alteration in immunological response may also play a role in the progression of the disease process. Disorders in the polymorphonuclear leucocyte function and monocyte function have been reported in persons with DS. T-cell functioning declines after the first 10 years of life. T-cell lymphocyte counts are low and an immature subset of T-lymphocytes is present. This latter effect occurs especially in institutions where the immunological system is under stress. The altered immune response together with higher calculus scores may explain the difference in severity of periodontal disease between institutionalized DS children and those living at home.     

幽门螺杆菌在干槽症发病中的意义初探

目的：初步探讨幽门螺杆菌（Hp)在干槽症（DS）发病中的作用,方法：通过对20例DS患者拔牙窝和对侧相应部位牙齿龈下菌班的Hp－PCR检测了解Hp感染情况;并分组治疗观察抗幽门螺杆菌（抗（Hp)治疗DS的效果。结果：20例DS患者中有19例（95．0％）拔牙窝Hp-PCR检测阳性,其对侧相应部位牙菌斑阳性率亦高达65．0％,分组治疗结果两组差异显著（P＜0．05）。结论Hp可能与DS发病有关,其致病机理的研究尚待深入。     

Human enamel erosion in constant composition citric acid solutions as a function of degree of saturation with respect to hydroxyapatite

The objective of this study was to investigate human enamel erosion under constant composition conditions, as a function of solution degree of saturation (DS) with respect to hydroxyapatite. The experimental conditions were relevant to the initial stages of enamel erosion by soft drinks. Nanoindentation was used to compare enamel surface softening caused by a control mineral water and two citric acid solutions with DS = 0.000 and DS = 0.032, both having pH 3.30. Enamel hardness and reduced elastic modulus were measured after 0, 30, 60, 120, 300 and 600 s exposure. A statistically significant change in enamel hardness was detected after 30 s exposure to both citric acid solutions, indicating that nanoindentation is extremely sensitive to the initial stages of erosion. There was a statistically significant difference between the mechanical properties of enamel exposed to the two citric acid solutions after 30, 60 and 120 s. At these times, the solution with DS = 0.000 caused twice as much enamel softening as that with DS = 0.032. This demonstrates that it may be possible to design a soft drink with a low erosive potential and a good taste by a small change in DS, at a typical drink pH.     

A link between parotid salivary Ig level and recurrent respiratory infections in young Down's syndrome patients

The purpose of the present investigation was to assess the correlation between recurrent respiratory infections and the levels of salivary Ig in a group of young Down's syndrome (DS) individuals. Twenty-three DS and 10 age- and sex-matched healthy individuals were included. DS individuals who had experienced three or more upper respiratory tract infections (n = 10) in the previous 12 months were compared to DS individuals who had not experienced recurrent respiratory infections (n = 13) and to healthy controls (n = 10). A statistically significant reduction in the Ig salivary secretion rate was recorded in the subgroup with recurrent respiratory infections. No significant differences were seen between the subgroup without recurrent respiratory infections and controls. It is suggested that the secretory immune system provides local immune protection against pathogens in the respiratory tract. Detection of salivary Ig levels may serve as a predictor of the susceptibility of DS individuals to recurrent respiratory tract infections.     

Kinetics of enamel demineralization in vitro.

Previously, we reported that the rate (R) of hydroxyapatite dissolution in acetic, lactic, and phosphoric acid solutions is a function of the degree of saturation with respect to the dissolving mineral, DS (defined as the ratio of the mean ionic activity product for hydroxyapatite [Ca5OH(PO4)3] in solution to its solubility product constant), and the sum of the acid activities (sumBiH) in solution: R = K(1-DS)m(sumBiH)n. The present study was undertaken to explore the general validity of this model in describing the kinetics of enamel demineralization. Thin sections of human enamel were exposed to partially saturated 0.1 mol/L lactic acid solutions, at two different DS levels, and at pH values of 4.3 to 6.0. Thin sections of human enamel were also exposed to solutions with four different concentrations of acetic and lactic acids (pH 4.3) with three different DS values and, at one DS value, to solutions of propionic acid. Mineral loss was monitored by quantitative microradiography. In solutions with pH values of 4.3 and 5.0, "lesions" were formed with well-defined surface layers, whereas, in solutions with pH 6.0, "lesions" were produced with no apparent surface layers. The formation of relatively intact surface layers was consistent with predicted phase transformations. Rates of mineral loss were found to be inversely proportional to both the degree of saturation with respect to enamel mineral, DS(En), and the pH of the solution and increased with increased activities of each organic acid, consistent with the proposed model. However, at the same DS(En) and acid activity, rates of demineralization were the same in the acetic and propionic acid solutions, whereas rates of demineralization in lactic acid were greater. It is suggested that specific interactions of acid species with enamel mineral may modify the rate of enamel demineralization. These in vitro findings suggest that relatively small differences in DS(En) values found in plaque fluid may result in very significant differences in the rate of enamel demineralization in vivo.     

Dry socket incidence compared after a 12 year interval

A survey was conducted over a 3 month period in 1983 to examine the influence of clinical factors on the incidence of dry socket (DS) after extractions of permanent teeth under local analgesia. The findings were compared with those of a similar 3 month survey in the same hospital in 1971. Age, sex and extraction site each significantly influenced the incidence of DS. The major difference from the 1971 survey was an increase in the DS incidence from 3.0% to 4.0% of extractions. This occurred mainly following multiple extractions and may indicate that patients, particularly in this group, are nowadays less tolerant of any post-extraction discomfort and hence more readily return for attention. This is particularly relevant in the present study since the broad definition of DS used in both surveys embraced even the mildest presentations of disturbed socket healing.     

Dental management of the Down and Eisenmenger syndrome patient

About 40% to 50% of Down syndrome (DS) patients can have significant congenital heart defects such as patent ductus arteriosus, Tetralogy of Fallot, and septal defects. Patients with large septal defects may develop Eisenmenger syndrome (ES), which is defined by the cardiac septal defect and pulmonary hypertension coupled with a reverse right to left shunting of blood flow. DS patients that suffer from this condition require special considerations in the delivery of their dental care to prevent further medical complications or emergencies such as infection, cyanotic episodes, and thromboemboli. Collaboration with the cardiologist is also essential to ensure a complete and comprehensive pre-operative work up. The purpose of this article is to describe the dental management of DS patients with ES under general anesthesia.     

Medical problems and oral care of patients with Down syndrome: a literature review

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.     

Morphological aspects of the gingiva in children with Down''s syndrome during experimental gingivitis

In a previous investigation, children with Down's syndrome (DS) showed an earlier, more rapid and more extensive gingival inflammation than normal healthy control children. These differences in gingival inflammation may be the result of aberrant morphology of the gingiva related to the genetic disorder in DS children. The aims of the present study were (i) to describe the structural composition of "normal" gingiva in DS compared to control children, (ii) to analyse the histological changes in the gingiva during plaque development and (iii) to investigate whether the clinical findings could be supported by morphological observations. The study was carried out in 8 DS and 8 matched control children. Their ages ranged from 5-10 years. Gingival normality was guaranteed by strict oral hygiene procedures. During a period of 21 days in which oral hygiene was abolished, gingival biopsies were taken from buccal sites of deciduous teeth following a predetermined schedule on days 0, 7, 14 and 21. Results on day 0 showed no morphological differences between the DS and control children regarding oral epithelium, junctional epithelium or connective tissue. During the experimental phase of the study, the amount of plaque accumulation in the DS children gave rise to a more extensive gingival inflammation than in the control children. The gingival inflammation in the DS group started earlier and included: (1) an acute inflammatory response, (2) an increase of the junctional epithelium area, (3) an increase of the infiltrated connective tissue area (ICT) and (4) a decrease in collagen fibre density of about 35-40% compared to day 0. The same phenomena were not seen until 7 days later in the control group. Conversely, the development of a perivascular lymphocyte infiltrate (LI) in the DS children was delayed compared to the control group. This may be caused by the impaired delayed-type hypersensitivity response in DS children. The development of 2 separate infiltrates (ICT and LI) in this age group and the different temporal development of ICT (day 7 for the DS and day 14 for the control group) and LI (day 14 for the DS and day 7 for the control group) does suggest different immunological mechanisms for both areas and both groups.     

Severe impairment of secretory Ig production in parotid saliva of Down Syndrome individuals

Infections associated with Down Syndrome (DS) are prevalent in the mucosal-gastrointestinal and respiratory systems, for reasons that are uncertain. The purpose of the present study was to assess the levels of parotid salivary immunoglobulins (Ig) in a group of DS individuals as a possible factor in the susceptibility of mucosal surfaces to infections. Twenty-nine DS and 10 age- and sex-matched healthy individuals were included. Salivary flow rate and IgA, IgG, and IgM concentrations were recorded. The secretion rates of IgA and IgG were diminished by 83% (p < 0.001) and 75% (p = 0.05), respectively, whereas the secretion rate of IgM was not statistically significantly lower. Analysis of the data suggests that DS individuals are immunodeficient in the humoral mucosal immune response. This may explain, in part, the high incidence of recurrent infections in target organs of the secretory immune system in DS subjects.     

Morphometric variables of the primary second molar in children with Down syndrome.

Thirty-seven second primary molar teeth of children with DS were examined from casts of 6 girls and 8 boys aged 7-14 years, obtained from two centers for DS in Jerusalem and Haifa, Israel. One hundred and eighty-two primary second molars of normal children were examined from dental casts of 26 boys and 21 girls, which were taken for routine orthodontic evaluation. The following variables were examined on the teeth: all the inter-cuspal distances, the angle between the cusps, the area within the line connecting cusp tips, maximal buccolingual and mesiodistal dimensions, maximal perimeter of the occlusal table, maximal area of the occlusal table, maximal perimeter of the tooth crown from occlusal view, and maximal area from occlusal view. The results indicate that the second primary molars in individuals with DS are generally larger in the external dimensions (bl, md) than teeth of normal children, with larger inter-cuspal distances ('internal dimensions'). No significant change in the angles between the cusps were recorded. Thus, it seems that DS second primary molars retain the same cuspal shape of normal teeth, but with larger proportions. Sexual dimorphism was found to be more pronounced in the DS children. It is suggested that in DS, there may be a transitory acceleration in mitotic activity of developing enamel organs at about the early stage of gestation, which persists during the initial stages of mineralization of the primary teeth. The initial acceleration would then be followed by the widely recognized retardation in growth, reflected in smaller permanent teeth.     

A paired comparison of dental care in Canadians with Down syndrome and their siblings without Down syndrome

OBJECTIVE: To test the hypothesis that, controlling for age, Canadians with Down syndrome (DS) have dental care that is different to that of their siblings without DS. METHODS: A cross-sectional survey of parents of children with DS among members of the Canadian Down Syndrome Society (CDSS), using a validated questionnaire. Parents were asked to complete two versions of the questionnaire: one for their child with DS and another for the sibling closest in age without DS. A total of 2327 questionnaires were distributed; 1221 questionnaires for people with DS and 950 for siblings without DS were returned. A paired analysis (McNemar test) of dental care indicators was performed on data from 938 family pairs, stratifying for age. RESULTS: For all the dental care indicators and age groups, many respondents indicated the same behaviours or experiences in their child with DS and a sibling without DS. However, depending on the particular form of dental care and the age group, 0-47% of families reported discordant dental care experiences for their child with DS and a sibling without DS. The greatest differences were observed for yearly consults (P = 0.029), restorations (P < 0.001), fluoride therapy (P = 0.013) and extractions (P = 0.029). CONCLUSION: These observations suggest that compared to their siblings without DS, Canadians with DS are receiving different dental care.     

Immunohistological study of neuronal markers in inflamed gingiva obtained from children with Down''s syndrome

The histological appearance of the gingiva in children with Down's syndrome (DS) was studied with special reference to inflammatory involvement and innervation. A dense infiltration of inflammatory cells was seen in the propria of most of the DS patients, including a few polymorphonuclear leucocytes. A hyperplasia of the epithelium was also found. The innervation of the gingiva was studied using immunohistochemistry. Nerve fibers as well as nerve bundles immunoreactive to neurofilament (NF) were seen in the propria, while occasionally intraepithelial NF fibers were observed. Calcitonin gene-related peptide (CGRP)-immunoreactive fibers and fiber bundles were also visualized, but they were less abundant than NF fibers. The density of NF and CGRP fibers and fiber bundles was estimated by semiquantitative evaluation. A higher density of NF and CGRP immunoreactive structures was observed in the propria of DS patients compared to the control subjects, while no obvious alteration was seen in their distribution in the propria. In addition, sparsely distributed fibers immunoreactive to peptide histidine isoleucine amide (PHI) and vasoactive intestinal polypeptide (VIP) fibers as well as neuropeptide Y (NPY) and tyrosine hydroxylase (TH) were seen, mainly surrounding blood vessels. A few substance P (SP) fibers were also found, mostly close to the epithelium. No obvious differences of these sparsely distributed fibers were seen in the DS patients compared to controls. Thus, a profound inflammatory involvement of the gingiva of DS patients is seen concomitant with a hyperinnervation of the presumed sensory component of the gingival innervation. In contrast, no alterations were seen in the density of neuronal markers related to autonomic nerve fibers. The sensory hyperinnervation observed is probably not specifically related to DS, but may be due to a sprouting of afferent nerves induced by the inflammatory reaction. However, factors released from the sensory afferents could contribute to the gingival inflammation seen in DS.     

Evaluation of the relationship between caries indices and salivary secretory IgA, salivary pH, buffering capacity and flow rate in children with Down's syndrome

The aim of this study was to compare the caries prevalence and salivary secretory IgA (sIgA), salivary pH, buffering capacity and flow rate between Down's syndrome (DS) and control subjects. Seventy-three institutionalised children with DS and 70 normal children aged 7-12 years old were included in this study. Tooth-brushing habits and daily dietary sugar exposures of the children, family income and education levels of the parents were recorded. DMFS and dfs scores were assessed according to the World Health Organisation's criteria and stimulated whole saliva samples were collected. Salivary sIgA levels were determined by radial immunodiffusion technique, the average salivary flow rate was measured from the total volume, and salivary pH and buffering capacity were determined using a pH micro-electrode. All data were analysed using SPSS version 11.0. The DMFS and dfs scores were significantly lower in the DS group than the control group (P < 0.05). Otherwise, the difference in plaque scores between the DS and control groups was not statistically significant (P > 0.05). There were no significant differences in tooth-brushing habits and daily dietary sugar exposures of the children, family income and education levels of the parents between the two groups (P > 0.05). Salivary sIgA levels were significantly higher in the DS group (P < 0.05). Salivary pH, buffering capacity and flow rate were quite similar in both the DS and control groups (P > 0.05). In conclusion, the patients with DS had a significantly lower prevalence of caries and significantly higher levels of salivary sIgA in this study. This finding tends to support the hypothesis that higher levels of salivary sIgA may protect against dental caries.     

Clinical and Histological Findings of Denture Stomatitis as Related to Intraoral Colonization Patterns of Candida albicans,Salivary Flow,and Dry Mouth

Purpose: Multifactorial etiological factors contribute to denture stomatitis (DS), a type of oral candidiasis; however, unlike other oral candidiasis, DS can occur in a healthy person wearing a denture. In this study, we therefore attempt to explore the association between candida, denture, and mucosal tissue using (1) exfoliative cytology, (2) the candidal levels present in saliva, on mucosal tissues and on denture surfaces, and (3) the salivary flow rate and xerostomic symptoms. Materials and Methods: A cross‐sectional study enrolled 32 edentulous participants, 17 without DS as controls and 15 with DS (Newton's classification type II and III). Participants with systemic or other known oral conditions were excluded. Participants completed a xerostomia questionnaire, and salivary flow rates were measured. Samples of unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. UWS was used for fungal culturing. Periodic acid‐Schiff (PAS) stain and quantitative exfoliative cytology were performed on samples from affected and unaffected mucosa from each participant. Levels of Candida species (albicans and non‐albicans) were determined in salivary samples (expressed as colony‐forming units, CFU), as well as from swab samples obtained from denture fitting surfaces, in addition to affected and unaffected mucosa. Results: There were no significant differences in salivary flow rates, mucosal wetness, or frequency of reported dry mouth comparing participants with and without DS. Exfoliative cytology of mucosal smears demonstrated significantly higher (p= 0.02) inflammatory cell counts in DS patients, as compared with smears of healthy denture‐wearers. Candida albicans was significantly more prevalent in saliva (p= 0.03) and on denture surfaces (p= 0.002) of DS participants, whereas mucosal candidal counts and the presence of cytological hyphae did not show significant difference comparing DS to healthy participants. Conclusions: In this investigation, we presented a unique group of healthy edentulous patients. This population may reflect the general DS population without systemic or other oral diseases. The prominent etiological factor for DS in this population is the presence of candida in denture and saliva. We found that other factors such as saliva flow/xerostomia, fitting of the denture, and the presence of candida in the mucosa, are less important in this population. Therefore, DS treatments in healthy patients should first focus on sanitization of an existing denture and/or fabrication of a new denture.     

Pregnancy, breast-feeding and drugs used in dentistry

BACKGROUND: and Overview. Despite advances in the study of birth defects related to drug exposures during pregnancy, medication use during pregnancy still causes anxiety and misunderstanding among both members of the public and health care professionals. This may result in a woman's unknowingly taking a medication that may harm the fetus or cause a birth defect or discontinuing medications necessary for treating chronic conditions. Using medications while breast-feeding also represents a challenge for patients and prescribers. Many mothers are told they must stop breast-feeding or "pump and discard" their breast milk if they are taking certain medications; however, in many cases, this advice-based on what may be limited education on the part of the health care provider about breast-feeding and medication use-may be incorrect. The authors review the current evidence regarding drugs that may be safe for pregnant or breast-feeding patients and medications that such patients should avoid. CONCLUSIONS: When considering prescribing in pregnancy, the dentist must weigh the risk to the fetus versus the benefit to the mother, and the appropriate conclusion should reflect current evidence. In some cases medication dosing should be avoided or altered; however, there are times when it is unnecessary to stop the use of medications. Breast-feeding also represents a clinical challenge, the risks and benefits of which need to be understood by both the patient and practitioner before any medication is administered. Practice Implications. Dentists should be familiar with the risks and benefits for pregnant or breast-feeding patients posed by five types of medications: analgesics and anti-inflammatories, antibiotics, local anesthetics, sedatives and emergency medications.