Correlation of bone age, dental age, and chronological age in survivors of childhood acute lymphoblastic leukaemia

Background. There is little information about oncotherapy-related dental development in childhood acute lymphoblastic leukaemia (ALL).
Objective.  The objective of this study was to compare bone age (BA) and dental age (DA) to chronological age (CA) in childhood ALL survivors.
Methods.  We retrospectively reviewed hand–wrist and panoramic radiographs of patients treated on contemporary single institution protocols for ALL between 1991 and 2004. We recorded patient demographics, therapeutic protocol, CA, DA, and BA. The cohort was divided into three categories based on age at diagnosis (< 6 years, 6–9 years, > 9 years).
Results.  Of 73 patients, 39 (53.4%) were boys; 55 (75.3%) were Caucasian. Median CA at diagnosis was 4.5 years (range: 0.1–11.0 years); time to study was 4.1 years (range: 0.3–11.4 years). BA was normal in 61 (83.6%), delayed in 10 (13.7%), and advanced in 2 (2.7%). DA was normal in 41 (56.9%), delayed in 8 (11.1%), and advanced in 23 (31.9%). Abnormal BA, abnormal DA, and discrepancy between BA and DA are not statistically significantly associated with investigated patient or treatment factors.
Conclusions.  DA may be altered in 43.1% of patients treated for ALL. A large prospective study is warranted to better define our observations and to determine their impact on dental and orthodontic management.     

Dental maturation of 18th and 19th century British children using Demirjian's method

Aim . To compare dental age with chronological age in a group of children born approximately 200 years ago and a group of modern children.
Methods . Dental maturation of 15 skeletal remains (range 3·0–15·1 years) of London children of known age-at-death was compared to an age and sex matched control group of contemporary children ( n  = 30). The method of Demirjian, Goldstein and Tanner (1973, 1976, 1978) was used to assess maturity.
Results . The difference between dental age (DA) and chronological age (CA) for both groups was not significant, suggesting similar maturation over 200 years, however, many of the younger children from Spitalfields were dentally delayed. Several of the younger individuals from both groups had a dental age less than the lowest limit of this scale (2·5 years), highlighting one pitfall of this method.
Conclusion . These results suggest that this method is not entirely suitable for younger children.     

An assessment of adverse effects of antiretroviral therapy on the development of HIV positive children by observation of dental mineralization chronology

J Oral Pathol Med (2010) 39 : 35–40
Background:  The difference between dental age (DA) and chronological age (CA) indicates an advance or delay in comparison with the normal standard. Considering that DA has a very close correlation with CA in a developing child, this study aimed to investigate the relationship between the effects of antiretroviral therapy on the development of HIV positive children, by observing the timing of dental mineralization.
Methods:  A retrospective examination was made of the medical records and dental panoramic radiographs of 50 HIV-positive pediatric patients, aged 37–168 months of age. Through these radiographs, their DA was estimated and compared with their CA.
Results:  The mean DA was significantly lower than the mean CA in the entire studied sample ( P  < 0.01). There was a statistical difference between children who received antiretroviral drugs and those who used no drugs ( P  = 0.02), i.e. the non-treated individuals presented practically no difference between CA and DA, while the treated patients showed a difference of 10.67 months.
Conclusion:  We conclude that the DA of HIV infected children was delayed when compared to the CA, and there was a positive association between the use of antiretroviral therapy and a delay in the chronology of dental mineralization in the sample.     

Dental maturation in British children: are Demirjian's standards applicable?

Objective . The objective of this study was to determine if the standards of dental maturation of Demirjian et al . (1973, 1976) are applicable to British children.
Design . The design was cross-sectional, retrospective.
Sample and method . The sample comprised 521 London children of Bangladeshi and white Caucasian (English, Welsh and Scottish) origin aged between 4 and 9 years. Dental age was assessed by crown and root stages of seven mandibular teeth from rotational pantomographs. Dental age was compared to chronological age using a t -test.
Results . Differences in dental maturation between the two ethnic groups were not significant. British children as a group were dentally advanced compared to the Canadian standards. The mean (± standard deviation) advancement in girls was 0·51 ± 0·79 years and in boys was 0·73 ± 0·73 years.
Conclusions . The standards of dental maturation described by Demirjian et al . (1973, 1976) may not be suitable for British children.     

Caries and dental fluorosis in a 0·25 and a 2·5 ppm fluoride area in the Sudan

The purpose of this study was to assess the caries prevalence of children living in areas with either 0·25 or 2·5 ppm fluoride in the drinking water, and to relate caries experience to the severity of dental fluorosis. The children, aged 6–16 years (mean 11·3 years), were lifelong residents of their rural villages. The severity of dental fluorosis in the maxillary central incisors, assessed by Deans index, was 1·4 ± 0·9 ( n  = 59) and 2·3 ± 0·9 ( n  = 65) in the 0·25 and 2·5 ppm areas, respectively. There was no significant difference in DMFT between children from the two areas (2·6 ± 2·3 n  = 59 versus 2·1 ± 2·3, n  = 65). In the low-fluoride area 75% of the children had decayed permanent teeth compared to 66% in the high-fluoride area. In the primary teeth, however, both the caries prevalence and the dmft were significantly lower in the 2·5 ppm area than in the low-fluoride area. Stepwise, multiple, linear regression analyses, including all children, showed a significant effect of age on DMFT (30% of the variance explained), but no explanatory effect of fluoride in drinking water, severity of dental fluorosis, or gender. Regression analyses based on children in the 2·5 ppm area alone, showed significantly higher DMFT by increased severity of dental fluorosis. In children with a mixed dentition ( n  = 66), there was no association between caries in the primary and permanent teeth.     

Vegetarianism and dental fluorosis among children in a high fluoride area of northern Tanzania

Objective . The purpose of this study was to compare the prevalence and severity of dental fluorosis among vegetarian and nonvegetarian children and adolescents living in an area where dental fluorosis is endemic.
Design . An analytical cross-sectional retrospective study.
Sample and methods . Children ( n  = 165) aged 6–18 years, from five schools in Arusha town were examined. The children had a life-long exposure to drinking water with 3·6 mg F/litre. The severity of dental fluorosis was assessed using the Thylstrup & Fejerskov Index (TFI).
Results . In the vegetarian group ( n  = 24), the prevalence of dental fluorosis (TFI score 1) was 67%, while 21% had severe fluorosis (TFI score 5). In the nonvegetarian group ( n  = 141) the prevalence of fluorosis and severe fluorosis was 95% and 35%, respectively. In bi-variate correlation analyses age, vegetarianism and a series of other factors related to childhood nutrition (meals per day, the use of home-made porridge, the use of fish, etc.) were significantly associated with the tooth prevalence of dental fluorosis (TPF, P < 0·05). Stepwise multiple linear regression analyses explained 30% of the variance in TPF; age 15% points and vegetarianism 13% points. Multiple logistic regression analysis showed that the risk of developing dental fluorosis was seven times higher among nonvegetarians than among vegetarians.
Conclusion . The significantly lower prevalence and severity of dental fluorosis among the vegetarian group compared to the nonvegetarians would seem to be related to diet.     

Effectiveness of a caries preventive program in pregnant women and new mothers on their offspring

Objective . The medical centre at Almirante Nef Naval Hospital, Vina del Mar, Chile, operates a mother and child preventive dental program (PDP) which includes women from their fourth month of pregnancy and mothers with their offspring. The aim was to evaluate the effectiveness of this prenatal and postnatal prevention program after the first four years.
Methods . The prevalence of early childhood caries of 180 1- to 3·5-year-old children enrolled in the PDP was compared with 180 non-participating children. The control group was randomly selected from the rolls of the healthy child system of the Valparaiso-San Antonio Health Service and was comparable by age, socio-economic status and level of fluoride in the drinking water (1·0 p.p.m. F) with the PDP group. Clinical caries examinations were conducted by two calibrated examiners using the WHO visual criteria.
Results . In the PDP group, 97% of the children were caries free compared with the 77% in the control group. The dft (mean ± SD) of the PDP children was 0·11 ± 0·78 versus 0·66 ± 1·55 for the control children, a difference of 83·3%. The differences between the groups in caries-free status and caries prevalence were both statistically significant ( P  < 0·05).
Conclusions . The preventive dental program was effective in inhibiting caries in pre-school children, even in a population already receiving the benefits of community water fluoridation.     

Oral lesions and dental caries status in perinatally HIV-infected children in Northern Thailand

Summary. Objective. To describe the prevalence of oral lesions and dental caries status in perinatally HIV-infected children.
Design. A cross-sectional study.
Setting. Paediatric HIV outpatient department at the Nakornping Provincial Hospital, Chiang Mai, Thailand.
Patients and methods. Forty children with perinatal HIV infection, from early infancy to 12 years of age, were included in the study. These children were examined for oral lesions and dental caries. A number of children receiving antifungal and antiretroviral (ART) therapy were recorded.
Results. The mean DMFT and DMFS scores were both 2·1 (SD = 2·3). The dft and dfs scores were 4·1 (SD = 5·0) and 10·9 (SD = 14·8), respectively. A total of 57·5% of the children had one or more oral lesions. Oral candidiasis and hairy leukoplakia were the most common oral lesions. Only 12·5% of children had received ART. A total of 22·5% of the children had a history of receiving antifungal therapy.
Conclusions. Oral lesions and dental caries were relatively high in this study. Consequently, treatment and prevention for oral lesions and dental caries are inevitably required for children with HIV infection in Northern Thailand. Furthermore, ART should be made available for all HIV-infected children to decrease the prevalence of HIV-associated oral lesions.     

Hutchinson-Gilford progeria syndrome: oral and craniofacial phenotypes

Objective:  Hutchinson-Gilford progeria syndrome (HGPS) is a rare early-onset accelerated senescence syndrome. In HGPS, a recently identified de novo dominant mutation of the lamin A gene ( LMNA ) produces abnormal lamin A, resulting in compromised nuclear membrane integrity. Clinical features include sclerotic skin, cardiovascular and bone abnormalities, and marked growth retardation. Craniofacial features include 'bird-like' facies, alopecia, craniofacial disproportion, and dental crowding. Our prospective study describes dental, oral soft tissue, and craniofacial bone features in HGPS.
Methods:  Fifteen patients with confirmed p.G608G LMNA mutation (1–17 years, seven males, eight females) received comprehensive oral evaluations. Anomalies of oral soft tissue, gnathic bones, and dentition were identified.
Results:  Radiographic findings included hypodontia ( n  = 7), dysmorphic teeth ( n  = 5), steep mandibular angles ( n  = 11), and thin basal bone ( n  = 11). Soft tissue findings included ogival palatal arch ( n  = 8), median sagittal palatal fissure ( n  = 7), and ankyloglossia ( n  = 7). Calculated dental ages (9 months to 11 years 2 months) were significantly lower than chronological ages (1 year 6 months to 17 years 8 months) ( P  = 0.002). Eleven children manifested a shorter mandibular body, anterior/posterior cranial base and ramus, but a larger gonial angle, compared to age/gender/race norms.
Conclusion:  Novel oral-craniofacial phenotypes and quantification of previously reported features are presented. Our findings expand the HGPS phenotype and provide additional insight into the complex pathogenesis of HGPS.     

颈椎骨龄与牙龄推断上海地区儿童年龄的准确性比较

目的 ：评估并比较Willems牙龄推断法和上海地区特异性颈椎骨龄回归公式2种方法在推测上海地区儿童实足年龄上的适用性及准确性。方法：选取符合纳入标准的上海地区8～15岁儿童的全景片和头颅侧位片640张（男160名,女160名,全景片和头颅侧位片各320张）,分别运用Willems法和颈椎骨龄回归公式评估得到牙龄和颈椎骨龄。采用SPSS 25.0软件包中的配对t检验或Wilcoxon符号秩检验,评估实足年龄与推断年龄之间的差异;通过比较2种方法的标准差、平均绝对误差、可接受误差内的正确判断率,对2种方法的准确性进行评价。结果：相比实足年龄,男性牙龄平均低估（0.75±1.03）岁,女性平均低估（1.05±1.18）岁;男性颈椎骨龄平均低估（0.78±1.40）岁,女性平均低估（0.53±1.31）岁。Willems牙龄推断法的总平均绝对误差为1.15岁,上海地区颈椎骨龄回归公式的总平均绝对误差为1.20岁。临床可接受误差在±0.5岁内的正确判断率Willems法和颈椎骨龄回归公式分别为26.25%和27.19%。结论：相比上海地区特异性颈椎骨龄回归公式,Willems法在推断上海地区8...     

Intra-nasal midazolam in conscious sedation of young paediatric dental patients

Summary. Objectives . To compare the effects of 3 different doses of intra-nasal midazolam in the conscious sedation of young paediatric dental patients and to compare the effectiveness of the sedation in the fasting and non-fasting child.
Design . Double blind random controlled trial.
Sample and Methods . Thirty-eight uncooperative young children aged 2–5 years (mean age 4·02 years) were randomly assigned to one of 3 groups. The groups and the doses of midazolam administered intra-nasally were A: 0·3 mg/kg, B: 0·4 mg/kg, and C: 0·5 mg/kg body weight. Each child in each group had two visits for restorative treatment: one without food (fasting) and the other with soft drink and light food (non-fasting) before treatment. Child behaviour and sedative effects were evaluated using the scoring system of Houpt. The vital signs were monitored continuously using a pulse oximeter and Dinamap machine.
Results . There was rapid onset of sedation with the maximal effect between 8 and 15 minutes. This sedation lasted for 25–40 minutes in Groups A and B and for 60 minutes in Group C. Conscious sedation and dental treatment were achieved in 79%, 96% and 100% of the children in Groups A, B and C, respectively. Consistently higher Houpt scores were seen in Groups B and C, with statistically significant differences between Groups A and C, and B and C (Tukey's range test, P < 0·05). There were no significant differences in the general behaviour of the child, the onset and the duration of sedation between the fasting and the non-fasting child (nonparametric anova P > 0·05). All the vital signs were within normal physiological limits and there were no significant adverse effects either with or without fasting.
Conclusions . All 3 doses of intranasal midazolam were effective in modifying the behaviour of the uncooperative child patient to accept dental treatment. This was irrespective of fasting.     

Craniofacial morphology in patients with hypophosphataemic vitamin-D-resistant rickets: a cephalometric study

Summary  Hypophosphataemic vitamin-D-resistant rickets (HVDRR) is a hereditary disease mainly transmitted as an X-linked dominant trait and characterized by certain general clinical signs (Filho HM, de Castro LC, Damiani D. Arq Bras Endocrinol Metab . 2006;50:802). In literature, only one study had been published in 1965 on the cephalometric findings in patients with HVDRR (Marks SC, Lindahl RL, Bawden JW. J Dent Child . 1965;32:259). This is the first detailed study on craniofacial characteristics of patients with HVDRR in the dental literature. The aim of this study was to determine the effect of HVDRR on the parameters of the craniofacial skeleton of young Jordanian patients using cephalometric analysis. Lateral cephalometric radiographs were made for 22 Jordanian children (aged 2–16 years) diagnosed with HVDRR. The cephalometeric parameters of HVDRR group were compared with those of normal control group matched for gender and chronological age using paired t -test. The HVDRR group had a significant increase in the SNBa angle ( P  < 0·01); as well as reduced anterior cranial base length ( P  = 0·01), reduced maxillary length, corpus mandibular length and mandibular height ( P  = 0·01, 0·04 and 0·008 respectively). The cranial base and gonial angles were significantly increased in diseased individual, but the SNA and ANB angles were significantly reduced ( P  = 0·018 and 0·000 respectively). The angulation of the lower incisor to mandibular plane was also significantly reduced in the diseased group compared with Jordanian norm ( P  = 0·004). Patients with HVDRR have deficiency in the anterior cranial base length, ramus height and cranial base angle. Patients with HVDRR also have class III skeletal relationship.     

Determinants of self-rated oral health status among school children in northern Tanzania

Summary. Objective . This study aimed to assess the perceived oral health status and to explore its relationship with clinically assessed dental fluorosis among school children in Arusha town, Tanzania.
Methods . A total of 478 students (mean age 15·7 years) completed questionnaires administered in the schools during May to July 2000. Clinical photos of the upper and lower incisors were taken under field conditions. A total of 461 slides were rated under laboratory conditions. The severity of dental fluorosis in the permanent maxillary central incisors was assessed using the Thylstrup & Fejerskov Index (TFI).
Results . The prevalence of dental fluorosis at TFI score ≥ 2 was 74%. A total of 67% of boys and 70% of girls rated their teeth as yellow to brown, 58% of boys and 68% of girls ( P  < 0·05) confirmed dissatisfaction with their dental appearance. Kappa values of 0·40–0·44 were obtained between dental fluorosis (TFI ≥ 2) and self-reported discoloration. The proportion of school children reporting dissatisfaction with oral condition and dental appearance increased with increasing TFI scores. Stepwise multiple logistic regression analysis explained 21% and 32% of the variance in the dissatisfaction with oral condition and dental appearance scores; TFI scores 11% and 15% of variation in points, and social and psychological variables 11% and 17%.
Conclusion . Whereas dental fluorosis at different diagnostic cut-off points impacts self-rated oral health negatively, social and personal factors are as important in shaping the responses of school children to oral condition and dental appearance.     

A prospective study of dental anxiety in a cohort of children followed from 5 to 9 years of age

Background.  The development of dental anxiety in children is poorly understood.
Aims.  The aims of this study were to measure changes in dental anxiety over time and to examine the relationship between anxiety, dental care, and other factors.
Design.  A prospective cohort study of children in the north-west of England followed from 5 to 9 years of age. The participants were clinically examined and their parents completed the same questionnaire at 5 and 9 years.
Results.  The majority (54.3% N  = 38) of participants who were anxious at 5 years were no longer anxious at 9 years, but a large proportion of children who were anxious at 5 remained anxious at 9 years of age (45.7% N  = 32). During the follow-up period, a larger proportion of children developed anxiety (11.7% N  = 85) than the proportion of children who were reported as being anxious at baseline (8.8% N  = 70). At 9 years of age, dental anxiety was significantly associated with girls; parental anxiety; a history of extraction; and irregular, asymptomatic dental visiting. These factors were also significantly associated with dental anxiety at 5 years old.
Conclusions.  Dental anxiety was cumulative in the study population over time, and its development influenced by multiple variables. Results suggest that adverse conditioning and vicarious learning are both important in the development of this condition.     

Assessment of dental maturity of Brazilian children aged 6 to 14 years using Demirjian's method

Summary. Dental maturity, often expressed as dental age, is an indicator of the biological maturity of growing children. A method for the assessment of dental maturity was first described by Demirjian, and is widely used and accepted, mainly because of its ability to compare different ethnic groups. This is possible, as the maturity scoring system proposed by the method is universal in application, although the conversion to dental age depends on the population considered.
Objectives. The aim of this study was to apply Demirjian's method to Brazilian children aged 6–14 years in order to obtain dental maturity curves for each sex, to compare this data with that obtained by Demirjian, and to determine whether there is a significant correlation between dental maturity and body mass index.
Methods. We retrospectively reviewed the orthopantomograms, height and weight measurements of 689 healthy children. Curves of dental maturity of males and females were constructed.
Results. When compared to the French-Canadian sample of Demirjian, Brazilian males and females were 0·681 years and 0·616 years, respectively, more advanced in dental maturity. There was no significant correlation between dental maturity and body mass index.     

Children choosing between general anaesthesia or inhalation sedation for dental extractions: the effect on dental anxiety

Summary. Aim. To compare the levels of dental anxiety experienced by children having dental extractions using general anaesthesia (GA) with those having extractions using local anaesthesia and inhalation sedation (IHS) when offered a programmed choice between the two techniques prior to treatment.
Design . Structured interview with child at pre-treatment and at one week (approximately) follow up.
Setting . Community: primary health care centre.
Subjects . Children aged 9–15 years referred to a local NHS Trust dental clinic ( n  = 88).
Intervention . Child and parent provided with information about IHS and its benefits over GA for the assistance in tolerating extraction of teeth and provided with a choice of procedure.
Main outcome measure . An eight question modified child dental anxiety scale.
Results . Full information was received from 76 children giving an 86% response rate. Post-operative dental anxiety was lower in children who had chosen (with their parent) IHS in comparison to those who had chosen general anaesthesia ( P < 0·05). Dental anxiety remained unchanged in the group who chose to have their extractions under GA.
Conclusion . Children and their parents who select IHS as opposed to GA to assist in extractions demonstrate less psychological distress.     

Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren

Abstract –  This study reports on the etiology and environment where dental injuries occurred and assesses the relationship between dental trauma, socio-economic status and dental caries experience. A population-based, matched case-comparison study was undertaken in 30 schools in two Ontario communities. Dental hygienists calibrated in the use of the Dental Trauma Index (DTI) screened 2422 children aged 12 and 14 years using DTI and Decayed, Missing and Filled Teeth indices. Cases ( n  = 135) were children with evidence of dental injury. Controls ( n  = 135) were children randomly selected after screening and matched with cases according to age and gender. Questionnaires were mailed to parents and children. Prevalence of dental injury was 11.4%, mostly minor injuries 63.7% (enamel fracture not involving dentin), affecting one upper central incisor (70.4%). The mean age at the time of dental injuries was 9.5 years (SD = 1.49; range: 6–13 years). Dental trauma most often occurred among boys at school because of falls or while playing sports. The relationship between dental injuries and the socio-economic indicators chosen was not statistically significant. However, a statistically significant direct relationship ( P  < 0.001) was shown between increased caries experience and dental injuries. This should focus attention on possible common-risk factors such as health-related behavioral problems that may affect both dental disease and dental injuries.     

Skeletal and dental age discrepancy and occlusal traits in children with growth hormone deficiency and idiopathic short stature

Clinical Oral Investigations - The aim of the study was to evaluate the dental and bone age delay and occlusal traits of children with growth hormone deficiency (GHD) and idiopathic short stature...     

Body adiposity status in teenagers and snacking habits in early childhood in relation to approximal caries at 15 years of age

Background.  The prevalence of overweight and obesity in children is steadily increasing in many countries. Dental caries and obesity are both multifactorial diseases and are associated with dietary habits.
Objective.  The purpose of this study was to investigate the relationship between body weight status in adolescents and snacking habits in early childhood to approximal caries prevalence at 15 years of age.
Methods.  This study is part of a series of surveys of oral health in children followed from the ages of 1 year to 15 years. Body adiposity status was estimated at 13.5–16.4 years using the International Obesity Task Force cut-off values [age-specific body mass index (isoBMI)]. Information about snacking habits in early childhood was collected from interviews conducted at 1 year and 3 years. Approximal caries information was obtained from bitewing radiographs at 15 years. Data related to isoBMI and approximal caries were available in 402 teenagers.
Result.  Adolescents with isoBMI ≥ 25 ( n  = 64) had an approximal caries prevalence that was a mean of 1.6 times higher than those with isoBMI < 25 ( n  = 338) (4.64 vs. 2.94; P  = 0.014). Furthermore, children's snacking habits at an early age were associated with approximal caries at 15 years.
Conclusion.  Overweight and obese adolescents had more approximal caries than normal-weight individuals. Moreover, the frequent consumption of snacking products during early childhood appears to be a risk indicator for caries at 15 years. Future preventive programmes should therefore include, on a multidisciplinary level, strategies to prevent and reduce both obesity and dental caries at an early age.