Dental findings in Kabuki make-up syndrome: a case report

This article documents the case history of a 9‐year‐old Brazilian child diagnosed with Kabuki make‐up syndrome (KMS). The clinical features are described, with emphasis on the craniofacial and orodental manifestations. The patient had the distinctive KMS craniofacial features consisting of long palpebral fissure, hypertelorism, high‐arched eyebrows with sparse hair in the lateral one‐third, eyes with eversion of the lateral one‐third of the lower eyelids, long and curved eyelashes, palpebral ptosis, large anteverted prominent ears in a lower position, broad, depressed nasal root with a flat nasal tip, and mild neuropsychomotor developmental deficits. The intraoral examination revealed an anterior open bite, overretention of primary teeth, and a high‐arched palate. Two findings in this child have not been previously reported in patients with KMS: the presence of supernumerary teeth and taurodontic teeth in the maxillary arch. The clinical and radiographic detection of these unique dental features may be helpful in identifying children who may have milder forms of KMS.     

Enamel microabrasion in an individual with Cohen syndrome

This case report describes the esthetic dental treatment of a patient with Cohen syndrome where microabrasion was used to treat dental fluorosis. The patient's teeth had white and light yellow spots, which were diagnosed as moderate dental fluorosis. These spots were treated with microabrasion using pumice paste and 37% phosphoric acid. The paste was applied with a rubber cup on a low-speed handpiece and manually using a wooden stick. It took four appointments to treat all of the patient's teeth. Topical neutral fluoride was applied after each appointment to decrease any dental sensitivity. The esthetic result was satisfactory. Esthetic dental treatment may result in positive emotional and behavioral changes in patients with special needs.     

Selection of restorative materials for the atraumatic restorative treatment (ART) approach: a review

The atraumatic restorative treatment (ART) technique or approach for the restoration of primary and permanent teeth has been widely adopted in, but not limited to, developing countries. However, the requirement for the placement of the restorative materials under often less-than-ideal conditions imposes significant restrictions on their selection; and there have been very few randomized clinical trials or reports comparing different types of restorative materials and treatments. Although conventional glass-ionomer cements (GICs) have relatively poor mechanical and adhesive strengths, their satisfactory biological features, ease of use, and low costs are distinct advantages. Most of the published reports of the clinical performance of the newer, high-strength esthetic conventional GICs specifically marketed for the ART approach have been from short-term studies. Satisfactory clinical performance has been demonstrated for single-surface posterior restorations only, over three years. Findings indicate that further improvements in restorative materials are still required for their use with the ART approach, together with further clinical investigations of the remineralization of shallow open caries lesions, as an alternative to placing definitive restorations.     

Cardiovascular response to epinephrine-containing local anesthesia in patients with cardiovascular disease

OBJECTIVE: The purpose of the present study was to examine the safety of epinephrine-containing local anesthesia for use on patients with cardiovascular disease. STUDY DESIGN: Twenty-seven patients with cardiovascular disease were studied. The cardiac functional capacity of 9 patients was New York Heart Association class I; 11, class II; and 7, class III. Hemodynamic responses to intraoral injection of 1.8 mL of 2% lidocaine with 1:80,000 epinephrine were measured with impedance cardiography. RESULTS: Systolic blood pressure and heart rate increased by 4.1% and 5.1%, respectively, immediately after the lidocaine-epinephrine injection. Consequently, rate pressure product increased by 10.0%. Cardiac index increased by 14.2%, and total peripheral resistance decreased by approximately 10%. No patient complained of cardiac symptoms. There were no significant differences in hemodynamic responses related to the extent of the cardiac functional capacity. CONCLUSION: We concluded that lidocaine-epinephrine was safe and had few, if any, hemodynamic consequences in patients with cardiovascular disease.     

Tenderness on palpation and occlusal abnormalities in temporomandibular dysfunction

Tenderness on palpation indicates objective painful symptoms. This study investigated the tenderness of the temporomandibular joint, muscles and their relation to occlusion in patients with temporomandibular dysfunction. Two hundred ten patients were examined; 96% had tenderness and 80% of cases of tenderness were diagnosed as occlusally related. The average number of tender areas was 5.4 per patient, despite the contribution of occlusion. Tenderness was observed most frequently in the lateral pterygoid muscle, followed by the insertion of temporal muscle. There was no correlation of temporomandibular joint tenderness to muscle tenderness, while tenderness of certain muscles to each other was correlated. Differences were related to the state of occlusion in the number of tender areas, to the ratio to tenderness of elevator muscles to horizontally acting muscles, and to the frequency of unilateral tenderness. The association of muscle tenderness and occlusion was suggested.     

Poly dental addiction

Poly dental addiction is a psychiatric condition characterized by patients insistently and repeatedly undergoing dental treatment where no organic pathology can be demonstrated and treatment consistently fails to alleviate their symptoms. In this paper two such cases are presented. One patient had multiple extractions and numerous surgical explorations for facial pain and the other had more than thirty dentures constructed over a four-year period for a burning mouth.     

Adhesion to enamel of light-cured poly-acid dental materials

The purpose of this study was to determine the tensile bond strengths of a resin-modified glass ionomer cement and a poly-acid modified resin composite to enamel. Three different enamel surface preparations (unetched enamel; enamel treated with 10 per cent polyacrylic acid; enamel etched with 35 per cent phosphoric acid), were used. On etched enamel, the glass ionomer cement (15.0 MPa) and the resin composite (14.3 MPa) had significantly higher bond strengths than the other groups tested, but were not significantly different from each other. In the acid treated groups, cohesive failure within the material occurred in all specimens, while in the other groups, all specimens failed adhesively. Further investigation is required to test the clinical efficacy of these restorative materials.     

Declining attendances for general anaesthesia and tooth extractions in children following the fluoridation of Melbourne

Attendances for tooth extractions under general anaesthesia in children aged one to seven years at the Royal Dental Hospital of Melbourne have declined about 80 per cent from 1977 to 1986. The form of the decline follows the general pattern of decreasing dental caries in younger children in Melbourne since fluoridation. Since 1983 the numbers of attendances and extractions have remained relatively constant. Now younger children requiring fewer extractions are attending the Hospital. While there has been an increase in the proportion of those needing one or two teeth removed, fewer children are having three or more teeth removed. Nevertheless a small proportion of children still require 10 or more teeth removed. Two-thirds of the children presenting since 1983 have been life-time residents of Melbourne, indicating that more than fluoridation is required to reduce dental caries to manageable proportions in some high risk groups.