Nonsyndromic craniosynostosis: diagnosis and contemporary surgical management

Contemporary surgical management of nonsyndromic craniosynostosis requires the combined expertise of a pediatric craniofacial surgeon and pediatric neurosurgeon. The goals of surgical intervention are the release of the affected suture, which allows for unrestricted development of the visceral components (eg, brain, eyes) and three-dimensional reconstruction of the skeletal components, which establishes a more normal anatomic position and contour. Surgeon who care for infants with these cranial and orbital malformations must maintain a thorough understanding of the three-dimensional anatomy, characteristic dysmorphology associated with the different types of synostosis, and the complex interplay that exists between surgical intervention and ongoing skeletal growth.     

POLARIZATION OF DENTAL CARIES AMONG INDIVIDUALS AGED 15 TO 18 YEARS

Objective:

To evaluate the role of socioeconomic variables and self-perceived oral health in the polarization of caries among adolescents in Santa Bárbara D''Oeste, Brazil.

Material and Methods:

Cross-sectional study. Sampling was randomized and sample size was defined according to WHO criteria. Two hundred and seventy seven adolescents (15 to 18 year-old) were examined by five trained examiners that assessed DMFT index according to WHO criteria. Self-perceived oral health, access to dental services and socio-demographic variables were self-reported. Student''s t tests, chi-square tests, and multivariate logistic regression (with significant caries index (SiC) as the outcome), were performed.

Results:

Mean DMFT was 5.48 (±4.22) and the proportion of "caries free" subjects was 15.5%. Mean DMFT (9.71±2.85) and mean D (1.67±2.18) of SiC positive subjects were significantly higher than mean DMFT (2.88±2.17) and mean D (0.45±0.87) of SiC negative subjects (p<0.0001). Mean D of white (0.76±1.51) was significantly smaller than mean D of non-white subjects (1.32±2.01). The only variable independently associated with the "SiC positive" outcome was "report of toothache within six months prior to the study" [OR=1.83 (95%CI 1.08 to 3.12)], p<0.001.

Conclusion:

SiC was associated with "report of toothache" but not with sociodemographic variables in the studied population.     

PATTERN OF DISOCCLUSION IN PATIENTS WITH COMPLETE CLEFT LIP AND PALATE

Objective:

to analyze the pattern of disocclusion during excursive mandibular movements and presence or absence of occlusal interferences and occlusal pathologies (gingival recession and abfraction).

Method:

examination of 120 individuals divided into two groups, as follows: Group 1-90 patients with complete cleft lip and palate (study group), subdivided into 30 patients with complete left unilateral cleft lip and palate, 30 patients with complete right unilateral cleft lip and palate and 30 patients with complete bilateral cleft lip and palate; Group 2-30 individuals without clefts (control group).

Results:

58.8% of patients in Group 1 presented unilateral or bilateral canine guidance, 26.6% presented unilateral or bilateral group function and 54.4% presented lateral movements through the posterior teeth. Regarding protrusive movements, 80% presented anterior guidance and 20% presented posterior guidance. In Group 2, 69.6% of individuals presented unilateral or bilateral canine guidance, 43.2% presented unilateral or bilateral group function and only 13.3% presented lateral movements through the posterior teeth; 3.4% presented protrusion through the posterior teeth.

Conclusions:

there was no difference in the pattern of disocclusion between subgroups of patients with clefts. Group 2 presented predominance of bilateral group function, whereas Group 1 presented a higher prevalence of posterior guidance during lateral movements. Protrusion occurred primarily through anterior guidance in Group 2 and through the posterior teeth in Group 1. There was high prevalence of occlusal interferences at the molar area for both groups, yet with no correlation with occlusal pathologies (recession and abfraction).     

A rare complication of idiopathic osteosclerosis

Idiopathic osteosclerosis (IO) is described as a localized no expansible radiopacity with unknown etiology. The IO is generally asymptomatic and could appear as round, elliptical or irregular in shape. The internal aspect is usually uniformly radiopaque. IO should be distinguished from condensing osteitis of dental origin, or other alveolar bone related radiopacities such as periapical cemental dysplasia. This condition may cause changes in tooth position or problems during orthodontic treatment. The purpose of the present study is to report a case of tooth resorption caused by ectopic eruption rote caused by IO. This condition represents a rare complication of IO.     

Occlusal disease management system: the diagnosis process

The goal of every dentist is to preserve the health of his or her patients' masticatory system, as well as to anticipate the long-term results when restorative treatment is provided. These goals cannot be accomplished in the presence of occlusal disease. During the routine oral examination, the signs and/or symptoms of occlusal disease must be noted and the patient educated about the need for further diagnosis and treatment. Better care can be provided to patients if occlusal disease and/or temporomandibular disorders are detected early and properly treated. Treating occlusal disease can lead to a long, healthy life of the dentition as well as to restorative success.     

Prevalence of mutans streptococci isolated from complete dentures and their susceptibility to mouthrinses

The aims of this study were to evaluate the incidence of mutans streptococci (MS - sessile form) on complete maxillary dentures after use of a specific denture paste, and to determine the minimum inhibitory concentration (MIC) and maximum inhibitory dilution (MID) of 3 oral mouthrinses: Cepacol, Plax and Periogard. Seventy-seven complete denture wearers were randomly assigned into 2 groups, according to the product used for denture cleaning: Control group - conventional dentifrice (Kolynos-Super White); and Test group: experimental denture cleaning paste. Denture biofilm was collected at baseline and after 90 and 180 days after treatment by brushing the dentures with saline solution. After decimal serial dilution, samples were seeded onto agar sucrose bacitracin to count colonies with morphological characteristics of MS. MS identification was performed by the sugar fermentation tests. After this procedure, brain heart infusion broth (BHI) was added to oral mouthrinses (Plax, Cepacol e Periogard) and seeded on Petri dishes. The colonies were seeded using the Steers multiplier and, after the incubation, the MIC and MID of the mouthrinses were calculated. The results showed an incidence of 74.0% (n=57) of MS in the 77 complete dentures examined in the study, being 76.3% (n=29) of the Control group (conventional dentifrice) and 71.8% (28) of the Test group (experimental denture cleaning paste). In both groups, the number of positive cases for MS decreased from day 0 to day 180. In the Test group there was a slight decrease in the incidence of Streptococcus mutans 90 days after use of the experimental denture cleaning paste, which was not observed in the Control group. As regards to mouthrinses, for both groups, Periogard showed antimicrobial action with the highest dilution, followed by Cepacol and Plax. In conclusion, the incidence of MS in complete dentures was high and Periogard was the mouthrinse with the strongest antimicrobial action against MS. The experimental denture cleaning paste showed a slight action against S. mutans after 90 days of treatment.     

Comparison of clinical productivity of senior dental students in a dental school teaching clinic versus community externship rotations

The aim of this study was to report on the clinical and monetary productivity of fourth-year dental students at community-based clinical sites and school-based clinics at the Harvard School of Dental Medicine (HSDM). This study included forty-seven students from the graduating classes of 2006, 2007, and 2008. These fourth-year students were required to spend twelve weeks at one of several participating community health centers throughout Massachusetts and New Hampshire. Students also treated their patient pool in the teaching practice at HSDM in the fourth year. The most common sixty American Dental Association procedure codes were compared, and variables were created by grouping them by specialty or type of service. HSDM dental students completed 8,365 procedures at an externship site during their community experience. An average of 178 procedures was completed per student, and mean revenue of $17,486 was produced. In comparison, the same students completed 3,640 procedures during an equal amount of time spent (normalized for this study) at the school teaching practice clinic, where each student completed an average of seventy-seven procedures and generated $16,802 in revenue. The results of this study show that fourth-year dental students at the community health centers, working under the supervision of adjunct faculty, completed more than double the number of procedures they did in the HSDM teaching practice clinic. However, the revenue generated was very similar at the two sites. In addition, the types of procedures performed by students at externship sites were simpler than the complex and specialized procedures performed at the HSDM clinic, which include fixed and removable prosthetics, periodontal surgery, and implantology.