Timing of first fillings in the primary dentition and permanent first molars of asthmatic children

The aim of this study was to analyze the timing of first fillings posteruptively in a cohort comprising 51 asthmatic children receiving inhaled corticosteroids and living in three communities in Ostrobothnia, Finland. They had all been born in the 1980s and had had asthma check-ups in the local asthma policlinic. A group of 102 healthy age- and sex-matched children served as controls. A longitudinal survival analysis of the timing of the first filling in the primary teeth and first permanent molars was conducted retrospectively using data from the annual dental health records. The timing of the first fillings in permanent first molars showed no statistically significant differences between asthmatic and healthy children, but the filling increments in the primary molars were consistently higher in the asthmatic group; the difference for the upper first primary molars was, for instance, statistically significant (risk ratio = 2.565; 95% confidence interval = 1.333-4.935). More extractions because of caries were also performed on primary molars in the asthmatic children. The findings support the hypothesis that factors related to the asthmatic condition might increase the risk of caries. A longer surveillance time would be needed to evaluate the effect of asthma on the permanent dentition.

Dentistry for the 21st century? Erbium:YAG laser for teeth

The first dental laser for use in cutting human teeth in vivo was cleared by the Food and Drug Administration for marketing in the United States. The authors explored, in summary form, the data provided to the FDA for the clinical use of the erbium:yttrium-aluminum-garnet, or Er:YAG, laser. The authors concluded that using the Er:YAG laser to treat dental hard tissue is both safe and effective for caries removal, cavity preparation and enamel etching.

Clinical outcomes for nursing caries treated using general anesthesia

This study did follow-up examinations of 84 Medicaid-eligible children with nursing caries after they received treatment for nursing caries utilizing general anesthesia. Results at six months suggest that parents are unresponsive to follow-up care and over half of the children seen had new smooth surface caries lesions. While results are preliminary, they suggest that major changes are needed in the tertiary care of children with nursing caries.

A child of suspected malignant hyperthermia during general anesthesia for dental surgery

Malignant hyperthermia is clinically an uncommon disorder characterized by acute hypercatabolic reactions in muscles in response to the triggering effects of certain drugs mainly used during anesthesia or to physical or emotional stress. We present a pediatric patient with multiple caries who was suspected to contract malignant hyperthermia while underwent the operative procedure of comprehensive restoration. Sinus tachycardia, hyperthermia, hypercapnia, metabolic acidosis, hyperkalemia and hypercalcemia developed unexpectedly during the operation. Fortunately, the patient survived the episode with early recognition and prompt management.

Post-operative pain relief in children following extraction of carious deciduous teeth under general anaesthesia: a comparison of nalbuphine and diclofenac

In a randomized double-blind study 60 children, undergoing the extraction of carious deciduous teeth under day-case general anaesthesia, were assigned to receive either intravenous nalbuphine hydrochloride 0.3 mg kg-1 (n = 21), one or more diclofenac suppositories 12.5 mg to a dose of 1-2 mg kg-1 (n = 19), or no analgesia (n = 20). The duration of anaesthesia was longer in the diclofenac group (9.6 min, SD 3.5) compared with control (7.2 min, SD 2.6) and nalbuphine (6.9 min, SD 3.0) groups respectively (P < 0.05). There were no statistically significant differences in post-operative pain scores during the 45 min post-operative period studied between the three groups using an objective pain score. We conclude that using this methodology we were unable to demonstrate any statistically significant differences between the analgesic effects of either intravenous (i.v.) nalbuphine or diclofenac suppositories compared with control.

A survey of reasons for extraction of permanent teeth in Singapore

A survey was carried out to determine the reasons for tooth extractions of permanent teeth in Singapore. Data were obtained from 52 dentists practising general dentistry over a period of 12 months. At the end of the 12-month period, data were collected from 1276 patients, from whom a total 272 teeth were extracted. In this population group, the results showed that the percentage of teeth extracted due to periodontal reasons and caries were about the same, that is 35.8% and 35.4%, respectively. There was an increase in teeth extracted due to periodontal reasons with age. In patients above 40 yr, an average of 76% of teeth were lost due to periodontal reasons. An average of 26.7% of teeth were lost due to periodontal reasons in patients under 40 yr old. However, the trend for loss of teeth due to caries is reversed. Posterior teeth were more frequently extract compared to anterior teeth. Third molars accounted for 24.7% of all extractions carried out, whilst central incisors were 8.0% of all extractions. Molars were often lost due to caries and lower anterior teeth were most frequently lost due to periodontal reasons. The results of this study did not demonstrate one predominant reason for extraction. Both caries and periodontal reasons were equally common causes of tooth extraction.

Periodontal reasons for tooth loss in an Asian population

This study analysed data on periodontal reasons for tooth extractions, obtained from 52 dentists practising general dentistry in Singapore. The results revealed that, out of 2172 teeth extracted from 1276 patients, 35.8% were lost due to periodontal disease and 35.4% due to caries. Extraction due to periodontal problems increased with age, were more conspicuous in the Indian ethnic group and were frequently associated with pocketing and tooth mobility.

Prosthetic rehabilitation of a child with induced anodontia

A case of prosthetic rehabilitation of a five and half year old child with induced anodontia is presented. Complete dentures were provided and patient was followed for a period of 20 months. As the permanent teeth erupt into the oral cavity, regular modifications have to be made on the denture base to facilitate their eruption.

Reasons for extraction of permanent teeth in Japan

Eight hundred forty-nine Japanese dentists were asked to record the reason for every tooth extraction of permanent teeth during 1 week in each of four seasons. The reasons were assigned to six groups: dental caries, periodontal disease, eruption problems, trauma, orthodontics and other reasons. Thirty-eight to 40% of the dentists returned the forms in each season, relating to a total of 11,175 extracted teeth. Overall, caries was the most frequent reason for tooth extraction (55.4%), followed by periodontal disease (38.0%). The females lost more teeth due to caries than did the males. In the > or = 16 age groups, caries was the main reason for tooth extraction. However, periodontal disease became principal only in the males aged 46-65 yr. Anterior teeth, especially in the mandible, represented the highest percentage of periodontal extractions. A considerable difference in the major reason for maxillary tooth loss was observed between both sexes. Maxillary premolars and molars in the males were extracted for periodontal disease as much as for caries, whereas caries was the predominant reason for loss of all maxillary teeth in the females.

Replacement therapy utilising autotransplanted wisdom teeth

Loss of 1st and 2nd molars among adolescents due to dental caries is not uncommon in developing countries. Whilst their replacement is indicated, conventional methods of treatment, namely, bridging and dentures are in most cases inaccessible because of prohibitive cost. Given that it is in the same age group that diagnosis of unfavourably embedded wisdom teeth becomes feasible, autotransplantation of the latter to replace the unsalvageable 1st and 2nd molars could be an alternative treatment. Available literature suggests a success rate of over 82% based on follow-up studies of over ten years. Observations at the Dental School Clinic of the University of Nairobi, Kenya, indicate that the time it takes the transplant to 'take' and assume its functional position is 4 to 8 weeks and 2.5 to 3.5 months respectively. Since the method is relatively straightforward, we are of the view that training undergraduates and practising dental surgeons in this technique should enhance utilisation of otherwise "useless" teeth to replace the lost 1st and 2nd molars in occlusal rehabilitation.

Dental findings in a patient with biliary atresia

The dental treatment of a 3-year-old male with biliary atresia is discussed. The patient was scheduled for a liver transplant and was receiving Cyclosporine A. Due to the severity of the dental condition and to reduce the possibility of infection, all twenty primary teeth were extracted. The extracted teeth displayed a marked greenish discoloration of both the crowns and the roots. Histological examination revealed extensive interglobular dentin, a number of faint yellow-brown lines contouring the developmental pattern and a distinctive fluorescent line. The dental and pharmacological considerations relating to the treatment plan for this case are reviewed.

Intraoral vascular malformation and airway management: a case report and review of the literature

A patient with a large airway venous malformation underwent anesthesia for a tooth extraction. The procedure was uneventful until extubation, immediately after which complete airway obstruction resulted. After unsuccessful attempts to relieve the problem, the patient's trachea was reintubated. Laryngoscopy showed that the venous malformation in the airway had enlarged and was responsible for the airway obstruction. Another attempt at extubation after corrective maneuvers was again unsuccessful. A tracheostomy was required, which was eventually removed after a complete recovery. Anesthesiologists must be concerned with any airway vascular abnormality. Most abnormalities involving the airway are either hemangiomas or venous malformations. The anesthesiologist must diagnose the problem correctly because even minor manipulation of a venous malformation may result in exsanguination, or the malformation may become engorged and compromise the airway.

Primary reasons for extraction of permanent teeth in Norway: changes from 1968 to 1988

The purpose of the present study was to investigate time trends in primary reasons for extraction of permanent teeth in Norway from 1968 to 1988. Johansen studied reasons for extraction of 8757 teeth in 4216 patients during a 3-week period in 1968. Twenty years later a random sample of 500 Norwegian dentists provided particulars about all extractions carried out during a 2-week period. 350 dentists (70%) replied in 1988 but 96 of them had not extracted any teeth during the observation period. Reasons for extraction of 985 teeth from 692 patients were available for analysis. Caries and its sequelae accounted for 35%, periodontitis for 19%, and orthodontic reasons for 20% of extractions in 1988. A comparison of the distribution of extraction according to reasons for patients over 20 yr of age revealed a highly significant difference between 1968 and 1988 (P less than 0.001) mainly due to a decrease in the role of caries and an increase in extractions for other reasons. Caries and its sequelae accounted for a higher proportion of extractions than periodontitis at all ages over 20 yr in 1968, only up to 45 yr of age in 1988. Thus it is concluded that the observed time trend in primary reasons for extraction corroborates expectations based on declining caries prevalence, increasing retention of teeth and a rise in dental attendance in Norway during the last 20 yr.

Enamel fusion using a carbon dioxide laser: a technique for sealing pits and fissures

The well-established enhanced resistance of lased enamel to demineralization is the basis for clinical application of the carbon dioxide laser to caries prevention. This in vitro study examined the effect of focused infrared laser radiation on sound enamel and early pit and fissure caries. Low power levels (2-5 W) induced localized melting and resolidification of enamel with little surface destruction. For sound fissures, fusion of enamel from the lateral walls of the fissure eliminated the fissure space, providing a sealant effect; while in carious fissures, carious enamel was vaporized and adjacent sound enamel fused to partially eliminate the defect. The technique for enamel fusion using CO2 lasers has potential application for sealing pits and fissures and producing physicochemical alterations in enamel which may have preventive benefits.

A clinical and histological evaluation of conservative pulpal therapy in human teeth

Three intermediary base materials, a zinc oxide-eugenol (Cavitec) and two calcium hydroxide liners (Life and Dycal), were selected at random for use as a base beneath amalgam or composite restorations on humans following complete caries removal. Life and Dycal, selected at random, were also used as direct and indirect pulp capping agents as clinically indicated. Clinical evaluations of signs and symptoms were made before treatment and at one-week, six-month, and one-year intervals following treatment. Histological evaluations were performed on three complete caries removal teeth and 18 direct pulp capping teeth six months following treatment. No significant differences in clinical symptomatology resulted between the materials in the complete caries removal group or the indirect and direct pulp capping groups.

Reasons for tooth extraction among Tanzanians

In 1988 a study was carried out among Tanzanians of different age groups to determine the reasons for tooth extraction. The major reason was found to be dental caries or its associated complications (81%) while periodontal diseases was the runner-up (13%). The molars teeth were the most commonly extracted. The results of this study are important in planning resources for and provision of emergency oral health care especially for the rural population.

[Role of Kiel bone in periodontal surgery. Report of a case]

A case in which an infrabony pocket was treated with Kiel bone is presented. The healing of the lesion was assessed by reentry 9 months after the procedure was completed.

A dental and facial anomaly not previously reported with VACTERL association: report of case

A case of VACTERL association has been presented in conjunction with possible hemifacial microsomia and fused teeth. Although the etiology of VACTERL association and hemifacial microsomia is unclear, the similarity of symptoms would suggest a common cause. A retrospective study of patients previously diagnosed with VACTERL association might reveal additional symptoms of dental and/or facial anomalies and warrant changing the acronym to VACTERL-DF in recognition of these dentofacial findings.