Premature Loss of Deciduous Teeth as a Symptom of Systemic Disease: A Narrative Literature Review

Skeletal indicators of pathology in the context of early tooth loss in children: A systematic literature review

OBJECTIVE

To provide an evidence-based resource for paleopathologists to consider multiple skeletal indicators of pathology associated with early tooth loss in children to aid in diagnosis.

MATERIALS

Three databases (Cochrane Library, MedLine, and Scopus) were used for a review.

METHODS

According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, a systematic review guideline, 85 articles were selected.

RESULTS

A total of 189 children had a syndrome or disease associated with early tooth loss. Our review, based on 25 diseases, lists the bone and dental lesions observable in archeological remains.

CONCLUSIONS

Based on a review of the literature, a synthesis of 25 diseases and syndromes that may be associated with premature loss of permanent or deciduous teeth in children was developed for paleopathologists. It highlights the importance of a thorough dental examination by paleopathologists to further assess past health conditions.

SIGNIFICANCE

This paper provides an extensive resource addressing early tooth loss in childhood to assist researchers with differential diagnosis.

LIMITATIONS

The articles included in this review are case reports based on living populations.

SUGGESTIONS FOR FURTHER RESEARCH

Further studies into diseases and their association with early tooth loss would complement this work, as would utilizing the differential diagnoses on archeological individuals to clarify its value and limitations.

A probable case of hypophosphatasia in St Bride's Lower Churchyard (1770-1849, London, UK)

OBJECTIVES

The objective of this study was to analyse an individual whose remains are characterised by early deciduous tooth loss and multi-focal lesions on the post-cranial skeleton.

MATERIALS

Skeletal remains of an immature individual buried between 1770 and 1849 in London.

METHODS

The remains were examined by visual macroscopic inspection, supplemented by radiographic examination of the mandible and maxillae. A differential diagnosis with possible conditions, frequent in this archaeological context, was conducted. A comprehensive examination of dental lesions was performed to investigate the aetiologies of deciduous tooth loss.

RESULTS

The individual exhibited a mosaic of skeletal and dental pathological changes, including premature loss of deciduous dentition, premature eruption of permanent teeth generalised bone loss in both the mandible and maxilla; osteomyelitis of the left radius; osteolytic lesion on the body of the second lumbar vertebra, and marked expansions of the rib shafts due to sub-periosteal new bone formation.

CONCLUSION

A differential diagnosis considered indicates that the pathological changes of the individual were most likely associated with a comorbidity involving hypophosphatasia and tuberculosis.

SIGNIFICANCE

We present in this study several oral signs that could alert paleopathologists and bioarcheologists to systematically consider the potential of a condition that is rarely encountered in archaeological contexts.

LIMITATIONS

Due to poor preservation, this study was confined to the analysis of a partial maxilla and mandible, a left radius shaft and the axial skeleton (rib heads and vertebrae) of the individual.

SUGGESTIONS FOR FURTHER RESEARCH

Further radiographic, histological and genetic analyses would confirm the diagnosis.

Effectiveness of traditional band and loop space maintainer vs 3D-printed space maintainer following the loss of primary teeth: a randomized clinical trial

This study evaluates the efficacy of 3D-printed band and loop space maintainers (3D-BLSMs) to mitigate concerns caused by early primary tooth loss in children when compared to their conventional equivalents. Over 9 months, 62 participants aged 6 to 12 years participated in a randomized clinical study. This study evaluated their failure rates (de-cementation, debonding, solder breakage, loop breakage, band breakage, and abutment tooth fracture), gingival health, and patient overall satisfaction. Random assignments were made to place the participants in two groups: traditional band and loop space maintainers or the 3D-BLSMs. The findings show that at 9 months, 3D-BLSMs provided significantly higher survival rates (77.4%) than conventional maintainers (51.6%, p < 0.01). Gum inflammation was mild in both groups, highlighting the need for good oral hygiene. In both groups, patient satisfaction exceeded 90%. Although there was some pain at first with 3D-BLSMs, this eventually subsided and aesthetic preferences disappeared. There were no negative consequences noted, and both groups needed ongoing dental treatment. In conclusion, with excellent patient satisfaction in both groups, 3D-printed space maintainers offer greater long-term durability in reducing dental concerns following early primary tooth loss.

Diagnosis and initial management of children presenting with premature loss of primary teeth associated with a systemic condition: A scoping review and development of clinical aid

BACKGROUND

Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists.

AIMS

To identify systemic conditions associated with PLPT and develop a clinical aid.

DESIGN

OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English-language full text.

RESULTS

Seven hundred and ninety-one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty-one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon-Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach.

CONCLUSIONS

A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral.

Thoughts on the Etiology of Cherubism

Cherubism is nowadays classified as an autoimmune disease and was first described in 1933. Although suspected at that time to be the result of defective tooth development, it was primarily classified as a bone disease caused by a mutation in the SH3BP2 gene. Despite a knock-in mouse model, phenotypic signs in the jaw area were not reproducible in this model. The features of classical cherubism can be attributed to a disturbed formation of the dental placode of the second molar. Since 2019, it has become clear that inhibition of the WNT pathway leads to the accumulation of SH3BP2 via tankyrase inhibition. As the dental placode is triggered via WNT (in epithelia) and MSX1 (in mesenchyme), aplasia of the second and third molars occurs due to a block in the WNT pathway. The mesenchymal part, which occurs prior to the body plan regulation of the WNT/MSX1 pathway, remains unaffected and provides the substrate for the giant cell granuloma. Considering macrophage polarization and the role of the extracellular matrix in general, cherubism is situated in the field of tension between autoimmune diseases and cancer. In this sense, we see the cause of cherubism in a WNT-related dysregulation, which can be proven postnatally in the neural crest-related tooth development of the replacement tooth ridge, both genotypically and phenotypically.

Orofacial characteristics in a child with Hajdu-Cheney syndrome

Hajdu-Cheney syndrome (HCS) also known as Cranio-skeletal dysplasia is a rare genetic disorder of bone metabolism. It is mainly characterized by acro-osteolysis and generalized osteoporosis. The other distinctive features include a dysmorphic face, short stature, aplasia of facial sinuses, and persistent cranial sutures. Although the condition begins to manifest since birth, the characteristic features become more prominent with age. This syndrome is usually recognized by dentists due to these craniofacial abnormalities. This case report aims to highlight a case of 6-year-old girl HCS who presented with aberrant facial features, premature exfoliation of teeth, unusual mobility of teeth and atypical root resorption in primary dentition.

Langerhans cell histiocytosis oral lesions in pediatric patients

Langerhans cell histiocytosis (LCH) is a disease with unknown etiology. It presents as single-system (affecting a single organ or tissue) or as multisystem (with or without risk organ involvement). The oral cavity may be involved or be the site of the first manifestation.

Aim

To describe, group, and determine the frequency of oral lesions in pediatric patients with LCH, and to relate these lesions to age and the different disease subtypes.

Materials and Method

Clinical and radiographic examinations were used to evaluate 95 patients diagnosed with LCH, aged 0 to 16 years, who were referred to the Department of Comprehensive Pediatric Dentistry at the School of Dentistry, University of Buenos Aires. Clinical histories were prepared and informed consents obtained. Lesions were diagnosed by observation, palpation and biopsies, and grouped according to affected tissues into bone, mucosal, and bone-mucosal.

Results

42.1% presented oral lesions, and in 14.73%, these lesions were the first manifestation of LCH. Ninety percent presented only bone lesions, while the remaining 10% presented bone-mucosal and mucosal lesions. In the single-system subtype, 52.5% presented bone lesions. In the multisystem subtypes (with or without risk organs), all three types of lesions were found. The association between age at which LCH was diagnosed and oral tissue involvement showed that bone-mucosal lesions occur in young children (average age 1.4 years) diagnosed with multisystem LCH. Oral mucosa was only affected in reactivations of the disease.

Conclusions

A high frequency of oral lesions was observed, which were sometimes the first manifestation of the disease, most often affecting bone tissue. Dentists can play an active role in the initial diagnosis of the disease.

Examining the Role of Vitamin D in Caries Susceptibility in Children's Deciduous Teeth: A Systematic Review

The global prevalence of dental caries in deciduous teeth remains a significant health concern, affecting almost 70% of children by the age of six in specific regions. This systematic review aspired to methodically investigate the association between vitamin D levels and susceptibility to caries in children's deciduous teeth. A detailed search, guided by the PRISMA and PROSPERO guidelines, was conducted across three prominent electronic databases: PubMed, Web of Science, and Scopus, culminating in August 2023. The search integrated various keywords related to vitamin D and dental caries in primary dentition, yielding an initial pool of 1678 articles. After meticulous scrutiny, seven studies with a total of 7655 participants were deemed suitable for inclusion. The studies represented diverse geographical regions, showcasing varied vitamin D levels and sun exposure. Patient habits like brushing frequency, dental visits, and vitamin consumption also varied across studies. The analysis pinpointed vitamin D deficiency as a potential risk factor in some of the studies, with Odds Ratios (OR) ranging from 0.68 to 2.15. Statistically significant associations between vitamin D deficiency and caries susceptibility were documented in three studies (ORs of 2.15, 1.98, and 1.70). This comprehensive review elucidates the complex relationship between vitamin D levels and dental caries in children's deciduous teeth. While some studies spotlight vitamin D's pivotal role in dental health, inconsistencies across studies and regional differences necessitate more in-depth, globally representative investigations. Ensuring optimal vitamin D levels may play an integral role in dental health strategies. However, it is important to highlight that the roles of these studied factors might differ in deciduous teeth compared to permanent teeth.

Prevalence of Delayed Eruption of Permanent Upper Central Incisors at a Tertiary Hospital in Riyadh, Saudi Arabia

Tooth eruption is defined as the axial movement of the tooth from its site of development in the alveolar bone to its functional position in the oral cavity. A delay in eruption can directly affect the accurate diagnosis, overall treatment planning, and timing of treatment. Thus, Delayed Tooth Eruption can have a significant impact on a patient’s proper health care. This study aimed to estimate the prevalence of delayed eruptions of permanent upper central incisors in Riyadh, Saudi Arabia. A retrospective study assessed panoramic radiographs of children between the ages of 6–10 years old who attended the Dental University Hospital clinics at King Saud University in Riyadh, Saudi Arabia between 2014 and 2020. The radiographs were collected and examined to detect any delayed eruption of the permanent upper central incisors. Panoramic radiographs with delayed erupted permanent upper central incisors were identified by tooth developmental stages and eruption sequence. Of the 745 radiographs, 23 (3.09%) presented at least one delayed erupted permanent upper central incisor of which boys and girls comprised 16 (69.5%) and 7 (30.4%), respectively. Retained primary teeth was the most causative factor of delayed eruption (43.4%), followed by the early loss of primary teeth (21.7%) and insufficient arch space. The present study is the first to assess the prevalence of delayed eruption of the permanent upper central incisors on a Saudi population. Boys were found to have more prevalence of delayed eruption of the permanent upper central incisors compared to girls. Clinicians should be aware of such a condition as early diagnosis of delayed eruption is essential for providing optimal dental care.

Premature Primary Tooth Loss and Oral Health-Related Quality of Life in Preschool Children

The present study aimed to evaluate the association between premature primary tooth loss and oral health-related quality of life (OHRQoL) in preschool children. A cross-sectional study was conducted in 769 5-year-old preschool children. The children and their parents or guardians answered the Brazilian version of the Scale of Oral Health Outcomes for 5-Year-Old Children for the assessment of OHRQoL. Meanwhile, clinical examinations were performed for the assessment of premature primary tooth loss. Unadjusted and adjusted multilevel Poisson regression models were utilized to investigate the associations between the variables. In the parental version of the scale, premature posterior primary tooth loss (rate ratio [RR] = 2.65; 95% confidence interval [CI] = 1.51-4.68), weak sense of coherence (RR = 2.25; 95% CI = 1.62-3.11), and visit to a dentist (RR = 1.61; 95% CI = 1.04-2.52) were associated with OHRQoL. Based on the children's perceptions, only the preschool type was associated with OHRQoL (RR = 1.92; 95% CI = 1.21-3.05). Premature posterior primary tooth loss had a greater impact on OHRQoL based on the parents' perception, whereas only the preschool type was associated with OHRQoL based on the children's perception.

Science Popularization Education regarding Oral Health-General Health for Nonmedical Undergraduates Applying a SPOC Teaching Model

Objective

To see how effective a blended teaching model based on a small private online course (SPOC) is in a science popularization education course on oral health-general health (OHGH).

Methods

The SPOC blended teaching model was created using an elective classroom course “Oral Prophylaxis and Hygiene” in conjunction with an online learning course called “Preventive Dentistry” from the China University massive open online course (MOOC) for the science popularization education on OHGH. Students' evaluations and teaching efficacy of this science popularization education course were tested using pre- and postcourse questionnaires.

Results

In all, 105 valid questionnaires were returned. Before the course, 95.2% of the students expressed an interest in learning more knowledge on oral disease and OHGH. When compared to those of the precourse, students' knowledge of oral diseases and OHGH was significantly higher (P < 0.0001) and the associated practice after science popularization education was much increased (P < 0.0001 or P = 0.0005), except for root canal therapy (P = 0.3886). The scores of students on the scientific popularization task also improved when compared to those of the previous classroom-only teaching (P < 0.0001). In the postcourse questionnaire, students rated the SPOC teaching mode significantly higher than both online learning and classroom teaching alone (P < 0.0001; P = 0.0117); the SPOC blended teaching was judged as more suitable for science popularization education (P < 0.0001).

Conclusion

The application of the SPOC teaching mode for the science popularization education course on OHGH to nonmedical undergraduates has better teaching outcomes and is more likely to be accepted by college students.