The maintenance of pulp health 17 years after root fracture in a maxillary incisor illustrating the diagnostic benefits of cone bean computed tomography

AIM

To demonstrate the maintenance of pulp health in a tooth with a fractured root without any complications or endodontic treatment and the advantage of cone bean computed tomography (CBCT) compared with traditional radiographs in the diagnosis of root fractures.

SUMMARY

The horizontal fracture of a maxillary central incisor is described that was an incidental finding on a routine radiographic examination 17 years after trauma. The tooth was asymptomatic. Intra-oral radiography revealed a complicated multiple root fracture with separation of the root fragments, which was not confirmed by CBCT. This case report illustrates spontaneous healing of root fracture and the reparative potential in the area of root fracture including preservation of pulp health and also demonstrates that CBCT is a more reliable imaging technique than conventional radiographs regarding root fracture diagnosis.

KEY LEARNING POINTS

The dental pulp is characterized by the ability to heal spontaneously in cases of root fracture. CBCT has advantages in diagnosing root fractures over intra-oral radiographs. CBCT should be employed with caution due to its increased radiation dose compared with periapical radiography.

Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water

Objectives

The purpose of this study was to analyze the prevalence of dental erosion among competitive swimmers of the local swimming club in Szczecin, Poland, who train in closely monitored gas-chlorinated swimming pool water.

Materials and methods

The population for this survey consisted of a group of junior competitive swimmers who had been training for an average of 7 years, a group of senior competitive swimmers who had been training for an average of 10 years, and a group of recreational swimmers. All subjects underwent a clinical dental examination and responded to a questionnaire regarding aspects of dental erosion. In pool water samples, the concentration of calcium, magnesium, phosphate, sodium, and potassium ions and pH were determined. The degree of hydroxyapatite saturation was also calculated.

Results

Dental erosion was found in more than 26 % of the competitive swimmers and 10 % of the recreational swimmers. The lesions in competitive swimmers were on both the labial and palatal surfaces of the anterior teeth, whereas erosions in recreational swimmers developed exclusively on the palatal surfaces. Although the pH of the pool water was neutral, it was undersaturated with respect to hydroxyapatite.

Conclusion

The factors that increase the risk of dental erosion include the duration of swimming and the amount of training. An increased risk of erosion may be related to undersaturation of pool water with hydroxyapatite components.

Clinical relevance

To decrease the risk of erosion in competitive swimmers, the degree of dental hydroxyapatite saturation should be a controlled parameter in pool water.

[Factors that modify de- and remineralization in dental enamel from the aspect of caries susceptibility]

The course of caries depends on an equilibrium between de- and remineralization of enamel. Epidemiologic studies performed during recent years in Poland have demonstrated a high incidence and severity of caries in children and teenagers. Therefore, the actual program of caries prevention covering the whole population of children and teenagers has not performed to the expectations, possibly because the program protocol does not discriminate between children susceptible and resistant to caries. The aims of this work included: 1. Analysis of tooth groups and surfaces as to their susceptibility to caries; 2. Evaluation of the influence of de- and remineralization modifying factors such as: a) dental plaque and sugars, b) caries-causing bacteria, c) enamel resistance to acids, d) biochemical properties of saliva--on the susceptibility to caries; 3. Evaluation of the uptake of fluorides from chewing gum by enamel in relationship to caries susceptibility. An initial clinical examination of permanent teeth was performed in 292 children aged 12 years. Subsequently, two groups were formed: one with 45 children free from caries and another with 77 children at high risk of caries. Control examinations of permanent teeth in both groups were carried out after one and three years from the initial examination. The clinical examination included a check-up of secondary dentition, counting of erupted teeth, sealed teeth, evaluation of oral hygiene status, gingivae, abnormalities in mineralization and measurement of the rate of microdemineralization. The biochemical analysis of saliva was done to measure the content of fluorides, calcium, phosphorus and magnesium, as well as pH. Microsamples of enamel were collected using acid biopsy and the content of calcium and fluorine in the superficial and underlying layer was assayed. The thickness of both layers obtained by biopsy was also measured. Commercial test kits--Dentocult SM and Dentocult LB, served to determine the amount of caries-causing bacteria in saliva. Additionally, the children and their mothers responded to a questionnaire on the diet, previous diseases, therapies with antibiotics and health habits. The results were analysed using Statgraphics software. Differences between means were checked using Student t-test in its classical form or as modified by B. L. Welch. Linear correlation indices were calculated and Spearman rank correlation test was performed. On the basis of the results obtained the following conclusions were drawn: 1. 12-year old children at high risk of caries need intense dental care due to: a) extensive involvement of masticatory surfaces of molar teeth and contact surfaces of premolar teeth, b) treatment inappropriate to actual needs in this group of children. 2. Effective programs to improve the knowledge and health of children at high risk to caries should be introduced due to the following facts: a) oral hygiene was unsatisfactory in the examined children, b) children consumed large quantities of sweets. 3. Disturbances in the mineralization of enamel and the use of antibiotics in childhood were without influence on the susceptibility of teeth to caries. 4. The content of fluorides, calcium and phosphorus in the saliva of children susceptible to caries could have been below the level necessary to maintain an equilibrium between de- and remineralization of enamel. 5. Susceptibility of teeth to caries could be due to differences in the chemical composition and structure of enamel, as it appears from the content of fluorides and calcium, depth of enamel biopsy and uptake of fluorides from chewing gum. 6. Chewing of fluoride-containing gums is a supportive measure in caries prevention, particularly recommended in children at high risk of caries. 7. Caries prevention should be individualized and matched to caries risk.