Biodentine™ as a temporary filling in deep carious lesions in permanent teeth: a prospective observational 33-month follow-up study

PURPOSE

The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36 months in school children from the remote village of Kerung, Nepal.

METHODS

From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33 months, respectively.

RESULTS

After 12 months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33 months was 67.6% and 50%, respectively. Radiographically, no pathology was observed.

CONCLUSION

This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1 year and in a substantial number of cases for up to 21 and 33 months.

Flowable Urethane Dimethacrylate-Based Filler for Root Canal Obturation in Primary Molars: A Pilot SEM and microCT Assessment

Pulpectomy in deciduous teeth involves endodontic access opening, root canal debridement and obturation with an appropriate filling material. EndoREZ (ER) is the urethane dimethacrylate-based filler, which can be used for root canal obturation in permanent and primary teeth. This observation aimed to evaluate the behavior of the ER as a filler in root canals of two primary molars after the physiological resorption process using the scanning electron microscopy (SEM) and micro-computed tomography (µCT) in second lower molars after their natural exfoliation. The SEM analysis revealed a non-uniform, porous and lacunary structure of ER, visually similar to the resorbed surface of the dentine. The µCT observations demonstrated the differences in the resorption level of the root and material surfaces. The preliminary observations suggest that ER is resorbed faster than root tissues and can therefore be a suitable material for the root canal filling in primary teeth. However, more investigations are needed to support these preliminary findings.

In vivo correlation of near-infrared transillumination and visual inspection with bitewing radiography for the detection of interproximal caries in permanent and primary teeth

PURPOSE

To evaluate near-infrared light transillumination (NILT) for interproximal caries detection in children by comparing the correlation between both NILT and visual inspection (ICDAS) with bitewing (BW) radiography and by investigating possible differences in caries detection with NILT between primary and permanent teeth.

METHODS

From 35 patients, 121 and 63 interproximal surfaces in, respectively, primary and permanent teeth were included. NILT images were obtained using DIAGNOcam™ (KaVo) and scored by two calibrated raters. A consensus diagnosis was reached for BW radiography; whereas, the ICDAS scores were obtained by one calibrated rater. Weighted Kappa (wκ) was used to evaluate inter- and intra-rater reliability of NILT and to evaluate the correlation between NILT, ICDAS and BW radiography.

RESULTS

The correlation between NILT and BW radiography was moderate to substantial for primary teeth [Rater 1: wκ = 0.61 (95% CI = 0.49-0.75), Rater 2: wκ = 0.55 (95% CI = 0.41-0.69)] and fair for permanent teeth [Rater 1: wκ = 0.34 (95% CI = 0.15-0.53), Rater 2: wκ = 0.33 (95% CI = 0.08-0.58)]. The correlation between ICDAS and BW radiography was moderate for primary teeth [wκ = 0.49 (95% CI = 0.35-0.63)] and substantial for permanent teeth [wκ = 0.62 (95% CI = 0.32-0.92)]. No significant differences were found between primary and permanent teeth.

CONCLUSION

NILT cannot be recommended as a single diagnostic tool for interproximal caries detection in primary teeth. The number of false negatives for dentine caries, especially in first primary molars, was too high. For the use in permanent teeth, NILT could be more accurate than BW radiography.

The impact of a prospective 4-year longitudinal school intervention for improving oral health and oral health inequalities in primary schoolchildren in Flanders-Belgium

BACKGROUND

Oral diseases and socio-economic inequalities in children are a persisting problem.

AIM

To investigate the 4-year longitudinal impact of an oral health promotion programme on oral health, knowledge, and socio-economic inequalities in primary schoolchildren.

DESIGN

The intervention was carried out between 2010 and 2014 within a random sample of Flemish primary schoolchildren (born in 2002). It consisted of an annual oral health education session. ICDAS/DMFT, care level, knowledge scores, and plaque index were used as outcome variables. Being entitled to a corrective policy measure was used as social indicator. Mixed model analyses were conducted to evaluate changes over time between intervention and control group and between higher and lower social subgroups.

RESULTS

A total of 1058 participants (23.8%) attended all four sessions. The intervention had a stabilizing effect on the number of decayed teeth and increased knowledge scores. No statistically different effect on the two social groups could be demonstrated. Socio-economic inequalities were present both at T₀ and T₄ .

CONCLUSION

The oral health promotion programme had a positive impact on oral health knowledge and stabilized the number of decayed teeth. No impact on inequalities could be demonstrated, although a higher dropout rate in children with a lower social status was seen.

A reject analysis of cone-beam CTs in under-aged patients

OBJECTIVES:

The main objective of this study was to perform a retrospective reject analysis (or audit) of 79 cone-beam CTs (CBCTs) taken in under-aged patients at the Ghent University hospital over a 2-year timespan.

METHODS:

Observer agreement between two oral radiologists and two senior year Master students in Paediatric Dentistry was performed for quality, diagnostic and therapeutic value. The senior year Master Students followed appropriate modules of an online course. Descriptive and comparative statistics were performed.

RESULTS:

For the oral radiologists, all intra rater reliabilities were moderate to good (Gwet's AC1 = 0.41-0.75). For the senior students in Paediatric dentistry, these varied highly from fair to very good (Gwet's AC1 = 0.28-0.95). There was a high level of disagreement between oral radiologists and students (Gwet's AC1 = 0.16-0.45) and in-between students concerning observed quality (Gwet's AC1 = 0.29). A total of 16 CBCTs (20%) was rejected, 24 images (30%) were acceptable and 39 images (50%) had an excellent quality. 50 CBCTs were perceived to have a diagnostic advantage. 13 of the images would have no influence on the therapy, according to the oral radiologists. A significant correlation was found between unacceptable quality, absence of perceived diagnostic advantage (p = 0.004, RR = 2.4) and influence on therapy (p < 0.0005, RR = 1.8). A small field of view (FOV) was positively correlated to an excellent quality of the image (p = 0.011, RR = 2.8).

CONCLUSIONS:

Image quality did not reach the proposed boundary of 10% according to the European Guidelines on Radiation Protection in Dental Radiology. This is the first published audit on an overall database of under-age children for CBCT.

Paediatric dental emergencies: a retrospective study and a proposal for definition and guidelines including pain management

AIM

This was primarily to perform a retrospective analysis of 1000 emergency dental visits in order to characterize the nature of the dental emergency and the treatment provided and secondly to define a guideline for dental emergency treatment in children including pain management.

MATERIALS AND METHODS

A retrospective review was conducted of 1000 patients (aged 0-16 years) who visited the dental emergency service of the paediatric dental clinic at the Ghent University Hospital, Belgium over a period of 3 years. Data regarding age, gender, reason for visit, year of visit, consequent appointments and treatment provided were collected. Statistical analysis was carried out using descriptive statistics (frequency distribution) and Chi-square test, with significance level set as P < 0.05.

RESULTS

The number of patients visiting with a dental emergency increased annually. Approximately half (50.2%) of all paediatric dental emergency consultations were based on pain due to caries and its consequences. More than a quartile (26.7%) of emergency patients suffered from dental trauma of either primar or permanent teeth. The majority (96.7%) of the patients reported pain, 16.3% of the patients did not necessarily need immediate attention.

CONCLUSION

Dental emergencies in a university hospital based setting were predominantly related to caries and trauma. A precise definition of dental emergencies is recommended in order to prevent abuse of paediatric emergency services.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Socioeconomic inequalities in caries experience, care level and dental attendance in primary school children in Belgium: a cross-sectional survey

OBJECTIVES

Oral health inequality in children is a widespread and well-documented problem in oral healthcare. However, objective and reliable methods to determine these inequalities in all oral health aspects, including both dental attendance and oral health, are rather scarce.

AIMS

To explore oral health inequalities and to assess the impact of socioeconomic factors on oral health, oral health behaviour and dental compliance of primary school children.

METHODS

Data collection was executed in 2014 within a sample of 2216 children in 105 primary schools in Flanders, by means of an oral examination and a validated questionnaire. Intermutual Agency database was consulted to objectively determine individuals' social state and frequency of utilisation of oral healthcare services. Underprivileged children were compared with more fortunate children for their mean DMFt, DMFs, plaque index, care index (C, restorative index (RI), treatment index (TI), knowledge and attitude. Differences in proportions for dichotomous variables (RI100%, TI100% and being a regular dental attender) were analysed. The present study was approved by the Ethics Committee of the University Hospital Ghent (2010/061). All parents signed an informed consent form prior to data collection. All schools received information about the study protocol and agreed to participate. Children requiring dental treatment or periodic recall were referred to the local dentist.

RESULTS

Underprivileged children had higher D1MFT (95% CI 0.87 to 1.36), D3MT (95% CI 0.30 to 0.64), plaque scores (95% CI 0.12 to 0.23) and lower care level (p<0.02). In the low-income group, 78.4% was caries-free, compared with 88.4% for the other children. Half of the low-income children could be considered as regular dental attenders, while 12.6% did not have any dental visit during a 5-year period.

CONCLUSION

Oral health, oral hygiene, oral healthcare level and dental attendance patterns are negatively affected by children's social class, leading to oral health inequalities in Belgian primary school children.

Addition of bioactive glass to glass ionomer cements: Effect on the physico-chemical properties and biocompatibility

OBJECTIVES

Glass ionomer cements (GICs) are a subject of research because of their inferior mechanical properties, despite their advantages such as fluoride release and direct bonding to bone and teeth. Recent research aims to improve the bioactivity of the GICs and thereby improve mechanical properties on the long term. In this study, two types of bioactive glasses (BAG) (45S5F and CF9) are combined with GICs to evaluate the physico-chemical properties and biocompatibility of the BAG-GIC combinations. The effect of the addition of Al³⁺ to the BAG composition and the use of smaller BAG particles on the BAG-GIC properties was also investigated.

MATERIALS AND METHODS

Conventional aluminosilicate glass (ASG) and (modified) BAG were synthesized by the melt method. BAG-GIC were investigated on setting time, compressive strength and bioactivity. Surface changes were evaluated by Fourier transform infrared (FT-IR), scanning electron microscopy (SEM), EDS and PO₄^3- -and Ca²⁺ uptake in SBF. Biocompatibility of selected BAG-GICs was determined by a direct toxicity assay.

RESULTS

The addition of BAG improves the bioactivity of the GIC, which can be observed by the formation of an apatite (Ap) layer, especially in CF9-containing GICs. More BAG leads to more bioactivity but decreases strength. The addition of Al³⁺ to the BAG composition improves strength, but decreases bioactivity. BAGs with smaller particle sizes have no effect on bioactivity and decrease strength. The formation of an Ap layer seems beneficial to the biocompatibility of the BAG-GICs.

SIGNIFICANCE

Bioactive GICs may have several advantages over conventional GICs, such as remineralization of demineralized tissue, adhesion and proliferation of bone- and dental cells, allowing integration in surrounding tissue. CF9 BAG-GIC combinations containing maximum 10mol% Al³⁺ are most promising, when added in ≤20wt% to a GIC.

Cone-beam computed tomography in pediatric dentistry, a retrospective observational study

OBJECTIVES

The aim of this study was to find the reasons for referral and their correlation with age, gender, field of view, and resolution for all patients under the age of 18 who underwent a cone-beam computed tomography (CBCT) scan between 1 May 2010 and 1 May 2012 in the dental out-patient clinic of the University Hospital Ghent.

MATERIAL AND METHODS

From the local CBCT database, 79 pediatric patients gave their consent. Subsequently age, gender, reason for referral, external or internal referral, field of view (FOV), and resolution data were collected. Descriptive and comparative statistical analysis was performed.

RESULTS

There seemed to be a correlation between orthodontic referrals and female patients. The majority of patients referred for trauma follow-up were 12 years and older. Fourteen percent of referrals were for dento-alveolar trauma, 18 % for other dento-alveolar reasons, 4 % for developing dentition-generalized, 36 % for developing dentition-localized, 10 % for endodontics, 1 % for periodontics, 16 % for surgical applications, and 1 % was for the visualization of the TMJ. Eighty percent of the CBCTs were taken at a FOV 50 × 55 mm. Larger FOV was used for surgical planning or follow-up reasons. The majority of the CBCTs was taken at a resolution of 200 μm, while a resolution of 150 μm was used for endodontic issues. From these results, a classification system for referral was developed.

CONCLUSIONS

From the present study, it can be concluded that a referral pattern could be detected which was correlated with gender, age group, FOV, and resolution. These results can help practitioners make the decision to refer for CBCT when extra three dimensional imaging is expected to have a benefit in therapeutic value for a pediatric or adolescent patient.

CLINICAL RELEVANCE

This study can guide dental professionals referring pediatric and adolescent patients for CBCT.

Fracture resistance of endodontically restored, weakened incisors

OBJECTIVES

To test the fracture strength of weakened bovine incisors endodontically treated with mineral trioxide aggregate (MTA), calcium phosphate bone cement (CPBC) or fibre reinforced composite (FRC) posts, and to evaluate the fracture mode.

METHODS

Weakened bovine incisors (n = 75), standardized according to the dentinal wall thickness at the cervical area, were randomly assigned to one control group and three experimental groups. Unfilled teeth were assigned to group 1 (n = 20) and served as control group. Group 2 (n = 17) consisted of teeth filled with MTA. In group 3 (n = 18), the incisors were filled with CPBC and in group 4 (n = 20) with FRC posts. All specimens were subjected to load at a cross-head speed of 60 mm min(-1) until fracture occurred. The initial (IL) and final fracture (FL) loads (N) were recorded, and the failure mode among the different groups was evaluated.

RESULTS

anova showed a statistically significant difference in fracture load among the groups. Tukey's test revealed a significant difference for the IL between the control group and the experimental groups with exception of the MTA group. The FL was not significantly different among the experimental groups. A high percentage of favourable fractures was seen in the FRC and CPBC groups.

CONCLUSION

FRC posts and CPBC could be promising materials to strengthen non-vital structurally compromised teeth.

Dental attendance in preschool children - a prospective study

BACKGROUND

At present, our understanding of the use of dental care services is incomplete, certainly where preschool children are concerned.

OBJECTIVES

To investigate what proportion of 3- and 5-year-olds living in Flanders (Belgium) have already visited the dentist, to describe parents' experience about their child's dental visit, and to explore factors that may have an impact on children's early dental visit.

DESIGN

Data were collected from 1057 children; validated questionnaires were completed, and children were examined by trained dentist at ages 3 and 5. Logistic regression analyses were performed to explain dental attendance.

RESULTS

At the age of 3, 62% and by 5 years, 21% had never visited the dentist. The first dental visit was considered a pleasant experience for the majority of children. Multivariable regression analyses revealed that children who were not first born, whose mothers had a higher educational level and whose parents had recently visited the dentist, had significantly higher odds for having visited the dentist at young age.

CONCLUSIONS

Parents of young children need to be informed about and motivated for an early dental visit. Promotion campaigns should focus on firstborn children, children from less educated parents, and parents who do not regularly see a dentist.

A decision tree for the management of exposed cervical dentin (ECD) and dentin hypersensitivity (DHS)

INTRODUCTION

Dentin hypersensitivity (DHS) is a problematic clinical entity that may become an increasing clinical problem for dentists to treat as a consequence of patients retaining their teeth throughout life and improved oral hygiene practices.

OBJECTIVES

The aim of this review was to develop a decision tree for the management of exposed cervical dentin (ECD) and DHS.

MATERIAL AND METHODS

A brief PUBMED literature search was performed on dentin hypersensitivity using "MeSH" terms, "review", and "management". In addition, some websites and local guidelines were screened.

RESULTS

From this review, it became clear that all dentate patients should routinely be screened for ECD and DHS. In this respect, underdiagnosis of the condition will be avoided and the preventive management can be initiated early.

CONCLUSION

A decision tree process and a flowchart for daily practice were designed which should be started up as soon as a patient present with ECD or suffers from DHS. This approach takes into account the possible improved quality of life of the patient and is further based on a hierarchy of treatment options. In this respect, active management of DHS will usually involve a combination of at-home and in-office therapies. Starting with the use of desensitizing toothpastes is strongly recommended.

Review: Finishing and polishing procedures of (resin-modified) glass ionomers and compomers in paediatric dentistry

BACKGROUND

A smooth surface has a beneficial effect on the aesthetic quality and longevity of a dental restoration, as well as on its biocompatibility with oral tissues. In this review studies on glass-ionomer cements (GIC), resin-modified glass-ionomer cements (RM-GIC), and compomers or polyacid-modified resin composites (PAM-C) were assessed as these are currently used in paediatric dentistry.

METHOD

Medline databases (USA National Library of Medicine) was searched using WinSpirs and Pubmed. This search used a keyword filter including dental materials, polishing procedures, and instrumentation including influencing factors.

FINDINGS

Although the literature shows different commercially available tools it seems that the ideal polishing instrumentation in paediatric dentistry for GIC and compomers is not yet on the market. Furthermore, the constant development of dental materials and polishing products impose a need for continuous scientific research.

Laser physics and a review of laser applications in dentistry for children

AIM

The aim of this introduction to this special laser issue is to describe some basic laser physics and to delineate the potential of laser-assisted dentistry in children.

REVIEW

A brief review of the available laser literature was performed within the scope of paediatric dentistry. Attention was paid to soft tissue surgery, caries prevention and diagnosis, cavity preparation, comfort of the patient, effect on bacteria, long term pulpal vitality, endodontics in primary teeth, dental traumatology and low level laser therapy. Although there is a lack of sufficient evidence taking into account the highest standards for evidence-based dentistry, it is clear that laser application in a number of different aetiologies for soft tissue surgery in children has proven to be successful. Lasers provide a refined diagnosis of caries combined with the appropriate preventive adhesive dentistry after cavity preparation. This will further lead to a new wave of micro-dentistry based on 'filling without drilling'.

CONCLUSION

It has become clear from a review of the literature that specific laser applications in paediatric dentistry have gained increasing importance. It can be concluded that children should be considered as amongst the first patients for receiving laser-assisted dentistry.

Review: behaviour management techniques in paediatric dentistry

BACKGROUND

Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child's behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child.

REVIEW

Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed.

FINDINGS

There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature.

CONCLUSION

A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children.

Dental caries and dental care level (restorative index) in children with diabetes mellitus type 1

INTRODUCTION

The aim of the study was to investigate caries experience and dental care index in diabetic children and to determine if correlation exists between caries experience and metabolic control, insulin treatment, and the duration of diabetes.

MATERIALS AND METHODS

The study group consisted of 52 children and adolescents, 3-16 years of age with type 1 diabetes attending the outpatient diabetic clinic at Ghent University Hospital, Belgium. Fifty healthy subjects recruited from the paediatric dental clinic served as the control group. Caries lesions were assessed using DMF-index both at cavity and non-cavity levels. Participants and/or their guardians provided information about oral hygiene habits and dietary habits. Diabetes-related data (type, duration, insulin regimen) were collected from medical records and completed with the lab data on HbAlc.

CONCLUSION

It became clear that, although children with type 1 diabetes mellitus could be expected to run a potential high caries risk taking into account the diabetes-associated biological and behavioural alterations, no significant differences were observed regarding caries experience and dental care between diabetic children and healthy controls. The level of untreated dental decay among the diabetic children is, however, considerably high, which was reflected by a significant lower dental attendance.

Comparison of curing depth of a colored polyacid-modified composite resin with different light-curing units

OBJECTIVE

To compare the depth of cure (DoC) of a colored polyacid-modified composite resin (PAM-C) with a traditional PAM-C and a fine hybrid composite resin using different light-curing units and different radiant energies.

METHOD AND MATERIALS

The DoC of the PAM-C Twinky Star (Voco, all shades), the PAM-C Glasiosite (Voco), and the composite resin Z100 (3M ESPE) shades A2 and A4 was determined using a penetrometer test method. The materials were cured in bulk using a halogen-based unit (Elipar Trilight, E = 18 J/cm2 and E = 32 J/cm2; 3M ESPE) and an LED curing unit (Elipar Freelight 2, E = 20 J/cm2; 3M ESPE) in split stainless steel molds. Immediately after curing, the height (mm) of the cured material was measured and taken as the DoC. Ranking of means was performed by Student-Newman-Keuls multiple comparison test, and statistically significant differences among mean values were detected with ANOVA.

RESULTS

Mean DoC for all materials and shades varied as follows: 4.705 to 8.870 mm (E = 32 J/cm2); 3.672 to 8.050 mm (E = 20 J/cm2); and 4.090 to 7.357 mm (E = 18 J/cm2). Two-way ANOVA revealed that the DoC depended significantly (P < .001) on the shade of the material and the curing device. Moreover, there was a significant interaction (P < .001) between the latter, indicating that the effect of the energy densities differed quantitatively among the shades.

CONCLUSIONS

In this study, DoC differed significantly among the materials and the shades. Twinky Star shade blue showed the highest DoC compared to Glasiosite and Z100 shades A2 and A4. The curing device with the highest energy density exhibited the highest curing depths.

Oral implications in children with gastroesophageal reflux disease

PURPOSE OF REVIEW

To emphasize oral complications in children with gastroesophageal reflux disease. Interest of pediatricians to conduct an orodental examination or to include a dental examination performed by a dentist should be encouraged, as dental erosion, for instance, may be present in these children.

RECENT FINDINGS

Dental caries, dental erosion, mucosal lesions and oral bacterial load have been studied extensively in children with gastroesophageal reflux disease, but there is no sound consensus about the impact of gastroesophageal reflux disease on oral health parameters.

SUMMARY

Gastroesophageal reflux and oral health deserve to be better understood and recognized by medical staff, pediatricians in particular. Literature on this subject contains many case reports and some cross-sectional studies, resulting in confusing conclusions for clinicians and researchers. Dental caries, dental erosion, mucosal lesions and oral bacterial load are the most frequently studied items in these kinds of study. Dental erosion seems to be an oral finding that should be studied in depth in these children, as conflicting results have been reported in literature, the latter being the result of the use of different indexes to collect clinical data.

Knoop hardness depth profile of polyacid-modified composite resins

OBJECTIVES

To determine the hardness versus depth profile of several polyacid-modified composite resins (PAM-Cs) as a function of shade (A2, A4) and compare the depth of cure (DoC) based on these profiles with that previously obtained with the scraping and penetrometer methods.

METHOD AND MATERIALS

Samples of 6 PAM-Cs (Hytac, 3M ESPE; F2000, 3M ESPE; Glasiosite, Voco; Dyract, Dentsply DeTrey; Dyract AP, Dentsply DeTrey; Compoglass F, Vivadent) and 3 composite resins (Herculite Enamel XRV, Kerr; Z100, 3M ESPE; Durafill VS, Heraeus Kulzer) with shades A2 and A4 were light-cured in bulk in split stainless steel molds (thickness ranging from 0.5 to 3.5 mm in steps of 0.5 mm). The Knoop hardness of the irradiated top (KHN(surface)) and nonirradiated bottom (KHN(bottom)) surfaces was determined as a function of sample thickness using a microhardness tester.

RESULTS

Regression analysis demonstrated that for a given material, KHN(bottom) equals KHN(surface) up to a specific depth (= DoC) depending on the material and shade and then decreases linearly with increasing depth. The decrease of the KHN per unit depth differs significantly among materials and shades. According to a regression analysis, the scraping and penetrometer methods overestimate the DoC of PAM-Cs compared to the method based on the change of the hardness indentation with depth.

CONCLUSIONS

Shade A2 results in greater values of DoC than shade A4, the effect depending quantitatively on the formulation of the material. Some formulations of PAM-Cs do not reach a DoC of 2 mm, a layer recommended to be applied in the incremental technique. The DoC as determined according to ISO 4049:2000 apparently is based on a lower degree of polymerization corresponding to a KHN of 80% of the irradiated surface.

Dental agenesis: genetic and clinical perspectives

Dental agenesis is the most common developmental anomaly in humans and is frequently associated with several other oral abnormalities. Whereas the incidence of missing teeth may vary considerably depending on dentition, gender, and demographic or geographic profiles, distinct patterns of agenesis have been detected in the permanent dentition. These frequently involve the last teeth of a class to develop (I2, P2, M3) suggesting a possible link with evolutionary trends. Hypodontia can either occur as an isolated condition (non-syndromic hypodontia) involving one (80% of cases), a few (less than 10%) or many teeth (less than 1%), or can be associated with a systemic condition or syndrome (syndromic hypodontia), essentially reflecting the genetically and phenotypically heterogeneity of the condition. Based on our present knowledge of genes and transcription factors that are involved in tooth development, it is assumed that different phenotypic forms are caused by different genes involving different interacting molecular pathways, providing an explanation not only for the wide variety in agenesis patterns but also for associations of dental agenesis with other oral anomalies. At present, the list of genes involved in human non-syndromic hypodontia includes not only those encoding a signaling molecule (TGFA) and transcription factors (MSX1 and PAX9) that play critical roles during early craniofacial development, but also genes coding for a protein involved in canonical Wnt signaling (AXIN2), and a transmembrane receptor of fibroblast growth factors (FGFR1). Our objective was to review the current literature on the molecular mechanisms that are responsible for selective dental agenesis in humans and to present a detailed overview of syndromes with hypodontia and their causative genes. These new perspectives and future challenges in the field of identification of possible candidate genes involved in dental agenesis are discussed.

The influence of social indices on oral health and oral health behaviour in a group of Flemish socially deprived adolescents

AIM

To investigate the impact of social indices on oral health and oral health behaviour in socially deprived adolescents and young adults in Flanders.

METHOD

The study design was cross-sectional and included 68 subjects aged 12 to 26, who called for help by "Habbekrats", a non-profit organisation rendering assistance to adolescents and young adults living on the fringes of our society. The clinical oral examination was performed using criteria based on the diagnostic criteria for caries prevalence surveys published by BASCD. Information on parental occupational level, educational level, living condition and oral health behaviour was gained using questionnaires completed by the participants themselves and their social workers.

RESULTS

The mean age was 16.2 years. Within the sample 92% and 90.8% respectively had a father or mother belonging to a low social level. For 68% of the sample the educational level was low. Concerning oral health behaviour 67% reported nutritional habits conducive to poor oral health whereas 64% reported good oral hygiene habits. The mean DMFS was 11.42 (SD = 14.33) and the mean care-index equalled 0.60 (SD = 0.39). Statistical analysis by means of a logistic regression model revealed that only the 'living condition' had a statistically significant influence on oral health behaviour (p < or = 0.05) and care-index (p < or = 0.05). There was no significant correlation between the parents occupation and subjects' educational level and the oral health behaviour and oral health status of the study group.

CONCLUSION

From this analysis it is clear that 'living condition' had a significant influence on the oral health behaviour and care indices of the studied population of socially deprived adolescents.

Cranial suture biology and dental development: genetic and clinical perspectives

Premature fusion of the calvarial bones at the sutures, or craniosynostosis (CS), is a relatively common birth defect (1:2000-3000) frequently associated with limb deformity. Patients with CS may present oral defects, such as cleft soft palate, hypodontia, hyperdontia, and delayed tooth eruption, but also unusual associations of major dental anomalies such as taurodontism, microdontia, multiple dens invaginatus, and dentin dysplasia. The list of genes that are involved in CS includes those coding for the different fibroblast growth factor receptors and a ligand of ephrin receptors, but also genes encoding transcription factors, such as MSX2 and TWIST. Most of these genes are equally involved in odontogenesis, providing a pausible explanation for clinical associations of CS with dental agenesis or tooth malformations. On the basis of the present knowledge on genes and transcription factors that are involved in craniofacial morphogenesis, and from dental clinics of CS syndromes, the molecular mechanisms that control suture formation and suture closure are expected to play key roles in patterning events and development of teeth. The purpose of this article is to review and merge the recent advances in the field of suture research at the genetic and cellular levels with those of tooth development, and to apply them to the dental clinics of CS syndromes. These new perspectives and future challenges in the field of both dental clinics and molecular genetics, more in particular the identification of possible candidate genes involved in both CS and dental defects, are discussed.

Seckel syndrome associated with oligodontia, microdontia, enamel hypoplasia, delayed eruption, and dentin dysmineralization: a new variant?

Seckel syndrome (SCKL) [OMIM Entry 210600] is a rare, autosomal recessive syndrome, characterized by severe intrauterine and postnatal growth retardation, microcephaly, mental retardation, and typical facial appearance with beaklike protrusion of the midface (bird-headed). Associated findings may include limb anomalies, dislocation of femoral heads, scoliosis, and gastrointestinal malformation. A 14-year-old boy is presented with brain hypoplasia, pachygyria, hydrocephaly, enamel hypoplasia and root dysplasia in the temporary dentition, and oligodontia, severe microdontia, and delayed eruption of the permanent dentition. The association of SCKL with the above unusual dental findings may represent a new phenotype.

Abnormal dentin structure in two novel gene mutations [COL1A1, Arg134Cys] and [ADAMTS2, Trp795-to-ter] causing rare type I collagen disorders

Histological and ultrastructural observations of dentin of two patients affected with rare types of type I collagen disorders are presented. In the first case, a homozygous nonsense mutation in ADAMTS2 (substitution of a codon for tryptophan by a stopcodon) causes type VIIC Ehlers-Danlos syndrome (EDS) with multiple tooth agenesis and focal dysplastic dentin defects. In the second case, a missense mutation in COL1A1 (substitution of arginine by cysteine) results in a type I EDS phenotype with clinically normal-appearing dentition. Tooth samples are investigated by using light microscopy (LM), transmission electron microscopy (TEM) and immunostaining for types I and III collagen, and tenascin. These are compared with samples from patients with types III and IV osteogenesis imperfecta (OI) in association with dentinogenesis imperfecta (DI), showing a consistently abnormal appearance of the dentin in all specimens, with variations being primarily those of degree of change. Similarities in histological changes include the alternating presence of normal and severe pathological areas in primary and secondary dentin, the latter being characterized by large canal-like structures in atubular areas. Ultrastructural evidence of pathological dentinogenesis include abnormal distribution, size and organization of collagen fibers, which may also be found in clinically unaffected teeth. The histological and ultrastructural changes seen can be explained on the basis of odontoblast dysfunction which may be secondary to the collagen defect, interfering with different levels of odontoblast cell function and intercellular communication. These observations on (ultra)structural dentin defects associated with the two novel gene mutations are the first ever reported.

Relative curing degree of polyacid-modified and conventional resin composites determined by surface Knoop hardness

OBJECTIVES

The aim of the present study was to investigate the relative curing degree at a depth of 2 mm of several polyacid-modified composites (PAM-Cs) as a function of shade.

METHODS

The Knoop hardness of the irradiated top and non-irradiated bottom surfaces of 2 mm thick samples of the PAM-Cs Hytac, F2000, Glasiosite, Dyract, Dyract AP, and Compoglass F and of the resin composites Z100, Herculite Enamel XRV, and Durafill VS, were determined for shades A2 and A4.

RESULTS

The top and bottom hardness of F2000 and Glasiosite ranged between that of the two composites Herculite and Z100. Compoglass, Dyract and Dyract AP had a lower top and bottom hardness than the hybrid composites, but higher than that of the microfilled composite Durafill. The top hardness of Hytac compared with that of the first group, whereas the bottom hardness compared with the second group. The bottom-to-top KHN ratio reflecting the relative curing degree at a depth of 2 mm was less than 80% for the two shades of Hytac and Compoglass as well as for the A4 shade of Dyract AP and Herculite.

SIGNIFICANCE

A hard top surface of a PAM-C is not an indication of adequate in depth polymerization. Shade A2 results in significantly greater values for the curing degree compared to shade A4, the effect depending quantitatively on the formulation of the material. Some formulations of PAM-C do not reach an adequate curing degree at a depth of 2 mm so that it is recommended to apply the incremental technique even in box-only cavities with layers of maximum 2 mm.

Self-mutilation behaviour in Lesch-Nyhan syndrome

Lesch-Nyhan syndrome (LNS), first described in 1964 by Lesch and Nyhan, is a rare X-linked genetic disorder involving (near) absence of the enzyme hypoxanthine-guanine phosphoribosyl transferase (HPRT). It occurs in 1:100,000 to 380,000 live births (1, 2). The deficiency of HPRT activity leads to an excessive uric acid production resulting in neurological, renal and musculoskeletal manifestations. Death usually occurs in the second or third decade from infection or renal failure. Clinical presentation is characterized by mental retardation, choreoathetosis, spasticity, hyperuricemia and cerebral palsy. A characteristic feature of LNS is the appearance of intractable self-injurious behaviour (SIB), usually in the form of severe lip and finger biting, gouging of eyes, face scratching and head banging requiring extreme management techniques such as the application of restraints and or extraction of teeth at an early age. In this case report a unique approach of SIB in LNS is presented.

Dentinogenesis imperfecta associated with short stature, hearing loss and mental retardation: a new syndrome with autosomal recessive inheritance?

The follow-up history and oral findings in two brothers from consanguineous parents suggest that the association of dentinogenesis imperfecta (DI), delayed tooth eruption, mild mental retardation, proportionate short stature, sensorineural hearing loss and dysmorphic facies may represent a new syndrome with autosomal recessive inheritance. Histological examination of the dentin matrix of a permanent molar from one of the siblings reveals morphological similarities with defective dentinogenesis as presenting in patients affected with Osteogenesis Imperfecta (OI), a condition caused by deficiency of type I collagen. A number of radiographic and histological characteristics, however, are inconsistent with classical features of DI. These findings suggest that DI may imply greater genetical heterogeneity than currently assumed.

Review: The physiology of saliva and transfer of drugs into saliva

Although saliva or oral fluid "lacks the drama of blood, the sincerity of sweat and the emotional appeal of tears", quoting Mandel in 1990 [I.D. Mandel, The diagnostic uses of saliva, J. Oral Pathol. Med. 19 (1990) 119-125], it is now meeting the demand for inexpensive, non-invasive and easy-to-use diagnostic aids for oral and systemic diseases, drug monitoring and detection of illicit use of drugs of abuse, including alcohol. As the salivary secretion is a reflex response controlled by both parasympathetic and sympathetic secretomotor nerves, it can be influenced by several stimuli. Moreover, patients taking medication which influences either the central nervous system or the peripheral nervous system, or medication which mimic the latter as a side effect, will have an altered salivary composition and salivary volume. Patients suffering from certain systemic diseases may present the same salivary alterations. The circadian rhythm determines both the volume of saliva that will and can be secreted and the salivary electrolyte concentrations. Dietary influences and the patient's age also have an impact on composition and volume of saliva. The latter implies a wide variation in composition both inter- and intra-individually. Sampling must therefore be performed under standardized conditions. The greatest advantage, when compared to blood sample collection, is that saliva is readily accessible and collectible. Consequently, it can be used in clinically difficult situations, such as in children, handicapped and anxious patients, where blood sampling could be a difficult act to perform.

Oral health in prevalent types of Ehlers-Danlos syndromes

BACKGROUND

The Ehlers-Danlos syndromes (EDS) comprise a heterogenous group of heritable disorders of connective tissue, characterized by joint hypermobility, skin hyperextensibility and tissue fragility. Most EDS types are caused by mutations in genes encoding different types of collagen or enzymes, essential for normal processing of collagen.

METHODS

Oral health was assessed in 31 subjects with EDS (16 with hypermobility EDS, nine with classical EDS and six with vascular EDS), including signs and symptoms of temporomandibular disorders (TMD), alterations of dental hard tissues, oral mucosa and periodontium, and was compared with matched controls.

RESULTS

All EDS subjects were symptomatic for TMD and reported recurrent temporomandibular joint (TMJ) dislocations. Abnormal pulp shape (13%) and pulp calcification (78%) were observed in subjects affected with classical EDS. Caries experience was higher in EDS compared with controls and was related to poor oral hygiene, influenced by increased mucosal fragility and restraint of (wrist) joint mobility. The overall periodontal status in EDS was poor, with 62% of EDS subjects presenting high periodontal treatment needs (community periodontal index for treatment need, CPITN = II).

CONCLUSION

Oral health may be severely compromised in EDS as a result of specific alterations of collagen in orofacial structures. When considering dental treatment in EDS, a number of tissue responses (mucosa, periodontium, pulp) and precautions (TMJ dislocation) should be anticipated.

Effect of a neutral citrate solution on the fluoride release of conventional restorative glass ionomer cements

OBJECTIVES

This study investigates the effect of a neutral citrate solution on the fluoride release of 10 acid-base setting glass ionomer cements during 140 days at 37 degrees C.

METHODS

Five disks of 10 acid-base setting restorative glass ionomers were prepared according to the manufacturer's instructions. These specimens were immersed individually in 25 ml of a 0.01 mol/l citrate solution with pH = 7. Over 140 days, the solutions were regularly renewed and the fluoride concentration eluted during each period was determined with a combined fluoride ion selective electrode.

RESULTS

The cumulative fluoride release was the result of an initial high release that ceased after some time and a long-term of low fluoride release. The long-term fluoride release was higher in neutral citrate solution than in water. For some formulations the short-term fluoride release also was higher in neutral citrate solution than in water suggesting that the polysalt matrix composition could be important in this respect.

SIGNIFICANCE

The fluoride release process is due not only to a loss of relatively loosely bound fluoride in the cement matrix, but also to the release of strongly bounded fluoride inducing a long-term fluoride release. The effect of citrate on the fluoride release process may increase depending on the acid (polyacrylic acid versus copolymers of polyacrylic acid) used for the polysalt formation in the hardening cement. Depending on the competition between the polyacrylate anion and the citrate anion for the metal cation extraction the fluoride release process may be retarded.

Children's coping with pain during dental care

OBJECTIVES

The purpose of this study was (i) to assess the coping strategies of 11-year-old children when dealing with pain at the dentist, (ii) to determine the extent to which the level of the children's dental fear and their experience with pain at the dentist are related to their ability to cope and their choice of strategies, and (iii) to analyse the possible differences between subsamples concerning dental caries.

METHODS

The coping strategies were investigated using the Dental Cope Questionnaire (n = 597); the level of dental fear was assessed using the Children's Fear Survey Schedule (CFSS-DS); a question is asked whether a child had experienced pain at the dentist in the past and dental caries was assessed using the DMFS index.

RESULTS

The results show that 11-year olds use a variety of coping strategies. Internal strategies are used most frequently, external coping strategies are used less frequently, and destructive strategies are hardly used. The subjects rate internal and external strategies as effective. Children with pain experience and fearful children use more coping strategies, with fearful children using more internal strategies. Reported pain and anxiety were related to the dental status.

CONCLUSIONS

The use and choice of coping strategies seems to be at least partly determined by the level of dental fear and the child's experience with pain.

Generalized joint hypermobility and temporomandibular disorders: inherited connective tissue disease as a model with maximum expression

AIMS

To study the relationship between generalized joint hypermobility (GJH) and temporomandibular disorders (TMD) by assessing prevalence and patient characteristics of TMD in a population of patients with maximum expression of GJH as a symptom of inherited connective tissue disease. In addition, diagnostic reliability of a series of clinical signs indicative of temporomandibular joint (TMJ) hypermobility was tested.

METHODS

The study sample consisted of 42 subjects with GJH, 24 with Marfan syndrome and 18 with Ehlers-Danlos syndrome. A subgroup of 27 individuals was selected by age (> or = 18 yrs) and was compared to 40 controls with TMD and normal peripheral joint mobility. TMD diagnoses were assigned to each subject according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).

RESULTS

In the GJH sample (n = 42), 71.4% of the subjects were symptomatic for TMD. Of those, 13.3% had sought treatment. A myofascial pain diagnosis was made in 69%, disc dislocation with reduction was diagnosed in 85.7%, and TMJ arthralgia in 61.9%. Multiple TMD diagnoses were assigned in 69% of the subjects; of these, 57% had 3 or more subgroup diagnoses. Joint noises (P < .01) and recurrent TMJ dislocations (P < .01) were a frequent finding in adult GJH subjects (n = 27) compared to controls, with symptomatic GJH subjects presenting more and more prolonged dislocation events than asymptomatic subjects (P < .001). TMJ hypermobility signs were expressed significantly more often in GJH compared to controls with TMD and normal joint mobility.

CONCLUSION

This study indicates a positive relationship between GJH and TMD.

Curing depth of (polyacid-modified) composite resins determined by scraping and a penetrometer

OBJECTIVES

The present study aimed to compare the curing depth of polyacid-modified composite resins (PAM-C) and some representative composite resins as a function of shade and post-cure using a scraping method and a penetrometer.

METHODS

The curing depth of the PAM-C Hytac, F2000, Glasiosite, Dyract, Dyract AP, and Compoglass F and of the composite resins Durafill VS and Z100 were determined for shade A2 and A4 using a scraping method based on ISO 4049:2000 and a digital penetrometer. Samples were light-cured (800 mW/cm2 at 40 s) in bulk in split stainless steel molds. Immediately after light-curing or after a 24 h post-cure, the height of the cylinder of cured material was measured and taken as the curing depth.

RESULTS

For both test methods, the curing depth was independent of post-cure (P > or = 0.05) but differed significantly among materials and shade (P<0.001). Moreover, there was a significant interaction between the latter (P<0.001). Regression analysis generally demonstrated that there was no significant systematic or proportional difference between the test methods. The curing depths of the PAM-C F2000 and Glasiosite were comparable to that of the hybrid composite Z100, but greater than the curing depth of the microfilled composite Durafill VS. The PAM-C Dyract AP, Dyract, Compoglass F and Hytac had a curing depth smaller than that of the microfilled composite.

SIGNIFICANCE

The scraping method based on ISO 4049:2000 and a digital penetrometer give comparable curing depths for PAM-C. The curing depth greatly varies among the materials and can be considerably smaller than that of a microfilled composite resin. Shade A2 results in significantly greater values for the curing depth compared to shade A4, the effect depending quantitatively on the formulation of the material.

Oral health and habits in children with asthma related to severity and duration of condition

AIM

This study was designed to examine the oral health status of asthmatic children and to compare the oral health condition and habits of different groups of asthmatic children.

METHODS

140 asthmatic children were involved in the present study. Of those, 30 were younger than 7 years of age, 73 were between 7 and 12, 37 were older than 12. Dental caries was scored according to the guidelines of the BASCD. No radiographs were taken. The gingival health and the amount of plaque were assessed using the bleeding index described by Mühleman and Son [1971] and the plaque index of Silness and Löe [1964] respectively. To differentiate between the asthmatic children three explanatory variables were used: the time the asthmatic symptoms had lasted, the exposure time to the medication and the severity of the asthmatic condition. Finally the parents and children were asked to fill in a questionnaire referring to oral health habits.

RESULTS

The mean dmft was 1.99 (SD+/-2.74) and the mean DMFT was 1.10 (SD+/-1.98). Non-parametric correlation and multiple logistic regression analyses showed no significant difference between the caries (dmft/s, DMFT/S), the gingival health (bleeding index) and plaque indices and the three explanatory variables. The impact of possible compensatory factors as oral hygiene and dietary habits was of no significant importance.

CONCLUSION

This analysis revealed that neither the period (of the disease and the medication) nor the severity of the asthma had a significant influence on the risk of caries and gingivitis in asthmatic children. No reported oral health and dietary habits could explain this lack of correlation.

Orofacial manifestations of congenital fibrillin deficiency: pathogenesis and clinical diagnostics

Mutations in the genes encoding fibrillin, an extracellular matrix protein involved in providing elastic properties to the connective tissues, may result in specific craniofacial and oral anomalies. A number of craniofacial (retrognathia, dolichocephaly, high palate) and dental (root deformity, pulp calcification) manifestations are considered pathognomic for the Marfan syndrome (MFS), a condition caused by congenital fibrillin-1 deficiency. Reports on similar features in congenital contractural arachnodactyly (CCA), caused by fibrillin-2 deficiency, support the hypothesis that fibrillin deficiency might result in a number of morphological anomalies by influencing tissue interaction during growth and development. Hence, clinical manifestations can be related to specific aspects of fibrillin deficiency pathogenesis, and may be adopted as diagnostic tools in the outlook for affected individuals.

Early Childhood Caries (ECC): what's in a name?

AIM

It is evident from the number of published scientific papers on Early Childhood Caries (ECC) that interest in this problem has grown in recent years. Many authors have been trying to devise a clear definition or classification for ECC. The aim of this review was to inventory the prevalence of ECC and to seek a consensus regarding definition and diagnosis. Further attention was paid to the aetiological factors including the role of microrganisms. Finally, education, parenting and treatment procedures were discussed.

METHODS

For this review, epidemiological studies on caries prevalence in children aged between 0 and 36 months were compiled through a systematic approach using Medline.

REVIEW

This clearly showed that ECC continues to be a serious public health problem and that there is a great variety of definitions and diagnoses used worldwide, reflected in the prevalence data. This review confirms the multicausal aetiology and the need for further research. The authors strongly support the recommendations formulated at the workshop in Bethesda 1999, and the policy statements by the AAPD.

CONCLUSION

More efforts should be made to reach the high risk groups within populations, in order to reduce the prevalence of ECC and S-ECC (Severe Early Childhood Caries) and consequently to ameliorate the quality of life of these children. Long-term intervention studies are required for the evaluation of these efforts.

[Clinical evaluation of the INJEX system, a local anesthesia system without needles: a comfort evaluation study]

The use of needless local anaesthesia systems in dentistry can be of a help in treating needle phobia patients. The aim of this comfort study was to compare a classical local infiltration anaesthesia with a needle-free system. INJEX (ROSCH AG Germany). A split mouth design study was performed. All patients in this study needed 2 restorations. In order to receive objective information on both systems needle-phobia patients were banned. Therefore the first restoration was performed with the classical system (with needle) and the well-acceptance was evaluated. The second restoration was done with the needle-free system. Both patient and dental practitioner performed an evaluation after each treatment. Evaluation by the patient was given by a questionnaire on the comfort of the treatment using Faces Pain Scale, Lickert Scale and a modified version of the Abbreviated Acceptability Rating Profile. By the dental practitioner the comfort of the treatment and the amount of local anaesthesia needed was evaluated. The study was approved by the ethical committee of Ghent University Hospital Belgium.

CONCLUSION

The INJEX system can be a valuable alternative to use in paediatric dentistry, although non needle phobia patients in this study did not preferred the needle free INJEX system above the classical local injection.

[Oral health risks in patients with cystic fibrosis]

Cystic Fibrosis (CF) patients can hypothetically be considered as being high caries risk patients; they frequently consume sugar-rich in-between-meal snacks/drinks and they have a high intake of sugar containing syrups and aerosols (also acidic) and salivary flow reducing medication (beta-2-adrenergica). The aim of this study was to investigate the determining factors of oral health in CF homozygotes, CF heterozygotes and healthy controls. CF homozygotes had significantly the lowest caries experience, while CF heterozygotes had a borderline not significant higher caries experience than healthy controls. CF homozygotes also had significant lower Streptococcus mutans counts than both other groups. CF homozygotes also had significant less gingival bleeding, while no significant differences in plaque and calculus amount were found between the three groups. On behalf of oral hygiene habits, no significant differences were found between the three groups. CF homozygotes appeared to consume more dairy products than the others. The influence of the typical CF medication on oral health did not play a significant role. CF homozygotes had a significant higher total salivary protein concentration than the others, while SDS-PAGE analysis showed a 68 kDa protein being specific in appearance for CF heterozygotes. CF homo- and heterozygotes had significant higher salivary sodium concentrations than controls. CF homozygotes also had a significant higher salivary phosphate concentration than both other groups. The impression that CF patients seem to possess an intrinsic salivary compensatory mechanism should be further investigated.

[Dental symptomatology associated with connective tissue anomalies]

Subjects affected with inherited disorders, of the connective tissue make up an important population, carrying high risks as to distinct aspects of oral health and dental treatment. These generalized conditions may produce serious clinical symptoms in different orofacial structures, which have to be dealt with, or anticipated, when considering dental treatment. The most prevalent disorders result from deficiency of Type I collagen, an important extracellular matrix protein regulating both the structural and mechanical properties of most of the orofacial tissues. Recurrent jaw fractures, an increased liability for development of temporomandibular disorders, periodontal disease and mucosal fragility, an abnormal tooth color and/or shape, and pulp obliteration may feature as major clinical manifestations of the respective disorders. Deficiency of fibrillin, a protein providing soft tissues with elastic capacities, may produce a long face with a high and narrow palate, an increased liability for the developnet of temporomandibular disorders and periodontal disease, and root dsyplasia. Whenever present, these manifestations/risk factors have to be integrated in dental treatment strategies. In cases with high risk for cardiovascular complications, specific preventive measures, such as cardiac output monitoring and the administration of appropriate local anesthetics, have to be taken before starting any invase dental treatment. The present paper aims to provide the practitioner with an appreciation of the most prevalent inherited disorders of the connective tissue with their respective genetics, molecular aspects of pathology, medical and oral manifestations, and guidelines for dental treatment.

[Use of osteoconductive materials in pediatric dental medicine]

Osteoconductive materials are well known to have the ability to form a characteristic scaffold for bone replacement. The use of these agents is mostly described in periodontal procedures. The present study deals with the use of two different osteoconductive materials used for repairing bone defects following traumatic injuries. The materials used were Bio-Oss (Geistlich) an allogenic demineralised bone and Fisiograft (Ghimas) a synthetic co-polymer of polyglicolic and polylactic acid. These materials were used in five different clinical cases with the objective to compare their typical properties during application and to evaluate radiographically and clinically their healing ability. In three cases filling of the alveolus was performed after extraction of traumatised incisors as a consequence of root resorption or fracture; two patients suffered from periodontal defects. All cases were followed every three months for at least two years and maximum 6 years. Regarding the handling of the materials all products were well accepted. From our clinical experience all modalities are found to be suitable. After clinical and radiographical evaluation normal bone formation was found in all cases without any complaints nor clinical symptoms. These clinical findings support the use of osteoconductive agents in the field of Paediatric Dentistry in well-defined indications.

Unusual oral findings in dermatosparaxis (Ehlers-Danlos syndrome type VIIC)

A 13-year-old patient with dermatosparaxis (Ehlers-Danlos syndrome type VIIC), an autosomal recessive disorder of procollagen-I-N-proteinase, is presented. The oral findings comprise micrognathia, hypodontia, localized microdontia, opalescent tooth discoloration, root dysplasia, pulp obliteration, severe gingival hyperplasia, frontal open bite, and severe restriction of TMJ mobility. The reported anomalies suggest the need for expanding the present phenotypic spectrum. This is the first report on oral findings in the syndrome.

Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003

AIM

This paper reviews the proceedings and conclusions of a meeting of experts concerned with the problem of hypomineralised incisors and molars (MIH). The aims of this meeting were to establish criteria for the judgement of MIH, to select representative cases and to discuss how the name of the condition was best described as hypomineralised, or hypomaturated, first permanent molars.

CONCLUSION

There was not complete agreement as to the correct diagnosis and aetiology of the condition. A suggested list of definitions of the judgement criteria to be used in diagnosing Molar Incisor Hypomineralisation (MIH) for prevalence studies was agreed upon.

[Sedation with nitrous oxide in daily practice]

Conscious sedation is recommended, together with behaviour management techniques, to facilitate treatment of dental fear or dental phobia patients. In this article the authors focus on inhalation sedation by means of nitrous oxide. The procedures and indications are explained and illustrated with clinical cases. On the strength of the literature and their own experience the authors reach the conclusion that Inhalation sedation is a kind of pharmacological behaviour management and an important additional tool to increase patient cooperation. Inhalation sedation can only be performed by trained practitioners under internationally accepted safety conditions. Inhalation sedation has a future in Belgium providing the appropriate law is adapted. This technique deserves a place in the dental curriculum.

Oral hygiene habits and oral health in cystic fibrosis

AIM

The present study was designed to investigate oral hygiene habits and fluoride use in cystic fibrosis (CF) homozygotes, heterozygotes and healthy controls as a function of caries experience (DMF-T) and oral cleanliness (dental plaque, dental calculus and gingival bleeding).

METHODS

Oral hygiene habits in CF homozygotes (n=42), heterozygotes (n=48) and healthy controls (n=62) were used in a multivariate analysis with caries experience (DMF-T) and oral cleanliness (dental plaque, calculus and gingival bleeding) as response variables.

RESULTS

CF homozygotes had a significantly lower caries experience (p< or =0.001) and less gingival bleeding sites (p< or =0.02). Oral hygiene habits were not significantly different between the three groups, except for intake of fluoride supplements. Significantly more CF homozygotes had received fluoride supplements. Oral hygiene habits did affect caries experience or oral hygiene differently in each study group.

CONCLUSION

No matter what oral hygiene habits were, CF homozygotes had an overall better oral health status. Apparently they seemed to possess intrinsic salivary compensatory mechanisms, as the significant higher use of fluoride supplements appeared not to be responsible for the better oral health.

Flow cytometry as a new method to quantify the cellular content of human saliva and its relation to gingivitis

BACKGROUND

Determining the cellular content of saliva by means of conventional microscopy chamber counting is a very time-consuming and operator-sensitive procedure. This study concentrated on the use of flow cytometry to examine the cellular content of saliva. Erythrocytes, leukocytes, epithelial cells and bacteria were quantified and the results were compared with caries experience and the presence of gingivitis.

METHODS

258 uncentrifuged vortexed paraffin-stimulated saliva samples (112 males and 146 females) were analyzed with the UF-100 flow cytometer. Salivary reference values were established for erythrocyte, leukocyte, epithelial cell and bacterial count. Caries experience (DMF) and the presence of gingivitis were recorded.

RESULTS

Caries experience or caries risk could not be assessed with flow cytometry. However, salivary flow cytometry may be useful in determining an individual's risk for gingivitis: a significant increase in salivary leukocytes was observed in individuals with gingivitis. At a cut-off level of 10(3) leukocytes micro l(-1) saliva, a sensitivity of 76% and a specificity of 45% was obtained. Other analytes were not significantly different between individuals with and without gingivitis.

CONCLUSION

Flow cytometry of paraffin-stimulated human saliva seems a promising diagnostic or predictive tool and further investigations of diseases of the oro-pharyngeal loge, such as tonsillitis and periodontitis, should be carried out in the future.