Factors influencing root resorption in retained mandibular second deciduous molars with congenital absence of second premolars: a cross-sectional study

BACKGROUND

There are currently no studies that quantitatively compare the relationship of root resorption to the patient's systemic history or craniofacial and intraoral morphology, especially in relation to possible host factors. Thus, this study aimed to clarify the factors associated with root resorption in retained mandibular second deciduous molars with the congenital absence of second premolars and predict the prognosis of retained mandibular second deciduous molars.

METHODS

A cohort of 5547 patients who visited the orthodontic clinic at Tokyo Medical and Dental University Dental Hospital between 2013 and 2022 was screened. Lateral cephalometric radiographs, panoramic radiographs, upper and lower dental models, and orthodontic treatment questionnaires were used as reference materials to apply the inclusion and exclusion criteria. Ultimately, 111 patients were included in the analyses. The patients were divided into two groups based on the root resorption levels of the retained mandibular second deciduous molars. Those with less root resorption were classified under the good condition (GC) group, whereas those with more root resorption were classified under the poor condition (PC) group. Demographic, clinical, and cephalometric parameters were compared between the groups. A multivariate logistic regression model was used to predict the probability of root resorption.

RESULTS

The prevalence of congenitally missing mandibular second premolars with persistent mandibular second deciduous molars was 2.0%. In a total of 111 patients, eighty-three teeth (53.2%) were classified into the GC group, whereas 73 teeth (46.8%) were classified into the PC group. The Frankfort-mandibular plane angle (FMA) [odds ratio (OR): 0.87], Frankfort-mandibular incisor angle (FMIA) (OR: 0.93), overbite (OR: 1.38), adjacent interdental space (OR: 1.46), distance from occlusal plane (OR: 0.80), and caries treatment (OR: 7.05) were significantly associated with the root resorption of the retained mandibular second deciduous molars.

CONCLUSIONS

Our findings suggest that skeletal morphology, oral morphological patterns, and history contribute to root resorption in retained mandibular second deciduous teeth with congenital absence of subsequent permanent teeth.

Investigation of the presence of Non-carious cervical lesions (NCCLs) in ancient adult skulls: analyzing data from prehistoric and historical samples through a systematic review and meta-analysis

OBJECTIVES

Historically, the prevalence of caries has undergone significant changes, particularly increasing with the industrialization of sugar consumption. When examining ancient populations, lower caries rates are discovered, attributed in part to dietary factors. These populations consumed abrasive foods, leading to occlusal wear and reduced non-axial occlusal forces, potentially influencing Non-Carious Cervical Lesions (NCCLs). Although some attribute NCCLs to abfraction, the mechanism remains debated. This systematic review aims to evaluate the presence of NCCLs in ancient populations, shedding light on the factors contributing to their occurrence.

MATERIALS AND METHODS

The present systematic review was registered on PROSPERO, and the manuscript was prepared following PRISMA guidelines.

RESULTS

After the literature search and article screening, data from 6 studies were included in the meta-analysis, with only 2 reporting NCCLs in ancient skulls, encopassing 17 subjects in 805 examined skulls, suggesting their presence even before the widespread use of toothbrushes. This finding indicates a potential etiopathogenic mechanism linked to abfraction, but the cause is complex and involves abrasive and erosive factors closely tied to dietary habits.

CONCLUSIONS

In summary, NCCLs were present in ancient populations, albeit with a much lower prevalence. Their occurrence cannot be solely attributed to wear mechanisms but must be connected to abrasive factors related to diet or practices with religious and cultural significance, such as the use of labrets.

CLINICAL RELEVANCE

Th the knowledge of NCCLs presence in acient sculls is crucial today for better understand the associated risk factors. In this context, the analysis of ancient skulls allows us to discern the role that tooth brushing and diet played in the formation of NCCLs, over the past century.

Identification of novel candidate genes associated with non-syndromic tooth agenesis in Mongolian families

OBJECTIVES

This study aimed to identify genetic variants associated with non-syndromic tooth agenesis (TA) in nine families from Mongolia using whole-exome sequencing (WES) and bioinformatics analysis.

MATERIAL AND METHODS

The study enrolled 41 participants, including three inherited and six non-inherited families. WES analysis was performed on 14 saliva samples from individuals with non-syndromic TA. The potential candidate genes were identified through variant filtering and segregation analysis. The filtered variants were then analyzed in silico mutation impact analysis.

RESULTS

WES analysis identified 21 variants associated with TA, and 5 of these variants met all filtering criteria. These variants were located in the exome region of MAST4, ITGA6, PITX2, CACNA1S, and CDON genes. The variant in PITX2 was found in eight participants from inherited and non-inherited families, while the MAST4 variant was identified in 6 participants from inherited families.

CONCLUSIONS

The study identified various genetic variant candidates associated with TA in different family groups, with PITX2 being the most commonly identified. Our findings suggest that MAST4 may also be a novel candidate gene for TA due to its association with the Wnt signaling pathway. Additionally, we found that five candidate genes related to focal adhesion and calcium channel complex were significant and essential in tooth development.

CLINICAL RELEVANCE

Identifying new pathogenic genes associated with TA can improve our understanding of the molecular mechanisms underlying the disease, leading to better diagnosis, prevention, and treatment. Early detection of TA based on biomarkers can improve dental management and facilitate orthodontic and prosthetic treatment.

Effect of arginine-fluoride varnish on preventing enamel erosion by paediatric liquid medicaments

BACKGROUND

The study objective was to examine the effect of arginine-sodium fluoride (Arg-NaF) varnish on preventing enamel erosion by acidic paediatric liquid medicaments (PLM).

METHODS

The treatment groups were: 1) 2% Arg-NaF; 2) 4% Arg-NaF; 3) 8% Arg-NaF; 4) NaF; 5) MI (CPP-ACFP) varnishes; and 6) no varnish. The pH of PLM (paracetamol and chlorpheniramine) was measured at baseline and after immersing the Perspex® blocks coated with varnishes at 0 min, 30 min, 1 h, and 4 h. Seventy-two enamel specimens (n = 72) were randomly divided into 2 groups by PLM and further by treatment groups. Then, the specimens were pre-treated with varnishes and subjected to erosive cycles (5 min, 2×/day for 4 days) by PLM. After each erosive challenge, the specimens were stored in artificial saliva. At baseline and after 4 days, the specimens were assessed for surface roughness (Ra) using 2D-surface profilometric analysis (SPA) and atomic force microscopy (AFM). Additionally, the Ca/P ratio was determined using scanning electron microscopy with energy-dispersive X-ray spectroscopy. Paired samples dependent t-test, 1-way ANOVA and 2-way ANOVA with Bonferroni post-hoc tests were used to analyse data with the level of significance set at p < 0.05.

RESULTS

The pH of PLM with 8% Arg-NaF was significantly higher than the other groups at 30 min and 4 h (p < 0.05). With paracetamol, no significant difference was observed between the baseline and post-erosive cycle measured enamel Ra (by SPA/AFM) and Ca/P ratio for all treatment groups (p > 0.05). The Ra determined by AFM, at the post-erosive cycle with chlorpheniramine, when treated with 4 and 8% Arg-NaF was significantly lower than the other groups (p < 0.05); except CPP-ACFP (p > 0.05). With the chlorpheniramine post-erosive cycle, the Ca/P ratio for 4, 8% Arg-NaF and CPP-ACFP treated specimens was significantly higher than the baseline Ca/P (p < 0.05).

CONCLUSION

The 4%/8% Arg-NaF and MI varnish® application exhibit an enhanced preventive effect against low pH (pH < 3.0) PLM-mediated enamel erosive challenges compared to 5% NaF varnish.

Acquired pellicle engineering with the association of cystatin and vitamin E against enamel erosion

OBJECTIVE

Evaluate CaneCPI-5 associated with Vitamin E in acquired enamel pellicle (AEP) engineering to prevent dental erosion.

METHODS

180 human enamel specimens were divided into 12 groups and treated with the following solutions: Cane+VitT and Cane+VitS- CaneCPI-5 + Vit E; Vit+CaneT and Vit+CaneS- Vit E + CaneCPI-5; VitT and VitS- Vit E; CaneT and CaneS- CaneCPI-5; ControlT and ControlS - AmF/NaF/SnCl2; WaterT and WaterS- Deionized water. Groups' name followed by "T" were first treated (200 μl; 2 min) and then incubated in human saliva (200 μl; 1 h) to form the AEP. For groups followed by "S", the AEP was formed and then treatment was applied. The erosive challenge consisted of immersion in 1% citric acid (1 min, 1x/day, for 3 days). The percentage of superficial hardness loss (%SHL) and the relative surface reflection intensity (%SRI) were subjected to normality and homogeneity tests, Shapiro-Wilk and Levene tests, respectively. Subsequently, the data were analyzed using two-way ANOVA, Tukey's test and Pearson's correlation (p < 0.005).

RESULTS

For%SHL and%SRI, water controls showed significantly lower protective capacity. Cane+VitT, Cane+VitS, and Vit+CaneS presented the lowest%SHL, and VitT and VitS did not differ from Vit+CaneT, but they were different from the other groups (p = 0.002). The greatest%SRI was found for the Cane+VitT, Vit+CaneT, VitT, Cane+VitS, Vit+CaneS, and VitS groups, which did not significantly differ. CaneT and ControlT, showed similar reflections compared to CaneS and ControlS.

CONCLUSION

CaneCPI-5 and Vitamin E demonstrated a synergistic protective effect against initial erosion.

CLINICAL SIGNIFICANCE

The results open up new possibilities for preventive approaches against erosion through the acquired pellicle engineering, with the combination of CaneCPI-5 and Vitamin E, which demonstrated to be more effective than commercial stannous mouthwash. Further research is warranted to explore the potential of this combination in diverse clinical settings.

Enamel defects of Axenfeld-Rieger syndrome and the role of PITX2 in its pathogenesis

OBJECTIVES

To investigate the detailed ultrastructural patterns of dental abnormalities affected by Axenfeld-Rieger syndrome (ARS) with a heterozygous microdeletion involving paired-like homeodomain 2 (PITX2) and explored the underlying molecular mechanisms driving enamel defects.

SUBJECTS AND METHODS

Sanger sequencing, genomic quantitative PCR analysis, and chromosomal microarray analysis (CMA) were used to screen the disease-causing mutation in one ARS proband. An exfoliated tooth from an ARS patient was analyzed with scanning electron microscopy and micro-computerized tomography. A stable Pitx2 knockdown cell line was generated to simulate PITX2 haploinsufficiency. Cell proliferation and ameloblast differentiation were analyzed, and the role of the Wnt/β-catenin pathway in proliferation of ameloblast precursor cells was investigated.

RESULTS

An approximately 0.216 Mb novel deletion encompassing PITX2 was identified. The affected tooth displayed a thinner and broken layer of enamel and abnormal enamel biomineralization. PITX2 downregulation inhibited the proliferation and differentiation of inner enamel epithelial cells, and LiCl stifmulation partially reversed the proliferation ability after Pitx2 knockdown.

CONCLUSIONS

Enamel formation is disturbed in some patients with ARS. Pitx2 knockdown can influence the proliferation and ameloblast differentiation of inner enamel epithelial cells, and PITX2 may regulate cell proliferation via Wnt/β-catenin signaling pathway.

Fluoride varnishes supplemented with nano-sized sodium trimetaphosphate reduce enamel erosive wear in vitro

OBJECTIVE

To evaluate the effect of fluoride (F) varnishes with sodium trimetaphosphate (TMP) on erosive tooth wear (ETW) in vitro.

METHODS

Enamel blocks (n = 100) were divided into 5 experimental groups (n = 20/group): Placebo (Pla - without F/TMP); 5 % NaF (NaF); 5 % NaF + 5 % micrometric TMP (NaF+5 %MICRO); 5 % NaF + 2.5 % nano-sized TMP (NaF+2.5 %NANO), and 5 % NaF + 5 % nano-sized TMP (NaF+5 %NANO). Blocks received a single varnish application (6 h contact), and were submitted to 4 daily erosive challenges (ERO, 0.05 M citric acid, pH 3.2, 90 s, under agitation), for 5 days. After ERO, half of the blocks (n = 10/group) were subjected to brushing abrasion (ERO+ABR). Profilometry, surface hardness (SH), and cross-sectional hardness (ΔKHN) were determined. The data were submitted to 2-way ANOVA and Fisher's LSD test (p < 0.05).

RESULTS

Enamel wear was significantly lower for ERO compared with ERO+ABR for all varnishes tested (p < 0.001), following the pattern NaF+5 %NANO < NaF+5 %MICRO < NaF < NaF+2.5 %NANO < Pla (both for ERO and ERO+ABR). The highest SH loss was observed for Pla and the lowest for NaF (ERO) and NaF+2.5 %NANO (ERO+ABR), without significant differences among NaF+2.5 %NANO, NaF, and NaF+5 %MICRO. The highest ΔKHN values were observed for NaF+5 %MICRO and NaF+5 %NANO at 5-30 µm, with less marked differences among the groups at 30-70 µm (ERO and ERO+ABR).

CONCLUSIONS

The addition of TMP to F varnishes significantly improves protection against ETW in vitro. The use of 5 % nano-sized TMP further enhances such effects.

CLINICAL SIGNIFICANCE

F varnishes containing TMP can reduce enamel loss caused by ERO or ERO+ABR.

Influence of Different Mouthwashes on the Efficacy of Fluoridated Dentifrices in Prevention of Enamel Erosion: An In Vitro Study

AIM

The purpose of the current study was to evaluate the impact of three various mouthwashes on the effectiveness of fluoride dentifrices in preventing enamel erosion.

MATERIALS AND METHODS

A total of 120 sound intact human premolar teeth which were extracted for orthodontic treatment were selected for the study. A 3 × 3 mm window section was positioned in the middle of the coronal surface of the tooth in order to define the study area. Each sample was placed in a solution of 1% citric acid (pH 3.5) for 10 minutes in order to produce an eroded surface. All samples were divided into two main groups (60 samples each) as follows: Group A for sodium fluoride dentifrices and group B for stannous fluoride dentifrices, again it is subdivided into: CHX: Chlohex ADS®, EO: Listerine®, CPC: Colgate® Plax (20 samples in each subgroup). After that, samples underwent the pH cycling model for 5 days. Samples were examined for surface loss using a scanning electron microscope.

RESULTS

In sodium fluoride dentifrices group, before intervention, the surface loss was 3.12 ± 1.03 in CHX group, 3.08 ± 1.20 in EO group, and 3.09 ± 0.96 in CPC group. After intervention, the less surface loss found with CHX group (2.18 ± 0.84), followed by CPC (2.34 ± 0.74) and EO group (2.46 ± 0.97). In stannous fluoride dentifrices group, before intervention, the surface loss in CHX group was 3.26 ± 1.19, in EO group, it was 3.18 ± 1.31, and in CPC group, it was 3.22 ± 1.06. After intervention, the less surface loss found with CHX: group (1.90 ± 0.54), followed by CPC (2.24 ± 0.28) and EO group (2.38 ± 0.20).

CONCLUSION

The present study concluded that the fluoride dentifrices' preventive effects against tooth surface loss were unaffected by a different mouthwashes with varying compositions and major constituents. In terms of erosion, fluoridated toothpaste containing stannous fluoride was found to provide better surface loss protection than sodium fluoride.

CLINICAL SIGNIFICANCE

Primary prevention and the eradication of contributing causes are the greatest strategies for preventing erosion. Simultaneously, antibacterial agent in the mouthwashes may help in enhancing the effect of fluoride in the enamel, owing to their high affinity for teeth structures. Therefore, in addition to cause-related treatment, further efforts to reduce tooth tissue loss are also necessary.

Developmental enamel defects and dental anomalies of number and size in children with growth hormone deficiency

Growth hormone is meaningfully involved in the processes of tooth cells differentiation and tissue formation. The aim of the study was to evaluate the occurrence of dental anomalies: microdontia, macrodontia, hypodontia and developmental defects of enamel (DDE) amongst a group of isolated growth hormone deficient (GHD) patients and healthy children. This cross-sectional study was based on a group of 101 Caucasian children: 33 with GHD (mean age 10.94, SD 2.51) and 68 being healthy, normal height subjects (mean age 10.4, SD 2.38). The dental examination in primary and permanent teeth was carried out by one trained and calibrated dentist, in accordance with the WHO guidelines. It was observed that 33% of GHD patients suffer from dental anomalies (hypodontia, microdontia or macrodontia), the difference between the study group and the control group was statistically significant (33% vs 4%, p < 0.001). Hypodontia and microdontia/macrodontia were the most common problems affecting 18% and 21% of the GHD individuals, respectively. The prevalence of DDE did not differ significantly between GHD group and the control group (58% vs 48%, p > 0.05). As children with GHD present more dental anomalies than their healthy coevals, clinicians should be aware of the possible oral health problems associated with GHD and consider dental screening and management as part of the patient's overall health care plan.

The Impact of Prenatal Vitamin D on Enamel Defects and Tooth Erosion: A Systematic Review

Prenatal Vitamin D has been suggested to be critical for dental health in children, affecting outcomes including the prevalence of enamel defects and tooth erosion. This systematic review aimed to evaluate the potential impact of prenatal Vitamin D levels on these dental health outcomes. A total of seven studies, involving 6978 participants, were included after a comprehensive search of PubMed, Web of Science, and Scopus from 2013 to June 2023. The average age of mothers varied across studies, with Vitamin D levels or supplementation practices displaying significant variation among the study populations. The age of children at examination ranged from 3.6 to 6.6 years. The analysis demonstrated a diverse association between Vitamin D levels and dental outcomes, with enamel defects reported in 21.1% to 64% of the children and opacities ranging from 36% to 79.5% across studies. Maternal Vitamin D insufficiency was identified as a significant risk factor for enamel defects in one study (OR: 3.55), whereas high prenatal Vitamin D levels indicated a protective effect against Hypomineralized Second Primary Molars (OR: 0.84) and Molar Incisor Hypomineralization (OR: 0.95) in another. Conversely, low Vitamin D levels increased the risk of enamel hypoplasia (OR: 1.29) and dental decay. The maternal and child demographics varied greatly across the studies, and the assessment and prevalence of Vitamin D deficiency or insufficiency were heterogenous. This review illuminates the potential influence of prenatal Vitamin D on dental health in children, underscoring the importance of adequate Vitamin D levels during pregnancy. However, more robust research is required to establish the optimal Vitamin D intake during pregnancy to ensure healthy dental outcomes in children.

Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro

OBJECTIVE

To compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model.

MATERIALS AND METHODS

81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS).

RESULTS

All three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion.

CONCLUSION

All three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro.

CLINICAL SIGNIFICANCE

To date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.

Non-traumatic emergency department dental visits among patients 0-25 years of age: A systematic review and meta-analysis

BACKGROUND

Nontraumatic dental conditions (NTDC) that made children attending to emergency departments (EDs) of tertiary hospitals can put significant financial and time strain on hospitals.

AIM

The aim of this systematic review and meta-analysis was to calculate the prevalence of paediatric presentations to EDs of tertiary hospitals for NTDC and describe the characteristics of these presentations.

DESIGN

A systematic search strategy using PubMed, Embase and Web of Science databases was performed to identify studies quantifying NTDC presentations to EDs of tertiary hospitals from inception through to July 2022. Eligible studies were critically appraised using the Joanna Briggs Institute checklist for studies reporting prevalence.

RESULTS

The search identified 31 099 studies, from which 14 were found to meet the inclusion criteria. A random effects model was used for meta-analysis, and the prevalence of NTDC reported through EDs of tertiary hospitals ranged from 52.3% to 77.9%.

CONCLUSIONS

Nontraumatic dental conditions, which may be preventable when caused by dental caries, made up a high proportion of dental visits to tertiary hospital EDs. Public health initiatives should be considered to reduce the burden of NTDC on EDs.

Pre-, Peri-, and Postnatal Risk for the Development of Enamel Defects in Permanent Dentition: A Birth Cohort in Southern Brazil

Purpose: The purpose of this study was to find potential risk factors associated with the occurrence of developmental defects of enamel (DDE) in permanent dentition of a birth cohort in Southern Brazil. Methods: This study is a 2004 birth cohort carried out in the city of Pelotas, Rio Grande do Sul, Brazil. A subsample of 996 children was clinically examined at 12 to 13 years of age. The pre- and perinatal variables used for this study were: twin pregnancy; type of delivery; prematurity; birth weight; Apgar score in the first and fifth minute; health problems at birth; and intensive care unit admission at birth. Gender and family income variables were also collected. Some postnatal variables were collected: "hospitalization in the first 24 months"; "breastfeeding"; "respiratory diseases in the first 48 months"; "urinary infection in the first 48 months"; and "ear pain in the first 48 months." To assess an association between the presence of DDE and various risk factors, unadjusted and adjusted Poisson regression with robust variance was performed with a respective prevalence ratio. Results: The prevalence of DDE was 40.8 percent. The variables investigated did not present a statistical association with DDE. Conclusion: No association of developmental defects of enamel in permanent dentition with any of the factors investigated in this study was found.

Dietary and metabolic effects on the oral status of patients with phenylketonuria: a nation-based cross-sectional study

OBJECTIVES

The aim of this study was to compare the prevalence of oral diseases (caries, periodontal disease, enamel defects) between patients with phenylketonuria (PKU), their siblings, and a matched control group.

MATERIALS AND METHODS

A total of 109 patients with PKU, 14 siblings of PKU patients, and 100 healthy individuals aged 6 to 68 years were recruited. All participants completed a questionnaire based on their health status. The patients' decayed/missing/filled teeth index (dmft/DMFT), gingival bleeding index (GBI), plaque control record (PCR), periodontal screening and recording index (PSR), and developmental enamel defects index (DDE) were recorded. Descriptive statistics and regression modeling were used to examine potential associations between the exposure and the outcomes of interest.

RESULTS

Patients with PKU had 1.6 times more caries (95% confidence interval (CI) 1.22 to 2.20; p = 0.001), seven times more enamel defects (95% CI 3.94 to 14.21; p < 0.001), and four times higher PSR values (95% CI 2.26 to 7.15; p < 0.001) than the control group. The siblings had significantly fewer enamel defects but no significant differences in caries and periodontal parameters compared to the PKU patients.

CONCLUSIONS

The results showed a higher risk for the development of caries, periodontitis, and enamel defects in PKU patients.

CLINICAL RELEVANCE

Implementation of preventive measures and regular dental care is necessary for patients with PKU.

Clinical status and assessment of caries on first permanent molars in a group of 6- to 13-year-old Tunisian school children

AIM

The present survey aimed to highlight the clinical status of first permanent molars (FPMs) among a group of children aged between 6 and 13 years in public primary schools in Tunisia and to determine the association between FPMs' dental caries, gingival bleeding, malocclusion, dental fluorosis, and enamel defects.

MATERIALS AND METHODS

The survey involved a cross-sectional study based on a dental examination conducted in public primary schools in Monastir Tunisia. A dental caries assessment was performed on FPMs using the International Caries Detection and Assessment System classification; the number of carious lesions in permanent and temporary dentition was established using the decayed/missing/filled teeth (DMFT) index. The Gingival Index and the Dental Aesthetic Index were used to determine the occurrence of gingival bleeding and malocclusions. Dean's index and the modified Development Defects of Enamel index were used to define the enamel defects. The χ² test was used to assess the difference between more than two groups, and the level of statistical significance was set at .05%.

RESULTS

A total of 545 children and 2080 FPMs were examined. The prevalence of dental caries in FPMs was recorded to be 35.8%. The overall mean DMFT index of the study population was 1.62 and the mean DMFT index was 1.41. The proportion of carious FPMs increased significantly with the age of the children (p < .05). The mandibular first permanent molar presented higher caries prevalence than its maxillary counterpart (p < .05). The presence of surfaces affected by molar incisor hypomineralization was recorded in 4.3% and the presence of surfaces affected by fluorosis was recorded in 4.6% of FPMs. No association was reported between FPMs' dental caries, gingival bleeding, malocclusion, and enamel defects (p > .05).

CONCLUSION

Although the prevalence of caries in FPMs was considered moderate, health promotion programs should be implemented on a large scale to decrease the prevalence of dental caries among school children.

Pathophysiology of Demineralization, Part I: Attrition, Erosion, Abfraction, and Noncarious Cervical Lesions

PURPOSE OF THE REVIEW

Compare pathophysiology for infectious and noninfectious demineralization disease relative to mineral maintenance, physiologic fluoride levels, and mechanical degradation.

RECENT FINDINGS

Environmental acidity, biomechanics, and intercrystalline percolation of endemic fluoride regulate resistance to demineralization relative to osteopenia, noncarious cervical lesions, and dental caries. Demineralization is the most prevalent chronic disease in the world: osteoporosis (OP) >10%, dental caries ~100%. OP is severely debilitating while caries is potentially fatal. Mineralized tissues have a common physiology: cell-mediated apposition, protein matrix, fluid logistics (blood, saliva), intercrystalline ion percolation, cyclic demineralization/remineralization, and acid-based degradation (microbes, clastic cells). Etiology of demineralization involves fluid percolation, metabolism, homeostasis, biomechanics, mechanical wear (attrition or abrasion), and biofilm-related infections. Bone mineral density measurement assesses skeletal mass. Attrition, abrasion, erosion, and abfraction are diagnosed visually, but invisible subsurface caries <400μm cannot be detected. Controlling demineralization at all levels is an important horizon for cost-effective wellness worldwide.

Delayed Eruption In Cleidocranial Dysplasia

Cleidocranial dysplasia is a rare autosomal dominant disorder of bones mainly affecting bones formed by intra-membranous and endochondral ossification. It presents clinically as brachycephalic skull, frontal bossing, depressed nasal bridge, hypertelorism, delayed closure of fontanelles, delayed eruption of permanent teeth, missing clavicles and wide pelvis. It runs in families; sporadic cases are rarer. Just over than 1000 cases have been reported. We are presenting here 2 cases of cleidocranial dysplasia in siblings.

Hospital Inpatient Admissions of Children and Adolescents for Nontraumatic Dental Conditions in Florida

Purpose: Barriers to regular dental care may lead to children being hospitalized for dental problems. The purpose of this study was to examine trends related to pediatric hospital inpatient admissions for nontraumatic dental conditions (NTDCs) in Florida between 2006 and 2016. Methods: Data were from the Florida Department of Health inpatient admission database and included zero- to 19-year-old patients. The authors calculated age-specific and age-adjusted rates of inpatient admission for NTDCs and the proportion of all hospitalizations they comprise. Results: There were 6,217 inpatient admissions for NTDCs of zero- to 19-year-olds in Florida between 2006 and 2016. The median charge was $21,654 per admission, and total charges were $196,220,470. Medicaid was the primary payer. Admission rates increased in all age groups, and age-adjusted rates increased by 62 percent during that period. The two most common NTDC diagnoses were periapical abscess without sinus tract and cellulitis of the mouth. Conclusions: The rate and cost for hospital inpatient admissions to treat nontraumatic dental conditions increased significantly for children and adolescents in Florida during the past decade. Establishment of a dental home at an early age and removing barriers to receiving regular and periodic dental care may result in more effective and efficient use of health care resources and better patient outcomes.

Feasibility of establishing tele-dental approach to non-traumatic dental emergencies in medical settings

PURPOSE

Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults.

METHODS

Participants with NTDCs in ED/UCs were examined extra and intra-orally: (1) directly by ED provider, (2) remotely by tele-dental examiner (trained dentist) using intra-oral camera and high-definition pan-tilt-zoom (PTZ) camera, (3) directly by treating dentist post ED/UC visit (if applicable) and, (4) secondary assessment by tele-dental reviewer. Comparisons were drawn between differential diagnoses and recommended managements provided by ED/UC providers, tele-dental examiner, treating dentist, and tele-dental reviewer.

RESULTS

13 patients participated in the study. The overall inter-rater agreement between the tele-dental examiner and tele-dental reviewer was high while it was low between tele-dentists and the ED providers. The preliminary testing of tele-dental intervention in the ED/UC setting demonstrated potential feasibility in addressing the NTDC landing in ED/UC. Larger interventional studies in multi-site setting are needed to validate this approach and especially evaluate impact on cost, ED/UC workflow and patient outcomes.

CLINICAL SIGNIFICANCE

Using tele-dentistry to triage non-traumatic dental visits to the emergency room may be a promising approach. Once this approach is validated through a larger study, tele-dental outreach could help in directing non-traumatic dental emergency patients to the appropriate dental setting to provide treatment for the patients.

Functional Analysis of PTH1R Variants Found in Primary Failure of Eruption

Although many variants of the parathyroid hormone 1 receptor (PTH1R) gene are known to be associated with primary failure of eruption (PFE), the mechanisms underlying the link remains poorly understood. We here performed functional analyses of PTH1R variants reported in PFE patients-namely, 356C>T (P119L), 395C>T (P132L), 439C>T (R147C), and 1148G>A (R383Q)-using HeLa cells with a lentiviral vector-mediated genetic modification. Two particular variants, P119L and P132L, had severe reduction in a level of N-linked glycosylation when compared with wild-type PTH1R, whereas the other 2 showed modest alteration. PTH1R having P119L or P132L showed marked decrease in the affinity to PTH_1-34, which likely led to severely impaired cAMP accumulation upon stimulation in cells expressing these mutants, highlighting the importance of these 2 amino acid residues for ligand-mediated proper functioning of PTH1R. To further gain insights into PTH1R functions, we established the induced pluripotent stem cell (iPSC) lines from a patient with PFE and the heterozygous P132L mutation. When differentiated into osteoblastic-lineage cells, PFE-iPSCs showed no abnormality in mineralization. The mRNA expression of RUNX2, SP7, and BGLAP, the osteoblastic differentiation-related genes, and that of PTH1R were augmented in both PFE-iPSC-derived cells and control iPSC-derived cells in the presence of bone morphogenetic protein 2. Also, active vitamin D₃ induced the expression of RANKL, a major key factor for osteoclastogenesis, equally in osteoblastic cells derived from control and PFE-iPSCs. In sharp contrast, exposure to PTH_1-34 resulted in no induction of RANKL mRNA expression in the cells expressing P132L variant PTH1R, consistent with the idea that a type of heterozygous PTH1R gene mutation would spoil PTH-dependent response in osteoblasts. Collectively, this study demonstrates a link between PFE-associated genetic alteration and causative functional impairment of PTH1R, as well as a utility of iPSC-based disease modeling for future elucidation of pathogenesis in genetic disorders, including PFE.

Quantitative evaluation of masking effect of resin infiltration on developmental defects of enamel

OBJECTIVE

Qualitative developmental defects of enamel (DDEs) are characterized by an intact hypermineralized surface enamel layer and a porous subsurface hypomineralized layer. This structure is similar to natural early caries lesions, which are effectively arrested by resin infiltration, a micro-invasive clinical procedure. An additional reported effect in early enamel caries is recovery of enamel translucency. Due to structural similarities, a similar mechanism is expected in qualitative DDEs. The objective of the present study was to observe quantitative color masking of qualitative DDEs when subjected to resin infiltration.

METHOD AND MATERIALS

A total of 70 selected enamel defects were subjected to resin infiltration in a nonrandomized study design. Each defect was subjected to photographic imaging using a digital camera both pre- and post-intervention. Each image was assessed using ImageJ digital software (National Institutes of Health) for CIE L*a*b coordinates.

RESULTS

There were significant changes observed in L*a*b coordinates of all DDEs, when subjected to resin infiltration.

CONCLUSION

The resin infiltration intervention was successful in masking the "white" opaque discolorations of developmentally affected enamel.

Collecting a Dental Payment during the Civil War - a Case of Persistence

The livelihood of the practicing dentist depends upon timely payment for the dental services provided. Receiving payment has never been an entirely predictable occurrence. There are countless reasons that commonly delay the collection of a dental debt and sometimes the debtor is forgiven when the amount of debt is outweighed by the perceived difficulty of collecting it. This narrative tells the story of a perseverant dentist, Dr. Lloyd Macgill and his successful pursuit of a debt while the Civil War raged on, at times not far from his office, and long after the death of the patient who owed him for services rendered.

Are routine microbiological samplings in acute dental infections justified? Our 10-year real-life experience

PURPOSE

Most patients with severe odontogenic infections are successfully treated with large spectrum probabilistic antibioc therapy, drainage of the collections and tooth treatment or extraction and are discharged home before antibiotic sensitivity results were available. The investigators hypothesized whether bacteriological sampling should be systematically performed in the management of patients with severe odontogenic infections.

METHODS

The investigators implemented a prospective observational study. The sample was composed of patients managed between January 2004 and December 2014 for severe odontogenic infection based on three criteria: hospital admission, intravenous antibiotic therapy, tooth extraction and collections drainage under general anesthesia. The predictor variable was the results of bacteriological sampling, culture and sensitivity. The outcome variable was antibiotic therapy adaptation according to antibiotic sensitivity results.

RESULTS

The sample was composed of 653 patients; 386 (59%) were male and 267 (41%) female, with a mean age of 37 years (range 18-88); 378 (58%) patients had been receiving oral antibiotics before admission to hospital, for a mean duration of 4.1 days (range 1 - 30). About 535 (81.9%) patients had swabs taken during surgery. Microorganisms were observed in 477 (89.1%) patients but in 377 (70.5%) they were polymorphic oropharyngeal flora. After culture, at least one antibiogram was obtained for 91 (17%) patients and the results led to antibiotic therapy being adapted in 23 (4.3%) patients.

CONCLUSION

The results suggest that bacteriological analysis had an impact on evolution in less than 5% of patients. Future studies will focus on the patients for whom the bacteriological analysis is essential.

Occlusal stress is involved in the formation of non-carious cervical lesions. A systematic review of abfraction

PURPOSE

This systematic review on abfraction studied whether stress is a mechanism in the formation of non-carious cervical lesions (NCCLs).

METHODS

A literature search was performed on three electronic databases (PubMed, ISI Web of Science, and EMBASE) using the keyword "abfraction" in publications published in English. The inclusion criteria were clinical and laboratory studies that investigated the role of abfraction in NCCLs. The title and abstract of the identified publications were screened by two investigators independently. Reviews, case reports, and irrelevant papers were excluded. Full text of the remaining publications were retrieved. A manual search was performed on the bibliographies of the selected publications to identify additional relevant publications for review.

RESULTS

A total of 372 publications were identified, and 165 duplicated publications and 166 irrelevant publications were excluded. From the bibliographies of the remaining 41 publications, 28 relevant publications were found. Therefore, 69 publications (31 clinical studies and 38 laboratory studies) were included in this review and the majority (56/69, 81%) found an association between occlusal stress and NCCLs. Although no clinical study demonstrated that NCCL was caused by stress alone, 23 studies reported that stress or occlusal factors were associated with NCCLs. Of the 38 laboratory studies, 24 that used finite element analysis found that stress was concentrated at the cervical region of the tooth. Nine laboratory studies suggested that stress was a mechanism for NCCLs, whereas five studies reported the opposite. In conclusion, current literature supported an association between occlusal stress and NCCLs.

CLINICAL SIGNIFICANCE

This systematic review of abfraction found the majority of studies reported an association between occlusal stress and non-carious cervical lesions.

Evaluation of internet search trends of some common oral problems, 2004 to 2014

OBJECTIVE

Internet search trend volumes can provide free, fast and pertinent information about peoples' online interests. No study has yet been conducted on internet search trends in dentistry. This study aims to investigate ten years' data on internet search volumes regarding some oral problems: "toothache", "tooth decay", "gum disease", "wisdom teeth" and "oral cancer". The study also aims to investigate the most common geographic search locations and to examine related searches.

RESEARCH DESIGN

Worldwide intermet search trend data over a period of 532 weeks (4 January 2004 and 15 March 2014) retrieved from the Google Trends web site was interrogated for each search term to identify search trends, regional interests, and related searches.

RESULTS

The search volumes for the terms "toothache "and "wisdom teeth" increased over the decade while "tooth decay", "gum disease", and "oral cancer" showed slight changes. Each term was most commonly searched in different counties: "toothache", Philippines; "tooth decay", Singapore; "Gum Disease", Ireland; "Wisdom Teeth", United States; and "Oral cancer", India. Related searches were mainly focused on symptoms and remedies of these problems.

CONCLUSIONS

Regional and time-related variations in search volumes may provide dental professionals with readily- and freely-available pertinent information on populations' internet searches regarding dental complaints.

Application of the community oral health indicator by non-dental personnel and its contribution to oral healthcare

Objective

To validate the Community Oral Health Indicator-COHI by non-dental personnel.

Methods

Risk assessment is an essential component in the decision-making process. Therefore, the COHI, an instrument to evaluate population oral health situation in a simple manner, was created. Community Health Agents (CHA) were trained to use the COHI (variables as number of teeth, presence of cavities, residual dental roots, oral lesions, etc.), while dentists for the COHI and DMFT. 60 individuals were examined, by CHA and DS, with these indicators in order to validate the use of COHI by non-dental personnel.

Results

Dental and soft tissues problems were well spread among those individuals. People with and without soft tissue damage, as well as with and without use and/or need for prostheses were found in the sample, proving it to be a heterogeneous population for the evaluated factors and representing the real population. The results of examinations performed by dentists using the COHI and DMF-T/dmf-t presented strong agreement when comparing the two instruments. When COHI and DMFT were compared, the results showed a concordance of 0.86 for the number of present teeth, and 0.85 for the number of residual roots. Likewise, when analyzing the data comparing the use of the COHI by DS and CHA a high agreement level, specificity and sensitivity was found.

Conclusion

The COHI has shown to be useful for detecting problems in oral health. Therefore, COHI may be used, after training, by non-dental personnel, contributing to the planning and organization of the community dental assistance.

Quantitative EDXRF analysis of Ca, K, Mn and Na in normal and pathological adult-human teeth

This work relates to the measurement of calcium, potassium, manganese and sodium levels in adult-human teeth from female and male patients and normal subjects. Energy dispersive X-ray fluorescence (EDXRF) technique was used for the measurements. Pathological and non-pathological adult-human teeth samples were collected from one male human patient and one female human patient who attended the dental clinic. The standard addition method was used to determine concentrations. Experimental results are presented and discussed in this work.

[Clinical experience of tracheal intubation using Trachlight in patients with unstable dentition]

BACKGROUND

Trachlight is a light-tipped stylet designed to guide tracheal intubation. It obviates the need for direct laryngoscopy and is reported to be particularly useful for managing difficult tracheal intubation. Its clinical application, however, is not limited to difficult airway management.

METHODS

Here we report our experience of the use of Trachlight in 64 adult patients who were at risk of dental injury during direct laryngoscopy because of unstable teeth around the incisors or severe alveolar disease.

RESULTS

Of 64 patients (33 men and 31 women) aged between 30 and 85, the trachea was successfully intubated using Trachlight without dental damage in 63 patients. In 1 patient, a tracheal tube was smoothly placed, but a tooth was injured after the removal of the stylet. No other complications associated with the use of Trachlight were noted.

CONCLUSIONS

Our experience suggests that Trachlight can be a helpful tool for intubation in patients having dental problems. Because of the blind nature of the technique, but preexisting lesions of the larynx and vocal cords might be overlooked in intubation using Trachlight. Further investigation is warranted to recommend Trachlight as a intubation technique of choice in patients with unstable dentition.

Limiting factors in orthodontic treatment: 2. The biological limitations of orthodontic treatment

Owing to a shortage in the orthodontic workforce in the United Kingdom, general dental practitioners carry out orthodontic treatment in selected cases. Orthodontic treatment may not always be successful due to various factors. Some of these limiting factors are related to the practitioner, others to the patients and the orthodontic appliances used. These three sets of factors were covered in the first part of this article. This second part deals with the biologic limitations of orthodontic treatment.

CLINICAL RELEVANCE

General dental practitioners and novice orthodontic practitioners may get into difficulties by embarking upon an orthodontic treatment which may not be feasible due to various limitations imposed by the underlying biology. This article provides a brief outline of these limitations.

Evaluating the effectiveness of school-based dental health education program among children of different socioeconomic groups

The aim of the present study was to evaluate the effectiveness of Dental Health Education programs among school children of different socioeconomic groups. The investigators made a visit to three different schools and studied 500 children. A ten items, open-ended, self-administered questionnaire was pretested on the primary and higher primary school children before and after an educational intervention. A second visit was made to one of the schools 1 year later and the same questionnaire was re-administered to those subjects who had participated in the original study. Results showed that although educational intervention was successful in improving the Dental health awareness of most children, the socioeconomic background is an important determinant for the same. Also, single-lecture technique seems to be inadequate in improving the knowledge of children in the long term.

[Oral manifestations of endocrine dysfunction]

Oral manifestations of endocrine dysfunction often may be observed initially by the dentist. Objective manifestations, such as ophtalmos in hyperthyroidism, signs of hypersecretion of GH in acromegaly, are easily recognized. Dentists should have some knowledge of many other diseases in this category that occasionally come in our attention. The present article will discuss the effects of over and under-secretion of each endocrine gland separately, showing its influence on the development and maintenance of the health of the teeth and supporting structures. Diabetes mellitus is the most common endocrinological disease, with an incidence of 3%. Periodontitis risk is three time greater in diabetic patients than in general population and it may worsen the diabetes evolution. Periodontitis in diabetic patients needs an rapid diagnosis and treatment. We also presents the oral aspects of thyroid, parathyroid, suprarenalian, growth hormone and female hormones pathology. The incidence of these troubles is less important, but oral manifestations may reveal an endocrine disfunction.

In sickness and in health

This final instalment in the literary series deals with the relationship between general and oral health and methods of maintaining good oral hygiene.

Influence of hot pressing on the microstructure and fracture toughness of two pressable dental glass-ceramics

Empress 1 and Empress 2 are well-known pressable all-ceramic dental materials that have generated substantial interest for many clinicians and patients. These two materials are reputed to benefit from heat pressing during the laboratory fabrication procedures, leading to better crystal distribution within a glass matrix, and hence an improved strength. The present study aimed to evaluate the effect of heat pressing on fracture toughness, microstructural features, and porosity. Results showed that Empress 1 had similar fracture toughness values before the pressing procedure, after it, and after the repressing procedure. The microstructural features were also similar among these specimens, but a more uniform distribution of leucite crystals was observed following the pressing and repressing procedures. Empress 2 demonstrated two different fracture toughness values. This was associated with the alignment of lithium disilicate crystals that occurred after the pressing and repressing procedures, which led to different indentation induced crack lengths, depending upon whether cracks propagated parallel to or perpendicular to the aligned crystals, the former having lower toughness than those that propagated in the perpendicular direction. Porosity, in terms of both the size and number of pores, was found to decrease after the pressing and repressing procedures for both materials. Repressing resulted in significant growth of the lithium disilicate crystals in Empress 2, but there was no change for the leucite crystals in Empress 1. The change in the lithium disilicate crystals' size did not have a noticeable effect on the fracture toughness of Empress 2. It was concluded that heat pressing did not significantly affect the fracture toughness of Empress 1, but resulted in two different values for Empress 2. It also decreased the size and number of pores for both materials, which could contribute to the strength improvement found after heat pressing, which has been reported in previous studies.