Impact of oral self-care on incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 study

OBJECTIVES

To assess whether oral self-care (tooth brushing, regular dental visits and use of dentures) affects incident functional disability in elderly individuals with tooth loss.

DESIGN

A 5.7-year prospective cohort study.

SETTING

Ohsaki City, Japan.

PARTICIPANTS

12 370 community-dwelling individuals aged 65 years and older.

PRIMARY OUTCOME MEASURES

Incident functional disability (new long-term care insurance certification).

RESULTS

The 5.7-year incidence rate of disability was 18.8%. In comparison with participants who had ≥20 teeth, the HRs (95% CIs) for incident functional disability among participants who had 10-19 and 0-9 teeth were 1.15 (1.01-1.30) and 1.20 (1.07-1.34), respectively (p trend<0.05). However, the corresponding values for those who brushed their teeth ≥2 times per day were not significantly higher in the '10-19 teeth' and '0-9 teeth' groups (HRs (95% CI) 1.05 (0.91-1.21) for participants with 10-19 teeth, and 1.09 (0.96-1.23) for participants with 0-9 teeth), although HRs for those who brushed their teeth <2 times per day were significantly higher (HRs (95% CI) 1.32 (1.12-1.55) for participants with 10-19 teeth, and 1.33 (1.17-1.51) for participants with 0-9 teeth). Such a negating association was not observed for other forms of oral self-care.

CONCLUSIONS

Tooth brushing may partially negate the increased risk of incident functional disability associated with having fewer remaining teeth.

Dental mesenchymal stem cells

Mammalian teeth harbour mesenchymal stem cells (MSCs), which contribute to tooth growth and repair. These dental MSCs possess many in vitro features of bone marrow-derived MSCs, including clonogenicity, expression of certain markers, and following stimulation, differentiation into cells that have the characteristics of osteoblasts, chondrocytes and adipocytes. Teeth and their support tissues provide not only an easily accessible source of MSCs but also a tractable model system to study their function and properties in vivo In addition, the accessibility of teeth together with their clinical relevance provides a valuable opportunity to test stem cell-based treatments for dental disorders. This Review outlines some recent discoveries in dental MSC function and behaviour and discusses how these and other advances are paving the way for the development of new biologically based dental therapies.

Rapamycin treatment attenuates age-associated periodontitis in mice

Interventions that target biological mechanisms of aging have great potential to enhance quality of life by delaying morbidity and mortality. The FDA-approved drug rapamycin is a compelling candidate for such an intervention. In a previous study, it was reported that 3 months of rapamycin treatment is sufficient to increase life expectancy and remodel the gut microbiome in aged mice. Transient treatment with rapamycin or a rapamycin derivative has also been shown to delay immune stem cell senescence and rejuvenate immune function in aged mice and elderly people. Periodontal disease is an important age-related disease involving altered immune function, pathological changes to the oral microbiome, and systemic inflammation. Periodontal disease is defined clinically by loss of alveolar bone and by connective tissue degeneration. Here, we describe significant alveolar bone loss during aging in two different mouse strain backgrounds and report that rapamycin treatment is sufficient to reverse age-associated periodontal disease in mice. Partial restoration of youthful levels of alveolar bone is observed in 22-month-old rapamycin-treated mice as rapidly as 8 weeks after initiation of treatment. To the best of our knowledge, this represents the first intervention shown to substantially prevent or reverse age-associated alveolar bone loss. These findings suggest the possibility that inhibition of mTOR with rapamycin or other pharmacological agents may be useful to treat a clinically relevant condition for which there is currently no effective treatment.

Trigeminocardiac reflex during non-surgical root canal treatment of teeth with irreversible pulpitis

BACKGROUND/PURPOSE

Trigeminocardiac reflex (TCR) is a unique clinical incident of acute change in hemodynamic balance, which may lead to hypotension, bradycardia, and even clinical crisis. Up to date, no study so far considers the impact of non-surgical root canal treatment (NSRCT) of irreversible pulpitis teeth under either local infiltration or block anesthesia on hemodynamic change possibly related to TCR.

METHODS

This study enrolled 111 patients with 138 irreversible pulpitis teeth that were treated by two sessions of NSRCT. The first session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second session included the root canal enlargement and debridement with minimal disturbance to the dental branches of the trigeminal nerve. Vital signs mainly the blood pressure were recorded during both NSRCT sessions.

RESULTS

The incidences of NSRCT patients with MABP decrease ≧10%, ≧15%, or ≧20% were all significantly higher in the first NSRCT session than in the second NSRCT session (all the P-values < 0.001). In the first NSRCT session, the incidence of patients with MABP decrease ≧10% was significantly associated with tooth type. For both upper and lower teeth, the patients with premolars treated by NSRCR had significantly higher incidences of MABP decrease ≧10% than those with either anterior or molar teeth treated by NSRCR (all the P-values < 0.05).

CONCLUSION

We conclude that vital pulp extirpation may lead to a substantial drop in patient's blood pressure possibly related to TCR.

The Effect of Diabetes Mellitus Type I on Periodontal and Dental Status

INTRODUCTION

Diabetes mellitus type I is a chronic metabolic disease with an autoimmune origin. The initial manifestations mainly appear during childhood and its prevalence is on the rise in many countries. Some of the complications of diabetes mellitus are problems related to oro-dental structures and periodontal diseases.

AIM

The present study was undertaken to evaluate the relationship between diabetes mellitus type I and dental and periodontal status in Tehran, Iran.

MATERIALS AND METHODS

This cross-sectional study was carried out on 50 patients with diabetes mellitus type I who were under treatment in the Diabetic Patients' Center in Tehran and 50 healthy individuals who did not have diabetes, all recruited from schools. The subjects were divided into two age groups of 6-12 and 13-18 years. In test group, HbA1c (glycosylated haemoglobin) level of the patients was collected from the medical records of Association of Diabetic Patients. To make sure that the control subjects did not suffer from diabetes mellitus, their blood glucose was measured with the Glucocard 01 blood glucose monitoring kit (GT-1920, Japan). The periodontal and dental status were assessed using dmft/DMFT (Decayed, Missing, Filled Permanent Teeth), GI (Gingival Index), PPD (Periodontal Pocket Depth), PI (Plaque Index) and CI (Calculus Index). The data obtained from each group were compared statistically using the Mann-Whitney test and Kruskal Wallis Test.

RESULTS

There was increase in PPD, GI and DMFT values with aging, with no significant differences between the diabetic and non-diabetic groups. PI and DMFT not only increased with aging but also were higher in both age groups in patients with diabetes compared to healthy subjects (p<0.05). GI was higher only in the 13-18 year age group in diabetic patients (p<0.01). There was no relation between the HbA1c (glycosylated haemoglobin) level, and periodontal indices (p<0.09).

CONCLUSION

It appears that patients with diabetes mellitus type I are more susceptible to periodontal diseases and tooth loss and such problems might be aggravated with aging.

Dental investigation of mummies from the Capuchin Catacombs of Palermo (circa 18th-19th century CE)

Within the framework of the Sicily Mummy Project, the orofacial complex of a significant sample of individuals (n=111) from the Capuchin Catacombs of Palermo, Italy, was inspected. The heads and dentitions of the mummies were documented and the recorded findings described: the state of preservation of skeletal and soft tissues; dental pathologies such as carious lesions and alveolar bone loss; enamel hypoplasia; and ante- and post-mortem tooth loss. Despite limitations in data collection, the oral health of these mummies was assessed and the frequencies of pathologies were compared to those of similar populations. From their position within the corridors of the Catacombs, sex and social status of the mummies were also inferred, allowing the dental pathologies to be specified in the social and historical context. Most interestingly, the rate of oral health problems did not differ between the groups of the members of the Capuchin Order and the laymen of the city of Palermo, despite their different lifestyles.

Magnetic resonance imaging and computed tomography as tools for the investigation of sperm whale (Physeter macrocephalus) teeth and eye

Background

Scanning techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) are useful tools in veterinary and human medicine. Here we demonstrate the usefulness of these techniques in the study of the anatomy of wild marine mammals as part of a necropsy. MRI and CT scans of sperm whale teeth (n = 4) were performed. The methods were compared and further compared to current standard methods for evaluation of tooth layering. For MRI a zero echo time sequence was used, as previously done for imaging of intact human teeth. For CT two different clinical scanners were used.

Results

The three scanners did not provide sufficient information to allow age estimation, but both MRI and CT provided anatomical information about the tooth cortex and medulla without the need for sectioning the teeth. MRI scanning was also employed for visualizing the vascularization of an intact eye from one of the stranded sperm whale.

Conclusions

Clearly, MRI was useful for investigation of the retinal vasculation, but optimum results would require well-preserved tissue. It was not possible to estimate age based on CT scans of tooth growth lines. Further research is needed to clarify the usability of MRI and CT as tools for marine mammal research when samples need to remain intact or when a spatial (three dimensional) arrangement of features needs to be determined.

Isolated teeth of Anhangueria (Pterosauria: Pterodactyloidea) from the Lower Cretaceous of Lightning Ridge, New South Wales, Australia

The fossil record of Australian pterosaurs is sparse, consisting of only a small number of isolated and fragmentary remains from the Cretaceous of Queensland, Western Australia and Victoria. Here, we describe two isolated pterosaur teeth from the Lower Cretaceous (middle Albian) Griman Creek Formation at Lightning Ridge (New South Wales) and identify them as indeterminate members of the pterodactyloid clade Anhangueria. This represents the first formal description of pterosaur material from New South Wales. The presence of one or more anhanguerian pterosaurs at Lightning Ridge correlates with the presence of ‘ornithocheirid’ and Anhanguera-like pterosaurs from the contemporaneous Toolebuc Formation of central Queensland and the global distribution attained by ornithocheiroids during the Early Cretaceous. The morphology of the teeth and their presence in the estuarine- and lacustrine-influenced Griman Creek Formation is likely indicative of similar life habits of the tooth bearer to other members of Anhangueria.

Tooth manganese as a biomarker of exposure and body burden in rats

BACKGROUND

Neonates and children are particularly vulnerable to the toxic effects of excess manganese (Mn), but studies of Mn exposure during these developmental periods are hampered by a lack of validated biomarkers. Deciduous teeth may be used to assess Mn exposure during these developmental periods but require further validation to determine the relationship between tooth Mn, Mn in target tissues, and exposure.

OBJECTIVES

To determine the relationship of tooth Mn concentrations with: (i) exposure dose, (ii) the timing/duration of exposure, and (iii) with Mn concentrations in blood, brain and bone.

METHODS

Rats in different treatment groups were orally exposed to 0, 25 or 50µg/g/day Mn either from postnatal day (PND) 1 - 21 and culled at PND 24, from PND 1 - 21 and culled as adults (>PND 290), or from PND 1 - throughout life and culled at >290 PND. Mn was measured in second molars, femurs, brain and blood by ICP-MS.

RESULTS

Tooth Mn increased significantly with dose in rats exposed for 21 PND and culled at 24 PND (p<0.001). In rats culled at >290 PND, tooth Mn increased with exposure duration (p<0.001) and reflected exposure duration. A significant, positive association between tooth Mn and Mn levels in blood (Spearman's rho 0.69, p<0.01) brain (rho 0.59, p<0.05) and bone (rho 0.69, p<0.01) was observed in animals with lifelong exposure. Tooth Mn and Mn levels in bone were also significantly positively associated in animals exposed only early in life (rho 0.76, p<0.001).

CONCLUSIONS

Teeth are a sensitive biomarker of active and past Mn exposure and Mn burden in tissues. Unlike blood, teeth retain information on exposure history over the short and long-term.

Dental Pulp Stem Cells Model Early Life and Imprinted DNA Methylation Patterns

Early embryonic stages of pluripotency are modeled for epigenomic studies primarily with human embryonic stem cells (ESC) or induced pluripotent stem cells (iPSCs). For analysis of DNA methylation however, ESCs and iPSCs do not accurately reflect the DNA methylation levels found in preimplantation embryos. Whole genome bisulfite sequencing (WGBS) approaches have revealed the presence of large partially methylated domains (PMDs) covering 30%-40% of the genome in oocytes, preimplantation embryos, and placenta. In contrast, ESCs and iPSCs show abnormally high levels of DNA methylation compared to inner cell mass (ICM) or placenta. Here we show that dental pulp stem cells (DPSCs), derived from baby teeth and cultured in serum-containing media, have PMDs and mimic the ICM and placental methylome more closely than iPSCs and ESCs. By principal component analysis, DPSC methylation patterns were more similar to two other neural stem cell types of human derivation (EPI-NCSC and LUHMES) and placenta than were iPSCs, ESCs or other human cell lines (SH-SY5Y, B lymphoblast, IMR90). To test the suitability of DPSCs in modeling epigenetic differences associated with disease, we compared methylation patterns of DPSCs derived from children with chromosome 15q11.2-q13.3 maternal duplication (Dup15q) to controls. Differential methylation region (DMR) analyses revealed the expected Dup15q hypermethylation at the imprinting control region, as well as hypomethylation over SNORD116, and novel DMRs over 147 genes, including several autism candidate genes. Together these data suggest that DPSCs are a useful model for epigenomic and functional studies of human neurodevelopmental disorders. Stem Cells 2017;35:981-988.

Variation in elemental composition of human teeth and its application for feasible species identification

Identifying human remains is a primary task in forensic science. In this study, we propose a possible new technique, handheld X-ray fluorescence (HHXRF), for determining whether a suspected tooth is an authentic human tooth. A total of 444 teeth obtained from 111 human skulls (male=62, female=49) aged between 30-67 years (51.81±8.37 years) were used as subjects. The teeth were scanned by HHXRF to acquire their elemental profile. Differences in elemental composition were analyzed for different tooth positions (numbers 1-32), between crown and root, and between sexes (male and female); also, the proportion of elements in relation to different human ages was examined. Teeth from 20 different animal species, serving as non-human teeth samples, were used to distinguish between human and non-human teeth through a stepwise discriminant analysis. Our results revealed that different tooth positions, different regions (crown and root) of a tooth, and different sexes demonstrated disparities in the proportion of several elements. The accuracy rate of predicting sex based on the elemental profile of human teeth was 65.5%. Likewise, a dissimilar distribution of elements between human and non-human teeth was observed, leading to a high degree of correctness of 83.2% for distinguishing them. In conclusion, elemental analysis by HHXRF could serve as a promising candidate tool for identifying human teeth in forensic science, but is ineffective for sex determination.

Surface architecture of the oropharyngeal cavity and the digestive tract of Mulloidichthys flavolineatus from the red sea, Egypt: A scanning electron microscope study

Surface architecture of the buccal cavity and the surface organization of the luminal mucosa of the oesophagus, stomach, and intestine of the carnivorous fish M. flavolineatus from the Red Sea were studied by using SEM. The results revealed that M. flavolineatus has four kinds of teeth; curved-blunt, wedge-shaped, flattened crowns, molariform and papilliform. Three types of taste buds (type I, II and III) were recorded in the oropharyngeal cavity. It was observed that taste buds and teeth are co-located in the pharyngeal region. Characteristic patterns of microridges of the surface cells in the oral cavity and oesophagus were observed. Mucous cells are distributed in the lining of the mouth cavity, oesophagus, stomach, and intestine. Characteristic patterns of mucosal folds throughout the alimentary canal, concerning oesophagus, stomach, and intestine were revealed. Numerous gastric pits, which represents the emergence of the gastric glands, were recorded in the anterior and middle regions of the stomach. Complex patterns of the folds and mucous cells were recorded in the intestinal mucosa. These results were discussed with other teleost fishes.

A reappraisal of Theroteinus (Haramiyida, Mammaliaformes) from the Upper Triassic of Saint-Nicolas-de-Port (France)

The earliest mammaliaforms are difficult to assess because the fossil record is poor and because their distinctive morphologies cannot be directly compared with more recent mammaliaforms. This is especially true for the haramiyid genus Theroteinus, only known in the Saint-Nicolas-de-Port locality (Rhaetian, France). This study presents a new definition of the type-species Theroteinus nikolai. A new species Theroteinus rosieriensis, sp. nov., is named and distinguished by the lingual shift of distal cusps, a larger size, and a stockier occlusal outline. Comparisons with Eleutherodon, Megaconus and Millsodon suggest that Theroteinus has potential close relatives among the Jurassic haramiyids.

Small teleost fish provide new insights into human skeletal diseases

Small teleost fish such as zebrafish and medaka are increasingly studied as models for human skeletal diseases. Efficient new genome editing tools combined with advances in the analysis of skeletal phenotypes provide new insights into fundamental processes of skeletal development. The skeleton among vertebrates is a highly conserved organ system, but teleost fish and mammals have evolved unique traits or have lost particular skeletal elements in each lineage. Several unique features of the skeleton relate to the extremely small size of early fish embryos and the small size of adult fish used as models. A detailed analysis of the plethora of interesting skeletal phenotypes in zebrafish and medaka pushes available skeletal imaging techniques to their respective limits and promotes the development of new imaging techniques. Impressive numbers of zebrafish and medaka mutants with interesting skeletal phenotypes have been characterized, complemented by transgenic zebrafish and medaka lines. The advent of efficient genome editing tools, such as TALEN and CRISPR/Cas9, allows to introduce targeted deficiencies in genes of model teleosts to generate skeletal phenotypes that resemble human skeletal diseases. This review will also discuss other attractive aspects of the teleost skeleton. This includes the capacity for lifelong tooth replacement and for the regeneration of dermal skeletal elements, such as scales and fin rays, which further increases the value of zebrafish and medaka models for skeletal research.

Synchrotron imaging of dentition provides insights into the biology of Hesperornis and Ichthyornis, the "last" toothed birds

Background

The dentitions of extinct organisms can provide pivotal information regarding their phylogenetic position, as well as paleobiology, diet, development, and growth. Extant birds are edentulous (toothless), but their closest relatives among stem birds, the Cretaceous Hesperornithiformes and Ichthyornithiformes, retained teeth. Despite their significant phylogenetic position immediately outside the avian crown group, the dentitions of these taxa have never been studied in detail. To obtain new insight into the biology of these ‘last’ toothed birds, we use cutting-edge visualisation techniques to describe their dentitions at unprecedented levels of detail, in particular propagation phase contrast x-ray synchrotron microtomography at high-resolution.

Results

Among other characteristics of tooth shape, growth, attachment, implantation, replacement, and dental tissue microstructures, revealed by these analyses, we find that tooth morphology and ornamentation differ greatly between the Hesperornithiformes and Ichthyornithiformes. We also highlight the first Old World, and youngest record of the major Mesozoic clade Ichthyornithiformes. Both taxa exhibit extremely thin and simple enamel. The extension rate of Hesperornis tooth dentine appears relatively high compared to non-avian dinosaurs. Root attachment is found for the first time to be fully thecodont via gomphosis in both taxa, but in Hesperornis secondary evolution led to teeth implantation in a groove, at least locally without a periodontal ligament. Dental replacement is shown to be lingual via a resorption pit in the root, in both taxa.

Conclusions

Our results allow comparison with other archosaurs and also mammals, with implications regarding dental character evolution across amniotes. Some dental features of the ‘last’ toothed birds can be interpreted as functional adaptations related to diet and mode of predation, while others appear to be products of their peculiar phylogenetic heritage. The autapomorphic Hesperornis groove might have favoured firmer root attachment. These observations highlight complexity in the evolutionary history of tooth reduction in the avian lineage and also clarify alleged avian dental characteristics in the frame of a long-standing debate on bird origins. Finally, new hypotheses emerge that will possibly be tested by further analyses of avian teeth, for instance regarding dental replacement rates, or simplification and thinning of enamel throughout the course of early avian evolution.

Electronic supplementary material

The online version of this article (doi:10.1186/s12862-016-0753-6) contains supplementary material, which is available to authorized users.

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients

BACKGROUND

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient's morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT).

MATERIAL AND METHODS

Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients' treatment plans. Clinicopathological data were retrieved from patients' medical files.

RESULTS

The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p < 0.001), whereas no significant difference was found for the other dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p < 0.001).

CONCLUSION

IMRT delivered lower radiation doses to teeth than 3DRT, but only for some groups of patients and teeth, suggesting that this decrease was more likely due to the protection of other high risk organs, and was not enough to remove teeth from the zone of high risk for radiogenic disturbance (>30Gy).

A Case of Bruxism-Induced Otalgia

Here, the author presents a case of bruxism-induced otalgia in a 29-year-old female patient. The pain was sharp and penetrating in character. It was usually worse in the morning and frequently radiated to the right temporal area. She had received unsuccessful medical treatments for migraine headache. The otoendoscopic examination revealed a normal tympanic membrane. A thorough inspection of her teeth revealed excessive wear on the incisal edges, and the cause of her otalgia was identified as bruxism-related temporomandibular joint disorder. After the use of an occlusal splint and repeated botulinum toxin injections in the masseter and anterior temporalis muscles, along with good sleep hygiene, she experienced significant relief of pain and symptoms. The author suggests that multidisciplinary cooperation between ENT clinicians and dentists is necessary for the quick and accurate diagnosis and treatment of bruxism and the consequential referred otalgia.

Age-Dependent Changes in Pb Concentration in Human Teeth

The result of exposure to Pb is its accumulation in mineralized tissues. In human body, they constitute a reservoir of approx. 90 % of the Pb reserve. The conducted research aimed at determining the accumulation of Pb in calcified tissues of permanent teeth. The concentration of Pb in 390 samples of teeth taken from a selected group of Polish people was determined using the AAS method. Average concentration of Pb in teeth amounted to 14.3 ± 8.18 μg/g, range of changes: 2.21-54.8 μgPb/g. Accumulation of Pb in human body was determined based on changes in Pb concentration in teeth of subjects aged 13-84 years. It was found that in calcified tissues of teeth, the increase in concentration of Pb that occurs with age is a statistically significant process (p = 0.02, the ANOVA Kruskal-Wallis test). It was determined that the annual increase in concentration of Pb in tissues of teeth is approx. 0.1 μg/g. Moreover, a different course of changes in Pb concentration in tissues of teeth in people born in different years was observed. The level of Pb concentration in teeth of the oldest subjects (>60 years) decreased for those born in the 1930s compared to those in the 1950s. Teeth from younger persons (<60 years) were characterized by an increasing level of Pb concentration. The analysis of changes of Pb indicates that for low exposure, a relatively greater accumulation of Pb concentration in calcified tissues of teeth can occur.

Anatomy and Disorders of the Oral Cavity of Chinchillas and Degus

Dental disease is among the most common causes for chinchillas and degus to present to veterinarians. Most animals with dental disease present with weight loss, reduced food intake/anorexia, and drooling. Degus commonly present with dyspnea. Dental disease has been primarily referred to as elongation and malocclusion of the cheek teeth. Periodontal disease, caries, and tooth resorption are common diseases in chinchillas, but are missed frequently during routine intraoral examination, even performed under general anesthesia. A diagnostic evaluation, including endoscopy-guided intraoral examination and diagnostic imaging of the skull, is necessary to detect oral disorders and to perform the appropriate therapy.

Meta-analysis of teeth from European populations before and after the 18th century reveals a shift towards increased prevalence of caries and tooth loss

Based on single studies, it has been hypothesised that Europeans have suffered less frequently from caries before the 18th century than after the 18th century and that females have higher caries prevalence, but systematic European-wide overviews are sparse. We collected published data on dental diseases (publication between 1981 and 2015 with reports on 29 cohorts with 4998 individuals and a total of 85817 teeth). Meta-analyses revealed that, over several hundred years, including the post-18th century era, Europeans had relatively constant frequencies of caries and ante-mortem tooth loss, but since the 18th century, the mean frequencies of these dental diseases increased (each p<0.05). Tooth loss correlated with caries and odontogenic abscesses (each p<0.05). Although the mean caries and ante-mortem tooth loss frequencies increased since the 18th century, there are overlaps with many pre-18th century cohorts. In addition, in contrast to previous hypotheses, no general increase of caries prevalence in females could in fact be verified. It is likely that changes in nutrition (more sugar) and dental health (possibly higher frequency of tooth extraction) could be the underlying factors which led to this minor to moderate shift of dental disease frequencies in Europe.

The Special Needs of Preterm Children - An Oral Health Perspective

Preterm births are defined as those before 37 weeks of gestation. With advances in fertility medicine and neonatal medicine, the numbers of preterm children in the community have significantly increased. Developmental delays and complications among preterm children are well recognized. Much less consideration is given to the dental complications of preterm children. Manifestations include palatal deformations, enamel defects, tooth size variations and tooth shape deformities, malocclusions, and increased risks of early childhood caries and tooth wear. This article explores orodental risks and orodental needs of preterm children and suggests preventive and management strategies for optimizing the oral health of special needs children.

Manganese accumulation in hair and teeth as a biomarker of manganese exposure and neurotoxicity in rats

Manganese (Mn) is an essential trace element to humans. However, excessive Mn causes cognitive impairment resulting from injury to the central nervous system within the hippocampus. No ideal biomarker is currently available for evaluating Mn exposure and associated neurotoxicity in the body. Hence, this study used Mn levels in the serum (MnS), teeth (MnT), and hair (MnH) as biomarkers for evaluating the association between Mn exposure and cognitive impairment in Mn-treated rats. A total of 32 male Sprague-Dawley rats were randomly divided into four groups, received 0, 5, 10, and 20 mg/(kg day) of MnCl2·4H2O for 5 days a week for 18 weeks, respectively. Lifetime Mn cumulative dose (LMCD) was used to evaluate external Mn exposure. Hippocampus, serum, teeth, and hair specimens were collected from the rats for Mn determination by graphite furnace atomic absorption spectrometry. Learning and memory functions were assessed using the Morris water maze test. Results showed that chronic Mn exposure increased the hippocampus (MnHip), MnS, MnT, and MnH levels, as well as impaired learning and memory function in rats. MnHip, MnT, and MnH levels were positively correlated with LMCD (r = 0.759, r = 0.925, and r = 0.908, respectively; p < 0.05), escape latency (r = 0.862, r = 0.716, and r = 0.814, respectively; p < 0.05), and the number of platform crossings (r = -0.734, r = -0.514, and r = -0.566, respectively; p < 0.05). No association was observed between MnS levels and the number of platform crossings (r = -0.286, p > 0.05). Thus, MnT and MnH detected long-term low-dose Mn exposure. These parameters can be reliable biomarkers for Mn exposure and associated neurotoxicity in Mn-treated rats.

What shapes the oral jaws? Accommodation of complex dentition correlates with premaxillary but not mandibular shape

BACKGROUND

Teeth are integrated into the vertebrate oral jaws to provide a functional unit for feeding, however little is known about how this integration occurs during growth and development. The purpose of this study is to identify the ontogenetic changes in oral jaw shape that are associated with the transition of the oral dentition from unicuspid teeth to multicuspid teeth. Here, we compare the shape of the occluding upper (premaxilla) and lower (mandible) jaws of the toothed Mexican tetra (Astyanax mexicanus) and the toothless (oral teeth present, pharyngeal teeth absent) zebrafish (Danio rerio) over development. Gross morphology combined with morphometric analyses were used to analyse shape changes of the occluding oral jaws in each species. Histological analyses were also used to examine the development of the mandibular symphysis.

RESULTS

The occluding edge of the premaxilla is the first region to ossify in the Mexican tetra, but the last to ossify in zebrafish. Morphometric analyses revealed that the early shape of the premaxillae (in fish younger than 8mm SL) is the same in each species but that the premaxilla shape changes significantly at larger sizes. These changes are apparent in the tooth bearing region of the Mexican tetra. The rostral region of the mandible also houses teeth, however ossification and shape in this region were surprisingly similar between species despite differences in the presence of oral dentition. Furthermore, we found that the mandibular symphysis of the Mexican tetra is composed of interdigitating bone, while the symphyseal region of the zebrafish is composed of fibrous connective tissue.

CONCLUSIONS

These differences in the jaw skeleton have likely evolved due to different feeding strategies utilised by each species. Our results show that premaxillae shape correlates strongly with the development of complex dentitions unlike in the mandible. This study provides important insights into the relationship between jaw and tooth development in bony fishes and suggests that these mechanisms may be similar amongst vertebrates.

The role of the wnt/β-catenin signaling pathway in formation and maintenance of bone and teeth

The Wnt signaling pathway is known as one of the important molecular cascades that regulate cell fate throughout lifespan. The Wnt signaling pathway is further separated into the canonical signaling pathway that depends on the function of β-catenin (Wnt/β-catenin pathway) and the noncanonical pathways that operate independently of β-catenin (planar cell polarity pathway and Wnt/Ca(2+) pathway). The Wnt/β-catenin signaling pathway is complex and consists of numerous receptors, inhibitors, activators, modulators, phosphatases, kinases and other components. However, there is one central, critical molecule to this pathway, β-catenin. While there are at least 3 receptors, LRP 4, 5 and 6, and over twenty activators known as the wnts, and several inhibitors such as sclerostin, dickkopf and secreted frizzled-related protein, these all target β-catenin. These regulators/modulators function to target β-catenin either to the proteasome for degradation or to the nucleus to regulate gene expression. Therefore, the interaction of β-catenin with different factors and Wnt/β-catenin signaling pathway will be the subject of this review with a focus on how this pathway relates to and functions in the formation and maintenance of bone and teeth based on mainly basic and pre-clinical research. Also in this review, the role of this pathway in osteocytes, bone cells embedded in the mineralized matrix, is covered in depth. This pathway is not only important in mineralized tissue growth and development, but for modulation of the skeleton in response to loading and unloading and the viability and health of the adult and aging skeleton.

A reappraisal of Polyptychodon (Plesiosauria) from the Cretaceous of England

Pliosauridae is a globally distributed clade of aquatic predatory amniotes whose fossil record spans from the Lower Jurassic to the Upper Cretaceous. However, the knowledge of pliosaurid interrelationships remains limited. In part, this is a consequence of a few key taxa awaiting detailed reassessment. Among them, the taxon Polyptychodon is of special importance. It was established on isolated teeth from the mid-Cretaceous strata of East and South East England and subsequently associated with numerous finds of near-cosmopolitan distribution. Here the taxon is reassessed based on the original dental material from England, with special focus on a large collection of late Albian material from the Cambridge Greensand near Cambridge. The dental material is reviewed here from historical and stratigraphic perspective, described in detail, and discussed in terms of its diagnostic nature. The considerable morphological variability observed in the teeth attributed to Polyptychodon, together with a wide stratigraphic range of the ascribed material, possibly exceeding 35 Ma (early Aptian to ?middle Santonian), suggests that the taxon is based on a multispecies assemblage, possibly incorporating members of different plesiosaur clades. Due to the absence of any autapomorphic characters or unique character combinations in the original material, Polyptychodon interruptus, the type species of Polyptychodon, is considered nomen dubium. From a global perspective, Polyptychodon is viewed as a wastebasket taxon whose material originating from different localities should be reconsidered separately.

Looking Beyond the Genes: The Interplay Between Signaling Pathways and Mechanics in the Shaping and Diversification of Epithelial Tissues

The core of Evo-Devo lies in the intuition that the way tissues grow during embryonic development, the way they sustain their structure and function throughout lifetime, and the way they evolve are closely linked. Epithelial tissues are ubiquitous in metazoans, covering the gut and internal branched organs, as well as the skin and its derivatives (ie, teeth). Here, we discuss in vitro, in vivo, and in silico studies on epithelial tissues to illustrate the conserved, dynamical, and complex aspects of their development. We then explore the implications of the dynamical and nonlinear nature of development on the evolution of their size and shape at the phenotypic and genetic levels. In rare cases, when the interplay between signaling and mechanics is well understood at the cell level, it is becoming clear that the structure of development leads to covariation of characters, an integration which in turn provides some predictable structure to evolutionary changes. We suggest that such nonlinear systems are prone to genetic drift, cryptic genetic variation, and context-dependent mutational effects. We argue that experimental and theoretical studies at the cell level are critical to our understanding of the phenotypic and genetic evolution of epithelial tissues, including carcinomas.

Thermotransduction and heat stress in dental structures during orthodontic debonding : Effectiveness of various cooling strategies

OBJECTIVES

Recent studies have indicated possible thermal damage to pulpal tissue during orthodontic debonding. This study aimed to analyze the thermal loads acting upon dental structures and their transfer to the pulp during orthodontic debonding. Specific goals were to analyze temperature changes in local dental tissues, thermotransduction to the pulp cavity, and the effectiveness of common cooling strategies and of simulated intrapulpal circulation.

MATERIALS AND METHODS

Metal brackets were bonded to five extracted human molars and subsequently removed. While a carbide bur was applied to debond the residual composite from the tooth surface, various cooling strategies (no/air/water cooling) were employed with or without simulated intrapulpal circulation, accompanied by temperature measurements with a thermographic infrared camera on the enamel surface and with measuring probes in the pulp cavity. Appropriate evaluation software was used to calculate the enamel-to-pulp temperature gradients and for statistical analysis.

RESULTS

Significant differences in temperature rise and heat development over time, both on the enamel surfaces and in the pulp cavities were found. The mean temperature rises associated with no/air/water cooling were 90.7/46.6/9.2 °C on the enamel surface versus 9/8/4.6 °C inside the pulp. However, thermotransduction from enamel to pulp remained below 10 % of the surface measurements in all groups. Simulated intrapulpal microcirculation was found to significantly reduce intrapulpal temperature levels.

CONCLUSION

During debonding of residual bracket adhesives, provided that a carbide bur is properly used, our data indicate a low risk of reaching critical intrapulpal temperatures even in the absence of dedicated cooling and no risk if the instrumentation is accompanied by air or water cooling.

Reconstructing temporal variation of fluoride uptake in eastern grey kangaroos (Macropus giganteus) from a high-fluoride area by analysis of fluoride distribution in dentine

Trace element profiling in the incrementally formed dentine of mammalian teeth can be applied to reconstruct temporal variation of incorporation of these elements into the tissue. Using an electron microprobe, this study analysed fluoride distribution in dentine of first and third mandibular molars of free-ranging eastern grey kangaroos inhabiting a high-fluoride area, to assess temporal variation in fluoride uptake of the animals. Fluoride content in the early-formed dentine of first molars was significantly lower than in the late-formed dentine of these teeth, and was also lower than in both, the early and the late-formed dentine of third molars. As early dentine formation in M1 takes place prior to weaning, this finding indicates a lower dentinal fluoride uptake during the pre-weaning compared to the post-weaning period. This is hypothetically attributed to the action of a partial barrier to fluoride transfer from blood to milk in lactating females and a low bioavailability of fluoride ingested together with milk. Another factor contributing to lower plasma fluoride levels in juveniles compared to adults is the rapid clearance of fluoride from blood plasma in the former due to their intense skeletal growth. The combined action of these mechanisms is considered to explain why in kangaroos from high-fluoride areas, the (early-formed) first molars are not affected by dental fluorosis while the (later-formed) third and fourth molars regularly exhibit marked to severe fluorotic lesions.

Genetic and environmental factors influencing tooth and jaw malformations in rabbits

Tooth alterations of 281 rabbits from 10 different breeds were evaluated, starting at the age of three weeks until they were fully grown. All rabbits were kept in an outdoor facility, fed with a pelleted diet and had free access to water and hay. The most common finding in 3182 clinical examinations was a gap between the mandibular incisors (38 per cent). Skull X-rays from 4 adult breeding rabbits, 15 offspring with clinical signs of dental disease and 12 clinically healthy siblings were assessed by two different methods using cephalometric distances and anatomical reference lines. Repeatabilities of cephalometric distances were mostly low and no significant associations to tooth health were found. The anatomical reference lines revealed dental findings even in rabbits that were graded as tooth healthy in previous clinical examinations. On the basis of the demonstrated age-dependent development of tooth and jaw malformations a first examination and selection at the age of 12 weeks can be recommended. Also genetic aspects for tooth and jaw malformations were considered. The estimated heritability for brachygnathia superior was 0.254 ± 0.169 for all examinations and 0.105 ± 0.092 comprising the last examination of each rabbit when fully grown.

Microscopic structure of dental hard tissues in primary and permanent teeth from individuals with Prader-Willi syndrome

OBJECTIVE

severe tooth wear, in terms of both erosive wear and attrition, is a significant problem in individuals with Prader-Willi syndrome (PWS). The purpose of the present study was to describe the structure of enamel and dentine in primary and permanent teeth from individuals with PWS.

DESIGN

thirty-two primary and 10 permanent teeth representing 16 individuals with PWS were investigated in the study. The enamel surface was studied using scanning electron microscopy (SEM). The microscopic structure of enamel and dentine was studied using SEM, microradiography and light microscopy.

RESULTS

the microscopic structure of enamel and dentine was found to be normal with the exception of a slight increase of interglobular dentine (IGD). Severe erosive defects were observed in primary teeth and also in permanent teeth with long exposure to the oral environment.

CONCLUSION

the erosive enamel defects in individuals with PWS seem more related to the factors in the oral environment than to enamel structure which appeared normal. The occurrence of IGD indicate deficient mineralization but is probably of minor clinical significance. Gastro-oesophageal reflux is worthy of further investigation in individuals with Prader-Willi syndrome.

Dental Calculus Arrest of Dental Caries

BACKGROUND

An inverse relationship between dental calculus mineralization and dental caries demineralization on teeth has been noted in some studies. Dental calculus may even form superficial layers over existing dental caries and arrest their progression, but this phenomenon has been only rarely documented and infrequently considered in the field of Cariology. To further assess the occurrence of dental calculus arrest of dental caries, this study evaluated a large number of extracted human teeth for the presence and location of dental caries, dental calculus, and dental plaque biofilms.

MATERIALS AND METHODS

A total of 1,200 teeth were preserved in 10% buffered formal saline, and viewed while moist by a single experienced examiner using a research stereomicroscope at 15-25× magnification. Representative teeth were sectioned and photographed, and their dental plaque biofilms subjected to gram-stain examination with light microscopy at 100× magnification.

RESULTS

Dental calculus was observed on 1,140 (95%) of the extracted human teeth, and no dental carious lesions were found underlying dental calculus-covered surfaces on 1,139 of these teeth. However, dental calculus arrest of dental caries was found on one (0.54%) of 187 evaluated teeth that presented with unrestored proximal enamel caries. On the distal surface of a maxillary premolar tooth, dental calculus mineralization filled the outer surface cavitation of an incipient dental caries lesion. The dental calculus-covered carious lesion extended only slightly into enamel, and exhibited a brown pigmentation characteristic of inactive or arrested dental caries. In contrast, the tooth's mesial surface, without a superficial layer of dental calculus, had a large carious lesion going through enamel and deep into dentin.

CONCLUSIONS

These observations further document the potential protective effects of dental calculus mineralization against dental caries.

Extraction of DNA from Human Skeletal Material

In recent years the recovery and analysis of DNA from skeletal remains has been applied to several contexts ranging from disaster victim identification to the identification of the victims of conflict. Here are described procedures for processing the bone and tooth samples including mechanical and chemical cleaning, cutting and powdering in the presence of liquid nitrogen, complete demineralization of bone and tooth powder, DNA extraction, DNA purification using magnetic beads, and the precautions and strategies implemented to avoid and detect contamination. It has proven highly successful in the analysis of bones and teeth from Second World War victims' skeletal remains that have been excavated from mass graves in Slovenia and is also suitable for genetic identification of relatively fresh human remains.

The dentary of Australovenator wintonensis (Theropoda, Megaraptoridae); implications for megaraptorid dentition

Megaraptorid theropods were an enigmatic group of medium-sized predatory dinosaurs, infamous for the hypertrophied claw on the first manual digit. Megaraptorid dentition is largely restricted to isolated teeth found in association with skeletal parts; however, the in situ maxillary dentition of Megaraptor was recently described. A newly discovered right dentary pertaining to the Australovenator holotype preserves in situ dentition, permitting unambiguous characterisation of the dentary tooth morphology. The new jaw is virtually complete, with an overall elongate, shallow profile, and fifteen visible in situ teeth at varying stages of eruption. In situ teeth confirm Australovenator exhibited modest pseudoheterodonty, recurved lateral teeth with a serrate distal carina and reduced mesial carina, similar to other megaraptorids. Australovenator also combines of figure-of-eight basal cross-section with a lanceolate shape due to the presence of labial and lingual depressions and the lingual twist of the distal carina. Computed tomography and three-dimensional imagery provided superior characterisation of the dentary morphology and enabled an accurate reconstruction to a pre-fossilised state. The newly established dental morphology also afforded re-evaluation of isolated theropod teeth discovered at the Australovenator holotype locality and from several additional Winton Formation localities. The isolated Winton teeth are qualitatively and quantitatively similar to the in situ dentary teeth of Australovenator, but are also morphometrically similar to Abelisauridae, Allosauridae, Coelophysoidea, Megalosauridae and basal Tyrannosauroidea. Qualitative characters, however, clearly distinguish the teeth of Australovenator and the isolated Winton teeth from all other theropods. Evidence from teeth suggests megaraptorids were the dominant predators in the Winton Formation, which contrasts with other penecontemporaneous Gondwanan ecosystems.

Effect of breastfeeding on malocclusions: a systematic review and meta-analysis

AIM

The objective of this systematic review was to investigate whether breastfeeding decreases the risk of malocclusions.

METHODS

Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: (i) ever versus never; (ii) exclusive versus absence of exclusive; and (iii) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias.

RESULTS

Forty-eight studies were included in the systematic review, and 41 were included in the overall meta-analysis (n = 27 023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those shorter breastfed (OR 0.40; 95% CI 0.29; 0.54).

CONCLUSION

Breastfeeding decreases the risk of malocclusions.

Hypophosphatasia: an overview of the disease and its treatment

This review presents the current knowledge on hypophosphatasia, a rare genetic disease of very variable severity (from lethal to mild) and clinical presentation, caused by defective production of tissue-non-specific alkaline phosphatase (TNSALP). Hypophosphatasia can affect babies in utero as well as infants, children, and adults. The article first presents the genetics of TNSALP and its many known mutations underlying the disease. Then, it presents the epidemiology, classification, and clinical presentation of the six different forms of the disease (perinatal lethal, prenatal benign, infantile, childhood, adult, and odontohypophosphatasia) as well as the essential diagnostic clues. The last section on treatment presents a survey of the therapeutic approaches, up to the ongoing phase 2 studies of enzyme replacement therapy.

An alternate method for extracting DNA from environmentally challenged teeth for improved DNA analysis

A grinding-free method to extract DNA from teeth via a direct minimal-invasive retrograde approach to the pulp cavity and dentine was compared to a standard grinding/pulverisation method. This alternate method uses endodontic dental files to access the root canals and pulp cavity for tissue and dentine harvest via the apical end of the roots and avoids mechanical damage to the crown and root morphology. In contrast, other methods require pulverisation of the whole root or tooth, transection or destruction of the occlusal surface to gain access to the DNA in the root canals and pulp chamber. This study compared two methods for preparing dentine powder from the roots of environmentally challenged teeth for forensic DNA analysis. We found that although the filing method was more laborious, and produced less dentine powder, the amount of amplifiable DNA per milligram of powder was substantially higher with the filing method compared to grinding the entire root. In addition, the number of short tandem repeat (STR) alleles detected and the peak height ratios of the STR profiles were notably higher. Although several other methods of extracting DNA-rich tissue from the pulp chamber of teeth have previously been reported, the method presented in this study is minimally invasive, thereby allowing the preservation of tooth and crown morphology.

Calcium orthophosphates (CaPO4): occurrence and properties

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates (CaPO4). This type of materials is of the special significance for the human beings because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (i.e., those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with CaPO4, while dental caries and osteoporosis mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenorthophosphates. Therefore, the processes of both normal and pathological calcifications are just an in vivo crystallization of CaPO4. Similarly, dental caries and osteoporosis might be considered as in vivo dissolution of CaPO4. In addition, natural CaPO4 are the major source of phosphorus, which is used to produce agricultural fertilizers, detergents and various phosphorus-containing chemicals. Thus, there is a great significance of CaPO4 for the humankind and, in this paper, an overview on the current knowledge on this subject is provided.

Dental fluorosis and skeletal fluoride content as biomarkers of excess fluoride exposure in marsupials

Particulate and gaseous fluoride emissions contaminate vegetation near fluoride-emitting industries, potentially impacting herbivorous wildlife in neighboring areas. Dental fluorosis has been associated with consumption of fluoride-contaminated foliage by juvenile livestock and wildlife in Europe and North America. For the first time, we explored the epidemiology and comparative pathology of dental fluorosis in Australian marsupials residing near an aluminium smelter. Six species (Macropus giganteus, Macropus rufogriseus, Wallabia bicolor, Phascolarctos cinereus, Trichosurus vulpecula, Pseudocheirus peregrinus) demonstrated significantly higher bone fluoride levels in the high (n=161 individuals), compared to the low (n=67 individuals), fluoride areas (p<0.001). Necropsy examinations of all six species from the high-fluoride area near the smelter revealed dental lesions considered characteristic of dental fluorosis in eutherian mammals. Within the high-fluoride area, 67% of individuals across the six species showed dental enamel lesions, compared to 3% in the low-fluoride areas. Molars that erupted before weaning were significantly less likely to display pathological lesions than those developing later, and molars in the posterior portion of the dental arcade were more severely fluorotic than anterior molars in all six species. The severity of dental lesions was positively associated with increasing bone fluoride levels in all species, revealing a potential biomarker of excess fluoride exposure.

Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists

BACKGROUND

The few studies that have assessed oral health in professional/elite football suggest poor oral health with minimal data on impact on performance. The aim of this research was to determine oral health in a representative sample of professional footballers in the UK and investigate possible determinants of oral health and self-reported impact on well-being, training and performance.

METHODS

Clinical oral health examination of senior squad players using standard methods and outcomes carried out at club training facilities. Questionnaire data were also collected. 8 teams were included, 5 Premier League, 2 Championship and 1 League One.

RESULTS

6 dentists examined 187 players who represented >90% of each senior squad. Oral health was poor: 37% players had active dental caries, 53% dental erosion and 5% moderate-severe irreversible periodontal disease. 45% were bothered by their oral health, 20% reported an impact on their quality of life and 7% on training or performance. Despite attendance for dental check-ups, oral health deteriorated with age.

CONCLUSIONS

This is the first large, representative sample study in professional football. Oral health of professional footballers is poor, and this impacts on well-being and performance. Successful strategies to promote oral health within professional football are urgently needed, and research should investigate models based on best evidence for behaviour change and implementation science. Furthermore, this study provides strong evidence to support oral health screening within professional football.

Prenatal and postnatal manganese teeth levels and neurodevelopment at 7, 9, and 10.5 years in the CHAMACOS cohort

BACKGROUND

Numerous cross-sectional studies of school-age children have observed that exposure to manganese (Mn) adversely affects neurodevelopment. However, few prospective studies have looked at the effects of both prenatal and postnatal Mn exposure on child neurodevelopment.

METHODS

We measured Mn levels in prenatal and early postnatal dentine of shed teeth and examined their association with behavior, cognition, memory, and motor functioning in 248 children aged 7, 9, and/or 10.5 years living near agricultural fields treated with Mn-containing fungicides in California. We used generalized linear models and generalized additive models to test for linear and nonlinear associations, and generalized estimating equation models to assess longitudinal effects.

RESULTS

We observed that higher prenatal and early postnatal Mn levels in dentine of deciduous teeth were adversely associated with behavioral outcomes, namely internalizing, externalizing, and hyperactivity problems, in boys and girls at 7 and 10.5 years. In contrast, higher Mn levels in prenatal and postnatal dentine were associated with better memory abilities at ages 9 and 10.5, and better cognitive and motor outcomes at ages 7 and 10.5 years, among boys only. Higher prenatal dentine Mn levels were also associated with poorer visuospatial memory outcomes at 9 years and worse cognitive scores at 7 and 10.5 years in children with higher prenatal lead levels (≥0.8 μg/dL). All these associations were linear and were consistent with findings from longitudinal analyses.

CONCLUSIONS

We observed that higher prenatal and early postnatal Mn levels measured in dentine of deciduous teeth, a novel biomarker that provides reliable information on the developmental timing of exposures to Mn, were associated with poorer behavioral outcomes in school-age boys and girls and better motor function, memory, and/or cognitive abilities in school-age boys. Additional research is needed to understand the inconsistencies in the neurodevelopmental findings across studies and the degree to which differences may be associated with different Mn exposure pathways and biomarkers.

Tooth matrix analysis for biomonitoring of organic chemical exposure: Current status, challenges, and opportunities

Epidemiological evidence supports associations between prenatal exposure to environmental organic chemicals and childhood health impairments. Unlike the common choice of biological matrices such as urine and blood that can be limited by short half-lives for some chemicals, teeth provide a stable repository for chemicals with half-life in the order of decades. Given the potential of the tooth bio-matrix to study long-term exposures to environmental organic chemicals in human biomonitoring programs, it is important to be aware of possible pitfalls and potential opportunities to improve on the current analytical method for tooth organics analysis. We critically review previous results of studies of this topic. The major drawbacks and challenges in currently practiced concepts and analytical methods in utilizing tooth bio-matrix are (i) no consideration of external (from outer surface) or internal contamination (from micro-odontoblast processes), (ii) the misleading assumption that whole ground teeth represent prenatal exposures (latest formed dentine is lipid rich and therefore would absorb and accumulate more organic chemicals), (iii) reverse causality in exposure assessment due to whole ground teeth, and (iv) teeth are a precious bio-matrix and grinding them raises ethical concerns about appropriate use of a very limited resource in exposure biology and epidemiology studies. These can be overcome by addressing the important limitations and possible improvements with the analytical approach associated at each of the following steps: (i) tooth sample preparation to retain exposure timing, (ii) organics extraction and pre-concentration to detect ultra-trace levels of analytes, (iii) chromatography separation, (iv) mass spectrometric detection to detect multi-class organics simultaneously, and (v) method validation, especially to exclude chance findings. To highlight the proposed improvements we present findings from a pilot study that utilizes tooth matrix biomarkers to obtain trimester-specific exposure information for a range of organic chemicals.

Dental peculiarities in the silvery mole-rat: an original model for studying the evolutionary and biological origins of continuous dental generation in mammals

Unravelling the evolutionary and developmental mechanisms that have impacted the mammalian dentition, since more than 200 Ma, is an intricate issue. Interestingly, a few mammal species, including the silvery mole-rat Heliophobius argenteocinereus, are able to replace their dentition by the addition of supernumerary molars at the back of jaw migrating then toward the front. The aim here was to demonstrate the potential interest of further studying this rodent in order to better understand the origins of continuous dental replacement in mammals, which could also provide interesting data concerning the evolution of limited dental generation occurring in first mammals. In the present study, we described the main stages of the dental eruptive sequence in the silvery mole-rat and the associated characteristics of horizontal replacement using X-ray microtomography. This was coupled to the investigation of other African mole-rats which have no dental replacement. This method permitted to establish evidence that the initial development of the dentition in Heliophobius is comparable to what it is observed in most of African mole-rats. This rodent first has premolars, but then identical additional molars, a mechanism convergent to manatees and the pygmy rock-wallaby. Evidence of continuous replacement and strong dental dynamics were also illustrated in Heliophobius, and stressed the need to deeply investigate these aspects for evolutionary, functional and developmental purposes. We also noticed that two groups of extinct non-mammalian synapsids convergently acquired this dental mechanism, but in a way differing from extant mammals. The discussion on the diverse evolutionary origins of horizontal dental replacement put emphasis on the necessity of focusing on biological parameters potentially involved in both continuous and limited developments of teeth in mammals. In that context, the silvery mole-rat could appear as the most appropriate candidate to do so.

Metallic Burden of Deciduous Teeth and Childhood Behavioral Deficits

Attention Deficit/Hyperactivity Disorder (ADHD) affects 5%–8% of children in the U.S. (10% of males and 4% of females). The contributions of multiple metal exposures to the childhood behavioral deficits are unclear, although particular metals have been implicated through their neurotoxicity. The objective of this study was to test the hypothesis that the body burden of Mn is positively correlated with ADHD symptoms. We also investigated the putative roles of Ca, Fe, Pb, and Hg. We collected shed molars from 266 children (138 boys and 128 girls) who lost a tooth between 11 and 13 years of age. The molars were analyzed for metals using ICP-OES. The third grade teacher of each child completed the Teacher’s Disruptive Behavior Disorders Rating Scale (DBD) to produce a score for “Total Disruptive Behavior” and subscale scores for “Attention Deficit Hyperactivity Disorder”, Hyperactivity/Impulsivity, Inattention, and Oppositional/Defiant. The mean Mn, Fe, Pb and Ca concentrations found in teeth was 3.1 ± 2.9 µg/g, 11.4 ± 12.1 µg/g, 0.5 ± 0.7 µg/g, and 3.0 × 10⁵ ± 0.8 × 10⁵ µg/g, respectively. Hg was not detected. No significant association was found between Mn and behavioral deficits. Ca was significantly negatively associated, and Pb showed a significant positive association with Hyperactivity/Impulsivity, Inattention, and Oppositional/Defiant Disorders. These findings call into question the putative independent association of manganese exposure and behavioral deficits in children, when the balance of other metallic burden, particularly Ca and Pb burdens play significant roles.

Interordinal gene capture, the phylogenetic position of Steller's sea cow based on molecular and morphological data, and the macroevolutionary history of Sirenia

The recently extinct (ca. 1768) Steller's sea cow (Hydrodamalis gigas) was a large, edentulous North Pacific sirenian. The phylogenetic affinities of this taxon to other members of this clade, living and extinct, are uncertain based on previous morphological and molecular studies. We employed hybridization capture methods and second generation sequencing technology to obtain >30kb of exon sequences from 26 nuclear genes for both H. gigas and Dugong dugon. We also obtained complete coding sequences for the tooth-related enamelin (ENAM) gene. Hybridization probes designed using dugong and manatee sequences were both highly effective in retrieving sequences from H. gigas (mean=98.8% coverage), as were more divergent probes for regions of ENAM (99.0% coverage) that were designed exclusively from a proboscidean (African elephant) and a hyracoid (Cape hyrax). New sequences were combined with available sequences for representatives of all other afrotherian orders. We also expanded a previously published morphological matrix for living and fossil Sirenia by adding both new taxa and nine new postcranial characters. Maximum likelihood and parsimony analyses of the molecular data provide robust support for an association of H. gigas and D. dugon to the exclusion of living trichechids (manatees). Parsimony analyses of the morphological data also support the inclusion of H. gigas in Dugongidae with D. dugon and fossil dugongids. Timetree analyses based on calibration density approaches with hard- and soft-bounded constraints suggest that H. gigas and D. dugon diverged in the Oligocene and that crown sirenians last shared a common ancestor in the Eocene. The coding sequence for the ENAM gene in H. gigas does not contain frameshift mutations or stop codons, but there is a transversion mutation (AG to CG) in the acceptor splice site of intron 2. This disruption in the edentulous Steller's sea cow is consistent with previous studies that have documented inactivating mutations in tooth-specific loci of a variety of edentulous and enamelless vertebrates including birds, turtles, aardvarks, pangolins, xenarthrans, and baleen whales. Further, branch-site dN/dS analyses provide evidence for positive selection in ENAM on the stem dugongid branch where extensive tooth reduction occurred, followed by neutral evolution on the Hydrodamalis branch. Finally, we present a synthetic evolutionary tree for living and fossil sirenians showing several key innovations in the history of this clade including character state changes that parallel those that occurred in the evolutionary history of cetaceans.

Multidisciplinary care in severe pediatric electrical oral burn

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result.

Fracture Resistance of Simulated Immature Teeth Obturated with Gutta-Percha or Resilon and Reinforced by Composite or Post

OBJECTIVES

The purpose of this ex- vivo study was to evaluate the fracture resistance of simulated immature teeth, obturated with Gutta-percha or Resilon and reinforced by either composite resin or fiber post.

MATERIALS AND METHODS

Eighty-four human maxillary incisors were divided into seven groups (n=12). Teeth in all groups were prepared until Peeso #5 (1.5mm) could be passed through the apex. Root ends received 4mm of MTA plug as an apical barrier. Groups received the followings: 1.Gutta-percha, 2.Resilon, 3.Gutta-percha + composite resin, 4.Resilon + composite resin, 5.Gutta-percha + fiber post, 6.Resilon + fiber post and 7.No obturation (control group). Access openings were filled with composite resin. Specimens were then subjected to oblique load using Instron Testing Machine. The mean peak load at fracture was recorded and analyzed using ANOVA.

RESULTS

Experimental groups had a significantly more fracture resistance than the control group (P< 0.05). No significant difference was seen between experimental groups. Teeth reinforced by fiber post showed favorable fracture resistance.

CONCLUSION

Treatment plans used in this study increase the fracture resistance of immature teeth. Use of fiber posts in immature teeth, may be the most favorable clinically applicable technique.

Oral health of elite athletes and association with performance: a systematic review

Background

We aimed to systematically review the epidemiology of oral disease and trauma in the elite athlete population and to investigate the impact of oral health on sporting performance.

Methods

Authors searched Ovid MEDLINE (1950 to October 2013), Ovid EMBASE (1980 to October 2013), EBSCO SPORTDiscus (up to October 2013) and OpenGrey (http://www.opengrey.eu). No date or language restrictions were applied. Papers were included if they evaluated the oral health of professional athletes. The methodological quality of papers was evaluated using a modification of the Newcastle-Ottawa scale.

Results

The literature search led to 9858 potentially relevant citations. Following a set of predefined exclusion criteria, 34 studies remained. Twenty-six studies reported on dental trauma, which ranged in prevalence from 14% to 47% varying by sport and country. Sixteen studies considered the oral health of athletes and reported high prevalence of oral diseases: dental caries 15–75%, dental erosion 36–85%, periodontal disease 15%. In four studies, a range between 5% and 18% of athletes reported negative impact of oral health or trauma on performance. The methodological quality of included studies was generally low.

Conclusions

Within the limits of the review, oral health of athletes is poor. We hypothesise that poor oral health associates with self-reported performance; however, this needs to be tested. Further studies on representative samples of athletes are needed to assess the size of the problem of poor oral health as well as to investigate the possible impact on performance using objective measures of performance.