Panoramic radiographs and dental patients with Down syndrome: A scoping review

INTRODUCTION

Life expectancy for people with Down syndrome (DS) has increased to 60 years, although poor oral health affects their quality of life. Panoramic radiographs (PRs) are usually well-tolerated by people with DS and can provide valuable diagnostic data for treatment planning and research. Methods A scoping review of peer-reviewed articles published between 1971and 2021 was conducted in accordance with the PRISMA extension for scoping reviews to determine the scope of use of PRs for people with DS.

RESULTS

937 papers were screened, and 52 papers were included and charted into seven categories in this review. A high prevalence of tooth agenesis (TA) and other anomalies were reported in 45% of papers. Severe periodontal disease was considered characteristic of DS in the 1970s-80s and the benefit of time-consuming treatment was questioned. Since 2000 case reports illustrate that improved oral care, orthodontic treatment, and dental implants under local or general anaesthetic can improve the quality of life for people with DS.

CONCLUSION

PRs play an important role in the diagnosis of anomalies, periodontal disease, and implant planning for patients with DS. This review highlights the gaps in research of caries, pathology, TMJ, systemic disease indicators, and guidelines for dentists. Systematic PR viewing, with a knowledge of characteristic features of DS, will assist diagnosis of pathology and improve comprehensive dental care treatment planning for children and adults with DS.

Research algorithm for the detection of genetic patterns and phenotypic variety of non-syndromic dental agenesis

Introduction: Dental agenesis (DA), brings together the anodontia, oligodontia, hypodontia, characterized by a deficit in the development of a variable number of teeth. The objectives of the study were to illustrate the phenotypic variability of non-syndromic DA, to identify cases of DA with hereditary genetic transmission, and establish the mode of DA genetic pattern in these cases, together with the determination of DA prevalence in the population group study. Patients, Materials and Methods: The cross-sectional observational study was performed on a mixed population group, consisting of 861 Caucasian patients, between January 2018–December 2019. The clinical evaluation protocol of patients with DA, used to illustrate their phenotype, included the following stages: oral examination, photographic examination, and radiological examination. The evaluation protocol specific to the family genetic study of patients with DA, involved the following three stages: family survey, construction of the family tree and analysis of the pedigree structure. Results: The prevalence of DA in the population group was 2.78%. Regarding the phenotype, DA mainly affected the upper arch (50% of cases); bilateral DA had a significantly increased incidence (83.33% of cases) compared to unilateral form; in most cases (75%), a patient lacked one to two teeth, the lack of two teeth being the most common form (83.33% of cases); the upper lateral incisors were the teeth most frequently involved in DA (31.11% of the total missing teeth). Regarding the family genetic study, hereditary DA with autosomal dominant inheritance was present in 37.50% of cases. In the other cases (62.50%), isolated, sporadic forms of DA were registered, suggesting a spontaneous de novo mutation or a disorder of odontogenesis of a non-genetic nature. Conclusions: We consider that this study is of interest for current scientific research with applicability in dental medicine, by bringing actual information on the prevalence of non-syndromic DA in South-East Romania, the variety of phenotypic spectrum of DA for this geographic area, and the role of heredity in the DA genetic determinism in the studied population.

Physical Status and Parent-Child Feeding Behaviours in Children and Adolescents with Down Syndrome in The United Arab Emirates

The prevalence of Down syndrome (DS) in the United Arab Emirates (UAE) is high in comparison to the global statistics. The aim of this study is to assess the physical status, feeding problems, parent-child feeding relationship and weight outcome in children and adolescents with DS in the UAE. In this cross-sectional study, 83 individuals aged between 2–19 years with DS were recruited from three humanitarian centres for differently abled in the Emirates of Sharjah and Dubai, UAE. Socio-demographic characteristics; height, weight, BMI and body composition; feeding problems (STEP-CHILD screening tool); and parent-child feeding relationship (child feeding questionnaire—CFQ) were assessed. Correlations and regression analyses were used to determine the relationships and the best predictor of weight outcome (BMI) in DS participants. The median age of the participants was 9 (8) years. Fifty-five (66.3%) males and twenty-eight (33.7%) females constituted a sex ratio of 1.96:1. Five (6.2%) participants were short for their age, and 20.6% were overweight/obese compared to the growth charts for DS population. Body composition of females showed significantly higher percent body fat than males (25.5 (14.3)% vs. 18.2 (4.0)%, p = 0.03; 29.9 (2.8)% vs. 16.3 (12.2)%, p = 0.006) in 5–8.99 years and 12–19.99 years, respectively. The most common feeding difficulties on STEP-CHILD tool were food selectivity (62.2%), continued eating in the presence of food (57.7%) and swallowing without sufficient chewing (50%). Median score of total-CFQ for the parent-child feeding behaviour was 3.2 (1.9); parental restriction 3.3 (1.0); pressure to eat 3.0 (0.8); concern about child weight 3.7 (2.3). Parent-child feeding relationship was significantly positively correlated with feeding problems, and body weight of the participants. The best predictor for BMI was the parental concern about child weight (OR: 1.4, p = 0.02). The findings can be valuable for the health care professionals, parents and caretakers of children and adolescents with DS in emphasizing the need for regular monitoring of their physical status, and feeding behaviours. In addition, it reinforces the role of parents in mindfully managing their child feeding relationship in promoting healthy eating behaviours and weight of their youth with DS.

Prevalence of Hypodontia in a Sample of Spanish Dental Patients

Objectives

The aim of this retrospective study was to evaluate the prevalence of hypodontia in a sample of dental patients, aged between seven and eleven years at University Alfonso X in Madrid (Spain).

Materials and Methods

The number of hypodontia cases and the most affected teeth were evaluated in 2500 panoramic radiographs in a random sample of dental patients consisting of 1235 females and 1265 males. We divided them according to age, number of hypodontia present in each patient (multiple or single), each side, each quadrant either in the upper jaw or in the mandible. The chi-square test (P <0.05) was used to compare the differences in agenesis among males and females.

Results

The sample of 2500 patients who were studied consisted of 1235 women, out of which 41 presented hypodontia (3.31%) and 1265 men, out of which 46 had at least a dental absence (3.63%). There was no significant difference in the proportion of hypodontia between men and women (p> 0.05).

Conclusion

The percentage of total agenesis of 2500 patients studied was 3.48%.

Prevalence and Characteristics of Congenitally Missing Permanent Teeth among Orthodontic Patients in Southern Croatia

BACKGROUND

Congenitally missing permanent teeth (CMPT) was recognized as a clinical and public health problem in pediatric dentistry.

AIM

To determine the prevalence of CMPT among orthodontic patients in Southern Croatia.

MATERIALS AND METHODS

In a retrospective study, we analyzed CMPT in patients from three different regions in Southern Croatia (SC). Two orthodontic practices from each region were selected and a total of 4649 records of patients aged 6 - 15 years, who were clinically examined for orthodontic treatment between 2008 and 2015, were evaluated. We excluded 219 patients and 4430 patients remained for further analysis.

RESULTS

There was no difference in prevalence of CMPT among regions in Southern Croatia, and the whole sample was evaluated. CMPT was found in 345(7.8%) patients. The highest proportion of CMPT was with one or two missing teeth 122 (81.9%) and 158 (80.6%), followed by those with three to five missing teeth or moderate hypodontia, 25(16.8%) and 35(17.9%), in males, and females respectively. Bilateral hypodontia of the lower second premolars and upper second incisors was more common than unilateral hypodontia.

CONCLUSIONS

The obtained results of high prevalence of CMPT in Southern Croatia reinforce the need for a timely diagnostics and treatment of moderate and severe cases.

Assessment of Midfacial Hypoplasia in Down Syndrome Fetuses - Validity of a Two-Line Approach and Introduction of a Novel Angle (Maxilla-Mandible-Nasion Angle)

PURPOSE

To scrutinize the validity of a novel angle (maxilla-mandible-nasion angle, MMN) as objective proof of midfacial hypoplasia in trisomy 21 fetuses.

MATERIALS AND METHODS

Volume data sets of 2(nd) trimester fetuses were reviewed in this retrospective study. After achievement of the correct midsagittal position, the fetal profile line (FP line) and the mandibulo-maxillary line (MML) were applied and the resulting angle was calculated. Additionally, the prefrontal space ratio (PFSR) was assessed. Both measurements were obtained from 401 euploid fetuses and 42 fetuses with trisomy 21. Values for MMN and PFSR<5(th) percentile were considered abnormal.

RESULTS

The study included 443 fetuses with a mean gestational age of 21.3 weeks (range: 14.0-26.3). The MMN angle sufficiently identified hypoplasia of the midface in trisomy 21 fetuses (mean: 14.6°; range: 10.1°- 22.0°) compared to controls (mean: 20.5°; range: 17.3°-23.7°; p<0.0001). Concomitantly, the PFSR of Down syndrome fetuses was significantly lower (mean: 0.53; range: 0.21-1.22) than in euploid individuals (1.38; range: 0.54-2.23; p<0.0001).

CONCLUSION

Calculation of the novel MMN angle in 2(nd) trimester fetuses reliably allows rapid assessment of craniofacial anatomy in order to rule out the midfacial hypoplasia frequently found in trisomy 21.

A Critical Evaluation of the Down Syndrome Diagnosis for LB1, Type Specimen of Homo floresiensis

The Liang Bua hominins from Flores, Indonesia, have been the subject of intense scrutiny and debate since their initial description and classification in 2004. These remains have been assigned to a new species, Homo floresiensis, with the partial skeleton LB1 as the type specimen. The Liang Bua hominins are notable for their short stature, small endocranial volume, and many features that appear phylogenetically primitive relative to modern humans, despite their late Pleistocene age. Recently, some workers suggested that the remains represent members of a small-bodied island population of modern Austro-Melanesian humans, with LB1 exhibiting clinical signs of Down syndrome. Many classic Down syndrome signs are soft tissue features that could not be assessed in skeletal remains. Moreover, a definitive diagnosis of Down syndrome can only be made by genetic analysis as the phenotypes associated with Down syndrome are variable. Most features that contribute to the Down syndrome phenotype are not restricted to Down syndrome but are seen in other chromosomal disorders and in the general population. Nevertheless, we re-evaluated the presence of those phenotypic features used to support this classification by comparing LB1 to samples of modern humans diagnosed with Down syndrome and euploid modern humans using comparative morphometric analyses. We present new data regarding neurocranial, brain, and symphyseal shape in Down syndrome, additional estimates of stature for LB1, and analyses of inter- and intralimb proportions. The presence of cranial sinuses is addressed using CT images of LB1. We found minimal congruence between the LB1 phenotype and clinical descriptions of Down syndrome. We present important differences between the phenotypes of LB1 and individuals with Down syndrome, and quantitative data that characterize LB1 as an outlier compared with Down syndrome and non-Down syndrome groups. Homo floresiensis remains a phenotypically unique, valid species with its roots in Plio-Pleistocene Homo taxa.