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Orofacial manifestations of sickle cell disease: implications for dental clinicians. Br Dent J 2021; 230:143-147. [PMID: 33574535 DOI: 10.1038/s41415-021-2601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/07/2020] [Indexed: 11/08/2022]
Abstract
Sickle cell disease is a multisystem disease associated with episodes of acute illness and progressive organ damage. It is one of the most common severe monogenic disorders worldwide and is now the fastest growing genetic disorder in the UK. Dental awareness of orofacial manifestation varies geographically due to the inheritance pattern and patient population affected by the disease. This article details the epidemiology, pathophysiology and the orofacial manifestations in light of current literature.
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Costa CPS, Alves MS, Lima-Neto LG, Valois EM, Monteiro-Neto V, Souza SFC. Is there bacterial infection in the intact crowns of teeth with pulp necrosis of sickle cell anaemia patients? A case series study nested in a cohort. Int Endod J 2021; 54:817-825. [PMID: 33434310 DOI: 10.1111/iej.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the presence of bacteria in permanent teeth with intact crowns (without caries, periodontal disease or dental trauma) in patients with sickle cell anaemia (HbSS genotype) by analysing their clinical, imaging and microbiological parameters. METHODOLOGY This is a case series study nested in a cohort. In the first follow-up of this cohort study (Journal of Endodontics, 2013, 39, 177), 10 HbSS patients with at least one tooth with an intact crown and clinically diagnosed with pulp necrosis by pulse oximetry adapted for dentistry and a cold pulp sensitivity test (n = 27 teeth) were selected. Changes in the pulp chamber, root and periodontal ligament were identified in the tomographic analysis. Bacterial culture, staining for live and dead bacteria, and real-time polymerase chain reaction with 16S rRNA primers were used to identify the presence of bacteria. Culture sample collection was performed immediately after access to the pulp chamber. The microbiome was analysed with a MiSeq sequencer (Illumina, San Diego, CA). RESULTS The diagnosis of pulp necrosis was confirmed clinically in 82% (22/27) of the teeth. The amount of bacterial load identified was less than 100 copies μL-1 in 23% (5/22) of the teeth with intact crowns and pulp necrosis. Thirteen bacterial species were identified that are commonly found in urinary tract infections, septicaemia and infective endocarditis. Only one of these species, Granulicatella adjacens, has also be found in primary endodontic infections. CONCLUSION Prospective clinical, imaging and microbiological analyses suggest that pulp necrosis of teeth with intact crowns in HbSS patients is not associated with the presence of bacteria.
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Affiliation(s)
- C P S Costa
- School of Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - M S Alves
- Parasitic Biology Postgraduate, CEUMA University, São Luís, Maranhão, Brazil
| | - L G Lima-Neto
- Parasitic Biology Postgraduate, CEUMA University, São Luís, Maranhão, Brazil
| | - E M Valois
- School of Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - V Monteiro-Neto
- Department of Pathology, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - S F C Souza
- School of Dentistry, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Gusmini MADS, De Sa AC, Feng C, Arany S. Predictors of dental complications post-dental treatment in patients with sickle cell disease. Clin Exp Dent Res 2020; 7:11-19. [PMID: 33225591 PMCID: PMC7853884 DOI: 10.1002/cre2.335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Our aim was to explore potential medical or dental indicators associated with dental complications and the utilization of emergency services in sickle cell disease (SCD), especially that clinical reports on adverse outcomes post‐dental treatment are scarce. Materials and methods A retrospective analysis of dental treatments of 47 eligible adults with confirmed SCD between May 2016 and October 2019. Logistic regression analysis was used whether clinical outcomes, course of dental treatment, and regularity of dental care are associated with dental complications after dental procedures and/or resulted in emergency care or hospital admissions. Results We identified a new, statistically significant association (p‐value = .01) between the number of prescription medications taken and complications (10%) after dental procedures. The most frequent dental procedures were tooth extractions (36%) and pain management (28%) during a non‐scheduled dental encounter (68%). The majority of cases did not participate in regular recall exams and periodical oral hygiene maintenance. Conclusions A higher number of prescription medications was associated with an increased risk of post‐dental complications in SCD patients. A thorough medical history, including a list of prescribed medications, and collaboration with the patient medical team are important to assess the risk of complications post‐dental procedures and the need for antibiotic prophylaxis according to the case complexity.
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Affiliation(s)
| | - Anny Clementino De Sa
- Department of General Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Szilvia Arany
- Department of General Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
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Evidence-based dental management in the new era of sickle cell disease: A scoping review. J Am Dent Assoc 2020; 151:668-677.e9. [PMID: 32854869 DOI: 10.1016/j.adaj.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is an emerging global health issue with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on dental treatment of SCD. TYPES OF STUDIES REVIEWED Using a scoping review approach, the authors examined citations from 13 national SCD guidelines and 10 books spanning 4 decades. The authors also searched the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Scientific Electronic Library Online, and GoogleScholar. Eligibility criteria included SCD, oral health care and dental treatment, related to oral and systemic health, original data, or observations. RESULTS Systemic treatment of SCD might have opposing effects on caries, perhaps explaining the conflicting results published. Malocclusion correlates with marrow expansion. Other unusual orofacial findings reflect ischemia. Of 86 full-text articles examined, only 1, a Brazilian esthetic dentistry study, was a randomized clinical trial. No disease-specific data were found on risk of developing bacterial endocarditis, safety of inhaled nitrous oxide, safety of epinephrine with local anesthetic, or the benefit of comprehensive oral health care. PRACTICAL IMPLICATIONS In SCD, oral health and systemic health could be strongly linked. Penicillin, vaccines, and hydroxyurea might impact caries and bone. The interaction of SCD treatments and oral health merit study.
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Costa CPS, Thomaz ÉBAF, Ribeiro CCC, Souza SDFC. Biological factors associating pulp necrosis and sickle cell anemia. Oral Dis 2020; 26:1558-1565. [DOI: 10.1111/odi.13415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/12/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
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Healthy Dental Pulp Oxygen Saturation Rates in Subjects with Homozygous Sickle Cell Anemia: A Cross-Sectional Study Nested in a Cohort. J Endod 2017; 43:1997-2000. [DOI: 10.1016/j.joen.2017.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/11/2017] [Accepted: 07/16/2017] [Indexed: 11/23/2022]
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Souza SFC, de Carvalho HLCC, Costa CPS, Thomaz EBAF. Association of sickle cell haemoglobinopathies with dental and jaw bone abnormalities. Oral Dis 2017; 24:393-403. [DOI: 10.1111/odi.12742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/10/2017] [Accepted: 08/13/2017] [Indexed: 01/01/2023]
Affiliation(s)
- SFC Souza
- Department of Dentistry; Federal University of Maranhão; São Luıs Brazil
| | - HLCC de Carvalho
- Postgraduate Dentistry Program; Federal University of Maranhão; São Luıs Brazil
| | - CPS Costa
- Postgraduate Dentistry Program; Federal University of Maranhão; São Luıs Brazil
| | - EBAF Thomaz
- Department of Public Health; Federal University of Maranhão; São Luıs Brazil
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de Carvalho HLCC, Rolim JYS, Thomaz ÉBAF, Souza SDFC. Are dental and jaw changes more prevalent in a Brazilian population with sickle cell anemia? Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:76-84. [DOI: 10.1016/j.oooo.2017.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 02/21/2017] [Accepted: 02/24/2017] [Indexed: 01/23/2023]
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Al-Alawi H, Al-Jawad A, Al-Shayeb M, Al-Ali A, Al-Khalifa K. The association between dental and periodontal diseases and sickle cell disease. A pilot case-control study. Saudi Dent J 2014; 27:40-3. [PMID: 25544813 PMCID: PMC4273253 DOI: 10.1016/j.sdentj.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 07/15/2014] [Accepted: 08/27/2014] [Indexed: 01/22/2023] Open
Abstract
Objective This is a pilot case-control study conducted to investigate the prevalence of dental caries and periodontal disease and examine the possible association between oral health deterioration and SCD severity in a sample of Saudi SCD patients residing in the city of Al-Qatif, Eastern Province, Saudi Arabia. Materials and methods Dental examination to determine the Decayed, Missing and Filled Teeth index (DMFT), Community Periodontal Index (CPI), and plaque index system were recorded for 33 SCD patients and 33 age and sex-matched controls in the Al-Qatif Central Hospital, Qatif, Saudi Arabia. Self-administered surveys used to assess socio-economic status; oral health behaviors for both SCD patients and controls were recorded. In addition, the disease severity index was established for all patients with SCD. SPSS data analysis software package version 18.0 was used for statistical analysis. Numerical variables were described as mean with a standard deviation. Results Decayed teeth were significantly more in individuals with ages ranging from 18 to 38 years with SCD compared to the control group (p = 0.036) due to oral hygiene negligence. The mean number of filled teeth was significantly lower in individuals with SCD when compared to the control group (p = 0.015) due to the lack of appropriate and timely treatment reflected in the survey responses of SCD patients as 15.2% only taking oral care during hospitalization. There were differences between the cases and controls in the known caries risk factors such as income level, flossing, and brushing habit. The DMFT, CPI, and plaque index systems did not differ significantly between the SCD patients and the control group. Conclusion Data suggest that patients with SCD have increased susceptibility to dental caries, with a higher prevalence of tooth decay and lower prevalence of filled teeth. Known caries risk factors influenced oral health more markedly than did factors related to SCD.
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Affiliation(s)
- Haidar Al-Alawi
- College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | | | - Mahdi Al-Shayeb
- College of Dentistry, University of Dammam, Dammam, Saudi Arabia
| | - Ali Al-Ali
- College of Dentistry, University of Dammam, Dammam, Saudi Arabia
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Basati MS. Sickle cell disease and pulpal necrosis: a review of the literature for the primary care dentist. Prim Dent J 2014; 3:76-79. [PMID: 25198336 DOI: 10.1308/205016814812135922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A case of difficult diagnosis of a patient with sickle cell disease and tooth pain fuelled a literature review by a primary care general dental practitioner. A literature search was conducted to review the relationship between sickle cell disease and pulpal necrosis. The results indicated statistically significant associations of sickle cell disease and tooth pain without any carious or traumatic pathology. It is important for the primary care dentist to be aware of the relationship between sickle cell disease and pulpal necrosis to prevent misdiagnosis and consequently mistreatment.
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Alves e Luna AC, Godoy F, de Menezes VA. Malocclusion and treatment need in children and adolescents with sickle cell disease. Angle Orthod 2013; 84:467-72. [DOI: 10.2319/070913-503.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
Objective:
To assess the prevalence of malocclusion and treatment need in children and adolescents with sickle cell disease (SCD).
Materials and Methods:
In this cross-sectional study, the sample size comprised 35 five-year-old children and 36 adolescents of both sexes, aged between 12 to 18 years, with SCD. Dental occlusion was assessed using two indexes: the Malocclusion Index (World Health Organization) and the Dental Aesthetic Index (DAI).
Results:
The prevalence of malocclusion in the preschool children was 62.9%. The main malocclusions observed in this age group were Class II (37.1%), increased overjet (28.6%), reduced overbite (28.6%), and open bite (17.1%). In the 12- to 18-year-old subjects, the prevalence of malocclusion was 100%, and the most prevalent types of malocclusion were maxillary overjet (63.9%) and maxillary misalignment (58.3%). It is noteworthy that the majority of adolescents (80.6%) had very severe or disabling malocclusions.
Conclusion:
The results revealed a high prevalence of malocclusion in children and adolescents with SCD. According to DAI score, the majority of the sample presented with very severe malocclusion and a compulsory treatment need.
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Affiliation(s)
- Ana Cláudia Alves e Luna
- PhD Student, Pediatric Dentistry, Dental School, University of Pernambuco, Camaragibe, Pernambuco, Brazil
| | - Fabiana Godoy
- PhD, Post-Doctoral Program, Pediatric Dentistry, Dental School, University of Pernambuco, Camaragibe, Pernambuco, Brazil
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Costa CPS, Thomaz EBAF, Souza SDFC. Association between Sickle Cell Anemia and Pulp Necrosis. J Endod 2013; 39:177-81. [DOI: 10.1016/j.joen.2012.10.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 10/11/2012] [Accepted: 10/18/2012] [Indexed: 11/26/2022]
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Passos CP, Santos PRB, Aguiar MC, Cangussu MCT, Toralles MBP, da Silva MCBO, Nascimento RJM, Campos MIG. Sickle cell disease does not predispose to caries or periodontal disease. SPECIAL CARE IN DENTISTRY 2012; 32:55-60. [DOI: 10.1111/j.1754-4505.2012.00235.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guzeldemir E, Toygar HU, Boga C, Cilasun U. Dental and periodontal health status of subjects with sickle cell disease. J Dent Sci 2011. [DOI: 10.1016/j.jds.2011.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Correlation between maxillofacial radiographic features and systemic severity as sickle cell disease severity predictor. Clin Oral Investig 2011; 16:827-33. [DOI: 10.1007/s00784-011-0577-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/26/2011] [Indexed: 12/26/2022]
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Dewan K, Owens J, Silvester K. Maintaining a high level of suspicion for recurrent malignant disease: report of a case with periapical involvement. Int Endod J 2007; 40:900-7. [PMID: 17764459 DOI: 10.1111/j.1365-2591.2007.01281.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To report the unusual endodontic presentation and radiographic features of a subgroup of pleomorphic adenoma called carcinoma ex pleomorphic adenoma and to stress the importance of maintaining a high level of suspicion in cases where primary or recurrent neoplasia is included in the differential diagnosis. SUMMARY This paper describes a case in which a patient with a previous history of malignant neoplasm presented with signs and symptoms similar to a dental infection. The pathology report however confirmed recurrence of the previous tumour in a malignant fashion. The importance of maintaining a high level of suspicion in early management of such disease is highlighted. KEY LEARNING POINTS *Pleomorphic adenomas, also known as benign mixed tumours, are common salivary gland tumours, which infrequently undergo malignant transformation, with potentially devastating consequences. *Malignant salivary gland tumours can present as dental swelling, dental pain and sudden loss of vitality of teeth so both general practitioners and specialists have the responsibility to evaluate such patients with a broad vision. *Radiographic differential diagnosis of periapical radiolucency should also include malignant salivary gland tumours. *This case highlights the need of vigilance at all times and emphasizes the benefits of biopsy and histological examination in the diagnosis of recurrent malignant salivary gland tumours.
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Affiliation(s)
- K Dewan
- Department of Restorative Dentistry, Morriston Hospital, Swansea, UK.
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Abstract
AIM To investigate radiographic manifestations of sickle cell anaemia (SCA) and whether or not a pulpal necrosis may develop without a pathological history. METHODOLOGY Thirty-six patients with homozygous SCA were evaluated, and a further 36 individuals without SCA were included in the study as a control group. All 72 patients participating in the study ranged between the ages of 16 and 40 years. General and dental histories of the individuals were recorded. Electrical pulp test, percussion and thermal tests were applied to all the teeth having no restorations. Orthopantomograms of all the subjects were taken. Data obtained from questionnaires, sensitivity tests and radiographic examinations were evaluated by chi-square and Fischer's exact test. RESULTS Fifty-one (6%) of the teeth having no restorations or history of trauma were determined as being nonvital in the SCA group. In 30 (83%) of these patients orofacial and dental pain with no obvious cause was detected and in 24 (67%) of the patients the quality of the bone tissue as examined radiologically had deteriorated. In eight (22%) of the patients cortical thinning and irregularity in the mandible was noted. A statistically significant difference between the SCA and control groups (P < 0.05) was found in terms of pulpal sensitivity and radiological findings. CONCLUSION SCA is a genetic and systemic disease which may cause pulp necrosis without necessarily having an identifiable aetiology. SCA causes radiographically observable differences in jaw structure especially in the mandible.
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Affiliation(s)
- A Demirbaş Kaya
- Department of Restorative Dentistry and Endodontics, School of Dentistry, Ege University, Izmir, Turkey.
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Long PH, Maronpot RR, Ghanayem BI, Roycroft JH, Nyska A. Dental pulp infarction in female rats following inhalation exposure to 2-butoxyethanol. Toxicol Pathol 2000; 28:246-52. [PMID: 10805142 DOI: 10.1177/019262330002800204] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Female Fischer 344 (F344)/N rats (10 per exposure group) were exposed to 2-butoxyethanol (BE) vapors (0, 31, 62.5, 125, 250, or 500 ppm 6 h/d, 5 d/wk, for 13 weeks) to characterize its prechronic toxicity. Dental lesions consisting of bilateral multifocal dental pulp thrombosis, pulp infarction, and odontoblast infarction were noted in the maxillary incisors of 3 of 4 rats from the 500-ppm group that were sacrificed when moribund during the first week of exposure. In addition, 1 rat from the 500-ppm group that was sacrificed on day 32 had similar unilateral incisor lesions but with additional findings consistent with a unilateral maxillary incisor fracture. In contrast, rats sacrificed after 13 weeks of exposure lacked dental lesions. In conclusion, BE has the potential to cause pulp thrombosis and odontoblast infarction in female rats. The apparent variability in response to BE noted in moribund sacrificed vs terminally sacrificed rats was attributed to development of tolerance to BE-induced hemolysis and subsequent incisor regeneration.
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Affiliation(s)
- P H Long
- Procter & Gamble Pharmaceuticals, Mason, Ohio 45040-9462, USA.
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