Evaluation of an early childhood caries preventive programme starting during pregnancy-Results after 3 and 6 years

BACKGROUND

Early childhood caries (ECC) has been found to be up to five times more common among children living in areas of low socio-economic status (SES) than among children in areas of higher SES.

AIM

To evaluate an ECC prevention programme from pregnancy to 3 and 6 years of age.

DESIGN

A prospective, controlled, intervention cohort study was initiated in 2013 in a low-SES area in Sweden. The intervention group received an individual interdisciplinary ECC prevention programme starting pre-birth, consisting of supportive oral health-promoting talks using motivational interviewing techniques and individual ECC preventive actions. A control group, consisting of pregnant women living in a comparable area, received ordinary routines.

RESULTS

Of the 336 pregnant women, 64 mothers (with 64 children) completed the programme, and 394 children were born in the control group. At the sixth year examination, the proportion of children with no caries was similar between the groups (53% resp. 52%, p = .976), whereas the proportion with decayed, missed, filled primary teeth (dmft = 1-5) was slightly lower (23% resp. 36%, p = .063), and the proportion with severe caries disease (dmft > 5) was higher (p = .013) in the intervention group (25%) than in the control group (12%).

CONCLUSION

No preventive effect regarding caries can be demonstrated at sixth year of age. Maternal behavioural change in dental care was not sufficient to even out inequalities in oral health in children, eventually due to difficulties in reaching the target group and the lack of effects among the families reached.

Translation and validation of the Swedish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) for adolescents

OBJECTIVE

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument developed for assessment of orthodontic aspects of oral health-related quality of life (OHRQoL). This study aimed to translate and validate the Swedish version of PIDAQ for use in Swedish adolescents 12-19 years of age.

MATERIAL AND METHODS

The translation was made according to the process described in 'Guidelines for Establishing Cultural Equivalency of Instruments' by Ohrbach et al. Field testing was performed in a group of consecutive patients who were about to start orthodontic treatment (untreated group) and a group of consecutive patients who had recently finished orthodontic treatment (treated group).

RESULTS

During the translation procedure, a Swedish version of PIDAQ was formed. In the field testing, a total of 144 questionnaires, 72 from untreated patients (mean age 14.6 years) and 72 from treated patients (mean age 17.3 years) were collected. The exploratory factor analysis detected two factors, which differs from the factor structure in the original questionnaire. The mean total PIDAQ score was significantly higher (p < .001) in the untreated group, 40.6 (20.3), than in the treated group, 9.4 (10.5), implying a high discriminant validity. Reliability was excellent, with internal consistency Cronbach's alpha values varying from 0.94 to 0.97.

CONCLUSION

The Swedish version of PIDAQ demonstrates good validity and excellent reliability and is suitable for future research on the effect of malocclusion on OHRQoL in Swedish 12- to 19-year-olds.

Cost-effectiveness of caries preventive interventions - a systematic review

OBJECTIVE

The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions.

MATERIAL AND METHODS

A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness.

RESULTS AND CONCLUSIONS

Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.

Early childhood caries risk assessment in 1-year-olds evaluated at 6-years of age

OBJECTIVES

The aim was to identify caries risk factors in 1-year-olds predicting dentine caries in 6-year-olds.

MATERIALS AND METHODS

Caries risk assessment was performed in 804 one-year-olds. Their parents answered a questionnaire, regarding family factors, general health, food habits and oral hygiene. Clinical examinations and caries risk assessments at 1, 3 and 6 years of age were performed. Simple and multiple regression analyses were used for identification of caries-associated factors.

RESULTS

Caries risk was found in 5% of the 1-year-olds, and 12% of the 3-year-olds. Dentine caries was found in 3% of the 3-year-olds and in 16% of the 6-year-olds. Caries risk assessment was associated with caries at 6 years of age (OR = 5.1, p < .001). Multiple logistic regression analysis found the following variables associated with caries at 6 years of age: Caries in sibling (OR = 2.1, p = .012), Beverage other than water (OR = 2.1, p < .001), Night meal (OR = 1.9, p = .002), Presence of mutans streptococci (MS) (OR = 1.6, p = .033) and Male gender (OR = 1.5, p = .053). An overall caries risk assessment was more reliable than any single caries risk factor.

CONCLUSIONS

Caries risk assessment for 1-year-olds in a region with low caries prevalence has limited accuracy to predict dental caries at 6 years of age. Caries risk often changes over time and should be reassessed on a regularly basis. The presence of MS in 1-year-olds did not increase the prognostic accuracy at 6 years of age.

Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa - a randomized cross-over study

BACKGROUND

Topical anaesthesia is important to optimize pain control during dental injection. Our aim was to describe a new simple method for topical anaesthesia of oral mucosa and to compare the effectiveness of ice and lidocaine 5% gel for topical anaesthesia of oral mucosa.

METHODS

A total of 40 patients aged 10.7-19.5 years were included. The side and method of application were both randomized. Heart rate was recorded, and discomfort and pain were evaluated with a visual analogue scale (VAS). A paired t-test was used to compare mean values, a chi² test was used to compare proportions, and a Pearson correlation test was used to examine correlations between variables.

RESULTS

When ice was used, buccal injection VAS pain was rated lower (p = 0.044), and VAS discomfort was rated higher (p = 0.001), in comparison to when lidocaine 5% gel was used. There was no significant difference in relative heart rate change between ice and lidocaine 5% gel at either needle stick or injection. Lidocaine 5% gel produced a relative heart rate reduction after palatal injection (0.99 ± 0.06) while buccal injection produced an increased relative heart rate (1.02 ± 0.08) (p = 0.010). Unpleasant taste was more frequently reported when lidocaine 5% gel was used (p = 0.025). An application time of 1 min was sufficient for both ice and lidocaine 5% gel to achieve pain reduction from needle stick in buccal mucosa.

CONCLUSION

The cheap and readily available described method using ice for topical anaesthesia of oral mucosa before dental injection is an effective alternative to lidocaine 5% gel.

TRIAL REGISTRATION

The European Union Drug Regulating Authorities Clinical Trials Database EudraCT201300530531. Date of registration: February 10th, 2014.

Evaluation of the ability of dental clinicians to rate dental anxiety

The aim of this study was to evaluate the ability of dental clinicians to rate dental anxiety. A total of 104 clinicians from 24 public dental clinics in the Region of Östergötland, Sweden, examined 1,128 adult patients undergoing their regular dental examination. The patients rated their dental anxiety using the Modified Dental Anxiety Scale and a Visual Analogue Scale. After the examination, the clinicians rated the patients' levels of dental anxiety on a Visual Analogue Scale. The correlation (r_s ) between the clinicians' and patients' ratings of dental anxiety was 0.45. Among highly dentally anxious patients, there was no correlation between clinicians' and patients' ratings. Dental clinicians rated dental anxiety lower than their patients did, especially if the patients were highly anxious. The ability of clinicians to rate dental anxiety was better when the clinician was older and the patient was older. There was an inverse association between clinicians' confidence and their ability to rate a patient's dental anxiety. In conclusion, clinicians are unsuccessful in identifying a dentally anxious patient without the concurrent use of patient self-assessment tools. A Visual Analogue Scale is a suitable screening tool in general practice for detection of dental anxiety.

Perception of orthodontic treatment need among Swedish children, adolescents and young adults

OBJECTIVE

Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.

MATERIALS AND METHODS

A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.

RESULTS

The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2 ± 1.5), than among subjects, age 15 (3.6 ± 1.2) (p = .0009), and subjects, age 19 (3.5 ± 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19.

CONCLUSIONS

The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.

Sublingual administration of atropine eyedrops in children with excessive drooling - a pilot study

BACKGROUND

Drooling can be a severe disability and have high impact on daily life. Reversible treatment is preferable.

AIM

To analyse whether sublingual administration of atropine eyedrops is a useful reversible treatment option for severe drooling in children with disabilities.

DESIGN

The study had a prospective, single-system research design. The participants served as their own controls. The study period was 3 weeks without treatment, 4 weeks with atropine eyedrop solution 10 mg/mL one drop a day followed by 4 weeks of one drop twice a day. Parents' rating of their child's drooling was assessed on a 100-mm VAS, and unstimulated salivary secretion rate measurement was performed together with notations about side effects and practicality.

RESULTS

Parents' VAS assessment of drooling decreased from a median (range) of 74 (40-98) at baseline to 48 (18-88) (P = 0.05) and 32 (12-85) (P = 0.004) after 4 weeks of atropine once a day and another 4 weeks of atropine twice a day, respectively (n = 11). Unstimulated salivary secretion rates decreased from baseline to end of study (P = 0.032). Several parents complained about difficult administration. No irreversible side effects were noted.

CONCLUSIONS

Sublingual atropine eyedrops may be an alternative for treatment of severe drooling in children with disabilities.

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

BACKGROUND

Early childhood caries (ECC) risk factors are suspected to vary between regions with different caries prevalence.

AIM

Identify ECC risk factors for 1-year-olds predicting dentin caries at 3 years of age in a region with low caries prevalence.

DESIGN

Caries risk was assessed by dental hygienist or dental assistant in 779 one-year-olds. The oral mutans streptococci (MS) score was performed from a tooth surface or (in pre-dentate children) from oral mucosa. A parental questionnaire with questions regarding family factors (siblings with or without caries), general health, food habits (night meals, breastfeeding, other beverage than water), oral hygiene habits and emerged teeth were answered by parents of the 1-year-olds. Dentin caries was assessed when the children were 3-year-olds. Simple and multiple logistic regression analyses were used for identification of caries-associated factors.

RESULTS

An increased caries risk was assessed in 4.4% of the 1-year-olds. Dentin caries was found in 2.6% of the 3-year-olds. Caries risk at 1 year was associated with caries at 3 years (OR = 6.5, p = .002). Multiple regression analysis found the variables Beverages other than water (OR = 7.1, p < 0.001), Caries in sibling (OR = 4.8, p = .002), High level of MS (score 2-3) (OR = 3.4, p = .03) and Night meal (OR = 3.0, p = .03) to be associated with caries. The single variables Beverage other than water between meals and Caries in sibling were more reliable than Caries risk assessed performed by dental personnel.

CONCLUSIONS

Behavioural, family and microbial factors are important when assessing caries risk among 1-year-olds in a region with low caries experience.

Cephalometric analysis of adults with Turner syndrome

Turner syndrome (TS) is a genetic disorder of females with a prevalence of 1/2000-3000 live female births. The aim of this study was to compare cephalometric variables from adult women diagnosed with TS to a standardized reference group of 31-year old healthy women, and to evaluate the possible effects of human growth hormone (hGH) therapy in women with TS. Registered TS subjects in the Southeast region of Sweden were invited to take part in the study. Twenty-one women aged 36 ± 13(18-57) years accepted participation. Lateral radiographs of the head were analyzed using standard cephalometric methods (Hasund analysis) and with the commercially available soft-ware program FACAD. Comparisons were made with roentgen-cephalometric standards from a reference group of nineteen 31-year old Swedish women. Analysis of the cephalometric radiographs from the TS subjects showed a more retrognathic maxilla (SNA 80.3 ± 5.4) (p = 0.0460) and mandible (SNB 77.0 ± 5.2) (p = 0.0014), and a correspondingly backward position of the chin (SN/Pg 78.9 ± 5.5) (p = 0.0046) as compared to the reference values of 31-year old women (SNA 83.2 ± 3.0, SN B 81.5 ± 2.3 and SNPg 83.0 ± 2.3, respectively). In addition there was an increased posterior inclination of the maxilla (SN/NL 8.6 ± 4.1), as compared to the reference values (SN/NL 5.3 ± 2.7) (p = 0.0048). There were no significant differences regarding sagittal or vertical jaw relations, mandibular inclination or cranial base angle between the TS-group and the 31-year olds with the reference values. No significant difference was seen in jaw relationship, as measured by the ANB value, however the Wits(index) (3.3 ± 3.5) was higher (p = 0.0001) than the reference values (-0.1 ± 1.8). Subjects with or without previous hGH administration did,not show any significant differences in cephalometric values. In conclusion, women with TS had a significantly more retrognathic maxilla (SNA) and mandible (SNB) and a correspondingly significantly posterior position of the chin (SN/Pg), a significantly increased posterior inclination of the maxilla (SN/NL) and a significantly increased Wits(index) as compared to the reference group of 31-year old women. No craniofacial variables differed significantly between previously hGH-treated and not hGH-treated women with TS.

Self-perceived oral health among 19-year-olds in a Swedish County--A comparative study between 2004 and 2011

For decades, Swedish dental professionals have collected clinical epidemiological data from the dental records. To supplement the epidemiology, Ostergötland County Council decided to examine patient perceptions of oral health: self-rated knowledge, self-perceived oral health, and opinions about oral health. The aim was to compare self-perceived oral health among 19-year-olds to determine differences between genders, various municipalities and between 2004 and 2011. This study analysed the responses from two cross-sectional surveys of the entire population of 19-year-olds in Ostergötland County, Sweden, performed in 2004 and 2011. Of the 2,413 (53%) (50% men, 50% women) 19-year-olds who responded to the questionnaire in 2004 and the 3,803 (67%) (50% men, 50% women) in 2011, most 19-year-olds (88.1% [2004] and 87.5 % [2011]) reported satisfaction with their oral health. Around half of the respondents rated their knowledge on periodontitis as low. Boys rated their knowledge about avoiding periodontitis higher than girls (p < 0.05 in 2004 and p < 0.001 in 2011). In 2004, 84.7% reported shooting pain. In 2011 that figure was 83.7%.The respondents expressed some uncertainty about the benefits of fluoride toothpaste (7.5% in 2004 and 9.3% in 2011), especially the boys (10.3% in 2004 and 10.5% in 2011). Girls reported both a higher social impact and greater concern about aesthetics related to their oral health. They also reported headache (27.5%) nearly twice as often as boys (14.2%) (p > 0.001). Responses between the municipalities did not differ, with the exception of items regarding periodontitis. Thus, this study found indications that perceptions of oral health and knowledge in Ostergötland County complied with Swedish Dental Act. The study also found patient perceptions of oral health among 19-year-olds to be good.

Risk factors for early colonization of mutans streptococci - a multiple logistic regression analysis in Swedish 1-year-olds

BACKGROUND

Mutans streptococci (MS) are closely related to the development of dental caries and are usually established in the oral cavity during early childhood. The aim of the study was to identify factors associated with the presence of MS in Swedish 1-year-olds.

METHODS

Parents completed a questionnaire on different caries-associated factors and an oral bacterial sample was collected from 1,050 (526 boys, 524 girls) 1-year-olds. Multiple logistic regression analyses were performed to identify risk factors for colonization with MS.

RESULTS

MS were found in 27% of the 1-year-olds with teeth. High or very high MS scores (2-3) were found in 72 (7%) of the children. MS score was correlated to the number of erupted teeth (p < 0.001). No difference due to gender was found. Multiple logistic regression analysis showed that presence of bacteria was associated with: caries in a sibling, other beverages than water between meals, and more than 8 erupted teeth. High or very high MS scores (2-3) were associated with other beverages than water between meals, and more than 8 erupted teeth.

CONCLUSIONS

Number of teeth present, diet and family aspects were factors associated with presence of MS in 1-year-olds. To develop high or very high MS scores, the number of erupted teeth and dietary habits are important.

Outcome of orthodontic care and residual treatment need in Swedish 19-year-olds

The purpose of the study was to assess the outcome of orthodontic care in Linköping, Sweden. The dental records of 207 (107 M, 100 F) 19-year-olds registered at one public dental health clinic were studied. A clinical examination was performed where malocclu- sions were registered, where after residual orthodontictreatment need was measured using the Index of Complexity, Outcome and Need (ICON). The 19-year-olds also filled in a questionnaire regarding residual subjective orthodontic treatment demand. Differences between genders were analysed. One hundred and ten (47 M, 63 F) individuals (53.1%) had partaken in orthodontic consultations. Orthodontic appliance treatment had been received by 86 (38 M, 48 F) individuals (41.6%). A residual orthodontic treatment need was registered in 28 (22 M, 6 F) individuals (13.5%). Residual subjective orthodontic treatment demand was expressed by 9 (3 M, 6 F) indi- viduals (4.3%). Eight (2 M, 6 F) of those had no residual treatment need. A higher (p = 0.006) rate of females (63.0%) than males (44.0%) had participated in ort- hodontic consultations. The proportion of males (35.5%) who had experienced orthodontic treatment was not significantly lower (p = 0.069) than among the females (48.0%). However, a lower (p = 0.009) proportion of treated males (55.3%; n = 21 out of 38) than of treated females (81.3%; n = 39 out of 48) had received their treatment by orthodontic specialists. At 19 years of age, the proportion of males with residual treatment need (20.6%) was higher (p = 0.002) than among the females (6.0%). Every patient with orthodontic treatment need and -demand at 19 years of age had previously been offered orthodontic treatment. The conclusion was drawn that the orthodontic care scheme had successfully diagnosed and treated orthodontic problems in the population. However, notable differences between genders regarding treatment modalities and the amount of residual treatment need at age 19 were found.

Impaired postural balance in turner syndrome

An impaired body balance has been found in Turner syndrome (TS) in clinical tests like Rombergs's test and walking on a balance beam. The aim of the study was to assess postural balance in TS subjects with specific balance testing using dynamic posturography and relate to body composition. Nineteen TS subjects (20-57 years) were included. Balance was measured with dynamic posturography (Equitest) and compared with 19 sex and age-matched controls (22-59 years). Equitest, visual, vestibular, and somatosensory systems were provoked with increasing difficulty (6 tests, SO1-SO6) and body sway was measured with a dual forceplate. Body composition was measured with DXA. No difference was found between the TS subjects and the controls on fixed platform with open eyes (SO1), with closed eyes (SO2), with stable platform and visual disorientation (SO3), or on unstable platform with open eyes (SO4). In the difficult tests on unstable platform the TS subjects did worse compared with controls both in the test with eyes closed (SO5), p<0.01, and in the test with visual disorientation (SO6), p<0.05. Composite (a merge of all six recordings) was significantly lower in the TS-group, p<0.05. In the TS group high total body weight was related to worse outcome on tests SO5, SO6, and composite, while total bone mass, age, height, or waist showed no significant association with balance scores. Our findings indicate that TS could have an increased risk for falling due to impaired ability to manage complex coordination tasks.

Er:YAG laser or high-speed bur for cavity preparation in adolescents

OBJECTIVES

The aim was to evaluate the effect on cavity preparation time, the pulse changes and the patient's subjective experience during removal of healthy tooth substance with high-speed bur and Er:YAG laser.

MATERIALS AND METHODS

Thirty-five (13 male, 22 female) 14-18-year-olds participated. After local anaesthesia, Er:YAG laser and high-speed diamond bur were used for a 2 mm deep cavity preparation on the middle of the buccal surface on contra-lateral healthy maxillary first premolars. The cavity preparation time and the pulse were measured during the treatment. Subjective experience was evaluated using a VAS-scale and a questionnaire. Wilcoxon Signed Rank test and Chi-2-test were used for statistical analyses.

RESULTS

The mean (SD) cavity preparation time was 3.7-times longer (p < 0.001) for the laser [59 (41) s] than for the high-speed bur [16 (4) s]. The mean pulse change during preparation differed (p < 0.05) between the bur (+2.2%) and laser (-4.4%). The smell was worse when laser was used (p < 0.01); 65.7% expressed less discomfort and 57.1% experienced a lower sound level when laser was used. Laser was preferred for future treatment in 62.9% of the adolescents.

CONCLUSION

Laser ablation caused unpleasant smell and longer cavity preparation time, but was preferred by a majority of the adolescents.

Orofacial dysfunction in individuals with Prader-Willi syndrome assessed with NOT-S

OBJECTIVE

The objective of the study was to evaluate orofacial dysfunction in individuals with Prader-Willi syndrome (PWS) and compare it with a healthy reference group.

METHODS AND MATERIALS

The Nordic Orofacial Test-Screening (NOT-S) protocol was used for evaluation of orofacial function in 45 (23 Male, 22 Female) individuals with PWS, aged 19.8 ± 9.5 years, and a reference group of 40 (18 M, 22 F) healthy individuals, aged 24.0 ± 16.3 years.

RESULTS

The NOT-S score was markedly higher for the individuals with PWS than for the healthy reference group (3.9 ± 2.1 vs 0.3 ± 0.5, p < 0.001). The most common domains of dysfunction in individuals with PWS were Oral motor function (60.0%), Habits (55.6%), Face at rest (53.3%), Speech (44.4%), Drooling (44.4%) and Breathing (42.2%).

CONCLUSIONS

Eighty-seven per cent of the participants with PWS demonstrated dysfunction in two or more domains, particularly in the domains Oral motor function, Habits and Face at rest.

Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa

BACKGROUND

Topical anaesthetics are important to provide pain control at dental injection.

AIM

The aim was to evaluate the effectiveness of the intraoral topical anaesthetics lidocaine 20% patch (DentiPatch) and lidocaine 5% gel.

DESIGN

The randomized unblinded cross-over study included 31 patients (ten boys, 21 girls) aged 13.5 +/- 2.5 years. Application of lidocaine patch or gel was randomly used at first and second visit in the upper premolar region. Heart rate was measured before and at each needle insertion after 2.5, 5, and 15 min and at injection after 15 min. Discomfort and pain were expressed in visual analogue scales (VAS). Paired t-test and Mann-Whitney U-test were used for statistic analyses.

RESULTS

Heart rate at buccal injection decreased more when the patch was used (P = 0.0149). Heart rate was lower at the second visit (P = 0.0287). Patients expressed less discomfort when the patch was used on both buccal (P = 0.0150) and palatal (P = 0.0391) site. Boys had lower heart rate and VAS pain scale ratings than girls.

CONCLUSIONS

Good pain control can reduce the patients' anxiety level--expressed in heart rate--at the second appointment. The patch and gel seem to provide similar pain reduction at needle stick and injection of local anaesthetics.

Longitudinal scintigraphic study of parotid and submandibular gland function after total body irradiation in children and adolescents

OBJECTIVE

Total body irradiation (TBI) and cyclophosphamide (CY) during allogeneic stem cell transplantation (ASCT) cause salivary gland dysfunction in children. The aim of this investigation was to study the scintigraphic functional changes over time of the parotid and submandibular glands in children and young adults one year after treatment with CY and TBI at ASCT.

METHODS

Salivary gland scintigraphy (SGS) was performed before ASCT, and 3-6 months and 12 months after ASCT. The three male patients who fulfilled the scintigraphic study had a mean age (+/- SD) of 17.3 +/- 9.8 years at ASCT.

RESULTS

The parotid secretion capacity (SPar) was 83.5 +/- 3.2% before ASCT and 48.5 +/- 25.8% during the next 3-6 months (P < 0.05). The SPar did not increase (48.1 +/- 12.4%) during the rest of the first year after ASCT. The submandibular emptying capacity (SSub) was 91.3 +/- 12.9% before ASCT and 35.4 +/- 2.3% after 3-6 months (P < 0.05). The SSub was 87.9 +/- 17.9% one year after ASCT.

CONCLUSIONS

The parotid glands were more sensitive to irradiation since they did not recover lost capacity to secrete saliva, while the submandibular glands recovered the secretion capacity at the one-year follow-up.

Signs and symptoms from ectodermal organs in young Swedish individuals with oligodontia

OBJECTIVES

The aim was to assess signs and symptoms from other ectodermal organs in addition to teeth in young individuals with oligodontia and to establish the prevalence of oligodontia.

SAMPLE AND METHODS

Children born 1981-94 reported by dental teams in the Public Dental Service to have oligodontia were asked to participate in a clinical study. The examinations comprised a structured interview on symptoms from ectodermal organs, and testing of salivary secretion.

RESULTS

One hundred and sixty-two individuals met the inclusion criteria, and 123 individuals (75.9%) participated in the clinical study. Half of the individuals had one to four signs or symptoms from ectodermal organs beside oligodontia. The most common sign was low salivary secretion. Twelve individuals (9.6%) with isolated oligodontia reported impaired function of the sweat glands, hair, or nails. The prevalence of oligodontia was 0.090%.

CONCLUSIONS

An early identification of individuals with oligodontia can be made in a majority of cases by checking that all permanent incisors have erupted at the age of 8 years. The validity in asking individuals about normal and abnormal function of ectodermal organs was found to be low. This indicates that there is a strong need to establish routine clinical criteria for dysplasia of ectodermal organs.

Scintigraphic study of the major salivary glands in pediatric bone marrow transplant recipients

Total body irradiation (TBI) at bone marrow transplantation (BMT) is shown to cause salivary gland dysfunction in children. The aim of the investigation was to study the function of major salivary glands in long-term surviving children following treatment with TBI, using salivary gland scintigraphy (SGS). Thirteen patients (seven male, six female), who had received TBI before the age of 13 years and survived more than 4 years, participated in the study. A reference group of 10 patients (nine male, one female) was examined shortly before they were to undergo BMT. The mean age was 14.1 +/- 4.1 years in the TBI-treated group and 12.8 +/- 5.9 years in the reference group. Unstimulated and stimulated whole salivary secretion rates were measured for 15 and 5 min, respectively, before SGS was performed. The percentage of stimulated secretion was 44.7 +/- 18.1% in the TBI-treated group compared to 58.4 +/- 13.0% in the reference group (P = 0.0438). Slower reaccumulation after excretion was found in the TBI-treated patients compared to the reference group (P = 0. 0300). The function of the major salivary glands in long-term survivors treated with TBI at BMT before the age of 13 years was found to be diminished, as shown by the reduced trapping rate and reduced emptying capacity, compared to prior to BMT. Bone Marrow Transplantation (2000) 26, 775-779.

Correlation between quantitative salivary gland scintigraphy and salivary secretion rates in children and young adults treated for hematological, malignant and metabolic diseases

OBJECTIVES

To study the correlation between whole salivary secretion rates and different variables from the radionuclide time-activity curve and to determine a reliable region for background correction in salivary gland scintigraphy.

METHODS

Salivary gland scintigraphy (SGS) was performed before bone marrow transplantation or more than 4 years later in 23 patients aged 13.5 (s.d. 4.9) years. Unstimulated and stimulated whole salivary secretion rates were measured before SGS. Six different methods for background correction were evaluated.

RESULTS

The unstimulated secretion rate was significantly correlated (P < 0.05) with the percentage stimulated secretion (S) and reaccumulation-slope (RS) after stimulation. The stimulated secretion rate was significantly correlated with RS, S and down-slope (DS). The temporal region above the parotid glands and the area above the thyroid gland was used for subtraction of background radiation for the parotid and submandibular glands respectively showed a strong correlation between repeated measurements of the variables analysed. The mean maximum uptake was 0.73-1.34% of total dose injected.

CONCLUSIONS

The salivary scintigraphic variables which correlated more strongly with salivary secretion rates were RS, S and DS. The temporal region above the parotid gland and the area above the thyroid gland can be used reliably for correction background radiation in the analysis of the time-activity curve in SGS of the parotid and submandibular glands respectively.

Subjective xerostomia in long-term surviving children and adolescents after pediatric bone marrow transplantation

BACKGROUND

The aim of the present investigation was to evaluate whether the subjective symptoms of dry mouth in long-term-surviving pediatric bone marrow transplant (BMT) patients are associated with low unstimulated salivary secretion rates (USSR) and with stimulated whole salivary secretion rates (SSSR).

METHODS

Fifty-three patients surviving > or =2 years after pediatric allogeneic BMT were included. USSR, SSSR, and the change in salivary secretion rates since the previous year were estimated. A questionnaire regarding subjective symptoms of xerostomia was answered.

RESULTS

The mean USSR and SSSR were 0.24+/-0.17 and 0.90 +/- 0.58 ml/min, respectively. Salivary gland dysfunction, defined as USSR < or =0.1 ml/min or SSSR < or =0.5 ml/min, was present in 35% of the patients. Seventy-nine percent of the patients expressed one or more symptom of dry mouth, and 49% gave at least two answers indicating dry mouth. The number of complaints increased with age at examination (P<0.05). Both USSR (P<0.01) and SSSR (P<0.01) were inversely correlated to the total number of complaints of xerostomia. A reduction in SSSR compared with the year before was correlated to two or more complaints of xerostomia (P<0.01). The presence of dry mouth at night or on awakening was indicative of both low USSR (P<0.01) and SSSR (P<0.001). Patients reporting dryness during the day had significantly lower SSSR (P<0.05).

CONCLUSION

The expression of subjective complaints of xerostomia among long-term surviving pediatric BMT patients is correlated to salivary gland dysfunction and age. It is very important to identify these patients with salivary gland dysfunction to relieve their symptoms and prevent secondary complications.

Absorbed doses in the head and oral cavity during total body irradiation

Conditioning before bone marrow transplantation (BMT) with total body irradiation (TBI) and cyclophosphamide carries the risk of severe long-term complications. The aim of the present study was to determine absorbed doses in the craniofacial area during TBI, using thermoluminescent dosimeters for both in vivo techniques and phantom measurements. The results from the phantom study showed that the mean deviation from the reference dose varied between -5.1 and +11.1%. The superficial part of left parotid gland received 11.1 +/- 1.5% more radiation compared with the reference. In patients, deviations from the reference dose varied in individual patients between -22.4 and +20.1% in various intra-oral sites. Since a small increase in dose can result in a significantly increased risk of pathology, the observed dose inhomogeneities for structures receiving tangentially directed radiation therapy, such as the parotid glands, may contribute to salivary dysfunction after TBI.

Impact of conditioning regimens on salivary function, caries-associated microorganisms and dental caries in children after bone marrow transplantation. A 4-year longitudinal study

Salivary function, dental caries and caries-associated salivary microorganisms were investigated in children undergoing BMT during a 4-year longitudinal study. Fourteen children were conditioned with CY and TBI and 12 with CY with or without BU. Four years after BMT the mean salivary secretion rate was 1.3 +/- 0.7 ml/min in the chemotherapy group, compared to 0.7 +/- 0.5 in the TBI/CY group (P < 0.05). The mean salivary secretion rate fell from 0.9 +/- 0.5 ml/min before TBI to 0.2 +/- 0.1 after 3 months (P < 0.01), 0.3 +/- 0.3 ml/min after 6 months (P < 0.01) and 0.5 +/- 0.6, 1 year after TBI (P < 0.05). Mean reduction in stimulated salivary flow 3 months after TBI was 78% in the TBI/CY group compared to 36% in the chemotherapy group (P < 0.05). Children conditioned with chemotherapy showed an increased salivary flow compared to baseline; this was not found in TBI-treated children, suggesting that damage to the salivary glands may be permanent. Four years after BMT, children conditioned with TBI had significantly higher counts of mutans streptococci (P < 0.05) and lactobacilli (P < 0.01) compared to age-matched controls. However, the prevalence of dental caries did not differ between children conditioned with TBI, chemotherapy and healthy controls.

Risk factors for salivary dysfunction in children 1 year after bone marrow transplantation

Bone marrow transplantation (BMT) in childhood has improved the survival for children with leukaemia, severe aplastic anaemia and some metabolic disorders. However, transplant procedures are associated with a high incidence of deleterious long-term complications. This study included 49 children, conditioned according to the Seattle protocols. Follow-up oral examinations were performed 1 year after BMT. Forty risk factors that may have influenced a low stimulated salivary secretion rate (SSSR) were studied. An SSSR < or = 0.5 ml/min, 1 year after BMT was regarded as the event. One year after BMT, the mean SSSR was 0.5 +/- 0.4 ml/min in children conditioned with total body irradiation (TBI) compared to 1.0 +/- 0.5 ml/min in non-irradiated children (P = 0.0013). Significant predictors for low SSSR in multivariate analysis were: conditioning with TBI (P = 0.0023), recipient female sex (P = 0.0121) and recipient seropositivity for between three and four herpes viruses (P = 0.0157).