Use of Antibiotics in early Childhood and Dental Enamel Defects in 6- to 12-year-old Children in Primary Health Care

Dental enamel defects (DED) are lesions that occur due several factors. Proper care is needed to promote their treatment and prevention. The aim of this study was to evaluate the occurrence of DED in permanent teeth of children who used antimicrobial drugs in the first four years of life. This is a crosssectional study carried out in a Primary Health Care (PHC) service, which included children from six to 12 years of age. DED were evaluated by oral examination, and data on the use of antimicrobials in early childhood were collected based on medical records. Data were analyzed with the chi-square test and Fisher's exact test. The sample included 144 children. In relation to DED, 50% (72) and 20.1% (29) presented opacity and hypoplasia, respectively. Amoxicillin was the most frequently prescribed drug, followed by sulfamethoxazole + trimethoprim. Among the children, 78.5% (113) were prescribed antimicrobial drugs at least once during the first 4 years of life, and 55% (79) of them presented some type of DED. There was no statistically significant association between the variables analyzed. In conclusion, there was high prevalence of children with DED, and amoxicillin was the most commonly prescribed antibiotic.

A TAC3 Missense Variant in a Domestic Shorthair Cat with Testicular Hypoplasia and Persistent Primary Dentition

A single male domestic shorthair cat that did not complete puberty was reported. At four years of age, it still had primary dentition, testicular hypoplasia, and was relatively small for its age. We hypothesized that the phenotype might have been due to an inherited form of hypogonadotropic hypogonadism (HH). We sequenced the genome of the affected cat and compared the data to 38 genomes from control cats. A search for private variants in 40 candidate genes associated with human HH revealed a single protein-changing variant in the affected cat. It was located in the TAC3 gene encoding tachykinin 3, a precursor protein of the signaling molecule neurokinin B, which is known to play a role in sexual development. TAC3 variants have been reported in human patients with HH. The identified feline variant, TAC3:c.220G>A or p.(Val74Met), affects a moderately conserved region of the precursor protein, 11 residues away from the mature neurokinin B sequence. The affected cat was homozygous for the mutant allele. In a cohort of 171 randomly sampled cats, 169 were homozygous for the wildtype allele and 2 were heterozygous. These data tentatively suggest that the identified TAC3 variant might have caused the suppression of puberty in the affected cat.

Measurement of Early Childhood Oral Health for Research Purposes: Dental Caries Experience and Developmental Defects of the Enamel in the Primary Dentition

Epidemiological investigations of early childhood oral health rely upon the collection of high-quality clinical measures of health and disease. However, ascertainment of valid and accurate clinical measures presents unique challenges among young, preschool-age children. The paper presents a clinical research protocol for the conduct of oral epidemiological examinations among children, implemented in ZOE 2.0, a large-scale population-based genetic epidemiologic study of early childhood caries (ECC). The protocol has been developed for the collection of information on tooth surface-level dental caries experience and tooth-level developmental defects of the enamel in the primary dentition. Dental caries experience is recorded using visual criteria modified from the International Caries Detection and Assessment System (ICDAS), and measurement of developmental defects is based upon the modified Clarkson and O'Mullane Developmental Defects of the Enamel Index. After a dental prophylaxis (toothbrushing among all children and flossing as needed), children's teeth are examined by trained and calibrated examiners in community locations, using portable dental equipment, compressed air, and uniform artificial light and magnification conditions. Data are entered directly onto a computer using a custom Microsoft Access-based data entry application. The ZOE 2.0 clinical protocol has been implemented successfully for the conduct of over 6000 research examinations to date, contributing phenotype data to downstream genomics and other "omics" studies of ECC and DDE, as well as traditional clinical and epidemiologic dental research.

A Technique for Utilizing Ankylosed Teeth for Anchorage

We present a novel method of reinforcing anchorage by utilizing ankylosed teeth. This technique provides simple solutions in otherwise challenging and complex cases.

Primary Fused Teeth and Findings in Permanent Dentition

OBJECTIVE

The aim of this study was to investigate the characteristics of primary fused teeth (PFT) and their effect on permanent dentition in a group of Turkish children.

SUBJECTS AND METHODS

Dental records of 13,450 pediatric patients who attended the Pediatric Dental Clinic in northern Turkey between 2015 and 2017 were reviewed. Forty patients had been diagnosed with PFT and were included in the study. Clinical and radiographic examinations were conducted, and the distribution of PFT was calculated by type, sex, affected jaw, associated dental anomalies, and clinical complications. Data analysis involved descriptive statistics.

RESULTS

A total of 50 PFT were detected in the 40 patients. The mean age of patients was 6.7 ± 0.3 years (range 3-10 years). The most common PFT were the mandibular lateral incisors and canines (34, 68%). The most prevalent type of PFT was type III (20, 40%). Of the 40 patients with PFT, 34 (85%) also ex-hibited other dental anomalies such as tooth aplasia, peg-shaped incisors, talon cusps, ectopic eruption, and delayed eruption in both related and unrelated areas. The most common complications of PFT were fusion-related tooth aplasia (n = 26 [76%]) and caries formation in the affected teeth (24 [48%]).

CONCLUSION

In this study, PFT were frequently observed in the mandibular anterior region. Caries formation and dental anomalies, especially permanent tooth aplasia, were often encountered in areas where PFT were seen. Hence, parents should be informed about possible dental problems associated with PFT and be encouraged to schedule regular follow-up appointments.

Globodontia in the Otodental Syndrome: A Rare Defect of Tooth Morphology Occurring with Hearing Loss in an Eight-Year-Old

Otodental syndrome is a hereditary disorder comprising globodontia and sensorineural hearing loss. Globodontia is characterized by distinctively bulbous, enlarged crowns of molar and primary canine teeth. Anomalies including taurodontism and hypodontia also occur. We report on the dental treatment and multidisciplinary management of an eight-year-old girl with this rare condition. Referral to Clinical Genetics and Oral Pathology was instrumental in establishing a diagnosis of otodental syndrome for this young patient and her mother, who had similar dental defects. CPD/Clinical Relevance: To increase awareness among practitioners of this rare dental disorder and highlight the need for multidisciplinary management of such cases.

Molar-incisor Malformation: Two Cases of a Newly Described Dental Anomaly

Molar-incisor malformation (MIM) is a recently described dental developmental anomaly with marked manifestations in the primary second molars and permanent first molars and sometimes the permanent maxillary central incisors. To date, there are only two known manuscripts that present this anomaly. The major manifestations are severe coronal cervical constriction of the affected molars and significant under-development of one or more roots. These abnormalities may be detected during routine radiographic examination or present as altered or ectopic eruption or early exfoliation. The characteristic radiographic features are sufficient to identify this abnormality properly. The purpose of this paper is to present two cases of MIM and discuss the impact of the dental abnormalities on patient management.

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

OBJECTIVE

To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls.

MATERIALS AND METHODS

The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization.

RESULTS

The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected.

CONCLUSIONS

Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.

Study of the frequency, localisation and morphology of supernumerary teeth in 1960 Spanish non-syndromic paediatric patients

AIM

The main objective was to study supernumerary teeth diagnosed during the routine checkups at the Paediatric Dentistry Service of Hospital de Nens, Barcelona (Spain), for four months.

MATERIALS AND METHODS

A transversal, descriptive study, was performed in 1,960 patients, aged 1 to 17 years, visited during routine oral checkups. An intraoral exploration (with intraoral mirror and probe) was performed to all patients, and subjects older than 5 years also underwent panoramic x-ray examination.

RESULTS

A total of 33 patients showed supernumerary teeth (1.68%), 22 boys and 11 girls. A total of 10 patients (8 boys/2 girls) had supernumerary teeth in the temporary dentition, 20 patients (12 boys/8 girls) in the permanent dentition and 3 patients (2 boys/1girls) in both temporary and permanent dentition. A total of 46 supernumerary teeth were diagnosed.

CONCLUSION

Any alteration in the number of teeth in patients younger than 5 years are difficult to diagnose, as x-rays are usually not taken. We believe that starting at 5 years old, a radiological exploration (panoramic x-ray) has to be carried out as a complement to the clinical examination.

The prevalence, pattern and clinical presentation of developmental dental hard-tissue anomalies in children with primary and mix dentition from Ile-Ife, Nigeria

BACKGROUND

The study of dental anomalies is important because it generates information that is important for both the anthropological and clinical management of patients. The objective of this study is to determine the prevalence and pattern of presentation of dental hard-tissue developmental anomalies in the mix dentition of children residing in Ile-Ife, a suburban region of Nigeria.

METHODS

Information on age, sex and socioeconomic status was collected from 1,036 children aged four months to 12 years through a household survey. Clinical examination was conducted to assess the presence of dental anomalies. Associations between age, sex, socioeconomic status, prevalence, and pattern of presentation of the developmental hard-tissue dental anomalies were determined.

RESULT

Two hundred and seventy six (26.6%) children had dental anomalies. Of these, 23.8% had one anomaly, 2.5% had two anomalies, and 0.3% had more than two anomalies. Of the children with anomalies, 49.3%were male, 50.7%were female, and 47.8%, 28.6% and 23.6% were children from low, middle and high socioeconomic classes, respectively. More anomalies were seen in permanent than primary dentition. Anomalies of tooth structure were most prevalent (16.1%); anomalies which affect tooth number were least prevalent (1.3%). Dens evaginatus, peg-shaped lateral, macrodontia, and talon cusp were more prevalent in the permanent dentition, and dens evaginatus peg-shaped lateral and macrodontia were more prevalent in the maxilla. There were significantly more macrodontia anomalies in males and in children of high socioeconomic status.

CONCLUSION

This large survey of dental hard-tissue anomalies found in the primary dentition and mixed dentition of children in Nigeria provides anthropological and clinical data that may aid the detection and management of dental problems of children in Nigeria.

Primary double teeth and their effect on permanent successors

AIM

Understanding the effects of primary double tooth (PDT) on permanent successors is important to ensure healthy permanent occlusion and aesthetics. The aim of this study is to determine the prevalence and type of PDT, their effect on permanent successors, and the accompanying dental anomalies/pathologies in a Turkish population.

MATERIALS AND METHODS

Study design: The records of 63 PDTs in 54 healthy Caucasian children among 10,000 patients were investigated. PDTs were classified according to Aguilo's classification.

RESULTS

The prevalence of PDT was 0.6%. Of the 63 PDTs, 14.3% were type I, 11.1% were type II, 31.7% were type III, and 41.3% were type IV; one (1.6%) was a triple tooth. Aplasia of the permanent lateral incisor was observed most frequently in association with type I (56%) PDT. All PDTs associated with a supernumerary permanent tooth were type IV. Dental anomalies/pathologies such as odontoma, talon cusp were observed. Caries involvement was observed most frequently in type IV (58.3%) PDT.

STATISTICS

The chi-squared test was used to determine whether successor aplasia depended on PDT type, and contingency coefficients (%) were calculated to determine the degree of association between aplasia and PDT type.

CONCLUSION

Clinicians should assess PDT clinically and radiographically to determine whether they are associated with aplasia of permanent lateral incisors (type I) or supernumerary permanent teeth (type IV). Type IV of PDT should be sealed with sealant or resin.

Pre- and postnatal determinants of deciduous molar hypomineralisation in 6-year-old children. The generation R study

BACKGROUND

Deciduous Molar Hypomineralisation (DMH) and Molar Incisor Hypomineralisation (MIH) are common developmental disturbances in pediatric dentistry. Their occurrence is related. The same determinants as suggested for MIH are expected for DMH, though somewhat earlier in life. Perinatal medical problems may influence the prevalence of DMH but this has not been studied sufficiently.

OBJECTIVE

This study aimed to identify possible determinants of DMH in a prospective cohort study among 6-year-old children.

STUDY DESIGN

This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life until young adulthood. The the data were used to identify the determinants of DMH. Clinical photographs of clean, moist teeth were taken with an intra-oral camera in 6690 children (mean age 6.2 years; 49.9% girls). Data on possible determinants that had occurred during pregnancy and/or the child's first year of life were on the basis of manual standardized measurements (like length and weight) and questionnaires. Multivariate analyse with backward and forward selection was performed.

RESULTS

A number of factors in the pre-, peri- and postnatal phase were found to be associated with DMH. After multivariate logistic regression analyses, Dutch ethnic background, low birth weight, maternal alcohol consumption during pregnancy, and fever episodes in the first year of the child's life were found to play a role in the development of DMH in 6-year-old children.

CONCLUSION

This study shows that Dutch ethnicity, low birth weight, alcohol consumption by the mother during pregnancy and any fever in the first year of the child's life are associated with DMH. Not only childhood factors but also prenatal lifestyle factors need to be taken into account when studying determinants for DMH.

Dentition abnormalities in a Timothy syndrome patient with a novel genetic mutation: a case report

The purpose of this paper was to present the case of a two-year-old male diagnosed with Timothy syndrome who presented with generalized enamel defects in the primary dentition. Timothy syndrome is an autosomal dominant condition characterized by a de novo missense mutation in the Cav1.2 L-type calcium channel CACNA1C. Timothy syndrome patients present with multiple clinical manifestations, including: cardiac arrhythmias; syndactyly; immune deficiency; intermittent hypoglycemia; and neurologic issues, including seizures, mental retardation, hypotonia, and autism. Craniofacial abnormalities reported include: low-set ears; flat nasal bridge; small upper jaw; thin upper lip; round face; and baldness at birth. Abnormalities in the dentition have been reported, including small, misplaced teeth with poor enamel and severe caries. At present, there is no thorough description of the dental abnormalities seen in a patient with Timothy syndrome.

Natal and neonatal teeth: a review of 23 cases

Natal teeth erupt in utero, whereas neonatal teeth present during the first month of life. The lower central incisors are the most frequently affected teeth. The etiology is unknown, and the choice of treatment depends on several factors. The purpose of this paper is to review 23 cases of children with natal or neonatal teeth who attended a dental care program in a university maternal and infant oral health clinic. There was no gender predilection. Most were natal teeth (83 percent) and presented a mild degree of mobility (64 percent). Only two patients had breast-feeding difficulties (nine percent). Tooth maintenance was the most common treatment of choice (64 percent), and only two patients presented Riga-Fede disease (nine percent).

Developmental malformation of primary and permanent dentition: a rare sequel of trauma

Dentofacial injuries that occur prior to the eruption of primary teeth can result in developmental disturbances not only in the primary but also in permanent dentition. Here we report a rare case of long term sequelae of trauma in a female child of 4 to 5 months of age which resulted in dilaceration and impaction of maxillary primary central incisors and subsequent enamel hypoplasia of the permanent maxillary central incisors.

Inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height

PURPOSE

The purpose of this study was to examine inter-relations between infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height of infraoccluded teeth.

METHODS

A total of 402 periapical radiographs of infraoccluded primary mandibular molars were reviewed. Infraocclusion, alveolar bone height, and tipping of adjacent teeth were measured.

RESULTS

Infraocclusion was most prevalent among primary mandibular first molars. The amount of infraocclusion was most profound among primary mandibular second molars (2.79±1.25). The shortest distal alveolar crest (reflected by the highest distance between the cementoenamel junction and bone crest) was observed among infraoccluded primary mandibular first molars (0.9±0.92). The permanent mandibular first molar and the primary mandibular first molar demonstrated the maximum tipping mesially and distally.

CONCLUSIONS

Infraocclusion of primary mandibular molars, tipping of adjacent teeth, and alveolar bone height of the infraoccluded teeth are inter-related.

Effects of different combinations of fused primary teeth on eruption of the permanent successors

PURPOSE

The fusion of primary teeth may be associated with the absence of 1 of the 2 permanent successors. Moreover, even if both successors erupt, developmental disturbances such as microdontia or delayed tooth formation may occur. The purpose of this study was to elucidate the effects of different combinations of fused primary teeth on the eruption of permanent successors.

METHODS

One hundred ninety-seven children with 247 fused primary teeth were examined. Combinations of primary teeth involved in the fusion were identified, and the effects of these different combinations on the presence, morphology, and eruption of the permanent successors were determined.

RESULTS

Three types of fusion in the primary teeth were identified: (1) between the maxillary central and lateral incisors (UCI/LI); (2) between the mandibular central and lateral incisors (LCI/LI); and (3) between the mandibular lateral incisor and canine (LLI/C). The results revealed an absence of the successional lateral incisor in 65% of UCI/LI cases and 74% of LLI/C cases, whereas only 16% of LCI/LI cases resulted in a missing successor.

CONCLUSIONS

Fused primary teeth are highly correlated with the absence of permanent teeth, and the prevalence depends on the combination of fused primary teeth.

Esthetic management of a primary double tooth using a silicone putty guide: a case report

The term double tooth is often used to describe fusion and gemination. The development of isolated large or joined teeth is not rare, but the literature is confusing when the appropriate terminology is presented. The objective of this paper is to present a case of a primary double tooth in a 5-year-old girl with a history of trauma. The tooth was endodontically treated and esthetic management was carried out using a silicone putty guide.

Nonsyndromic tooth agenesis patterns and associated developmental dental anomalies: a literature review with radiographic illustrations

Tooth agenesis is one of the most intriguing phenomena, because it is frequently associated with other oral anomalies, structural variations and malformations of other teeth, late eruption, transposition and crowding. The diagnosis can be quite challenging as radiographic examination is critical for the diagnosis but not always possible and the late developing teeth may be sometimes scored developmentally missing. Accurate diagnosis therefore requires radiographic, clinical, and dental cast examinations. It is an important clinical and public health problem. Patients with missing permanent teeth may suffer from a reduced chewing ability, inarticulate pronunciation, and an unfavorable aesthetic appearance. Clinically, early diagnosis of a dental anomaly can alert the clinician to the possible development of other associated dental anomalies in the same patient or family, and avoid the possible sequelae. Understanding of tooth agenesis patterns and their impact on diagnosis, prevention, and eventually therapeutics are becoming integral parts of comprehensive dental care. Dental examination with radiographic screening of hypodontia in early childhood should be emphasized as part of public oral health policy to allow early diagnosis and timely intervention.

Dental Findings and Management in a Mucopolysaccharidosis Type IIIB Patient

Mucopolysaccharidosis type IIIB (MPS IIIB) is an autosomal recessive disorder caused by deficiency of the lysosomal enzyme a-N-acetylglucosaminidase. Affected subjects present developmental delay, attention deficit disorder, uncontrollable hyperactivity, and aggressive behavior, followed by progressive dementia and death in late adolescence. The purpose of this paper is to report the dental findings and treatment in a child with MPS IIIB. His primary molars and permanent mandibular incisors presented obliterated pulp chambers and root canals, which may be a clinical manifestation of this disorder.

Regional odontodysplasia. A literature review and three case reports

AIM

The purpose of this article is to report some unusual characteristics related to gender, location and manifestations of severe Regional Odontodysplasia detected in three subjects. Regional Odontodysplasia is a rare disturbance of dental development whose aetiology is still unknown. Anomalies involve enamel, dentin, pulp and dental follicle causing atypical structure, colour, shape, size and eruptive disturbances of the affected teeth. Its early onset may lead to craniofacial development disturbances.

CASES REPORTS

This article reports three cases with unusual characteristics observed in male children who were assisted by a paediatric dentist. Generally the disease affects one hemiarch and it is very rare that it crosses the midline as in one of the presented cases. Regional Odontodysplasia has been predominantly described in the maxilla and in women, however these three cases are in boys and two of them occured in the mandible.

CONCLUSION

Regional Odontodysplasia is a rare disease, causing severe dental, growing and craniofacial development anomalies. Treatment needs to be personalised, aiming at preservation of the affected teeth taking into account their risk to develop severe infections. Parents should be made aware of the need for an extensive follow-up.

Crown-root fracture of fused primary teeth--a case report

In the primary dentition, traumatic injuries affecting the tooth-supporting structures are common due to increased bone resilience in children. Crown-root fracture, defined as a fracture involving enamel, dentin, and cementum, is uncommon in the primary dentition, comprising only 2% of dental traumas. This article reports the treatment and follow-up of a 2-year-old boy who suffered a traumatic crown-root fracture involving a primary anterior incisor that was fused to a supernumerary tooth.

The primary Maxillary Central Incisor in the Solitary Median Maxillary Central Incisor syndrome

AIM

Solitary Median Maxillary Central Incisor (SMMCI) is a developmental anomaly in the permanent dentition with one single central incisor in the maxilla, positioned exactly in the midline. This condition has been associated with extra- and intraoral malformations in the frontonasal segment of the cranium and face. It is not known whether the centrally located permanent incisor is always preceded by a centrally located primary incisor. The aim was to analyse whether a permanent single central incisor in SMMCI is always preceded by a primary single central incisor and to study extra- and intraoral phenotypic traits of the condition.

STUDY DESIGN

cross-sectional radiographic study of 11 children, visual analysis of photos and dental and panoramic radiographs.

RESULTS

Nine of the 11 cases exhibited a primary SMMCI with one symmetrical crown and root. Two cases exhibited two separate primary central incisor crowns with fused roots. The phenotypical traits (indistinct philtrum, lack of normal upper lip contour, missing superior labial frenulum and distinct mid-palatal ridge) were findings observed in young children with a primary SMMCI.

CONCLUSION

The present study concludes and stresses the necessity of diagnosing of the SMMCI condition early in life. Furthermore, paediatric dentists are recommended to be aware of the condition and to refer these patients to interdisciplinary diagnostics and treatment.

Clinical and radiographic evaluation and comparison of six cases of fusion involving the primary dentition

Fusion occurs infrequently, but could cause esthetic, spacing, and periodontal problems. An understanding of fused teeth and their associated problems is important to provide prophylactic measures, thereby preventing or minimizing possible complications. The purpose of this case report was to highlight the infrequency of fused primary teeth by virtue of the number of such cases reported in the literature. Six cases of asymptomatic dental twinning anomalies in the primary dentition are reported in this study, and a clinical and radiographic presentation of the cases of fusion of primary incisor teeth is illustrated. This clinical entity has been found to appear with varied clinical and radiographic appearances. All cases are different from each other. This study's fourth patient is of particular interest because he is the second known case of bilateral fusion of the primary mandibular central and lateral incisors to be reported in the literature. An association of fusion of primary incisors with the number of succedaneous teeth was observed.

The influence of orotracheal intubation on the oral tissue development in preterm infants

PURPOSE

Preterm children may not be prepared for extra-uterine life and thus need neonatal intensive care, such as artificial ventilation through orotracheal intubation. Oral tissue development changes as a result of the use of an orotracheal tube and its mechanical influence in preterm neonates has not been intensively studied. The purpose of the present study was to determine the association of orotracheal intubation with incidence of oral alterations in preterm infants.

MATERIALS AND METHODS

A retrospective cohort of 117 subjects who were born during the period 2002-2003 in Brazil were evaluated and the data were analysed using the Fisher and Mann-Whitney exact tests. A 95% confidence interval was calculated for observed oral conditions.

RESULTS

The cohort revealed that the most frequent oral conditions included anterior crossbite, superior alveolar contour and palatal deformation.

CONCLUSIONS

The association between the intubated-infant group and the non-intubated-infant group suggested that mechanical trauma had an influence on the oral structure development.

Severe oligodontia and dental anomalies in a child with a history of multiple natal teeth: An eight-year retrospective

This article reports the case of a boy born with 11 natal teeth who had many alterations in his permanent dentition. In this case, 22 teeth were missing and a shape anomaly was detected in eight teeth. The treatment consisted of prosthetic rehabilitation and follow-up of teeth eruption and jaw growth.

Association between developmental enamel defects in the primary and permanent dentitions

AIM

To determine if the presence of developmental enamel defects (DED) in the primary dentition is a risk indicator for the presence of DED in the permanent dentition in children with mixed dentition, as well as others factors.

MATERIALS AND METHODS

A cross-sectional study was undertaken in 1296 school children ages six to 72 years. The DED [FDI; 1982] in both dentitions were identified by means of an oral exam scoring enamel opacities [classified as demarcated or diffused], and enamel hypoplasia. Sociodemographic and socioeconomic variables were collected through a questionnaire. Socioeconomic status (SES) was determined based on the occupation and maximum level of education of parents. Statistical analysis included logistic regression.

RESULTS

Mean age of participants was 8.40 +/- 1.68; 51.6% were boys. DED prevalence was 7.5% in the permanent dentition and 10.0% in the primary dentition. The logistic regression model, adjusting for sociodemographic and socioeconomic variables, showed that for each primary tooth with DED, the odds of observing DED in the permanent dentition increased 7.38 times [95% CI = 1.17-1.64; p < 0.001].

CONCLUSION

An association between DED presence in both permanent and primary dentitions was observed. Further studies are necessary to fully characterise such relationship.

Regional odontodysplasia: management of an acute case with a scanning electron microscope

Regional odontodysplasia (RO) is an uncommon, nonhereditary, odontogenic developmental disturbance characterized by hypoplasia and hypocalcification of the dental tissues that produce so-called "ghost teeth." This report describes a case of a 2.5-year-old girl who came to the clinic with RO affecting her right maxillary arch. The distinguishing characteristics of this case were the involvement of both the primary and permanent dentitions and the early occurrence of odontogenic abscesses that required the patient's hospitalization. Ultrastructural analysis revealed dental tissue failures that compromised the integrity of the involved teeth, justifying the high susceptibility to caries that was clinically observed. Follow-up was characterized by periodic prosthetic adjustments to maintain the patient's ability to masticate and for social interaction, beyond allowing normal development of her maxillofacial complex. Patients with RO require individualized treatment planning and close follow-up with a multidisciplinary approach.

Infantile refsum disease with enamel defects: a case report

The purpose of this paper was to present the case of a 15-year-old female diagnosed with infantile Refsum disease (IRD) that presented with generalized enamel defects in the primary and permanent dentition. IRD is an inherited autosomal recessive disorder characterized by aberrant peroxisome function. IRD patients present with multiple clinical manifestations, including: retinitis pigmentosa; nystagmus; sensorineural hearing loss; mental and developmental delays; neuromotor defects; and cerebral ataxia. Craniofacial abnormalities reported include: high forehead; hypoplastic supraorbital ridges; epicanthal folds; midface hypoplasia; and large anterior fontanelle. At present, there is only one known report of dental anomaly associated with this syndrome. This represents the first known reported case in the pediatric dental literature.

Comparison of enamel defects in the primary and permanent dentitions of children from a low-fluoride District in Australia

PURPOSE

The purpose of this study was to compare developmental defects of enamel (DDE) in the primary and permanent dentitions of children from a low-fluoride district.

METHODS

A total of 517 healthy schoolchildren were examined using the modified DDE criteria.

RESULTS

The prevalence of DDE in the primary and permanent dentition was 25% and 58%, respectively (P<.001). The mean number of teeth with enamel opacity per subject was approximately threefold compared to that affected by enamel hypoplasia (3.1±3.8 vs 0.8±1.4, P<.001 in the primary dentition and 3.6±4.7 vs 1.2±2.2, P<.001 in the permanent dentition). Demarcated opacities (83%) were predominant compared to diffuse opacities (17%), while missing enamel was the most common type of enamel hypoplasia (50%), followed by grooves (31%) and enamel pits (19%) (P=.04). In the permanent dentition, diffuse and demarcated opacities were equally frequent, while enamel grooves were the commonest type of hypoplasia (52%), followed by missing enamel (35%) and enamel pits (5%; P<.001).

CONCLUSIONS

In a low-fluoride community, developmental defects of enamel were twice as common in the permanent dentition vs the primary dentition. In the primary dentition, the predominant defects were demarcated opacities and missing enamel, while in the permanent dentition, the defects were more variable.

Hallermann-Streiff syndrome: case report and literature review

Hallermann-Streiff syndrome is a rare genetic disorder characterized primarily by head and face abnormalities. Patients show birdlike faces; hypotrichosis; various ophthalmic disorders; and dental abnormalities including absence of teeth, natal and neonatal teeth, enamel hypoplasia, and supernumerary teeth. In addition, delayed eruption of existing teeth and severe agenesis of permanent teeth are frequent findings. Dental and hereditary disorders can be associated with disturbances during tooth development and cause shortened roots. Short roots are a rare developmental anomaly in the permanent dentition, and the etiology is not well established. The generalized form is extremely rare. Generalized diminished root formation can lead to early loss of teeth. This article provides a case report of a 9-year-old boy with Hallermann-Streiff syndrome. Extraoral examination revealed a brachycephalic head, proportionate short stature, sparse hair, and atrophic skin. His face was characterized by a thin beak-shaped nose and retrognathia, resulting in a characteristic birdlike appearance. Radiographically, all teeth of the permanent dentition showed severely underdeveloped roots and partially underdeveloped crowns. The predisposition to severe dental caries and dental malformations makes it imperative to schedule effective prevention measures, especially since root canal treatment to preserve teeth can be hampered due to underdeveloped roots.

Enamel defects in the complete primary dentition of children born at term and preterm

PURPOSE

This study's purpose was to compare the frequency of enamel defects (ED) in the complete primary dentition (CDD) of term children (TC) and preterm children (PTC) and to analyze neonatal factors associated with ED in PTC.

METHODS

The study group was formed by 45 PTC, cared for at the Follow-up Clinic for Preterm Children of the Federal University of São Paulo, Brazil. The control group included 46 school-children born at term.

RESULTS

ED was more frequent in PTC (87%) than in TC (44%; P<.05). All 34 PTC with tracheal intubation at birth presented ED, showing a strong association between both. The variable was not included in the regression model. To analyze neonatal factors associated with ED in PTC, a model of logistic regression was adjusted. Malnutrition at term-corrected age increased the risk of ED in PTC 7.8 times. Opacity (white/cream) and hypoplasia (missing enamel) were frequent types of ED in this series. PTC and TC presented with high ED frequencies.

CONCLUSIONS

The frequencies of enamel defects were elevated in term and preterm children, but were higher in the latter. Tracheal intubation was strongly associated with enamel defects, and extrauterine growth restriction significantly increased the risk for enamel defects in preterm children.

Prevalence of congenital dental anomalies in the primary dentition in Taiwan

PURPOSE

The purpose of this study was to investigate the prevalence of congenital anomolies in the primary dentition in preschool Taiwanese children compared to Caucasion populations.

METHODS

The study group comprised 2,611 children (1,442 boys ond 1,169 girls) between 2 and 6 years-old in the primary dentition phase using a random sampling technique. The presence of hypodontia, hyperdontia, and double teeth (fusion ond gemination) were recorded ond analyzed using Fisher's exact test.

RESULTS

The prevalence of hypodontia was approximately 2%. Unilaterol missing teeth were more frequently observed than bilateral missing teeth. The primary mandibular right lateral incisor was the most frequently missing tooth. The prevalence af hyperdontia was less than 1%. All of the supernumerary teeth were located in the primary maxillary incisor area. The prevalence of double teeth was approximately 3%. All double teeth were located in the anterior region, and most of them were found in the mandibular lateral incisor and canine area. There were no differences in the prevalence of anomalies between the sexes.

CONCLUSIONS

The prevalence of hypodontia and double teeth, but not hyperdontia, was significantly higher in Taiwanese children vs Caucasian children. Early detection of primary dental anomalies may help prevent oral disease in children.

An unusual triplication of primary teeth-a rare case report

Odontogenic anomalies can occur as a result of conjoining or twinning defects. This article reports the case of fusion in a 10-year-old boy in relation to the primary maxillary right incisors. Clinicoradiographic examination revealed the presence of triple teeth, ie, fusion between the maxillary right incisors along with a supernumerary tooth on the labial surface. The offending triple tooth was extracted under local anesthesia. The extracted tooth was sectioned using a hard tissue microtome at three levels-the coronal, middle root, and apical levels, respectively-and these sections were visualized under a stereomicroscope. Based on the histologic findings, a final diagnosis of fusion was confirmed. A brief review of the literature on triple teeth is also presented.

Hereditary opalescent dentin: a report of two cases

AIM

The aim of this case report is to present the clinical and radiographic findings of hereditary opalescent dentin to facilitate an early diagnosis.

BACKGROUND

Hereditary opalescent dentin (or dentinogenesis imperfecta) may manifest itself in three variations: i.e., Shields type I, Shields type II, and Shields type III. Dentinogenesis imperfecta occurs as an autosomal dominant trait with variable expressivity, either in presence with osteogenesis imperfecta or as a separate clinical entity in persons who have none of the features of osteogenesis imperfecta.

CASE DESCRIPTION

A seven-year old boy and his mother were both diagnosed with hereditary opalescent dentin. A review of the family dental history revealed that this condition affected not only the child's mother but his maternal grandfather and great grandfather. Both the son and the mother exhibited the same clinical and radiologic features as those reported previously with no evidence of osteogenesis imperfecta.

SUMMARY

Being an autosomal disease, hereditary opalescent dentin runs in the family and can affect both the deciduous and permanent dentitions as a dominant trait.

CLINICAL SIGNIFICANCE

Once a patient is diagnosed with hereditary opalescent dentin, other family members should be evaluated given the condition is hereditary.

[An obscure anomaly: regional odontodysplasia]

In a 3-year-old child, acute dental abscesses in combination with clinical and radiographic impressions of a number of deciduous teeth indicated regional odontodysplasia as probable diagnosis. Histological examination of the removed deciduous teeth confirmed the diagnosis. Early determination of this regional developmental anomaly in the odontogenesis is of great importance for optimal guidance of the dental care of a patient with regional odontodysplasia.

Prevalence of 3-rooted primary mandibular second molars among chinese patients

PURPOSE

The purpose of this study was to determine the prevalence of 3-rooted primary mandibular second molar teeth in Chinese patients via vertical bitewing radiography.

METHODS

Vertical bitewing radiographs of 227 patients previously obtained from the Department of Pediatric Dentistry, Taichung Veterans General Hospital, Taichung City, Taiwan, from June 2004 to July 2007 were retrospectively screened and examined. Images of 185 patients (92 boys and 93 girls; mean age=5.6 [range=2.5-11.9] years old) with bilateral primary mandibular second molars were studied. The gender, symmetry, and frequencies of occurrence of 3-rooted primary mandibular second molars were compared.

RESULTS

Eighteen (9%) 3-rooted primary mandibular second molars were found in the 185 patients, with a bilateral incidence of a symmetrical distribution of 28% (5/18). The prevalence of 3-rooted primary second molars did not differ significantly between the mandible's right and left sides (P<.41), or with gender (P<.31).

CONCLUSIONS

The data presented here indicate that approximately one tenth of Chinese individuals have a 3-rooted primary mandibular second molar and that this condition is bilaterally symmetric in approximately one third of such individuals in a Taiwan hospital.

Double primary teeth in children under 17 years old and their correlation with permanent successors

BACKGROUND

The existence of double primary teeth associated with further problems in permanent successors may have deleterious effects on occlusion and esthetics. The purposes of this study were to investigate the prevalence of double teeth in a group of Taiwanese children under 17 years old, and to compare the distribution of the different types of double primary teeth and their relationship to permanent successors.

METHODS

A total of 7868 qualified dental records of children under age 17 from the pediatric dental clinic of Chang Gung Memorial Hospital-Kaohsiung Medical Center were selected for this study. Panoramic radiographs were obtained from each child. The distribution of double teeth was investigated according to sex differences, types and clinical positions. The occurrence of double primary teeth and their effects on the permanent dentition were also recorded.

RESULTS

The prevalence of double primary teeth in children under 17 years old in this study was 0.72%. Double primary teeth were found mostly in the mandibular lateral incisors and canines (63.2%). Approximately 56% of cases experienced further problems in the permanent successors. Hypodontia (51.5%) was the most common problem in the permanent successors.

CONCLUSION

The close relationship between double primary teeth and permanent successors justifies radiographic examination to evaluate the number and condition of permanent successors and determine a proper treatment plan.

Non-syndromic oligodontia in permanent dentition of monozygotic twins: report of a rare case

AIM

To report a case of non-syndromic oligodontia involving 26 permanent teeth in monozygotic twin sisters and to discuss the possible genetic etiology, inheritance pattern and associated dental anomalies of this condition.

BACKGROUND

Hypodontia constitutes one of the most common developmental anomalies in humans and is defined as developmental absence of one or more teeth with reported prevalence of 1.6 to 9.6% in the permanent dentition. Oligodontia is defined as agenesis of six or more teeth excluding third molars.

CASE REPORT

This article describes a case of non-syndromic oligodontia involving 26 permanent teeth in monozygotic twin sisters. The twins had positive family history of hypodontia in their paternal grandmother, parental consanguinity (first cousin) and similarity in pattern of oligodontia. Root formation of permanent maxillary first molars and central incisors was delayed in both the twins.

SUMMARY

This article reports a case of non-syndromic oligodontia in permanent dentition of monozygotic twins. Possible genetic etiology, inheritance pattern and associated dental anomalies are discussed.

CLINICAL SIGNIFICANCE

Strong genetic link associated with oligodontia help the dentist to know the possibility of its occurrence in other family members and in future generations.

Orthodontic extrusion in the transitional dentition: a simple technique

Extrusion of teeth may be necessary in cases of delayed eruption, primary retention, traumatically intruded teeth, or subgingivally fractured teeth. Removable appliances are advantageous, as anchorage is not as tooth-dependant as in the case of fixed appliances. They are cost-effective, operator friendly, and a valuable treatment option to consider in cases where extrusion of anterior teeth in the transitional dentition is necessary. The purpose of this paper was to describe a simple, cost-effective technique using a removable appliance for extrusion of incisors in the transitional dentition.

Prevalence of enamel defects related to pre-, peri- and postnatal factors in a Brazilian population

OBJECTIVES

The aim of this paper is to evaluate the prevalence of enamel defects in infants from a socially and economically poor population and the possible association of these defects with disturbances occurring in the pre-, peri- and postnatal periods of human development.

PARTICIPANTS

117 infants aged between 16 and 18 months old were included in four groups based on gestational age and whether part or full term pregnancy.

METHOD

The data were collected in two stages: hospital-based, where gestational and birth records were examined, and home-based, where dental examinations and nutrition were evaluated. The teeth were cleaned and dried with gauze and examined in the open air, avoding direct sunlight in the knee-to-knee position. The enamel defects were coded according to the modified Developmental Defects of Enamel Index. Besides this, body weight and height were considered as anthropometric measures for the evaluation of nutritional status by the National Center for Health Statistics standards.

MAIN OUTCOME MEASURES

The data were analyzed using the chi-square and Fisher Exact tests. Besides these tests, logistic regression models were used.

RESULTS

The prevalence of enamel defects was 49.6%, higher in the group of male infants (p<0.001). The most frequent type of defect and the most affected surface were, respectively, diffuse opacity (9.5%) and the buccal surface (83.3%), located in the gingival half (6.7%). The logistic regression model showed that educational level, gestational age and intrauterine growth retardation (IUGR), besides a lack of breastfeeding, increased the probability of enamel defects up to level of 5%.

CONCLUSIONS

The association between enamel defects and the etiologic factors shown in this study suggest the existence of social influences regarding oral health and teeth development.

[Correlations between the presence of a mesiodens and position abnormalities, diastemas, and eruption disturbances of maxillary frontal teeth]

A mesiodens is often diagnosed coincidentally during a radiological examination. However, a mesiodens may also be diagnosed in relation to a clinically identified central diastema and an eruption disturbance, or a rotation of a central incisor. In this study of a group of 162 children and adolescents varying in age from 4 to 18 years, with a mesiodens, the frequency of position abnormalities, diastemas, and eruption disturbances of the maxillary frontal teeth was registered retrospectively. One or more of these complications was diagnosed in 72% of the patients. Usually, removal of the mesiodens in children and adolescents results in spontaneous recovery of the complications. Early diagnosis and early treatment are therefore important.

Long-term management of a child with regional odontodysplasia: a case report

Regional odontodysplasia, or "ghost teeth," is a dental abnormality derived from both epithelial and mesenchymal components of the tooth bud. Teeth within a particular quadrant are affected. Affected teeth usually have thin enamel and dentin of poor quality with shortened roots, open apices, or enlarged pulp chambers. The permanent teeth and maxillary arch are observed to be more severely affected than primary teeth and the mandibular arch (ratio=1.6:1), respectively. Eruption of the affected teeth is delayed or may not happen. The cause of the phenomenon is unknown. Since this problem affects both dentitions and can involve multiple care disciplines, patients often require oral care over a long period of time. The purpose of this report was to present the management of a case from initial presentation at the age of 20 months to a final prosthesis completion at the age of 22 years. The long-term treatment may involve a pediatric dentist, orthodontist, oral surgeon, and prosthodontist.

Clinical and microstructural aberrations of enamel of deciduous and permanent teeth in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy

OBJECTIVE

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) causes multiple endocrine deficiencies, oral candidiasis and different forms of ectodermal dystrophy including enamel hypoplasia, documented in permanent teeth. Our purpose was to examine dental aberrations associated with APECED, including possible manifestations in primary teeth.

DESIGN

We studied clinically, radiographically, and by scanning electron microscopy (SEM) teeth of children belonging to two APECED families with different mutations in the AIRE gene.

RESULTS

In addition to enamel defects in the permanent teeth we observed hypoplastic pits and hypomaturated patches in the deciduous teeth with underlying changes in the prismatic ultrastructure. The enamel of the permanent molars exhibited a layered arrangement with included whirl-like formations.

CONCLUSIONS

Our findings confirm that APECED causes enamel defects that are individually but chronologically distributed, and can alter enamel development early enough to affect deciduous teeth.

Palatal and labially impacted maxillary canine-associated dental anomalies: a comparative study

AIM

To determine the association of impacted maxillary canines with other developmental dental anomalies and compare them with a control population and to compare palatally and labially impacted canine associated anomalies.

METHODS AND MATERIALS

Ninety non-syndromic orthodontic patients from a south Indian population, with either labial or palatal impactions of one or both maxillary canine teeth, were selected for the study group. A group of 250 patients who had normally erupted maxillary canines were selected as controls. Clinical findings and panoramic radiographs were used to identify dental anomalies.

RESULTS

Prevalence of premolar rotation was found to be 80% in the study group followed by canine rotation (20%), taurodontism (26.6%), infraocclusion of premolars (25.5%), impacted mandibular canine (11.1%), and peg lateral (7.7%). Forty-nine (54.4%) palatally impacted, 37 (41.1%) labially impacted, and 4 (4.4%) centrally impacted canines were also observed. Of the 250 subjects in the control group 78.8% presented with premolar rotation. Maxillary canine transmigration, infraocclusion of premolars, anomalies of maxillary lateral incisors, and taurodontism showed significant associations with palatally impacted canines (P<0.05).

CONCLUSION

The present study illustrates a significant association of anomalous maxillary lateral, anomalous mandibular canine, taurodontism, infra occlusion of premolar, over retained deciduous molar, and maxillary canine transmigration with ectopically placed canines. These associations suggest these conditions may share a common genetic origin and existence of these anomalies can anticipate maxillary canine impaction which can help in cautious observation and early treatment for maxillary canine impaction.

CLINICAL SIGNIFICANCE

Anomalous lateral incisors can serve as a predictor for palatal maxillary canine impaction. These anomalies could serve as an easily recognized, early warning sign for the monitoring of the canine position and timely early referral in appropriate cases.

Clinical and microstructural aberrations of enamel of deciduous and permanent teeth in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy

OBJECTIVE

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) causes multiple endocrine deficiencies, oral candidiasis and different forms of ectodermal dystrophy including enamel hypoplasia, documented in permanent teeth. Our purpose was to examine dental aberrations associated with APECED, including possible manifestations in primary teeth.

DESIGN

We studied clinically, radiographically, and by scanning electron microscopy (SEM) teeth of children belonging to two APECED families with different mutations in the AIRE gene.

RESULTS

In addition to enamel defects in the permanent teeth we observed hypoplastic pits and hypomaturated patches in the deciduous teeth with underlying changes in the prismatic ultrastructure. The enamel of the permanent molars exhibited a layered arrangement with included whirl-like formations.

CONCLUSIONS

Our findings confirm that APECED causes enamel defects that are individually but chronologically distributed, and can alter enamel development early enough to affect deciduous teeth.