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Traumatic dental injuries (TDIs) in the primary dentition may result in tooth discolouration and fractures. The aim of this child-centred study was to explore the differences between preschool children's eye movement patterns and visual attention to typical outcomes following TDIs to primary teeth.An eye-tracker recorded 155 healthy preschool children's eye movements when they viewed clinical images of healthy teeth, tooth fractures and discolourations. The visual search pattern was analysed using the eye movement analysis with the Hidden Markov Models (EMHMM) approach and preference for the various regions of interest (ROIs).Two different eye movement patterns (distributed and selective) were identified (p .05). Children with the distributed pattern shifted their fixations between the presented images, while those with the selective pattern remained focused on the same image they first saw.Preschool children noticed teeth. However, most of them did not have an attentional bias, implying that they did not interpret these TDI outcomes negatively. Only a few children avoided looking at images with TDIs indicating a potential negative impact. The EMHMM approach is appropriate for assessing inter-individual differences in children's visual attention to TDI outcomes.

Although usually considered to be of developmental origin, dentigerous cysts (DCs) have been reported to form in response to chronic periapical inflammation associated with primary teeth that have necrotic, infected pulps. This article describes the management of a DC associated with tooth 21 in a seven-year-old Caucasian child with a history of multiple TDIs to the primary maxillary incisors. Chronic periapical inflammation associated with a necrotic pulp in tooth 61 was identified as the likely cause of the lesion. Initial conservative management involved marsupialization of the lesion by extracting the necrotic tooth 61. Following significant decompression of the cyst, surgical enucleation was carried out under general anaesthesia and an orthodontic attachment was bonded to the crown of the unerupted tooth 21 to facilitate traction. Histopathological assessment of the enucleated tissue confirmed it to be a DC. Two years after the initial presentation, teeth 21 and 22 had erupted into the oral cavity, improving patient aesthetics. However, the root of tooth 22 was transposed with the crown of the unerupted tooth 23. This case highlights the undesirable sequelae that may occur following delayed and inappropriate management of TDIs.

Supernumerary teeth are reported to occur in both primary and permanent dentitions, but their exact aetiology remains unclear. To date, there have been no documented reports of supernumerary teeth formation subsequent to traumatic dental injuries (TDIs) to the primary incisors. This case report illustrates such an unusual consequence where a supernumerary tooth developed subsequent to a subluxation injury to teeth 51 and 61 in a 4-year-old Caucasian girl. This emphasizes the importance of reviewing TDIs, as well as providing parents with sufficient information about possible sequelae at the time of trauma. Nevertheless, it also provides an excellent basis for future investigations, which are essential to establish this correlation and to prove causation.

BACKGROUND Silver diamine fluoride (SDF) is a cariostatic agent used to adjunctively manage dental caries in high-risk groups. However, black staining is a frequently reported side effect following SDF application and influences the acceptability of this treatment. AIM To evaluate the staining potential of SDF and the influence of the potassium Iodide (KI) application on the degree of black staining over time. DESIGN Extracted carious primary molars were collected and sorted into pairs matched by tooth type, size and location of the carious lesion (n = 35). Teeth were stratified to receive either 38% SDF, KI immediately after SDF application, or 12% SDF. Standardised timelapse photography and image processing software was used to evaluate staining over a period of 7 days. RESULTS Following SDF application, the onset of black staining occurred within 2 min and increased in value for up to 6 h post-application. The use of KI immediately after SDF application resulted in no noticeable staining of the carious dentine or surrounding enamel. No significant differences were evident in the staining potential between the different SDF concentrations (38% and 12%). Furthermore, root surface and cementum was found to stain darker and more readily when compared with the coronal enamel surface. CONCLUSION SDF has the ability to visibly stain dental hard tissues and its staining potential may be modified by application of KI.

AIM To investigate the root canal morphology of hypomineralised second primary molars(HSPM) using micro-CT(μCT) compared with non-hypomineralised second primary molars (non-HSPM). METHODOLOGY Ten HSPM and 10 non-HSPM were divided into Group 1(maxillary HSPM), Group 2 (mandibular HSPM), Group 3(maxillary non-HSPM), and Group 4 (mandibular non-HSPM). All teeth were scanned using μCT to assess the following parameters: (i) root canal configuration, (ii) pulp volumes, and (iii) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. Two-way ANOVA was employed for descriptive analysis (P

AIM To outline the current literature surrounding natal teeth, and then, in a pilot study, to evaluate natal teeth using micro-computed tomography (micro-CT) to determine their anatomical profile, and compare and contrast different analytical methods to assess natal teeth. METHODS 2 extracted natal teeth (mandibular central incisors) and 1 exfoliated mandibular primary central incisor were subjected to micro-CT analysis. RESULTS Within natal teeth, there were no statistical differences in tooth mineral density (TMD) of both enamel and dentine (P > .05), whereas mandibular primary central incisors had a significantly higher TMD of both enamel and dentine in comparison with both natal tooth 1 and natal tooth 2 (P

Background No published studies exist on the remineralizing potential of Tooth Mousse Plus® (TMP) when applied for less than 3 min. Aim To evaluate (i) the remineralizing potential of TMP on artificial carious lesions, when applied thrice daily for 60 s, and (ii) the benefit of using a fluoridated dentifrice prior to TMP application. Design Carious lesions, 120–200 μm deep, were produced by placing molars in demineralizing solution for 96 h, and sections 100–150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or 1000 ppm F dentifrice (Group B), or TMP (Group C), or a 1000 ppm F dentifrice followed by TMP application (Group D), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. Results Post-treatment maximum mineral content at the surface zone (Vmax) was significantly increased and lesion depth (LD) significantly decreased in Group C, while only the Vmax increased in Group D. Increase in LD was observed in Group B; however, no significant differences were noted in percentage LD changes between groups B, C, and D (P > 0.05). Conclusions TMP applied for 60 s significantly remineralized the artificial carious lesions. No additional benefit was evident when TMP was preceded by treatment with 1000 ppm F dentifrice.

Objectives To assess the changes in the oral health-related quality of life (OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia (DEGA). Methods Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%. Results One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 (SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly (P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset. Conclusions The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA.

BACKGROUND The health and well-being of children are intimately linked to their parents' physical, emotional, and social health and social circumstances. AIM To conduct a meta-analysis of studies that have used the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the family impact scale (FIS) changes following their children's dental treatment under general anaesthesia (DGA). METHODOLOGY A systematic search was undertaken using the PRISMA guidelines. The inclusion criteria consisted of patients below 16 years of age, DGA, pre- and post-operative assessments, and the use of ECOHIS and COHRQoL. FIS changes were the primary outcome measure, where the mean difference (MD) was calculated. RESULTS After initial search of 105 studies in the database, twenty-one articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 [95% CI: 1.15-1.89; P

Aim The aim of the present study was to investigate the success rate of various treatment modalities and complications associated with the occurrence and treatment of impacted mandibular permanent canines. Methods Seventy-four southern Chinese children and adolescents who received treatment for impacted mandibular canines over a 27-year period were included in the analysis. Treatment modalities and complications that had been recorded in the clinical and surgical notes and that could be diagnosed from the available radiographs were noted. Results The most commonly-performed treatment for the correction of an impacted mandibular canine was surgical removal of the impacted tooth (n = 59). In cases where surgical exposure of the impacted canine followed by bonding an attachment was performed (n = 7), the average time required for the canine to erupt postoperatively through the soft tissue was 12.2 months (±10.2 months). Lack of movement of the tooth after traction was the only complication reported in these patients (n = 3). The most frequently-reported postoperative sequela observed for all treatment modalities was swelling of the soft tissues around the surgical site (n = 6), and this was persistent even after 48 h. Conclusions The success rate after surgical intervention and orthodontic traction was 57.1%.

The aim of the present study was to perform a qualitative assessment of published clinical studies, using the Medline database between 2006 and 2016, on commonly used pulpotomy medicaments. Standardized criteria proposed by Fuks and Papagiannoulis in 2006 was used by three independent examiners who assessed a total of 64 studies and graded the papers as grades A (38-42), B1 (32-37), B2 (25-31), or C (

Aim The aim of the present study was to determine the association of both buccally- and palatally-impacted canines with other dental anomalies. Methods This retrospective study was conducted on a population of 533 southern Chinese children and adolescents who had impacted maxillary canines that had been treated in the Paediatric Dentistry and Orthodontics Clinic, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong. Descriptions of the impacted canine and other associated anomalies were obtained from the case notes and radiographs. Clinical photographs and study casts were used, where available. Results A total of 253 (47.5%) patients with impacted maxillary canines were diagnosed with other dental anomalies. Microdontia was the most frequently-occurring anomaly reported in these patients, with the maxillary lateral incisor the most commonly affected tooth. Other odontogenic anomalies that were associated with both buccally- and palatally-impacted canines included hypodontia, supernumerary teeth, transposition of other teeth, enamel hypoplasia, other impacted teeth, and dens invaginatus. Conclusion Both buccally- and palatally-impacted canines were found to be associated with other odontogenic anomalies.

Background This study compared the chemical, morphological and microhardness changes in carious dentine following application of NaOCl-based (Carisolv), papain-based (Papacarie) chemomechanical caries removal agents with conventional rotary method. Methods Thirty-two carious and eight non-carious human permanent molars were used. The carious molars were randomly distributed into four groups: Group 1 (positive control) – molars were left without caries removal; Group 2 – caries excavated with rotary method; Group 3 – caries excavated with Carisolv; Group 4 – caries excavated with Papacarie. Group 5 (negative control) consisted of eight sound molars. After caries excavation, all specimens were prepared for chemical, morphological analysis and Vickers hardness testing. Results EDX analysis showed no significant difference in Ca wt%, P wt% and Ca/P ratio among Groups 2 to 5. Vickers hardness of dentine from Groups 3 and 4 was significantly lower (p

Background To date, research on the relationship between dental caries experience and adiposity status is debated. Aim To determine associations between dental caries experience and adiposity status among a community sample of preschool children in Hong Kong. Design Among a random sample of 5-year-old children, clinical assessment for dental caries was conducted using WHO criteria. Anthropometric measurements for body weight, body height, waist circumference (WC), hip circumference, and triceps skinfold thickness (TRSKF) were performed to assess general adiposity, central adiposity, and peripheral adiposity. Associations between adiposity status and caries were examined in regression analyses. Results The response rate was 83.1% (324/390). Regression analyses (adjusted for tooth brushing habits, snacking habits, and socio-demographic factors) identified that weight/height ratio z-score was associated with caries experience: prevalence of dental caries experience (dmft > 0), OR 1.41 (95% CI 1.04, 1.91), and ‘very high’ caries experience (dmft ≥ SiC10 Index value), OR 1.62, (95% CI 1.05, 2.50). In addition, WC z-score was associated with ‘very high’ caries experience (dmft ≥ SiC10 Index value), OR 1.72, 95% CI 1.06, 2.81. Conclusion In a Hong Kong community sample of preschool children, dental caries experience was associated with general adiposity (as assessed by weight/height ratio) and central adiposity (as assessed by WC).

Objectives This investigation aimed to evaluate the secular trend exhibited by developing permanent teeth in 5 to 6 years old southern Chinese children. Methods Four hundred radiographs of children born in the years 1981 (n=200) and 2001 (n=200) were randomly selected, and then age and gender matched. Maxillary and mandibular teeth on the left side were scored. The number of tooth developmental stages (n-tds) for each stage of development and total n-tds in crown and root development was calculated. Logistic regression, X2 test for occurrence of trend and Fisher's exact test were used to evaluate the variations in n-tds between crown and root maturation and also maturation among different teeth. Dental maturation between boys and girls was also compared. Results In the maxillary dentition, children born in 2001 showed advanced dental maturation (odds ratio, 1.29; P=0.001), and girls exhibited earlier maturation than boys (odds ratio, 1.43; P=0.001). In the mandibular dentition, no significant difference between the years was observed (odds ratio, 0.97; P=0.761), however, girls showed accelerated development than boys (odds ratio, 1.26; P=0.002). Variations in maturation were also observed between individual tooth in the same arch and between the arches. Conclusions Children born in 2001 demonstrated accelerated dental development only in the maxillary dentition. Girls born in 1981 and 2001 exhibited advanced maturation than boys. Variations in development among different teeth in the year groups indicate the need for inclusion of all developing teeth to establish a secular change. Am. J. Hum. Biol. 25:329–334, 2013. © 2013 Wiley Periodicals, Inc.

Aim The incidence of impacted maxillary canines in Caucasians reportedly ranges from 1% to 3%. The objectives of this study were to estimate the prevalence and determine the characteristics of impacted maxillary canines in southern Chinese children and adolescents. Methods This retrospective audit involved 533 subjects with impacted maxillary canines that had been treated between February 1982 and February 2009. A customized data entry form was prepared to record and evaluate the status of impacted canines. Results The 533 subjects (327 females and 206 males) with impacted maxillary canines, who were identified from the population of 26 039 subjects, represented a prevalence of 2.1%. Four hundred and forty-two (82.9%) of these subjects had unilaterally impacted canines, while 91 (17.1%) of them had bilateral impactions. In 442 subjects with unilateral canine impactions, 220 (49.8%) were buccally placed, 194 (43.9%) were palatally placed, and 28 (6.3%) of the canines were found to lie within the arch. Conclusions The overall prevalence of impacted maxillary canines in this study of 2.1% was similar to the figures quoted for Caucasian populations. In subjects with unilateral impactions, buccally impacted canines demonstrated a slightly higher incidence (49.8%) compared to palatally impacted canines (43.9%).

To describe and compare the oral health behaviors of preschool children with and without cerebral palsy (CP), and to assess the oral health knowledge and attitudes of their primary caregivers (PCGs). Seventy-two preschool children with CP were recruited from 23 Special Child Care Centers in Hong Kong. An age- (±3 months) and gender-matched sample of children from mainstream preschools was recruited as a "control group." Assessment of children's oral health behaviors and the PCGs' oral health knowledge and attitudes was conducted using questionnaires. Preschool children with CP were less likely to have ever attended a dentist (p 0.05), but PCGs of children with CP more frequently reported provision of tooth brushing assistance to their children (p 0.05). Difference in oral health behaviors existed between preschool children with and without CP. PCGs of children with and without CP had similar oral health knowledge and attitudes.

In the past few decades, there has been an increase in demand for safety evaluation and control of dental materials used daily in dentistry; however, this task is difficult and cumbersome. Dental materials that are passive and do not react with the oral environment will be more stable and have superior durability. It is expected that dental materials will be universally accepted and will not cause harm or injury to the surrounding structures in the oral cavity. This is an entirely negative approach to the material tolerance and biocompatibility, and hides the possibility that some positive gains can be achieved. Side-effects of dental materials are believed to be rare, and generally, those that have been reported are mild. There are wide varieties of materials used in dentistry, which include liners, irrigants, intracanal filling materials, intracanal medicaments, prosthetic materials, restorative materials, subgingival implants, and mouth rinses. Therefore, in this study, the biocompatibility of various commonly-used clinical materials used in contemporary dentistry was discussed.

Objectives Numerous clinical signs may be indicative of a canine impaction; however, studies determining the efficiency of visual inspection and digital palpation in localizing an impacted maxillary canine are sparse. Of the radiographic techniques, no studies have compared the accuracy of the horizontal and the vertical parallax techniques to determine the location of an impacted canine. Hence, the objectives of this study were to evaluate the efficiency of visual inspection and digital palpation, and to compare the accuracy of the horizontal and vertical parallax techniques in determining the location of an impacted maxillary canine. Methods The study sample comprised the records of 522 patients who had attended a dental hospital. The location of an impacted maxillary canine was determined radiographically using the vertical and the horizontal parallax principles. The findings were then confirmed from the surgical records in those cases that had undergone surgical intervention of the impacted canine. Results The position of the impacted canine was determined successfully by visual inspection and digital palpation in 85.3 and 85.2% of the cases respectively. Conclusions The vertical parallax technique demonstrated a higher degree of accuracy (97.7%) and a greater degree of diagnostic capability (98.2%) when compared with the horizontal parallax technique (92.6 and 78.0% respectively).

Objective This study sought to perform mutational analysis of the RUNX2 gene in an 8-year-old girl with a diagnosis of cleidocranial dysplasia (CCD) without supernumerary teeth (proband) and her parents, plus in age and gender matched control subjects. Methods Ethical approval and informed consent was obtained for this study. Blood samples were obtained and the isolated DNA was used to amplify exons 0–7 of the RUNX2 gene using specific primers, which was subsequently sequenced. Results No mutations were identified in the coding regions of the RUNX2 gene. Conclusion The absence of supernumerary teeth in this individual with CCD demonstrates that there are variations in the phenotypes and mere absence of mutations does not imply that CCD phenotype is not governed by RUNX2 gene as only two-thirds of the individuals exhibiting a CCD phenotype would reveal a RUNX2 mutation; therefore, the influence of copy number variations including large insertions, intragenic deletions, duplications, and inversions of genes cannot be excluded completely.

Schwartz-Jampel syndrome (SJS) is a rare autosomal recessive skeletal dysplasia associated with myotonia. The manifestations of SJS include short stature, blepharophimosis, and skeletal anomalies. The combination of skeletal and muscular abnormalities may result in oro-dental manifestations such as atypical facies, with micrognathia, microstomia, pursed lips, crossbite, cleft palate, as well as mandibular hypoplasia, the risk of dentigerous cysts, and impacted teeth. The use of general anesthesia in patients with SJS is dangerous, as there is a risk of malignant hyperthermia. The purpose of this paper is to describe a 3-year-old Chinese boy diagnosed with SJS at birth. His intra-oral examination revealed significant dental findings such as dentin defects with generalized attrition and hypodontia of the permanent dentition. Comprehensive dental treatment was provided at the same time as lower right limb surgery to reduce the potential complications with general anesthesia.

OBJECTIVES. To evaluate the reliability of panoramic radiographs (PRs) for identifying supernumerary teeth (ST) and to determine whether the level of dental training of the observer influenced the identification of ST. METHODS. Seventy-five PRs were randomly selected from the patient records and 18 examiners independently rated 25 radiographs each, for specific risk factors as well as for a measure of adequacy. Subsequently, the results were paired with those of the other examiners who assessed the same set of PRs. Descriptive statistics were computed using Fisher's exact test, and kappa statistics were used to assess the inter- and intra-observer reliability. RESULTS. Four hundred and fifty PRs were available for analysis. The overall sensitivity and specificity figures were 50% and 98.3%, whereas the positive and negative predictive values were 90.6% and 83.6%, respectively. The sensitivity figures for Junior House Dental Officers and Postgraduate Paediatric Dental Trainees were 39.2% and 60.8%, whereas the specificity figures were 99.4% and 95% with slight inter-examiner and moderate intra-examiner reliability. CONCLUSIONS. Panoramic radiographs are unreliable for identifying ST, and higher level of dental training is essential for identifying ST.

Free Special Issue: Abstracts of the 23rd Congress of the International Association of Paediatric Dentistry

Wong HM, McGrath CPJ, King NM. Rasch validation of the early childhood oral health impact scale. Community Dent Oral Epidemiol 2011; 39: 449–457. © 2011 John Wiley & Sons A/S Abstract – Objectives: The early childhood oral health impact scale (ECOHIS), a proxy measure to assess the impact of oral health problems and on the quality of life of preschool children and their families, has been translated into Chinese and validated employing the classical test theory. However, some invariable problems are related to this theory. The objective of this study was to assess the metric properties of the ECOHIS by applying the item response theory. Methods: A random sample of 1296 Chinese preschool children in Hong Kong participated in the study and were subjected to an oral examination for their caries status. Their parents were asked to respond to the ECOHIS and an extra set of questions concerning their socio-demographic backgrounds. The collected data were analysed using Rasch model. Results: The obtained results support the interpretation of adequate total fit of persons and items, because the mean infit MNSQ (1.08) and outfit MNSQ (0.94) for persons, and the mean infit MNSQ (0.99) and outfit MNSQ (0.94) for items, are within the acceptable ranges (0.6–1.4). The difficulty spread of the items was between −0.81 and 1.96 logits, and the levels of respondents spanned from −5.56 to 6.72 logits on the person–item map. The spread of respondents was skewed and mistargeting, between the items and respondents, was confirmed. Combination of responses of ‘often’ and ‘very often’ was suggested because of their flat probability showing on the characteristic curves. Conclusions: Rasch model has been shown to be a feasible and practicable way of assessing the metric properties of the ECOHIS. The results allow the use of ECOHIS to be recommended for clinical research in oral health-related quality of life in young children with minor modifications.

Lee GHM, McGrath C, Yiu CKY, King NM. Sensitivity and responsiveness of the Chinese ECOHIS to dental treatment under general anaesthesia. Community Dent Oral Epidemiol 2011; 39: 372–377. © 2011 John Wiley & Sons A/S Abstract – Objective: This study aimed to investigate the sensitivity and responsiveness of the Chinese version of the Early Childhood Oral Health Impact Scale (ECOHIS) to dental treatment under general anaesthesia (GA). Methods: A consecutive sample of primary caregivers of children (aged 5 and younger) with early childhood caries (ECC) attending a university hospital dental clinic for dental treatment under GA was recruited over a 12-month period. Caregivers self-completed the ECOHIS prior to and 3 months following their child dental treatment under GA. In addition, caregivers rated the change in their child’s overall health condition compared to before treatment on a global transition scale. Sensitivity of the measure was assessed by determining distribution changes in ECOHIS scores; responsiveness was assessed by investigating whether the observed changes took the form of a gradient according to the global transition judgement, in terms of the observed change in scores and effect size. Results: Following treatment under GA, there was significant changes in ECOHIS scores (P

This study reports a novel identical complex disease allele harboring two non-synonymous mutations that were identified in two southern Chinese individuals of the same family with cleidocranial dysplasia (CCD). Blood samples were obtained from the proband, his parents, plus 100 matched control subjects. Exons 0 to 7 of the RUNX2 gene were amplified using specific primers and sequenced. Multiple sequence alignment and protein structure modeling was performed using ClustalW2 and MODBASE software while PolyPhen-2 and MutationTaster applications were employed to predict the disease-causing potential of the identified mutations. A complex disease allele in two affected individuals harboring two non-synonymous mutations in a cis-position on exons 4 (D273N) and 5 (P299L) were identified. The identified mutations were in the conserved region and changed the protein structure.

International Journal of Paediatric Dentistry 2011; 21: 132–140 Background. Although child formula fluoridated dentifrices can be used safely by young children their remineralizing capability remains questionable. Aims. To evaluate the remineralizing potential of child formula dentifrices on primary teeth. Design. In vitro single-section technique utilizing a 7 days pH-cycling model. Methods. Primary teeth were placed in demineralizing solution for 96 h to produce artificial carious lesions 100 μm deep, and then cut longitudinally into 50 sections 100–150 μm thick and randomly assigned to five groups. Sections in Groups A to D were treated with dentifrices containing 500 ppm AmF, 500 ppm MFP, 500 ppm MFP and xylitol, or 500 ppm NaF, respectively. Group E sections were treated with a nonfluoridated dentifrice. Outcome measurements. Lesions were evaluated using polarized light microscopy and microradiography. Results. Group D (500 ppm NaF) sections exhibited a significant decrease in lesion depth, whereas those in Group E (nonF) showed a significant increase in depth (P

International Journal of Paediatric Dentistry 2010; 20: 330-335 Objectives. To assess and compare the oral health status of preschool children with and without cerebral palsy (CP). Methods. Preschool children with CP (72) were recruited from 23 Special Child Care Centers in Hong Kong. An age (+/-3 months) and gender matched sample of preschool children from mainstream preschools were recruited as the control group. Dental caries status, gingival health status, tooth wear, developmental defect of enamel, malocclusion, dental trauma and oral mucosal health were assessed and compared between the two groups. Results. Significant differences in gingival health status were found between children with and without CP (mean plaque index scores, P = 0.001 and mean gingival index scores, P 0.05), prevalence of enamel defects (P > 0.05) and dental trauma (P > 0.05). Conclusions. Differences of oral health status exist among preschool children with and without CP. Preschool children fare worse in terms of gingival health, tooth wear, oral mucosal health and malocclusion.

Lee GHM, McGrath C, Yiu CKY, King NM. A comparison of a generic and oral health–specific measure in assessing the impact of early childhood caries on quality of life. Community Dent Oral Epidemiol 2010; 38: 333–339. © 2010 John Wiley & Sons A/S Abstract – Objectives: The aim of this study was to compare the performance of a generic health-related quality-of-life measure, the Pediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) and an oral health–specific quality-of-life measure, the Early Childhood Oral Health Impact Scale (ECOHIS) in assessing the impact of severe early childhood caries (S-ECC) on the children’s quality of life. Methods: A trained and calibrated examiner conducted a clinical oral assessment of 111 children (mean age: 49 ± 12 months): 64 of whom were categorized as having S-ECC and 47 as being caries-free. Primary caregivers completed a Chinese version of the PedsQL™ 4.0 and the ECOHIS. Clinical examinations were conducted blind of the parental assessments. Results: The ECOHIS scores were significantly higher for the S-ECC group than for the caries-free group (P ≤ 0.001). No significant difference was found between the PedsQL™ 4.0 scores in relation to caries status, except for the subscale of physical functioning (P = 0.04). Correlation of caries status with the ECOHIS scores was strong (r = 0.66; P 0.05). Conclusions: The oral health–specific measure, ECOHIS, shows better discriminant property between children with S-ECC and caries-free children than the generic measure, PedsQL™ 4.0. The ECOHIS appears more sensitive than PedsQL™ 4.0 in assessing the impact of dental caries on the life quality of preschool children.

Aim The aim of the present study was to assess risks prior to third molar removal. A 2-D panoramic radiograph or a 3-D cone-beam computed tomography (CBCT) scan can be used to visualize the proximity of the third molar to the mandibular canal. We aimed to correlate panoramic indicators of risk with the incidence of contact between these two structures on CBCT scans. Methods Patients were selected from a Western Australian population if they had a panoramic radiograph that illustrated signs of risk of inferior alveolar nerve injury and had a CBCT scan on file. Statistically-significant relationships between the relative position and distance between the mandibular canal and third molar were investigated using χ2 -test and Fisher's exact test in Stata version 13. Results Within the Western Australian sample (N = 100), of six possible panoramic indicators of risk, two were significantly associated with contact between the tooth and mandibular canal on CBCT: (a) interruption of the radiographic white line of the canal; and (b) darkening of the root(s). Conclusions Two panoramic radiograph risk signs are significantly more likely to indicate contact on the CBCT scans: interruption of the white line and darkening of the root(s). Further research is required to develop CBCT prescription guidelines for surgical planning.

The journal suppl. entitled: Special Issue: Abstracts of the 22nd Congress of the International Association of Paediatric Dentistry ... 2009

Purpose This investigation sought to identify the common manifestations of KBG syndrome in the literature and to determine the major oral abnormalities in a 12-year-old Chinese boy. Methods PUBMED search, using the keyword phrase "KBG syndrome," produced 20 articles. Due to the disparities in the quality of evaluations in the reports, any physical feature that was not discussed was assumed to be absent. Results Of the 54 cases, including the present case, 36 (67%) were males. Mental retardation or global developmental delay was reported in 42 (78%) cases, while 46 (85%) exhibited shortness of stature. Oral features occurred in 53 (98%) cases; macrodontia was present in 49 (96%) cases; the present case was the only one with hyperdontia and a talon cusp. Other features were craniofacial anomalies, followed by abnormalities of the nose, hand, mouth, eyes, eyebrows, philtrum, costovertebrae, ears, and, less frequently, low hairline and lower extremity abnormalities. Conclusions Cardinal features of KBG syndrome include facial dysmorphism, short stature, skeletal anomalies, and mild developmental delay; intraorally, macrodontia of the maxillary central incisors occurs in most cases. This is the first known report of KBG syndrome in a Chinese subject and the only case with hyperdontia and a talon cusp.

Background. Dentine affected by amelogenesis imperfecta (AI) is histologically altered following loss of the hypoplastic enamel and becomes hypermineralized, which would make bonding less predictable. Aim. This study examined the effect of etching time on the microtensile bond strength (µTBS) to AI-affected primary dentine. Design. Flat coronal dentine surface was obtained from extracted AI-affected and noncarious primary molars. Teeth were etched either for 15 or for 30 s using 34% phosphoric acid. Prime & Bond® NT™ (Dentsply De Trey), an etch-and-rinse adhesive, was applied to dentine surfaces, air-dried and light-cured, followed by composite build-ups. The bonded teeth were sectioned into beams of 0.8 mm2 and stressed to failure under tension. Representative fractured beams from each group were examined under scanning electron microscopy. Results. The extended etching time had an adverse effect on the µTBS for the normal dentine, while no significant difference was found for AI-affected dentine. When the AI-affected dentine was etched for 30 s, the fracture occurred in the demineralized dentine at the base of the hybrid layer. Conclusion. Bonding to AI-affected dentine compromised the bonding of the etch-and-rinse adhesive. The bonding could not be improved by increasing etching time.

– Primary tooth impaction is a rare phenomenon when compared to permanent teeth impaction. The purpose of this report is to present a 5-year-old Chinese girl who exhibited impaction of tooth 51, its unusual consequence on the permanent successor tooth and its comprehensive management. Her parents revealed that at 6 months of age, the patient had fallen from her bed and struck her face on the floor; however, there were no teeth present in the oral cavity. The intraoral examinations identified a bony-like projection on the buccal aspect of the alveolus in the 51 region. Radiographic examination revealed that tooth 51 exhibited an unfavourable orientation, with the crown directed towards the palate. Therefore, the impacted tooth 51 was surgically removed, and two years later tooth 11 erupted into the oral cavity with an indentation on its incisal aspect, which resembled the crown of the primary teeth, thus giving the appearance of a tooth within a tooth or ‘dens in dente’. Subsequently, enameloplasty and composite resin build-up was performed on tooth 11 for aesthetic reasons. It is very unusual to have the clinical crowns of both primary and permanent teeth in such close proximity within the alveolar bone, and the present case is a good example to emphasize that trauma to the primary teeth is of considerable importance due to the close proximity of the primary teeth to permanent tooth germs.

Summary. Objectives. This study was designed to gather data on infant feeding habits and oral hygiene practices of Hong Kong preschool children, on the dental knowledge and attitudes of their caregivers and on the oral health status of the same group of children. Design. Cross-sectional study. Sample and methods. Data was gathered for a total of 369 boys and 297 girls (207 1-year-olds, 269 2-year-olds and 190 3-year-olds) with a mean age of 20·19 (± 0·38) months. Information related to children attending six randomly selected Maternity and Child Health Centres. It was obtained by examining the children and by interviewing the attending caregivers and completing a questionnaire. Each child was given an oral examination using a torch, disposable mirror and wooden tongue spatula. Results. Only 7% of the children were exclusively breast-fed. More than 98% (656/666) of infants used a nursing bottle for at least some drinks. Over 62% (411/656) had used a nursing bottle to take fluids other than water and infant formula. At bedtime, 56% (361/656) were given a nursing bottle prior to sleep and 96% (340/361) of these bottles contained formula milk. Of these children, only 37% (131/361) finished the contents of the bottle before falling asleep. Over 73% (139/190) of the children continued to use a feeding bottle after 2 years of age. Non-nutritive sucking habits were practised by 35·6% (237/666) of the children. Visible plaque, on the labial surface of at least two maxillary incisors, was found in 19·5% (120/615) of the children. Oral cleansing habits were practised for 66·2% (441/666) of the children. Toothbrushing habits were reported for 42·3% (260/615) of the dentate children, of whom 19% (49/260) had their teeth brushed twice daily. Toothpaste was used by 49·23% (128/260) of the children and 57·3% (149/260) brushed their own teeth. Caries was seen in 7·6% of the infants (47/615). Of the caregivers, 67·7% said they did not think carious primary teeth needed to be restored. Among the mothers, 12·6% (43/342) did not know the oral condition of their child. Reportedly, 82% (417/510) and 87·5% (446/510) of the mothers had not received any oral health care information during the ante- or postnatal periods. Nearly all, 97%, of the respondents said that they would like to receive more information on oral health care.

Introduction Milk is an universal dietary component that could be an effective medium for the delivery of fluoride. The objective of this study was to determine whether the frequency of treating artificial carious lesions with fluoridated milk of different concentrations alters the re-mineralizing potential. Materials and Methods Artificial carious lesions, (90-180孠deep), were formed on the buccal and lingual enamel surfaces of extracted molars using a de-mineralizing solution. The teeth were sectioned to create specimens 100-150孠thick. The sections were painted with a varnish except for the outer surface of the lesion. The specimens were randomly divided into thirteen groups and treated with: water, plain milk or fluoridated milk (2.5ppm, 5ppm, 10ppm) once, twice or on alternate days using a 20-day pH cycling model. Lesion depth and mineral content (Vmax) before and after the pH cycle were evaluated using polarized light microscopy and microradiography. Paired t-test, ANOVA and Student-Newman-Keuls tests were employed to make comparisons within each group and between the different groups. Results Fluoridated milk (2.5ppm, 5ppm, 10ppm) significantly reduced the lesion depth and increased the Vmax of the lesions in comparison to the control groups (p

The occurrence of supernumerary teeth in the premolar regions of three patients is reported. Of the 20 supernumerary teeth identified, 16 had crowns which resembled premolars and may thus be considered to be supplemental premolars, while the remainder were conical in shape. The delayed development of the supernumerary teeth in the premolar region supports the hypothesis that these teeth were part of a post-permanent dentition. The eruption of six of the eight supernumerary teeth in the 30-year-old patient demonstrated that given time some of these teeth can erupt into the dental arch.

A system of diagnosing occlusal caries from bitewing radiographs was developed in an attempt to overcome the problems of clinical diagnosis found in other studies. Standardised bitewing radiographs for 1172 Berkshire schoolchildren aged 11–13 years who were participating in a toothpaste trial, were assessed for occlusal caries under uniform magnification and illumination. The radiographic scores were then compared with the clinical records for these subjects. The radiographic technique proved to be acceptably reproducible at 82.6 %. However, only 33.2 % of the lesions present were detected on the radiographs. It is concluded that bitewing radiographs for the detection of occlusal caries are of little value in epidemiological studies.

Clinical examinations of 276 5-year-old children were carried out twice yearly for 2 1/2 years, and a further 1104 11--12-year-old children were examined annually for 3 years. Fifty per cent of permanent first molar teeth had erupted by 6.4 years; the mean age of eruption for permanent second molar teeth was 12.2 years. One year after these mean eruption dates over 10% of first molars and 45% of second permanent molars were already carious. Although development of caries was initially slower in permanent first molars, between the ages of 7.5 and 8.5 years the caries increment rose to 18.8%. By the age of 15 years the DMF was 92% for first and 68% for second molar teeth. The missing and filled proportion of the total DMF rose consistently. This represents the amount of treated caries and exceeded the amount of untreated caries in permanent first molars at all age levels. The rate of caries initiation in the present investigation emphasizes that restorative programmes and preventive regimens for children must be based on frequent recall examinations of not more than 6-monthly intervals.