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Solitary median maxillary central incisor (SMMCI) is a rare finding. Growth deficiency or other systemic abnormalities may or may not be seen in children with this anomaly. Nevertheless, the growth and development of all children with SMMCI should be closely monitored. This article reports the dental findings of three Chinese girls with SMMCI, but no growth deficiency or other systemic involvement. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study was intended to examine the treatment-associated change in aspects of oral-health-related quality of life (QoL) among children (and their families) undergoing dental rehabilitation under general anaesthesia (GA). METHODS: The parents or caregivers of a consecutive clinical sample of children receiving comprehensive dental treatment under GA at the University of Otago School of Dentistry, Dunedin, and the Christchurch Oral Health Centre, Christchurch, New Zealand, were interviewed by telephone before and after the treatment. Questions were asked relating to the impact of the condition on the child and the family. The post-treatment questionnaire also sought information related to parental satisfaction with the care provided under GA. RESULTS: The parents or caregivers of 95 children participated in the study: 49 had treatment completed at the University of Otago School of Dentistry; and 46 were treated at the Christchurch Oral Health Centre. The child sample comprised 55.8% males and 44.2% females with a mean age of 5.1 years. Their mean dmft was 8.2. A consistent pattern of improvement was found with each indicator used. Complaints of pain, problems with eating and sleeping, and behaviour concerns showed significant improvements, with 100% improvement for children for whom frequent pre-GA problems associated with eating, sleeping and behaviour were reported. Sixty-six parents had to arrange time away from employment on the day of the GA and almost half of those incurred a loss of income. The majority of parents reported a high degree of satisfaction with the care received. CONCLUSIONS: Treating young children with high disease experience in a single session under GA results in immediate improvement in oral health and aspects of their QoL for both the children and their families. [ABSTRACT FROM AUTHOR]

Incontinentia pigmenti, or Block-Sulzberger Syndrome, is an X-linked dominant disorder with characteristic skin, hair, eye and tooth abnormalities. It is classically considered a male-lethal disorder with recurrent miscarriages of male foetuses. A few cases of surviving males with incontinentia pigmenti have been reported in the medical literature. This article reports the medical and dental findings of a boy diagnosed with incontinentia pigmenti. [ABSTRACT FROM AUTHOR]

It has been suggested that asthmatic children may have a higher caries risk, both as a result of their medical condition and the physical and physiological effects of their pharmacotherapy. By examining the association over time between asthma and caries increment, this study tested the hypothesis that childhood asthma is associated with an increased caries increment. In a long-standing New Zealand cohort study, participants' long-term asthma histories and the 3-year net caries increment between the ages of 15 and 18 years were examined. Of the 781 who were examined at 15 and 18 years, 39 participants were consistently taking anti-asthma medication at the ages of 9, 11, 13 and 15 years (and were labelled in this study as 'medication-determined asthmatics'), 56 were identified as consistent wheezers at the ages of 9, 11, 13 and 15 years ('wheeze-determined asthmatics') and 36 were members of both groups. A smaller group (n = 9) was identified as being very-long-term asthmatics (asthma at 5 years of age and at the ages of 9, 11, 13 and 15 years). Some 206 study members were identified as having no history of asthma, asthma medication or significant wheeze at any time up to and including 18 years. The overall mean net caries increment between the ages of 15 and 18 years was 2.06 surfaces (SD, 3.76). There were no significant differences in caries increment between the 206 asthma-free participants and any of the asthma groups. This study provides little evidence for an asthma-caries causative relationship. [ABSTRACT FROM AUTHOR]

To assess the cross-sectional construct validity of the Malay-translated and cross-culturally adapted FACT-H&N (v 4.0) for discriminative use in a sample of Malaysian oral cancer patients. A cross-sectional study of adults newly diagnosed with oral cancer. HRQOL data were collected using the FACT-H&N (v 4.0), a global question and a supplementary set of eight questions ('MAQ') obtained earlier in pilot work. Of the 76 participants (61.8% female; 23.7% younger than 50), most (96.1%) had oral squamous cell carcinoma; two-thirds were in Stages III or IV. At baseline, patients' mean FACT summary (FACT-G, FACT-H&N, FACT-H&N TOI, and FHNSI) and subscale (pwb, swb, ewb, fwb, and hnsc) scores were towards the higher end of the range. Equal proportions (36.8%) rated their overall HRQOL as 'good' or 'average'; fewer than one-quarter rated it as 'poor', and only two as 'very good'. All six FACT summary and most subscales had moderate-to-good internal consistency. For all summary scales, those with 'very poor/poor' self-rated HRQOL differed significantly from the 'good/very good' group. All FACT summary scales correlated strongly (r>0.75). Summary scales showed convergent validity (r>0.90) but little discriminant validity. The discriminant validity of the FHNSI improved with the addition of the MAQ. The FACT-H&N summary scales and most subscales demonstrated acceptable cross-sectional construct validity, reliability and discriminative ability, and thus appear appropriate for further use among Malaysian oral cancer patients. [ABSTRACT FROM AUTHOR]

Objective: implementing appropriate pharmacological and non-pharmacological interventions to alleviate pain related to routine dental procedures in paediatric patients could enhance children's ability to manage dental care. The aim of this review was to investigate the effectiveness of and provide recommendations for interventions that can be used to reduce intra-operative and post-operative pain associated with routine paediatric dental procedures., Methods: A systematic review of randomised controlled clinical trials (RCT) was conducted. Multiple electronic databases were systematically searched. The Cochrane risk-of-bias tool for RCTs was used to evaluate the quality of the included studies. A meta-analysis was performed to determine the effectiveness of the interventions using the Cohen's d standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. The GRADE tool was used to assess the certainty of evidence to make recommendations., Results: The review included forty-five RCTs comprising 3093 children. Thirty-seven RCTs were included in the meta-analysis, which showed the effectiveness of behavioural interventions (SMD = -0.50, 95% CI -0.83 to -0.18), mechanoreceptor and thermal receptor stimulation (SMD = -1.38, 95% CI -2.02 to -0.73) for intra-operative pain, and pre-emptive oral analgesics (SMD = -0.77, 95% CI -1.21 to -0.33) for reducing post-operative pain in children receiving routine dental care., Conclusion: The GRADE results for these interventions were strong recommendation (IB) for their use, based on moderate evidence and their benefits far outweighing the harm, and they can be delivered readily with minimal training to reduce the pain experience of paediatric patients.

Background: Understanding predictors of pain associated with paediatric dental procedures could play an important role in preventing loss of cooperation, which often leads to the procedure having to be performed under general anaesthesia. Aim: We aimed to identify predictors of intra-operative and post-operative pain associated with routine dental procedures in children. Materials and Methods: A systematic review of observational studies was performed using electronic searches on MEDLINE, EMBASE, PsycINFO, Global Health via OVID, PubMed, Scopus, and SciELO. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate the quality of the included studies, which were meta-analysed to estimate the impact of dental procedures and anxiety on children's pain perception. A meta-regression analysis was also performed to determine the relative effect of predictors on children's pain perception measured as mean differences on a visual analogue scale (VAS). Results: The search identified 532 articles; 53 were retrieved for full-text screening; 6 studies were included in the review; and 4 were eligible for the meta-analysis. The meta-analysis showed the types of procedures that predicted intra-operative pain, with dental extractions being the most painful (Mean VAS Difference [MD] 46.51 mm, 95% confidence interval [CI] 40.40 to 52.62 mm). The meta-regression showed that pain scores for dental extractions were significantly higher than polishing (the least painful procedure (reference category)) by VAS MD = 23.80 mm (95% CI 5.13-42.46 mm, p -value = 0.012). It also showed that highly anxious children reported significantly higher pain scores during dental procedures by a 12.31 mm MD VAS score (95% CI 5.23-19.40 mm, p -value = 0.001) compared to those with low anxiety levels. Conclusions: This systematic review demonstrates that the strongest predictors of intra-operative pain associated with paediatric dental procedures are dental extractions followed by drilling. Children with high anxiety also reported more pain for similar procedures. Tailoring interventions to reduce pain associated with paediatric dental procedures should be a priority for future research, as reducing pain can impact compliance and could reduce the need for general anaesthesia in dental treatment.

Postnatally, severe vitamin D deficiency commonly results in rickets as well as potential defects in tooth mineralization. The effects of milder deficiency on oral health outcomes later in life are still unclear. This study used micro-computed tomography (μCT), energy dispersive X-ray analysis (EDX), and Raman spectroscopy to investigate mineral density, total density, and elemental composition of enamel and dentine in 63 exfoliated primary incisors from participants with known 25-hydroxyvitamin D levels (25-OHD) at birth. No differences in mineralization and chemical composition using μCT and EDX analysis were observed irrespective of 25-OHD status. Subtle structural differences were observed via Raman spectroscopy, with more crystalline enamel observed in those with sufficient 25-OHD at birth. Although subtle, the differences seen suggest further attention should be given to children with known milder levels of vitamin D deficiency in early life. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)., (© 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).)

Vitamin D (25OHD) status during pregnancy is closely correlated with foetal and new-born 25OHD. Calcification for primary teeth begins from the fourth month of intrauterine life and from birth for permanent teeth. Dental consequences of severe 25OHD deficiency are well documented; however, consequences are less documented for milder degrees of 25OHD deficiency. This study examined the dental consequences of vitamin D deficiency/insufficiency during gestation and infancy in a cohort of 81 New Zealand children. Pregnancy and birth data for the children and their mothers and 25OHD status during gestation, birth and at five months were obtained, and dental examinations were conducted. Associations between 25OHD and enamel defects or caries experience were investigated. Of the 81 children, 55% had experienced dental caries and 64% had at least one enamel defect present. Vitamin D insufficiency (25OHD < 50 nmol/L) at all timepoints was not associated with enamel defect prevalence, but during third trimester pregnancy it was associated with an increased caries risk IRR of 3.55 (CI 1.15-10.92) by age 6. In conclusion, maternal 25OHD insufficiency during the third trimester of pregnancy was associated with greater caries experience in primary dentition. No association was found between early life 25OHD and enamel defect prevalence or severity.

The etiology of dental anomalies is multifactorial; and genetic and environmental factors that affect the dental lamina have been implicated. We investigated two families of European ancestry in which males were affected by taurodontism, microdontia and dens invaginatus. In both families, males were related to each other via unaffected females. A linkage analysis was conducted in a New Zealand family, followed by exome sequencing and focused analysis of the X-chromosome. In a US family, exome sequencing of the X-chromosome was followed by Sanger sequencing to conduct segregation analyses. We identified two independent missense variants in KIF4A that segregate in affected males and female carriers. The variant in a New Zealand family (p.Asp371His) predicts the substitution of a residue in the motor domain of the protein while the one in a US family (p.Arg771Lys) predicts the substitution of a residue in the domain that interacts with Protein Regulator of Cytokinesis 1 (PRC1). We demonstrated that the gene is expressed in the developing tooth bud during development, and that the p.Arg771Lys variant influences cell migration in an in vitro assay. These data implicate missense variations in KIF4A in a pathogenic mechanism that causes taurodontism, microdontia and dens invaginatus phenotypes., (Copyright © 2019 Gowans, Cameron-Christie, Slayton, Busch, Romero-Bustillos, Eliason, Sweat, Sobreira, Yu, Kantaputra, Wohler, Adeyemo, Lachke, Anand, Campbell, Drummond, Markie, van Vuuren, van Vuuren, Casamassimo, Ettinger, Owais, van Staden, Amendt, Adeyemo, Murray, Robertson and Butali.)

Aims: This study investigated the association between the prevalence of oral health problems (caries, gingivitis, mucosal pigmentation and enamel defects in one to 5 year-old children exposed and not exposed to environmental tobacco smoke before and/or after birth. Exposure to environmental tobacco smoke (ETS) in childhood may have significant health effects., Methods: A structured questionnaire was used to collect data on a child's current and previous illnesses, oral health behaviours, dietary habits, parental smoking behaviours and parents' dental history. The intraoral examination recorded dental caries (dmfs), enamel defects, gingival health, melanin pigmentation and soft tissue health. Stimulated saliva was collected. Total sIgA levels were quantified using indirect competitive ELISA with a SalimetricsTM kit., Results: The 44 children (aged 15-69 months) recruited were divided into two groups: ETS and non-ETS (control). There were 22 children in each: 16 who were exposed to ETS during and after gestation were identified as the ETSB subgroup. Participants exposed to ETS were more likely to have had upper respiratory tract and middle ear infections during the neonatal period and had higher mean dmft, mean dmfs, mean percent of surfaces with demarcated opacities and mean GI than the non-ETS participants. The children exposed to ETS before and after birth had the highest occurrence of enamel opacities showed a higher risk for dental caries even though more children in this group used the recommended fluoride toothpaste (1000 ppm fluoride). Mothers who smoked either never breastfed their children or breastfed their children for less than the recommended period of 6 months. Children exposed to ETS were shown to have higher mean total sIgA (μg/ml) than the children in the control group., Conclusions: Associations between ETS exposure before and after gestation and oral health, including salivary changes in young children were shown in the present study. Dental health professionals should include a question about household smoking in children's dental histories, which would allow opportunities to discuss the impact of smoking on child oral health. Longitudinal oral health studies should include a history of maternal smoking during pregnancy and afterwards.

The oral health of children and adolescents mirrors their general health. Because oral health care is often delivered in isolation from general health care, oral signs and symptoms do not always alert practitioners to their significance beyond the mouth. An important example of this is the association of a higher risk of dental caries and periodontal disease in children and adolescents with overweight, obesity and prediabetic conditions. Oral-health practitioners need to consider the health conditions that their patients may have. This will aid in diagnosis and alert the practitioner to oral conditions that may not resolve without general health-care intervention also. This paper reviews the more common oral conditions involving periodontal health in children and adolescents, and discusses the diagnosis of these conditions, potential associated health problems and the roles of pediatric dentistry and periodontology in the management of these conditions with the goal of children entering adulthood with healthy dentitions., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objectives: Prior to the introduction of the Southern District Health Board's reconfigured Community Oral Health Service in Otago, a project was undertaken with parents to investigate their knowledge, understanding and views of the historical School Dental Service and of the Community Oral Health Service that was being introduced., Methods: Focus groups were run during 2011 in ten selected schools (parents with children in years 1-8) across two areas in Otago to represent ur ban and rural settings and to represent parents who were already travelling to dental services., Results: Parents valued the traditional School Dental Service in Otago highly, generally agreeing that the service based in schools was accessible and convenient for parents and children. Rural parents who had always taken their children to dental appointments viewed it as a normal process, accepting that there could not be a service located in every school. Parents were aware that facilities were out-of-date. They highlighted the challenges of locating therapists since they started moving from school to school in the later 1990s and felt it was difficult for children seeing different therapists at each recall. There were diverse views on the proposed new system. Some parents felt that school-aged children should go to dental clinics on their own or with peers, while other parents welcomed the opportunity to attend when their child was having health care., Conclusion: It appears that the Community Oral Health Services should have an ongoing process to seek the views of parents and children about the service.

Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious complication of bisphosphonate therapy. The mechanism underlying BRONJ pathogenesis is poorly understood., Objectives: To determine the effects of zoledronic acid (ZA) and geranylgeraniol (GGOH) on the mevalonate pathway (MVP) in osteoblasts generated from the human mandibular alveolar bone in terms of cell viability/proliferation, migration, apoptosis and gene expression., Materials and Methods: Primary human osteoblasts (HOBs) isolated from the mandibular alveolar bone were phenotyped. HOBs were cultured with or without ZA and GGOH for up to 72 h. Cellular behaviour was examined using a CellTiter-Blue® viability assay, an Ibidi culture-insert migration assay, an Apo-ONE® Homogeneous Caspase-3/7 apoptosis assay and transmission electron microscopy (TEM). Quantitative real-time reverse transcriptase polymerase chain reaction (qRT 2 -PCR) was used to determine the simultaneous expression of 168 osteogenic and angiogenic genes modulated in the presence of ZA and GGOH., Results: ZA decreased cell viability and migration and induced apoptosis in HOBs. TEM revealed signs of apoptosis in ZA-treated HOBs. However, the co-addition of GGOH ameliorated the effect of ZA and partially restored the cells to the control state. Twenty-eight genes in the osteogenic array and 27 genes in the angiogenic array were significantly regulated in the presence of ZA compared with those in the controls at one or more time points., Conclusion: The cytotoxic effect of ZA on HOBs and its reversal by the addition of GGOH suggests that the effect of ZA on HOBs is mediated via the MVP., Clinical Relevance: The results suggest that GGOH could be used as a possible therapeutic/preventive strategy for BRONJ.

The aim of this study was to compare total IgA in the whole saliva of children with Down syndrome with levels in sibling and parent groups. IgA measurements were presented as the concentration in saliva (μg/ml) and also adjusted for salivary flow rate (SFR; μg/min). Twenty children with Down syndrome, ten siblings and twenty parents were recruited. Stimulated whole saliva was collected from the participants and SFR calculated. The measurement of salivary IgA (sIgA) was carried out using an indirect competitive Enzyme-Linked Immunosorbent Assay. The difference in the mean SFR between children with Down syndrome, parents and siblings were not statistically significant. The mean salivary concentration of IgA was higher in children with Down syndrome (95.1 μg/ml) compared with siblings (48.3 μg/ml; p=0.004). When adjusted for SFR children with Down syndrome had mean sIgA levels of 98.8 μg/min and the siblings 48.6 μg/min (p=0.008). The children with Down syndrome had sIgA levels similar to those of the parents (92.5 μg/ml; 93.2 μg/min). There was a positive correlation between age and sIgA concentration in the siblings (p=0.008) but not for children with Down syndrome (p=0.363). This suggests that under similar environmental influences, the levels of sIgA in children with Down syndrome are higher than in the siblings, from a very young age., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Radiography can serve as a useful aid in the diagnosis of numerous oral conditions, with a place in nearly all of the disciplines of dentistry. As such it can have a beneficial role in caring for the oral health of children and adolescents. The following review discusses the use of radiography in the diagnosis of oral conditions in children and adolescents, with particular reference to the diagnosis of dental caries, dental trauma, growth and development and in other dental scenarios, along with the importance of incidental findings. The risks associated with radiation exposure from the use of radiography are discussed, how these need to be balanced with the possible benefits associated with such use, as well as how risks could be minimised. Summary recommendations are also presented, providing an overview of the use of radiography for oral diagnosis in various clinical scenarios for children and adolescents.

Raman spectroscopy was used to investigate how the effect of pre-treatment protocols, with combinations of hydrochloric acid (HCl), sodium hypochlorite (NaOCl) and hydrogen peroxide (H2O2), for molar-incisor hypo-mineralisation (MIH) altered the penetration depth of polymer infiltrants (ICON, DMG, Hamburg, Germany). Furthermore, the effect on the structure of the MIH portions of the teeth with treatment is examined using multivariate analysis of spectra. It was found that pre-treatment protocols improved penetration depths. The structure of the MIH portion post-treatment appeared much closer to that of normal enamel suggesting a diminution of protein in the MIH region with treatment.

Management of the pulpal tissue in primary teeth is a clinical challenge facing dental practitioners on a regular basis. This article reviews the most common treatments used at the present time in the management of the pulp in deciduous teeth. It gives an overview of treatment options and the indications and contra-indications for the different treatment modalities. The evidence behind the medicaments used, their actions and success rates are discussed. Practical guidelines for choosing to retain or extract deciduous teeth and management of the primary tooth pulp with different clinical presentations are discussed. Areas of future research are highlighted.

The mevalonate pathway (MVP) and the anti-angiogenic effect of bisphosphonates have been shown to play a role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). This study determined the effect of the bisphosphonate, zoledronic acid and the replenishment of the MVP by geranylgeraniol on human gingival fibroblasts. Cell viability, apoptosis, morphological analysis using transmission electron microscopy, and gene expression for vascular endothelial growth factor A, bone morphogenic protein 2, ras homologue gene family member B, epiregulin and interferon-alpha were conducted. Results showed cellular viability was decreased in the presence of zoledronic acid and the co-addition of zoledronic acid with geranylgeraniol restored cell viability to control levels. Caspase 3/7 was detected in zoledronic-acid-treated cells indicating apoptosis. Transmission electron microscopy revealed dilation of the rough endoplasmic reticulum with zoledronic acid and the appearance of multiple lipid-like vesicles following the addition of geranylgeraniol. Zoledronic acid significantly (P < 0.05, FR > ± 2) up-regulated vascular endothelial growth factor A, bone morphogenic protein 2, ras homologue gene family member B and epiregulin at one or more time points but not interferon-alpha. Addition of geranylgeraniol resulted in a reduction in the expression of all five genes compared with zoledronic-acid-treated human gingival fibroblasts. The study concluded geranylgeraniol partially reversed the effects of zoledronic acid in human gingival fibroblasts both at the cellular and genetic levels, suggesting the regulation of these genes is mediated via the mevalonate pathway., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Avulsion of a primary tooth is a serious dental trauma, and the guidelines of the International Association of Dental Traumatology and textbooks in paediatric dentistry do not recommend replantation. Such management can result in severe damage to the supporting structures, and together with avulsion itself is commonly associated with developmental disturbances of the permanent tooth. We report the case of replantation in a 9-month-old child with a successful outcome, in a unique situation where conditions were optimal and careful long-term follow up was possible., (© 2012 John Wiley & Sons A/S.)

The prevalence of dental caries continues to increase, and novel strategies to reverse this trend appear necessary. The probiotic Streptococcus salivarius strain M18 offers the potential to confer oral health benefits as it produces bacteriocins targeting the important cariogenic species Streptococcus mutans, as well as the enzymes dextranase and urease, which could help reduce dental plaque accumulation and acidification, respectively. In a randomized double-blind, placebo-controlled study of 100 dental caries-active children, treatment with M18 was administered for 3 months and the participants were assessed for changes to their plaque score and gingival and soft-tissue health and to their salivary levels of S. salivarius, S. mutans, lactobacilli, β-haemolytic streptococci and Candida species. At treatment end, the plaque scores were significantly (P = 0.05) lower for children in the M18-treated group, especially in subjects having high initial plaque scores. The absence of any significant adverse events supported the safety of the probiotic treatment. Cell-culture analyses of sequential saliva samples showed no differences between the probiotic and placebo groups in counts of the specifically enumerated oral micro-organisms, with the exception of the subgroup of the M18-treated children who appeared to have been colonized most effectively with M18. This subgroup exhibited reduced S. mutans counts, indicating that the anti-caries activity of M18 probiotic treatments may be enhanced if the efficiency of colonization is increased. It was concluded that S. salivarius M18 can provide oral health benefits when taken regularly.

Background: Dental problems in early childhood can have a very significant effect not only on the oral health of young children but on their quality of life and that of their families. Added to this are the long term risks they carry into the permanent dentition., Aim: To review current literature on the management of early childhood caries and its influence on wider oral and general health., Results: Recent studies suggest that the risks for dental caries, periodontal disease, malocclusion and other general health problems including overweight and obesity may be increased in children who have had early childhood caries. Traditional restoration of damaged primary teeth has been shown to have only moderate outcomes depending on the techniques and materials used and the ability of children to cooperate because of age or other factors., Conclusions: More recent interesting approaches that seal enamel caries, only partially remove carious dentine or attempt to entirely seal carious dentine lesions merit not only discussion but also longer term investigation. With increasing demands on health funding, dentistry must look at how the most appropriate care can be provided to allow children to reach adulthood with healthy permanent dentitions - something that less than half the population currently achieve.

Objective: To compare the severity of dental caries in the primary dentitions of children under 7 years (who received comprehensive restorative treatment under general anaesthesia, GA) from an optimally fluoridated area (0.85 ppmF) and a low-fluoride area (approximately 0.1 ppmF)., Research Design: Consecutive clinical case series: clinical details (diagnoses and the treatments provided) were recorded for children who had received comprehensive dental care under GA between 2000 and 2009. Age, gender, ethnicity, socio-economic status and fluoridation status (determined from the residential address) were also recorded., Results: Of the 1396 treated children, 55.7% came from fluoridated areas and 52.5% were male. On average, children from low-fluoride areas were 2.4 months younger and presented with more decayed deciduous teeth than those from fluoridated areas (4.9 and 3.9 teeth respectively; p<0.0001). For each tooth type, the mean number of carious teeth at presentation was greater among the children from low-fluoride areas. In the multivariate model, the number of deciduous teeth affected by caries was lower among older children, those residing in a fluoridated area and among those seen after 2001. It was higher among those not living in high-SES areas., Conclusions: Children with severe dental caries had statistically significantly lower numbers of lesions if they lived in a fluoridated area. The lower treatment need in such high-risk children has important implications for publicly-funded dental care.

Background: To be maximally effective, oral health preventive strategies should start at birth. There appear to be few reports on pregnant women's knowledge of oral health care for their developing children., Objectives: This exploratory study assessed Dunedin expectant mothers' knowledge of the oral health care of their future children., Methods: A questionnaire was developed to assess expectant mothers' knowledge of child oral health and appropriate prevention strategies. Three public Lead Maternity Carer (LMC) organisations and 30 private individual LMCs were asked to distribute the questionnaire to their clients attending appointments during a one-month period. Questions focused on the mother's knowledge of oral health practices for their future children, including oral hygiene and access to dental care., Results: Fewer than half of the participants thought they had enough information about their child's oral health needs. One-quarter thought that toothbrushing should not start until after two years of age. The majority thought their child should not be seen by a dental professional until this age, while one-fifth did not think their child should be seen until four years old. Poorer child oral health knowledge was found in first-time mothers, younger women, those from low-SES groups, and those who were not New Zealand (NZ) Europeans., Conclusions: A substantial number of participants were unaware of how to provide appropriate oral health care for their children despite the available information. This lack of awareness needs to be taken into account when designing oral health promotion strategies for parents of very young children.

Aim:  The aims were to identify the predominant causes and types of orofacial injury in young children attending clinics at a University Dental School in Dunedin, New Zealand., Material and Methods:  A retrospective analysis of data from the records of all children aged 0-10years who had been seen for orofacial trauma in 1999 and 2000 was undertaken., Results and Conclusions: Three hundred traumatic incidents in 288 children were analysed; 86.6% had causes noted. In very young children, most injuries were because of falls, while collisions, falling and sports were responsible for more injuries in school-aged children. Playground equipment and ride-on vehicles played a role particularly in the older children. There were no incidents of trauma as a result of road traffic accidents. Ten injuries were caused by animals, mainly dogs. Location was recorded for two-thirds of accidents: the predominant place was at home, followed by school. No seasonal variation was apparent. There were 228 non-dental injuries, of which the majority were to the lips. The predominant dental injuries in both dentitions were concussions and subluxations with a significantly higher occurrence of both in the primary dentition (P<0.001). Upper central incisors were most often involved. The age distribution for boys and girls was similar. In conclusion, the causes and types of orofacial trauma in this group of young New Zealand school children attending a university dental school were similar to other studies, except for the high proportion of concussions recorded in both dentitions. While the injuries were well described, not all records noted the cause or location. This has resulted in changes to the standard recording form to provide consistency in data capture. Information from this study will also be used to support child injury prevention strategies in New Zealand., (© 2011 John Wiley & Sons A/S.)

Background/aim: Few studies have investigated how patients feel about traumatic injuries to teeth. Dentists may focus on treating an injury and neglect to address how the patient views the severity, or aesthetics. Addressing these issues may improve trauma management and communication between dentists and patients. The aim of the study was to compare children's, adolescents' and young adults' perceptions of common dental injuries to the maxillary central incisor teeth., Materials and Methods: A cross-sectional study was conducted with 138 participants selected by convenience sampling and divided into 6- to 10-year, 11- to 17-year and 18- to 24-year age groups. Participants were shown six coloured photographs of traumatic injuries to central incisors and asked four questions. Data were analysed using SPSS. Group differences were evaluated using Mann-Whitney U and Kruskal-Wallis H tests., Results and Conclusions: There were statistically significant differences between the 6- to 10-year and 18- to 24-year age groups as to which traumatic injury would hurt the most (P < 0.05). Responses from younger participants appeared to be affected by the presence of blood in photographs, while young adults were more 'tooth-focused.' Younger children selected extrusion as the most painful injury, and the oldest group selected the complicated crown fracture. For the youngest age group, a missing anterior tooth was least concerning aesthetically, while young adults were most likely to choose discolouration (P < 0.05). Most in each age group thought crown fractures (particularly complicated ones) would be the most difficult for a dentist to treat., Conclusions: Statistically significant differences (P < 0.05) were found among the youngest and oldest age groups in their perceptions of which type of injury would hurt most and which injury was the least attractive. This study suggests that children and young adults may perceive the significance of their dental injuries quite differently than dental professionals., (© 2011 John Wiley & Sons A/S.)

Objectives: The aim of the study was to compare the relative amounts and nature of the proteinous content of sound and molar-incisor hypomineralisation (MIH) enamel., Methods: TCA (20%) was used to dissolve the mineral phase and precipitate the proteins from enamel pieces sectioned from sound and MIH enamel. The protein content was estimated using a miniaturized version of the method of Lowry et al. Samples of the solubilised protein were separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), stained with Coomassie Blue R250 and tryptic fingerprint/mass spectrometry (MS/MS) of bands in excised gel pieces used for protein identification., Results: Compared to sound enamel, brown enamel showed a 15-21-fold higher protein content, and yellow and chalky enamel showed about 8-fold higher protein content. Tryptic fingerprint/MS performed on excised 50-70kDa areas demonstrated serum albumin, type I collagen and antitrypsin to be common to all types of enamel. Yellow and brown enamel showed more abundant serum albumin and antitrypsin, and the presence of serum antithrombin. Albumin is reported to be an inhibitor of crystal growth, and antitrypsin and antithrombin inhibit kallikrein 4 proteolytic activity., Conclusions: The combination of the effects of serum proteins on developing enamel may result in elevated proteinous content and reduced mineral content as seen in MIH enamel., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objectives: To characterize molar-incisor hypomineralisation (MIH) defects of different severities quantitatively and qualitatively using X-ray microtomography (XMT) and to measure the range of reduction in mineral density (MD) of MIH enamel compared with the normal range., Methods: Ten sound teeth and ten MIH teeth were scanned using a commercial XMT system. Four hydroxyapatite phantoms of different densities were used as calibration standards with each scan. A calibration equation derived from the phantoms with each tooth was used for MD calibration. MD was traced from the cementum-enamel junction (CEJ) to the cusp tip and from the dentine-enamel junction (DEJ) to the outer enamel surface., Results: In sound teeth, MD increased from CEJ to cusp/incisal tip, while in MIH teeth MD dropped from the CEJ to the occlusal region, then increased again at the cusp tip. MD was highest midway between DEJ and outer enamel in sound teeth. In MIH, enamel showed normal thickness and MD was highest near the DEJ and then decreased towards the outer enamel. MD of MIH enamel was on average about 19% lower than sound enamel. The MIH defects seemed to follow the incremental lines of enamel formation., Conclusions: MIH defects are hypomineralised defects of different severities that follow the natural incremental lines of enamel formation. Cuspal areas are usually only mildly affected and cervical enamel always appears to be sound.

Objectives: To study the relation between the mechanical properties of hypomineralised enamel, and its laser fluorescence (LF)., Methods: Five extracted teeth with molar-incisor hypomineralisation (MIH) were sectioned longitudinally through the defects and polished to prepare the hypomineralised enamel for testing. Hardness (H) and elastic modulus (E) of enamel were measured using nanoindentation. Measurement recording started from the cervicoenamel junction and proceeded occlusally in increments of 200 microm. Laser fluorescence readings were taken along the same line and at the same sites using a DIAGNOdent pen., Results: H, E, and LF readings from cervical enamel were within the expected range for normal sound enamel. After log transformation of the H and E measurements to allow for linear correlation analysis, there was a significant and moderately strong inverse correlation between LF and H or E samples (r (between specimens)=0.59, r (between specimens)=0.39, respectively; p<0.001)., Conclusions: This study shows that, in the absence of dental caries, increased DIAGNOdent readings can indicate enamel hypomineralisation. While the increased LF readings in carious enamel are thought to be related to the presence of caries bacterial metabolites, the increased readings in hypomineralised enamel may be related to proteins in the hypomineralised enamel and/or light scattering by the inhomogeneous enamel.

Amelogenesis imperfecta (AI) is a group of hereditary conditions that affect enamel formation. It is associated with a high morbidity for the patients and may present major restorative and sometimes orthodontic challenges for the dental team. Early recognition followed by appropriate preventive and restorative care is essential in the successful management of AI. A multidisciplinary approach with careful planning from early childhood will maximise the treatment options available for the permanent dentition and optimise the final outcome. In this case, a team consisting of two paediatric dentists, an orthodontist, a restorative dentist, and an oral and maxillofacial surgeon were involved in the management of the patient over a 12-year period. Treatment included preventive advice, interim composite restorations, two phases of orthodontic treatment, orthognathic surgery and placement of cast crowns. The patient is extremely happy with the result.

Objectives: The objective was to review the outcomes for three groups of children after two, three and four years following comprehensive dental treatment under general anaesthesia (GA) for 292 children aged 1.8 to 5.9 years of age., Design: The study was a retrospective review of ongoing dental treatment needs following treatment under GA., Methods: Information including the individual tooth treatments carried out, ongoing care, fluoride status, socioeconomic status and ethnicity was obtained from dental records from the School of Dentistry and the Otago District Health Board School Dental Service. The accuracy of the records was evaluated by clinically examining 10 percent of the children., Results: Ninety-five percent of the treated children were followed up. Fifty-five percent had new caries recorded. For the treatments provided, amalgam had a mean success of 57.1 percent, composite 73.4 percent, compomer 85.2 percent, stainless steel crowns 92.8 percent and pulpotomies 84.6 percent. The majority of replaced restorations were because of new carious lesions., Conclusions: This study indicated that most of the restorative procedures and materials used have very successful outcomes in these high-risk children. Ongoing risk of dental caries is high despite current preventive approaches. Other preventive approaches should be investigated.

Congenital contractural arachnodactyly (CCA) is an inherited disorder of connective tissue similar to Marfan's syndrome. The craniofacial and oral features of a young girl with CCA are described. The patient has the typical features of CCA as well as some additional dental anomalies which have not previously been reported with this syndrome. These include banded pitted enamel hypoplasia and hypomineralization, long, spindly tapered roots, and pulp canal obliteration with multiple pulp stones. Dentists must be aware of the clinical features of a patient's syndrome to determine whether there are implications for dental treatment such as a need for antibiotic prophylaxis. It is important to exclude Marfan's syndrome as a differential diagnosis for CCA because the former has more associated complications and a less favorable prognosis.

Aim: Cheeses have been investigated for their potential cariogenicity in several studies and have been shown to produce little change in the resting pH in dental plaque and little or no demineralisation of enamel in most intra-oral cariogenicity studies. The aim of the present study was to investigate the cariogenicity of four processed cheese formulations., Methods: Enamel demineralisation was measured intra-orally in bovine enamel, and aliquots of 10g of each test cheese were used to assess plaque pH using the plaque harvesting technique after the San Antonio criteria. In a second experiment, the same cheeses were assessed for their effects on enamel using the intra-oral cariogenicity test (ICT) with bovine enamel., Results: None of the four cheeses caused pH drops below the critical pH and two of the cheeses raised the pH slightly. The effects on pH were all significantly different from those of the sucrose saliva control. None of the cheeses produced microhardness changes that were statistically significantly different from the saliva control., Conclusion: None of these cheeses as tested were found to lead to acidogenicity and by inference to be cariogenic. They were therefore deemed to be safe for teeth when used as a food.

Aim: To investigate the prevalence and severity of tooth wear in the primary dentition of a representative sample of New Zealand school children and relate these to possible risk factors., Design: A cross-sectional study., Setting: Primary schools in Dunedin, New Zealand., Participants: 104 children of both sexes, aged between 5 and 8 years, randomly selected., Methods: Clinical examinations of the buccal, occlusal/incisal and lingual surfaces of deciduous canines and molars., Main Outcome Measure: Degree of wear and the presence of dentinal cupping of teeth. Information on weaning and consumption of fruit-based drinks at bed time, frequency of consumption of fruits, yoghurt, pickled foods, fizzy and fruit-based drinks., Results: The prevalence of tooth wear was similar in boys and girls and there were no significant differences between sides of the arches. A high percentage (82%) of children had at least one primary tooth with dentine exposed. While maxillary canines showed the greatest prevalence of dentine exposed, maxillary molars displayed the greatest prevalence of cupping. Severe tooth wear was less prevalent among children weaned after 12 months (14.3%) than those weaned earlier (27.9% P < 0.01). There were no statistically significant associations between wear and the consumption of fruit, yoghurt, pickled foods, fizzy drinks or fruit-based drinks., Conclusions: Tooth wear associated with dentine exposure is common in 5-8 year old children. This is not significantly associated with dietary factors, but appears to be related to early weaning from the breast.

Preventive dental care for children and adolescents requires a good understanding of the dental caries process and the particular relationships that exist throughout childhood and young adulthood. Only when these relationships are understood can they be used to diagnose dental caries risk and apply appropriate preventive therapies and restorative care that is effective. The need to diagnose risk when applying preventive care is as important for individual patients as it is for population groups. At the individual level, the aim is to aid the development of a healthy functioning dentition for life. This applies in the population group level but the cost benefits also become important in justifying the funding to carry out preventive practices. Risk can be determined by general factors including the socioeconomic status, access to optimally fluoridated drinking water and age. Specific factors include the microbiology of the dental plaque, dietary practices, oral hygiene practices, individual fluoride use and previous dental caries history. Once the risk has been diagnosed and the related factors identified, the best preventive approach can be selected. This may include oral hygiene, dietary change, fluoride recommendations, restorative care using fluoride releasing materials or antibacterial mouthwashes. The dentist may play several roles in preventive dental care. The first is as the giver of advice and care for the individual child patient; the second is as an advocate to help the child get the care by getting the consent and support of the parents; and the third may be to lobby for the appropriate funding to obtain this care in publicly funded programs.

Undoubtedly, to achieve the goals set for oral health in New Zealand, representative leadership is essential for effective coordination of work force planning, education, and research. It is to be hoped that, from discussion and debate, this Forum will be able to make suggestions or recommendations for a structure that can be developed to allow the appropriate representation and leadership to drive research and work force planning for the provision of oral health care in New Zealand.

Panoramic radiographs of 1,608 children and adolescents aged 10 to 15 years (797 males and 811 females) were reviewed to determine the prevalence of tooth and jaw abnormalities. Abnormalities were detected on 21 percent of the radiographs (23 percent females and 17.3 percent males); 879 teeth were diagnosed with abnormalities on 331 radiographs. The more common abnormalities were malpositioned teeth, missing teeth, misshaped teeth, and teeth with hypoplastic appearance. Bony abnormalities and growth problems were detected in a few radiographs. This study demonstrates the value of panoramic radiography in detecting or confirming dental abnormalities, and supports recommendations on the use of panoramic radiography to aid in the assessment of dental development.

This study investigated the disposal of clinical waste within dental surgeries in Bangkok, Thailand and followed the waste trail to the rubbish tips. A questionnaire was sent to all dental practices in the Bangkok Metropolitan Area. The response rate was 57.7 per cent. At the same time, rubbish collectors and scavengers were interviewed to see if they encountered clinical dental waste. Few dentists complied with all recommendations for the disposal of waste. Most waste was disposed of into the domestic rubbish stream. Rubbish collectors and scavengers knew what dental rubbish looked like and some had had needle-stick injuries. Although recommendations can be made to the dental profession to alter their behaviour, real improvement is unlikely without changes to legislation and social policy.

The effectiveness of electronic dental anesthesia (EDA) for pain control during restorative procedures was compared with local anesthetic injection (LA) in 32 children aged 6 to 12 years. Each child selected had two antimere primary or permanent molars requiring similar-sized Class I or Class II restorations. The pain levels during restorative treatment were assessed using a visual analogue scale. Heart rates and behavior were also recorded. A crossover design was used with each child acting as his/her own control. The results showed that overall, EDA was less effective than LA for cavity preparation. The reported pain scores for EDA were higher in permanent teeth for the deeper cavities, and with one of the operators. The pre- or post-treatment anxiety scores were not found to differ significantly between the two restorative appointments. However, children with the highest pretreatment scores were more likely to report higher pain scores with EDA. Despite this, 63% of the children preferred EDA to LA. Dental anxiety, cavity depth, the tooth being treated, and operator attitude may also be important factors in determining the success of EDA.

Several previous studies using food consumption tables or diet records have estimated that children aged 1 to 12 years resident in fluoridated (1 ppm) areas receive, on average, between 0.05 and 0.07 mg fluoride/kg body weight from foods and drinks alone. In this study, the duplicate-diet approach, which is a more accurate method of determining nutrient intake, was used to determine if levels of fluoride intake from foods and drinks are similar to those estimated from food consumption tables or diet records. Duplicate portions of all foods and drinks consumed over 24 hours by 66 children aged 3 to 4 years resident in fluoridated and low-fluoride areas of New Zealand were collected on three separate days over a period of 12 months and analyzed for fluoride. Fluoride intake from the use and ingestion of toothpastes and fluoride supplements was also determined for each child. It was hypothesized that the total amount of fluoride received by children in low-fluoride areas from diet, toothpastes, and fluoride supplements was similar to that received by children in fluoridated areas from diet and toothpastes. The mean fluoride intake from foods and drinks alone in the low-fluoride areas was 0.008 +/- 0.003 mg/kg body weight (0.15 +/- 0.06 mg/day; n = 34) and in the fluoridated areas was 0.019 +/- 0.009 mg/kg body weight (0.36 +/- 0.17 mg/day; n = 32). The mean fluoride intake from foods and drinks and toothpastes in the low-fluoride areas was 0.027 +/- 0.012 mg/kg body weight (0.49 +/- 0.25 mg/day) and in the fluoridated areas was 0.036 +/- 0.015 mg/kg body weight (0.68 +/- 0.27 mg/day). Fluoride intake from diet alone did not exceed 0.04 mg/kg body weight (0.74 mg/day), and fluoride intake from diet and toothpaste did not exceed 0.07 mg/kg body weight (1.31 mg/day). The results suggest that levels of fluoride intake from foods and drinks alone as estimated by the duplicate-diet approach are much lower than previously estimated from food consumption tables or diet records. It was calculated that if all children in the low-fluoride areas were to take currently recommended dosages of fluoride tablets, which have been based on dietary surveys and diet records, then the total fluoride intake of some children in the low-fluoride areas would exceed that of their counterparts in the fluoridated areas. The results suggest that currently recommended dosages of fluoride tablets need to be further reduced if dental fluorosis in children is to be avoided.

Proximal contact loss due to caries may contribute to the appearance of marginal alveolar bone loss (ABL) in the deciduous dentition. Children referred for treatment to the School of Dentistry, University of Otago, usually have special problems related to caries or management, or both, and the aim of the study was to determine the prevalence of marginal ABL in children treated in this clinic, and to compare it with that found in a previous study in a random sample of New Zealand 5-year-olds. Posterior bite-wing radiographs of 187 children, aged 4 to 14 years, were selected for examination. A total of 1,523 sites, from the distal of the deciduous cuspids to the mesial of the deciduous second molar or the first permanent molar if present, were examined. ABL was recorded when there was complete absence of the lamina dura and the distance from the cemento-enamel junction to the crest of the alveolar bone was > 2 mm. ABL was found in 20.8 percent of the children; 31.9 percent of these sites were adjacent to extensive proximal caries; 83.3 percent were in the maxilla, and 95.8 percent were between deciduous teeth. The youngest age at which ABL was found was 5 years. Among the children with ABL, 48.7 percent had ABL in more than one site. Comparison of the prevalence of ABL at age 5 in the present study (19.2 percent) with the one previously reported for a random population (2.1 percent), suggested that, because of the special characteristics of the children attending the University clinic, students are exposed to an exaggerated image of caries and periodontal diseases in children.

For children with extensive caries of primary teeth, or with deformed or traumatised teeth, restoration with composite using a crown form gives excellent results. Strength is gained by full crown coverage. The aesthetics are very acceptable. The technique also allows primary teeth to be modified to resemble permanent teeth when these are missing and the primary teeth are being kept until more definitive treatment is provided. Caries is usually well controlled, and space loss due to further tooth breakdown is avoided.