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Invasive atypical fibroxanthomas and undifferentiated pleomorphic sarcomas of the scalp are relatively rare spindle cell tumors that recur at high rates. Wide local excision and Mohs surgery alone are not feasible for the definitive management of lesions adhering to the underlying pericranium and/or calvarium. This brief clinical study presents 2 patient cases and includes a systematic review of the literature. In our literature review, 2 of 4 patients treated with outer table resection had no disease recurrence, 1 died due to an unrelated cause, and 1 died due to disease progression. Three of 9 patients treated with full-thickness craniectomy had no disease recurrence, 5 patient outcomes were not specified, and 1 died from disease progression. There are currently no recommendations for the management of these invasive scalp lesions. We believe invasive atypical fibroxanthomas/undifferentiated pleomorphic sarcomas of the scalp without frank calvarial involvement can be effectively treated with outer table resection., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

We report the case of a male presenting with a large, fungating Marjolin ulcer over a prior craniectomy defect that had undergone several attempts at reconstruction. On presentation, he had a large area of exposed, fibrotic dura that ultimately required excision of the outer layer prior to placement of Integra (Integra LifeSciences, Plainsboro, NJ) and subsequent split-thickness skin grafting. Although there have been four other reports of dermal regeneration templates being used on exposed dura, this is the first case report of one being used on exposed dura that required dural preparation prior to placement. We discuss our rationale for this method of reconstruction, the histology of dermal regeneration template incorporation, and why this approach was necessary to allow for incorporation in this patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Leach et al.)

Introduction: Recent reviews lament the lack of evidence on the efficacy of regenerative procedures to induce further root maturation despite claims of a paradigm shift in the way infected, necrotic immature teeth with arrested root development can be endodontically treated. The majority of reports are either case series or successful case reports where nonstandardized images may make interpretation uncertain., Methods: This prospective clinical study reports on preliminary outcomes of regenerative endodontic procedures carried out on 16 teeth, 3 mandibular premolars and 13 traumatized central incisors, after 18-month reviews. Qualitative analysis of resolution of periapical radiolucencies and apical closure was undertaken. Quantitative analysis compared preoperative and recall radiographs by using a geometrical imaging program that calculated percentage changes in root length and dentin wall thickness., Results: Qualitative assessment showed 90.3% resolution of the periapical radiolucency. Apical closure was assessed as incomplete in 47.2% and complete apical closure in 19.4% of cases. Quantitative assessment showed change in root length varying from -2.7% to 25.3% and change for root dentin thickness of -1.9% to 72.6%., Conclusions: Patterns of continued root maturogenesis were variable at 18-month review. Reviews at 36 months showed continued root maturogenesis for 2 cases. Quantitative analysis can control for changes in angulation but may introduce other measurement errors. However, not all anterior teeth were suitable for TurboReg assessment because overlapping of the cementoenamel junctions and/or further eruption of teeth often precluded stable landmark positioning. Discoloration of the crown was a common consequence, with unaesthetic results in 10 of the 16 cases., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: The dental profession has a pivotal role in cancer prevention. In Queensland, oral health therapists (OHTs) are in a unique position to provide quality smoking cessation programmes and intervention strategies to young adolescents through the school based oral health services they provide., Methods: This study undertook a smoking cessation and prevention programme targeted to female high school students in a dental setting. An oral health therapist delivered an anti-smoking message and educated adolescents of the health-risk effects of smoking., Results: A total of 1217 female students were recruited with 621 (51%) in the intervention group and 596 (49%) in the control group. There was a significant improvement in the knowledge of both systemic and oral health effects of smoking in the intervention group (p < 0.04). The results of the study demonstrated that the dental setting is an effective avenue for educating young individuals on smoking related conditions., Conclusions: A smoking cessation and prevention programme targeted to female high school students in a dental setting provides a novel means of delivering an anti-smoking message and educating adolescents of the health-risk effects of smoking., (© 2013 Australian Dental Association.)

Marfan syndrome (MFS) is a connective tissue disorder of variable inheritance that affects multiple organ systems. Cardiovascular, ocular, and skeletal abnormalities are cardinal features of the syndrome. Orofacially, MFS patients typically exhibit skeletal class II malocclusion, dolichofacial growth pattern, mandibular retrognathia, malar hypoplasia, high arched palate, dental crowding, and root anomalies. The purpose of this paper is to provide a review of the literature, as well as describe an 11-year-old female with MFS diagnosed at the age of 10.5 years. This report emphasizes the orofacial findings in MFS and highlights particularities of dental treatment when social deficits and intellectual disabilities are also implicated., (©2013 Special Care Dentistry Association and Wiley Periodicals, Inc.)

Background: There is little information available regarding dental emergencies for children in Australia. The aim of this study was to investigate the reasons for dental emergency cases which were treated at a public oral health clinic in a low socioeconomic district in south-east Queensland., Methods: From a register kept at a public oral health clinic, we analysed the monthly number of emergency visits for children over a three-year period (January 2008 to August 2010) with respect to numbers treated, reasons for presentation and types of treatment rendered., Results: During the period 2008-2010, there was a mean of 196 ± 86 cases presenting for emergency care each month. The proportions of the various types of emergencies remained fairly consistent over the three-year period, with the majority presenting for caries related problems (74-75%), followed by trauma (8-9%), orthodontic treatment related (2-5%) and other reasons (16-11%). Between 8-11% of cases were preschool children who were added to the waitlist for treatment for caries under general anaesthesia at the public hospital., Conclusions: Trends in the past three years at a public oral health clinic in a low socioeconomic district in south-east Queensland show that dental caries constitute nearly three-quarters of all paediatric emergency appointments., (© 2012 Australian Dental Association.)

Background: The study of enamel hypoplasia (EH) and opacity in twins provides insights into the contribution of genetic and environmental factors in the expression of enamel defects., Aim: This study examined prevalence and site concordance of EH and opacity in the primary dentition of 2- to 4-year-old twins and singleton controls to assess the relative contribution of genetics and the environment to the aetiology of these defects., Design: The study sample consisted of 88 twin children and 40 singletons aged 2-4 years of age. Medical histories were obtained and the children examined for enamel defects., Results: The prevalence of EH by teeth was 21% in monozygotic twins (MZ), 22% in dizygotic twins (DZ), and 15% in singleton controls. Twins showed a higher prevalence of EH compared with singletons (P < 0.05). Factors contributing to increase EH in twins were neonatal complications including intubation. There were no significant differences in site concordance of EH within the MZ twin pairs compared with DZ twin pairs when only presence of EH was considered, whereas a greater concordance was noted between MZ twin pairs compared with DZ twin pairs when both presence and absence of EH were considered., Conclusions: The results suggest that both genetic and environmental factors contribute to observed variation of EH, although it is likely that environmental factors exert a greater influence., (© 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.)

Purpose: The purpose of this study was to compare developmental defects of enamel (DDE) in the primary and permanent dentitions of children from a low-fluoride district., Methods: A total of 517 healthy schoolchildren were examined using the modified DDE criteria., Results: The prevalence of DDE in the primary and permanent dentition was 25% and 58%, respectively (P<.001). The mean number of teeth with enamel opacity per subject was approximately threefold compared to that affected by enamel hypoplasia (3.1±3.8 vs 0.8±1.4, P<.001 in the primary dentition and 3.6±4.7 vs 1.2±2.2, P<.001 in the permanent dentition). Demarcated opacities (83%) were predominant compared to diffuse opacities (17%), while missing enamel was the most common type of enamel hypoplasia (50%), followed by grooves (31%) and enamel pits (19%) (P=.04). In the permanent dentition, diffuse and demarcated opacities were equally frequent, while enamel grooves were the commonest type of hypoplasia (52%), followed by missing enamel (35%) and enamel pits (5%; P<.001)., Conclusions: In a low-fluoride community, developmental defects of enamel were twice as common in the permanent dentition vs the primary dentition. In the primary dentition, the predominant defects were demarcated opacities and missing enamel, while in the permanent dentition, the defects were more variable.

Congenital aplasia of the major salivary glands is rare, and there have been few cases of the condition reported to date. In many cases, absence of the salivary glands is associated with syndromes involving the ectodermal tissues. The xerostomia encountered in affected children is usually associated with increased risk for caries and infections of the soft tissues. The purpose of this paper was to describe the case of a 10-year-old boy with bilateral aplasia of the submandibular and parotid salivary glands and the preventive and restorative treatment rendered. This case study demonstrates the importance of timely diagnosis of this condition in order to prevent the serious oral complications from xerostomia.

Aim: The aim of the present investigation was to compare dental development in children from a non-Caucasian population (Saudi Arabia) with age- and gender- matched children from a Caucasian population (Australia)., Study Design: Randomised study comparing two population groups using a common set of standards., Methods: Dental ages of 842 Australian and 456 Saudi Arabian children were assessed from orthopantomograms (OPGs) using the method of Demirjian and co-workers. The children were divided into male and female groups of 5-6, 7-8, 9-10, 11-12, and 13-14 year-olds, and the dental age of each child compared to that the corresponding calendar age group., Results: In both Australian and Saudi Arabian children, the dental ages were higher than the corresponding calendar ages. The largest difference between calendar and dental ages (1.10±0.80 years, p<0.001) was noted in 11-12 year-old Saudi Arabian girls, and the smallest difference (0.33±1.19 years, p<0.01) in 11-12 year-old Australian boys. These discrepancies between calendar and dental ages were significantly different between Australian and Saudi Arabian children (p<0.01)., Conclusions: Although the results suggest that dental development of both Caucasian and non-Caucasian children are generally underestimated by current standards, a few age-specific differences between the two types of population can be discerned.

Background: Dental erosion (DE) in children is a significant oral health issue and has become a focus for research in clinical paediatric dentistry., Aim: This study investigated DE in the primary dentition of 2- to 4-year-old twin and singleton children with regard to the genetic, medical and dietary factors associated with the condition., Design: The 128 subjects consisted of 88 twin children (31 monozygous, 50 dizygous, 7 unknown zygosity) and singletons (n = 40) aged 2-4 years. Medical, dental, and dietary histories were obtained. The children were examined for DE using a modified index., Results: The prevalence of DE by subject affected was 77% in monozygotic twins (MZ), 74% in dizygotic twins (DZ), and 75% in singleton controls (P > 0.1). Of the teeth scored, 12% had mild, 10% moderate, and 1% severe lesions, and DE was more severe in the older age group (P < 0.05). Concordance rates for erosion lesions in MZ and DZ co-twins were not statistically significant., Conclusions: The prevalence of DE and the concordance of erosion lesions were similar between MZ and DZ twins and singleton children, suggesting that the contribution of genetic factors to DE is negligible., (© 2010 The Authors. International Journal of Paediatric Dentistry © 2010 BSPD, IAPD and Blackwell Publishing Ltd.)

Purpose: The aim of the present investigation was to compare the prevalence of taurodontism in the permanent mandibular first molars of nonsyndromic children with hypodontia and supernumerary teeth with age- and gender-matched controls., Methods: The crown-body root ratios of the permanent first molars were determined from orthopantomograms of 83 children with hypodontia (> or =1 missing teeth) and 37 children with supernumerary teeth (> or =1 extra teeth) compared with normal case controls., Results: In children with hypodontia, only girls showed a significantly higher tendency for taurodontism compared to case controls (P=.003), while boys with hypodontia showed a similar prevalence of taurodontism as controls (P=.83). Children with multiple missing teeth were significantly more susceptible to taurodontism than children with a single missing tooth (P=.004). By contrast, the prevalence of taurodontism in children with supernumerary teeth was not significantly different from that of controls., Conclusions: Compared to normal case controls, children with nonsyndromic hypodontia are more likely to show taurodontism of the permanent first molar teeth whereas children with nonsyndromic supernumerary teeth are not.

Purpose: The purpose of this study was to investigate the rate of dental development in children with nonsyndromic hypodontia and nonsyndromic hyperdontia compared to age- and gender-matched controls., Methods: Dental age assessment was performed using orthopantomograms on 115 children (63 girls, 52 boys) with hypodontia and 61 children (22 girls, 39 boys) with hyperdontia and compared with 176 normal controls, case-matched for gender and age., Results: Both girls and boys with hypodontia showed a significant delay in dental development compared to case controls. The mean differences between dental age and chronological age in hypodontia girls and boys were -0.1+/-1.5 years and -0.1+/-1.2 years, respectively, compared to 1.0+/-1.0 years and 0.8+/-0.8 years in the case controls, respectively (P<.001 for both boys and girls). The delay in dental development was accentuated during puberty. By contrast, no significant differences were observed between hyperdontic children and case controls., Conclusions: Nonsyndromic hypodontia children experience delayed dental development, whereas nonsyndromic hyperdontia children have similar rotes of dental development compared to normal children. These findings have implications for management of dental growth and development in children with agenesis of the teeth and supernumerary teeth.

Background: Despite high clinical significance, the microbiology of the dental biofilm in young children remains poorly understood., Aim: The aim of this longitudinal study was to investigate five Streptoccocus species commonly found in the oral biofilm of children, namely Streptococcus mutans, Streptococcus sobrinus, Streptococcus mitis, Streptococcus sanguinis, and Streptococcus salivarius to determine their relative numbers in caries-free pre-term children, and age-matched full-term controls., Design: Plaque and saliva samples were obtained from 15 pre-term children and 15 age-matched controls at ages 3, 6, 12, 18, and 24 months. A quantitative real-time PCR technique was used to determine the numbers of five species of Streptococcus using probes and primers specific for each bacterial species., Results: All species of Streptococcus generally increased from ages 3 to 24 months. The relative ratios of the bacteria remained fairly constant at all ages studied (P > 0.1). There were no significant differences in numbers of all Streptococcus species between pre-term children and full-term controls at all the ages investigated between., Conclusion: The results show that the relative numbers of S. mutans, S. sobrinus, S. mitis, S. sanguinis, and S. salivarius remain relatively constant from 3 to 24 months of age in caries-free pre- and full-term children.

Purpose: The purpose of this study was to investigate risk factors for enamel hypoplasia (EH) and enamel opacity (EO) in the permanent teeth of healthy schoolchildren from a nonfluoridated community in Australia., Methods: Children with EH (N=104) or EO (N=104) were compared with matched controls without enamel defects (N=105). Subjects who previously resided in on optimally fluoridated town provided data on the effects of drinking fluoridated water., Results: The main risk factors for EH were low socioeconomic status (P < .04), respiratory infections (P < .001), exposure to cigarette-smoking (P = .001), asthma (P = .007), otitis media (P = .01), urinary tract infection (UTI; P = .03) and chickenpox (P = .001). Combinations of either chickenpox and UTI or chickenpox and exposure to cigarette-smoking were associated with relatively high numbers of EH. While use of adult toothpaste (1000 ppm) at 0 to 3 years old increased risks for EH, there were less EO in children who used child toothpaste (300 ppm fluoride, 86% vs. 95%; P = .02) or who drank optimally fluoridated water compared to those who did not (4% vs. 29%; P < .001)., Conclusions: Children with low socioeconomic status, histories of respiratory or chickenpox infections, exposure to cigarette-smoking, urinary tract infections, otitis, and use of adult toothpaste are predisposed to enamel hypoplasia. By contrast, drinking optimally fluoridated water at 0 to 3 years old reduces the risk for enamel opacities.

Background: Inadequate detection of caries in the primary dentition due to non-use of bitewing radiography is commonly encountered in paediatric practice. The present study investigated the increased benefits of using bitewing radiography in addition to the visual-tactile examination technique for detection of primary dentition caries in a non-fluoridated community, and determined the prevalence of "hidden" occlusal caries in the primary dentition., Methods: Primary teeth were scored for caries at the restorative threshold using a visual-tactile technique followed by bitewing radiographic examination in a sample of 611 schoolchildren aged 6.4 +/- 0.5 yrs to 12.1 +/- 0.8 yrs residing in a non-fluoridated city., Results: Overall, at the restorative threshold, the visual-tactile technique could detect 62 per cent of occlusal caries compared to 74 per cent for bitewing radiography (p < 0.001). The prevalence of "hidden" occlusal caries was 12 per cent. In contrast, for primary molar proximal surface caries, the visual-tactile technique could detect only 43 per cent of caries compared with 91 per cent for bitewing radiography (p < 0.001)., Conclusions: In the primary dentition, use of bitewing radiography increases the detection rate of proximal surface caries substantially. It is recommended that bitewing radiography be included as part of the routine examination of children with proximal surfaces that cannot be visualized.

The aim of this case-control study of 617 children was to investigate early childhood caries (ECC) risk indicators in a non-fluoridated region in Australia. ECC cases were recruited from childcare facilities, public hospitals and private specialist clinics to source children from different socioeconomic backgrounds. Non-ECC controls were recruited from the same childcare facilities. A multinomial logistic modelling approach was used for statistical analysis. The results showed that a large percentage of children tested positive for Streptococcus mutans if their mothers also tested positive. A common risk indicator found in ECC children from childcare facilities and public hospitals was visible plaque (OR 4.1, 95% CI 1.0-15.9, and OR 8.7, 95% CI 2.3-32.9, respectively). Compared to ECC-free controls, the risk indicators specific to childcare cases were enamel hypoplasia (OR 4.2, 95% CI 1.0-18.3), difficulty in cleaning child's teeth (OR 6.6, 95% CI 2.2-19.8), presence of S. mutans (OR 4.8, 95% CI 0.7-32.6), sweetened drinks (OR 4.0, 95% CI 1.2-13.6) and maternal anxiety (OR 5.1, 95% CI 1.1-25.0). Risk indicators specific to public hospital cases were S. mutans presence in child (OR 7.7, 95% CI 1.3-44.6) or mother (OR 8.1, 95% CI 0.9-72.4), ethnicity (OR 5.6, 95% CI 1.4-22.1), and access of mother to pension or health care card (OR 20.5, 95% CI 3.5-119.9). By contrast, a history of chronic ear infections was found to be protective for ECC in childcare children (OR 0.28, 95% CI 0.09-0.82). The biological, socioeconomic and maternal risk indicators demonstrated in the present study can be employed in models of ECC that can be usefully applied for future longitudinal studies., (Copyright 2009 S. Karger AG, Basel.)

Purpose: The purpose of the investigation was to determine factors associated with dental erosion in a group of schoolchildren in Queensland, Australia., Methods: Dental examinations were carried out on 714 children aged 5.5 to 14.6 years from 8 randomly selected Australian schools. A total of 3,165 primary and 2,976 permanent teeth were scored for dental erosion using a modified erosion index. Dental caries experience was determined from clinical examination and bitewing radiographs. Enamel defects were recorded using the developmental defects of enamel index., Results: There were 225 children (32%) who exhibited no erosion and 489 (68%) who had erosion of at least one tooth. Erosion was found in 78% of subjects with primary teeth and 25% of subjects with permanent teeth (P<.001). Children with erosion in the primary and permanent dentition were more likely to have: (1) a lower socioeconomic status (primary dentition, P<.001 and permanent dentition (P<.001); (2) enamel hypoplasia in permanent dentition (P=.001); (3) dental caries in the primary dentition (P=.001); and (4) permanent dentition (P=.002)., Conclusions: In Australian schoolchildren, the prevalence of dental erosion in the primary dentition is approximately 3 times greater than in the permanent dentition. Dental erosion is strongly associated with caries experience and enamel hypoplasia.

The discovery that the PTEN tumor suppressor encodes a phosphoinositide 3-phosphatase has raised interest in the effects of constitutive activation of PI 3-kinase. To gain insight into PI 3-kinase function, we have stably expressed a myristoylated form of the catalytic subunit p110alpha (myr-p110) in cells. The myr-p110 associated with the endogenous p85 regulatory subunit and retained lipid and protein kinase activity. Stable lines expressing myr-p110 had 2- to 4-fold more PI 3-kinase activity than controls. Expression of myr-p110 altered cellular morphology and increased the saturation density in culture. These clones were morphologically transformed but Akt and pp70(s6k) were not constitutively activated in contrast to transient assays and from tumor cell lines deficient in PTEN. In addition, the ability of PDGF to induce activation of Akt and pp70(s6k) was diminished. Therefore, expression of a myristoylated PI 3-kinase in murine fibroblasts induces a morphological transformation of the cells., (Copyright 2000 Academic Press.)