Resident’s Name: Anna Haritos Date: May 1, 2009
Article title: Damage to the primary dentition resulting from thumb and finger (digit) sucking
Author(s): Fukuta, et al.
Journal: Journal of Dentistry for Children
Volume (number): 63
Month, Year: Nov – Dec 1996
Major topic: digit habits
Minor topic(s): age to eliminate digit habits
Type of Article: research article
Main Purpose(s): to investigate the influence of thumb and finger sucking on malocclusion (both the anterior and posterior sections of the primary dentition in three age groups (3, 4 and 5 yrs))
Overview of method of research: retrospective chart review (2018 charts); habit was determined from parent and patient reports that had been documented in the chart. 930 subjects met the inclusion criteria: no oral habits, only indulged in digit sucking, complete primary dentition, no permanent dentition, no dental caries, restorations or missing teeth. Of these 930 subjects, 671 had no history of oral habits, and 259 had oral habits. The following data was obtained: anterior overjet and overbite, mesial, flush or distal step of second primary molars. Hypothesis: higher incidence of overjet and overbite in oral habit group than non-oral habit group.
Findings: Of the original 2018 charts, 59.8% had no oral habit, while 40.2% had an oral habit. Maxillary protrusion was significantly higher in 3 year old digit suckers than 3 year olds without a digit sucking habit. In three to five year olds, the digit sucking group had a significantly higher frequency of open bite than the non-digit sucking group. Variations of terminal plane types were not significant between the two groups in 3 and 4 year olds; however of the 5 year olds, distal steps were significantly more frequent in the digit sucking group than the non digit sucking group.
Key points/Summary: Anterior open bite and maxillary protrusion represent the most frequent malocclusion associated with digit sucking. Potential that posterior occlusion damage is a late manifestation of the digit habit. Age of cessation should be at 3 to 4 years of age, before the terminal plane begins to change from the habit.
Assessment of article: good article to confirm anticipatory guidance used by the clinician
Thursday, April 30, 2009
Wednesday, April 29, 2009
Management of Non-Nutritive Or Digit Sucking Habits in Children- A Practical Approach
Resident’s Name: Laura Randazzo Sabnani Date: May 1, 2009
Article title: Management of Non-Nutritive Or Digit Sucking Habits in Children- A Practical Approach
Author(s): Morley K, McIntyre T
Journal: Journal of Pediatric Dentistry
Volume (number):60:11
Month, Year: November 1994
Major topic / Main purpose: To review reasons for and treatment for cessation of non-nutritive or digit habits in children
Methods and Materials: N/A
Result/Summary: There are two different views regarding thumbsucking. The psychoanalytical believe that if digit sucking continues past age 4 it is indicative of an underlying psychological disturbance. The behavioral theorist believe that digit sucking is a learned habit with no underlying emotional or psychological cause. The negative effects of thumb sucking are increased overjet, anterior open bite, and posterior crossbite. These are dependant on the intensity, duration, and frequency of habit. This article advises that a digit habit should be ignored until age 4. At that time the societal background should be investigated because children coming from an unstable home environment the digit sucking is a sense of security for them. The presence of other habits needs to be addressed and caution should be used when stopping the digit habit. School and peer relationships should be address and stopping a habit should not be initiated when a child first starts a new school. Family employment status should be reviewed and evaluted if there is recent increased stress for the family. To stop the habit behavior modification should be initiated. The child should be shown models and photographs of children who have stopped their digit habit. The parents are asked to place stars on a calender everytime a child stops sucking their thumb. Appliance therapy can also be used in addition to behavior modification. The author recommends a fixed digit crib over a removable one.
Assessment of article: Good article with a great example of a handout to give to parents.
Thumb Sucking
Resident’s Name: Chad Abby Date: 5/1/2009
Article title: Thumb-sucking: Literature review
Author(s): Eric D. Johnson DDS, Brent E. Larson DDS
Journal: Journal of Dentistry for Children
Month, Year: November-December 1993
Major topic: Thumb-sucking
Type of Article: Literature review
Author(s): Eric D. Johnson DDS, Brent E. Larson DDS
Journal: Journal of Dentistry for Children
Month, Year: November-December 1993
Major topic: Thumb-sucking
Type of Article: Literature review
Main Purpose: To review the literature relative to the causes, risks prevalence, and contributing factors of Non-Nutritive Sucking (NNS) habits.
Overview of method of research: Reviews of literature
Findings: Two theories of behavior that address the problem of NNS are the psychoanalytic theory of psychosexual development and the learning theory. The psychoanalytic theory holds that the response arises from an inherent psychosexual drive, and that digit sucking represents a type of anxiety management by the child and abruptly extinguishing it could be detrimental to the normal emotional development of the child. The learning theory advocates that NNS stems from an adaptive response and assumes no underlying psychological cause to prolonged NNS. It assumes all forms of NNS had adaptive value at some earlier developmental stage and the response was subsequently rewarded and eventually became a “learned habit.” Although overwhelming evidence supports the learning habit it has been suggested that an increase in stress or anxiety in a child’s life can convert an empty thumb habit into a meaningful stress-reduction response. Therefore it is important as physicians to screen patients with an NNS habit properly for possible psychological disturbances before initiating treatment.
Findings: Two theories of behavior that address the problem of NNS are the psychoanalytic theory of psychosexual development and the learning theory. The psychoanalytic theory holds that the response arises from an inherent psychosexual drive, and that digit sucking represents a type of anxiety management by the child and abruptly extinguishing it could be detrimental to the normal emotional development of the child. The learning theory advocates that NNS stems from an adaptive response and assumes no underlying psychological cause to prolonged NNS. It assumes all forms of NNS had adaptive value at some earlier developmental stage and the response was subsequently rewarded and eventually became a “learned habit.” Although overwhelming evidence supports the learning habit it has been suggested that an increase in stress or anxiety in a child’s life can convert an empty thumb habit into a meaningful stress-reduction response. Therefore it is important as physicians to screen patients with an NNS habit properly for possible psychological disturbances before initiating treatment.
Key points/Summary: Prolonged digit-sucking habit can have significant effects on dentofacial development. Malocclusion caused by thumb-sucking is more a matter of individual response to stimuli than a highly classified cause and effect syndrome. Some spontaneous corrections of the dentofacial effects can be expected, if the NNS habit persists until nine years of age and is then stopped. This spontaneous correction takes place primarily during the first year after habit cessation and is involved with dentoalveolar changes – a decrease in dental openbite and retroclination of the upper incisors. Studies demonstrate a decrease in digit-sucking habits with an increase in pacifier use, less than 3 percent of children who used a pacifier developed a thumb-sucking habit. The prevalence of digit-sucking in North American children at ages two and five is approximately 23 and 18%. The thumb sucking habit has been found to be stronger, more persistent, and more widespread in girls than in boys, however there are no sex-linked factors that account for the sex differences in thumb-sucking habits. The majority of children with an NNS habit began the habit during the first three months of life. Every study that linked thumb-sucking with age demonstrated a decreased prevalence of NNS habits with increased age. There has been no correlation found between thumb-sucking and mode of feeding. Also it has been found that children who sucked their thumbs were less likely to have a care-giver present as they fell asleep. Children from a “high socioeconomic group” demonstrated oral habits (finger-sucking, fingernail biting, tongue habits, and lip or check habits) more frequently than children from a middle or low socioeconomic class. Children of parents with an extensive education were more likely to develop a finger-sucking habit whereas children whose parents had little or no theoretical education were more likely to develop a pacifier habit.
Assessment of article: Good article – a great literature review on numerous thumb-sucking studies
Post-Exposure Treatment of HIV – Taking Some Risks for Safety’s Sake
Author(s): David K. Henderson MD
Journal: The New England Journal of Medicine
Month, Year: November 2007
Major topic: HIV exposure management
Type of Article: Editorial
Findings: The occupational infection and eventual death of a health care worker in 1988 was controversial and led to a variety of post exposure protocols. These included increased education about HIV, safety measures like plastic coated test tubes and the investigation and eventual implementation of a chemoprophylaxis with nucleoside analogue zidovudine secondary to exposure. Education and informed consents were given before beginning the course. This course has some scientific evidence but it was mainly done so that the hospital would be seen as a worker advocate. The workers were told about the mutagenic and teratogenic risk but it still was scrutinized in the media and scientific literature. Current literature and experiences support the earlier decision, although the course has been modified to include antiretrovirals and other nucleoside analogues. Risk factors have also been elucidated as part of a 1995 study; a deep injury, injury with a device visibly contaminated with blood from the source patient, a procedure involving a needle placed in the source patient’s artery or vein and exposure to a source patient who dies of AIDS within 2 months. Post exposure chemoprophylaxis with zidovudine was associated with a reduction in risk of transmission by 81%, although the study was performed under non-ideal conditions. While the efficacy and risk of administering chemoprophylactic drugs, most people have found the fear of infection outweighs the inherent risks of prophylactic treatment.
Key points/Summary: While the efficacy and safety of chemoprophylactic treatment has not been absolutely determined, it is still often used at the very least to offset the fear and trepidation secondary to occupational exposure.
Assessment of article: An editorial but well written and good information to have on hand particularly if a member of your staff is exposed.
Brian Schmid DMD
Journal: The New England Journal of Medicine
Month, Year: November 2007
Major topic: HIV exposure management
Type of Article: Editorial
Findings: The occupational infection and eventual death of a health care worker in 1988 was controversial and led to a variety of post exposure protocols. These included increased education about HIV, safety measures like plastic coated test tubes and the investigation and eventual implementation of a chemoprophylaxis with nucleoside analogue zidovudine secondary to exposure. Education and informed consents were given before beginning the course. This course has some scientific evidence but it was mainly done so that the hospital would be seen as a worker advocate. The workers were told about the mutagenic and teratogenic risk but it still was scrutinized in the media and scientific literature. Current literature and experiences support the earlier decision, although the course has been modified to include antiretrovirals and other nucleoside analogues. Risk factors have also been elucidated as part of a 1995 study; a deep injury, injury with a device visibly contaminated with blood from the source patient, a procedure involving a needle placed in the source patient’s artery or vein and exposure to a source patient who dies of AIDS within 2 months. Post exposure chemoprophylaxis with zidovudine was associated with a reduction in risk of transmission by 81%, although the study was performed under non-ideal conditions. While the efficacy and risk of administering chemoprophylactic drugs, most people have found the fear of infection outweighs the inherent risks of prophylactic treatment.
Key points/Summary: While the efficacy and safety of chemoprophylactic treatment has not been absolutely determined, it is still often used at the very least to offset the fear and trepidation secondary to occupational exposure.
Assessment of article: An editorial but well written and good information to have on hand particularly if a member of your staff is exposed.
Brian Schmid DMD
Friday, April 24, 2009
Feeding, Artificial Sucking Habits, and Malocclusions in 3-year-old Girls in Different Regions of the World
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Dan Boboia Date: 4/24/09
Article title: Feeding, Artificial Sucking Habits, and Malocclusions in 3-year-old Girls in Different Regions of the World
Author(s): Calgar, Esber et al.
Journal: Journal of Dentistry for Children
Volume (number): 72:1
Month, Year: 2005
Major topic: To determine feeding methods, artificial sucking habits, and the presence of malocclusions in 3-year-old girls living in different regions of the world
Methods:
Children from the following countries were involved in this study: Brazil, Japan, Mexico, Norway, Sweden, Turkey and the U.S.
Sixty 3-year-old girls were selected from each of these populations; due to attrition the group size decreased to 49 by the time the children reached age 3
During the interview and examination the following variables were evaluated:
1) breast-feeding, bottle-feeding, duration, and frequency
2) sucking habits
3) posterior and anterior crossbites
4) other malocclusions / normal occlusion
Results:
High prevalence of breast-feeding in all groups (78-98%)
High prevalence of bottle-feeding (almost all had used a bottle for various periods of time)
Except for the US, digit-sucking was considered low; it was noted that those who started digit-sucking had difficulty discontinuing it
Pacifier sucking was popular in most areas with the exception of Nigeria
Malocclusion ranged from 38-98%; great differences in the prevalence of malocclusions were registered in this study; only one Japanese patient had a malocclusion; in the Oslo, Norway sample only 38% of children had normal occlusion; its concluded that this resulted from high prevalence and long duration of artificial sucking habits
Conclusions:
1) High prevalence of breast-feeding was over 78% in the countries studied
2) Almost all subjects used a nursing bottle for some time
3) Low prevalence of digit-sucking, with the exception of the US sample
4) Pacifier-sucking is popular in most areas; however, none of the Japanese girls experienced the habit
5) Prevalence of normal occlusion in different samples ranged from 38-98%
Article Assesment:
Fair article; would have liked to see more discussion regarding the differences in malocclusion among the groups studied
Lutheran Medical Center
Resident’s Name: Dan Boboia Date: 4/24/09
Article title: Feeding, Artificial Sucking Habits, and Malocclusions in 3-year-old Girls in Different Regions of the World
Author(s): Calgar, Esber et al.
Journal: Journal of Dentistry for Children
Volume (number): 72:1
Month, Year: 2005
Major topic: To determine feeding methods, artificial sucking habits, and the presence of malocclusions in 3-year-old girls living in different regions of the world
Methods:
Children from the following countries were involved in this study: Brazil, Japan, Mexico, Norway, Sweden, Turkey and the U.S.
Sixty 3-year-old girls were selected from each of these populations; due to attrition the group size decreased to 49 by the time the children reached age 3
During the interview and examination the following variables were evaluated:
1) breast-feeding, bottle-feeding, duration, and frequency
2) sucking habits
3) posterior and anterior crossbites
4) other malocclusions / normal occlusion
Results:
High prevalence of breast-feeding in all groups (78-98%)
High prevalence of bottle-feeding (almost all had used a bottle for various periods of time)
Except for the US, digit-sucking was considered low; it was noted that those who started digit-sucking had difficulty discontinuing it
Pacifier sucking was popular in most areas with the exception of Nigeria
Malocclusion ranged from 38-98%; great differences in the prevalence of malocclusions were registered in this study; only one Japanese patient had a malocclusion; in the Oslo, Norway sample only 38% of children had normal occlusion; its concluded that this resulted from high prevalence and long duration of artificial sucking habits
Conclusions:
1) High prevalence of breast-feeding was over 78% in the countries studied
2) Almost all subjects used a nursing bottle for some time
3) Low prevalence of digit-sucking, with the exception of the US sample
4) Pacifier-sucking is popular in most areas; however, none of the Japanese girls experienced the habit
5) Prevalence of normal occlusion in different samples ranged from 38-98%
Article Assesment:
Fair article; would have liked to see more discussion regarding the differences in malocclusion among the groups studied
Pacifier use, early weaning, and cry/fuss behavior
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/25/2009
Article title: Pacifier Use, Early Weaning, and Cry/Fuss Behavior
Author(s): Kramer MS, Barr RG, et al..
Journal: JAMA 286(3)
Volume (number): 322-326
Date: July 18, 2001
Major topic: Pacifier and its effect on Breast feeding
Type of Article: Double blind, randomized clinical trial
Main Purpose: This study evaluated whether advice to avoid use of the pacifier and use other techniques to soothe an infant reduces the risk of early weaning from breast feeding, and increases the risk of crying and fussing.
Materials and Methods: 281 randomized mothers were placed into two groups. Both groups received a basic breastfeeding package consisting of a 45 minute interview promoting breastfeeding. In the experimental group, mothers were asked to avoid pacifiers when the infant cried or fussed, and instead offer the breast. In the control group, all options were suggested to calm the infant. Follow up calls were placed at 10 days and 3 weeks postpartum. A behavior diary was completed by the mothers at 4, 6, and 9 weeks for 3 days at each interval.
Findings: 258 mothers, 127 experimental and 131 controls completed the study. The experimental intervention resulted in 38.6% avoiding the pacifier use, while the control group avoided pacifiers in 16% of the cases. The diaries confirmed a reduced number of pacifier insertions per day. However, early weaning from breast feeding was similar between the two groups at 3 months of age (18.9% vs 18.3%). Observation analysis indicated the daily pacifier use was more significant for early weaning, 25% vs. 12.9% who had never received a pacifier. The response rate for the diaries was fair with only 57.4% at the 9 weeks. Observations noted included slightly less crying and fussing at 4 and 6 weeks, and identical at 9 weeks
Key points/Summary : The experimental intervention reduced pacifier use, yet it did not reduce crying and fussing behavior at all time intervals. It also did not have an effect on reducing the risk of early weaning of breast feeding. However the pacifier use was strongly associated with early weaning, perhaps because of breastfeeding difficulties or reduced motivation to breastfeed.
Assessment of article: Interesting study to contrast with the advocates of breastfeeding who suggest that pacifiers use cause nipple confusion and early weaning
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/25/2009
Article title: Pacifier Use, Early Weaning, and Cry/Fuss Behavior
Author(s): Kramer MS, Barr RG, et al..
Journal: JAMA 286(3)
Volume (number): 322-326
Date: July 18, 2001
Major topic: Pacifier and its effect on Breast feeding
Type of Article: Double blind, randomized clinical trial
Main Purpose: This study evaluated whether advice to avoid use of the pacifier and use other techniques to soothe an infant reduces the risk of early weaning from breast feeding, and increases the risk of crying and fussing.
Materials and Methods: 281 randomized mothers were placed into two groups. Both groups received a basic breastfeeding package consisting of a 45 minute interview promoting breastfeeding. In the experimental group, mothers were asked to avoid pacifiers when the infant cried or fussed, and instead offer the breast. In the control group, all options were suggested to calm the infant. Follow up calls were placed at 10 days and 3 weeks postpartum. A behavior diary was completed by the mothers at 4, 6, and 9 weeks for 3 days at each interval.
Findings: 258 mothers, 127 experimental and 131 controls completed the study. The experimental intervention resulted in 38.6% avoiding the pacifier use, while the control group avoided pacifiers in 16% of the cases. The diaries confirmed a reduced number of pacifier insertions per day. However, early weaning from breast feeding was similar between the two groups at 3 months of age (18.9% vs 18.3%). Observation analysis indicated the daily pacifier use was more significant for early weaning, 25% vs. 12.9% who had never received a pacifier. The response rate for the diaries was fair with only 57.4% at the 9 weeks. Observations noted included slightly less crying and fussing at 4 and 6 weeks, and identical at 9 weeks
Key points/Summary : The experimental intervention reduced pacifier use, yet it did not reduce crying and fussing behavior at all time intervals. It also did not have an effect on reducing the risk of early weaning of breast feeding. However the pacifier use was strongly associated with early weaning, perhaps because of breastfeeding difficulties or reduced motivation to breastfeed.
Assessment of article: Interesting study to contrast with the advocates of breastfeeding who suggest that pacifiers use cause nipple confusion and early weaning
Thursday, April 23, 2009
The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3 yea
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/25/2009
Article title: The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3 year-old children
Author(s): Ogaard B, Larsson E., Linsten R.
Journal: Am. J. Orthod. 106 (2)
Volume (number): 161-6
Date: August 1994
Major topic: Habits influence on posterior cross-bites
Type of Article: Research article
Main Purpose: This study evaluated the prevalence of posterior cross-bites in children from Norway and Sweden and its relationship with sucking habit.
Materials and Methods: 445 3 year olds, 250 from Norway, and 195 from Sweden were included in the study. During the exam, the families were questioned about sucking habits , duration of finger sucking or dummy sucking (pacifier) and if ongoing, gender, and if Swedish. Clinically, intercanine width of both maxillary and mandibular arches were measured, and if a posterior cross-bite was present. As a control, 15 medieval skulls with full primary dentition were measured. No sucking habits were assumed from these skulls.
Findings: Of the posterior cross-bites, 90% involved cuspids. Finger sucking was more common in females. The duration of pacifier use is longer in Swedish children. In finger suckers, posterior cross-bites could be predicted with upper intercanine width while in the pacifier group, posterior cross-bite groups could be predicted with upper and lower intercanine widths. Both arches were narrower in Swedish children, especially in girls, and pacifier use decreased upper and increased lower intercanine width. At least 2 years of pacifier use affected the upper jaw and 3 years in lower jaw. Breast vs. bottle feeding had no influence on the development of posterior. Swedish children tended to have narrower jaws and also a higher prevalence of posterior cross-bites. Norwegian children had a normal or slightly increased prevalence of posterior cross-bites with pacifier use. Intercanine width was significantly influenced by the duration of the habit in years. It was seen that the longer the pacifier habit, the stronger the effect of the intercanine width: decrease in maxillary width and increased mandibular width. “This study supports the hypothesis that in a pacifier habit, the cheeks show increased activity and the tongue repositions back and downward. The low position of the tongue decreases maxillary arch development thus decreasing intercanine width and expands the lower arch causing the lower intercanine width to increase.
Key points/Summary : Nonsuckers showed no relationship between the tested variables and development of a posterior cross-bite. Pacifier use influences development of a posterior cross-bite. And lastly, finger sucking has some effect but it is less certain
Assessment of article: Thorough discussion of the influence of habits on intercanine width. Useful in practice.
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/25/2009
Article title: The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3 year-old children
Author(s): Ogaard B, Larsson E., Linsten R.
Journal: Am. J. Orthod. 106 (2)
Volume (number): 161-6
Date: August 1994
Major topic: Habits influence on posterior cross-bites
Type of Article: Research article
Main Purpose: This study evaluated the prevalence of posterior cross-bites in children from Norway and Sweden and its relationship with sucking habit.
Materials and Methods: 445 3 year olds, 250 from Norway, and 195 from Sweden were included in the study. During the exam, the families were questioned about sucking habits , duration of finger sucking or dummy sucking (pacifier) and if ongoing, gender, and if Swedish. Clinically, intercanine width of both maxillary and mandibular arches were measured, and if a posterior cross-bite was present. As a control, 15 medieval skulls with full primary dentition were measured. No sucking habits were assumed from these skulls.
Findings: Of the posterior cross-bites, 90% involved cuspids. Finger sucking was more common in females. The duration of pacifier use is longer in Swedish children. In finger suckers, posterior cross-bites could be predicted with upper intercanine width while in the pacifier group, posterior cross-bite groups could be predicted with upper and lower intercanine widths. Both arches were narrower in Swedish children, especially in girls, and pacifier use decreased upper and increased lower intercanine width. At least 2 years of pacifier use affected the upper jaw and 3 years in lower jaw. Breast vs. bottle feeding had no influence on the development of posterior. Swedish children tended to have narrower jaws and also a higher prevalence of posterior cross-bites. Norwegian children had a normal or slightly increased prevalence of posterior cross-bites with pacifier use. Intercanine width was significantly influenced by the duration of the habit in years. It was seen that the longer the pacifier habit, the stronger the effect of the intercanine width: decrease in maxillary width and increased mandibular width. “This study supports the hypothesis that in a pacifier habit, the cheeks show increased activity and the tongue repositions back and downward. The low position of the tongue decreases maxillary arch development thus decreasing intercanine width and expands the lower arch causing the lower intercanine width to increase.
Key points/Summary : Nonsuckers showed no relationship between the tested variables and development of a posterior cross-bite. Pacifier use influences development of a posterior cross-bite. And lastly, finger sucking has some effect but it is less certain
Assessment of article: Thorough discussion of the influence of habits on intercanine width. Useful in practice.
modifications of the palatal crib habit-breaker appliance to prevent paltal soft tissue embedment
Article title: Modifications of the palatal crib
Author(s):Gawlik JA, Ott NW, Mathieu GP
Journal: Journal of Dentistry for Children
Volume (number):
Date: November-December 1995
Major Topic: Habit breaking appliances
Type of Article: Professional Opinion
Main Purpose: Review purpose and design of habit breaking appliance and recommend improvements in design
Materials and Methods:
Literature concerning habit-breaking appliances was reviewed. The most common problems were discussed and recommendations to the design were made.
Findings:
Design of palatal crib appliance: bands on first permanent or second primary molars. A palatal arch wire is formed using a .036 or greater diameter heavy stainless steel wire. Shorter lengths of wire are positioned and soldered to the arch to form a smooth rounded crib. Sharp spurs or hay rakes should not be used. Wires should be passive with .5-1mm relief from the tissue. The crib should be in the intercanine area, covering the extent of the open bite. It should also not interfere with the mandibular teeth.
A problem encountered with this appliance is the wire embeds into the palatal tissue. When this happens, removal can be very painful and require local anesthesia.
Modified design: Orthodontic acrylic can be added to the palatal region of the appliance, so that it is supported by the acrylic and the wire is incapable of being imbedded in the palatal tissue. Palatal acrylic and a crib can also be added to a Hawley retainer, but this treatment is often compromised by poor compliance.
Key points/Summary:
Goals of a habit therapy include a design that is nonpunitive, unobtrusive and nondamaging to oral soft and hard tissues.
The author recommends addition of an acrylic palatal button with .040 or .045 inch palatal wires.
Assessment of article:
It’s a pretty good idea. Habit appliances are pretty much a toss-up anyway. I’ve seen them imbed, but usually the kid is sucking even thought the appliance is there.
Wednesday, April 22, 2009
Prevalence of Bruxism and Associated Correlates in Children as Reported by Parents
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Derek Banks Date: April 24, 2009
Article title: Prevalence of Bruxism and Associated Correlates in Children as Reported by Parents
Author(s): A Cheifetz, S Osganian, E Allred, H Needleman
Journal: Journal of Dentistry for Children
Volume (number): 72:2
Month, Year: 2005
Major topic: Oral Habits
Minor topic(s): Amalgam in Pediatric Dentistry
Type of Article: Bruxism
Main Purpose: Evaluate reported prevalence of nocturnal bruxism, and demographic correlations
Overview of method of research: 854 surveys were given to parents of patients at 4 private pediatric dental offices and at Children’s Hospital Boston Dental Clinic about nocturnal bruxism, demographic information, and questions about purported associated factors.
Findings: Due to differing methodologies in different studies (e.g. parent/patient report vs. observation of wear facets intraorally), the precise prevalence of bruxism is not known. Other studies have shown that bruxers respond more negatively to life events and tend to be more anxious, aggressive, and hyperactive. Bruxism was reported to commence at a mean age of 3.6 years and ceased at a mean age of 6 years. Only 5% of the study population reported subjective TMD symptoms such as jaw clicking, muscle tenderness, pain on opening, or limited opening. There was a statistically significant association between the child’s bruxism habit and parental bruxism (P<0.0005). 48% of children reported to be bruxers had at least one parent who also had a history of bruxism, which was true for only 32% of reported nonbruxers. Naturally, bruxism was reported more often in families who sleep with the doors open. Children with psychological disorders are 3.6 times more likely to brux. Droolers were 1.7 times more likely and sleeptalkers 1.6 times more likely to brux. Children with oral habits (e.g. thumb, pacifier) were less likely to brux than their non-habit-posessing counterparts.
Key points/Summary : Of the 38% of parents reporting that their children brux, the following factors were significantly associated with the reported bruxism: familial history, open bedroom doors, drooling, sleeptalking, and psychological disorders
Assessment of article: Interesting.
Lutheran Medical Center
Resident’s Name: Derek Banks Date: April 24, 2009
Article title: Prevalence of Bruxism and Associated Correlates in Children as Reported by Parents
Author(s): A Cheifetz, S Osganian, E Allred, H Needleman
Journal: Journal of Dentistry for Children
Volume (number): 72:2
Month, Year: 2005
Major topic: Oral Habits
Minor topic(s): Amalgam in Pediatric Dentistry
Type of Article: Bruxism
Main Purpose: Evaluate reported prevalence of nocturnal bruxism, and demographic correlations
Overview of method of research: 854 surveys were given to parents of patients at 4 private pediatric dental offices and at Children’s Hospital Boston Dental Clinic about nocturnal bruxism, demographic information, and questions about purported associated factors.
Findings: Due to differing methodologies in different studies (e.g. parent/patient report vs. observation of wear facets intraorally), the precise prevalence of bruxism is not known. Other studies have shown that bruxers respond more negatively to life events and tend to be more anxious, aggressive, and hyperactive. Bruxism was reported to commence at a mean age of 3.6 years and ceased at a mean age of 6 years. Only 5% of the study population reported subjective TMD symptoms such as jaw clicking, muscle tenderness, pain on opening, or limited opening. There was a statistically significant association between the child’s bruxism habit and parental bruxism (P<0.0005). 48% of children reported to be bruxers had at least one parent who also had a history of bruxism, which was true for only 32% of reported nonbruxers. Naturally, bruxism was reported more often in families who sleep with the doors open. Children with psychological disorders are 3.6 times more likely to brux. Droolers were 1.7 times more likely and sleeptalkers 1.6 times more likely to brux. Children with oral habits (e.g. thumb, pacifier) were less likely to brux than their non-habit-posessing counterparts.
Key points/Summary : Of the 38% of parents reporting that their children brux, the following factors were significantly associated with the reported bruxism: familial history, open bedroom doors, drooling, sleeptalking, and psychological disorders
Assessment of article: Interesting.
Tuesday, April 21, 2009
The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits
Author(s): Constantine Oulis, George Vadiakas, John Ekonomides and Joanna Dratsa
Journal: Journal of Clinical Pediatric Dentistry
Month, Year: 1994
Major topic: adenoid effect on bite and habits
Type of Article: Observational study
Findings: Adenoids are described as hypertrophied state of the pharyngeal tonsils in the upper posterior wall of the nasopharynx and consist of the upper part of the Waldeyer Ring. Adenoids may be associated with rhinitis, sinusitis and otitis media. The inferior posterior movement of the tongue and mandible to achieve an open airway may posturally affect the position of the teeth. This investigation studied the incidence of crossbite and oral habits in children whose hypertrophy was significant enough to require surgical treatment. One hundred twenty Caucasian children in Athens, Greece, who had an adenoidectomy scheduled were included in the study. They were screened for the number of teeth in crossbite and oral habits. Severity of airway obstruction was determined surgically and radiographically. The children were split into 2 age groups: 3-5 y.o. and 5-8 y.o. There was a 74% agreement between ragiographic and surgical screening of airway obstruction confirming lateral cephalometrics as a viable addition to screening of restricted airways. 45.8% and 47.2% of patients had posterior crossbite in the younger and older populations respectively (normally 7-10% in the mixed dentition). 89% of permanent molars had erupted in crossbite. The higher the degree of obstruction, the higher the number of children in crossbite. Eighty percent of children with a 3rd or 4th degree obstruction were in crossbite. Only 13% of patients with a 1st or 2nd degree obstruction were in crossbite. All children, according to parental interview, with a posterior crossbite had a history of mouth-breathing during sleep. 71.4% were continuous mouth-breathers. Interestingly, the use of a pacifier or a digit sucking habit was not correlated with crossbite.
Key points/Summary: Larger airway obstructions in young children will very often lead to posterior crossbite. Patients in crossbite who do not have a history of digit sucking or pacifier use should be evaluated for upper airway obstruction with the lateral ceph film a valuable tool.
Assessment of article: Interesting correlation and something to look out for in our population.
Brian Schmid DMD
Journal: Journal of Clinical Pediatric Dentistry
Month, Year: 1994
Major topic: adenoid effect on bite and habits
Type of Article: Observational study
Findings: Adenoids are described as hypertrophied state of the pharyngeal tonsils in the upper posterior wall of the nasopharynx and consist of the upper part of the Waldeyer Ring. Adenoids may be associated with rhinitis, sinusitis and otitis media. The inferior posterior movement of the tongue and mandible to achieve an open airway may posturally affect the position of the teeth. This investigation studied the incidence of crossbite and oral habits in children whose hypertrophy was significant enough to require surgical treatment. One hundred twenty Caucasian children in Athens, Greece, who had an adenoidectomy scheduled were included in the study. They were screened for the number of teeth in crossbite and oral habits. Severity of airway obstruction was determined surgically and radiographically. The children were split into 2 age groups: 3-5 y.o. and 5-8 y.o. There was a 74% agreement between ragiographic and surgical screening of airway obstruction confirming lateral cephalometrics as a viable addition to screening of restricted airways. 45.8% and 47.2% of patients had posterior crossbite in the younger and older populations respectively (normally 7-10% in the mixed dentition). 89% of permanent molars had erupted in crossbite. The higher the degree of obstruction, the higher the number of children in crossbite. Eighty percent of children with a 3rd or 4th degree obstruction were in crossbite. Only 13% of patients with a 1st or 2nd degree obstruction were in crossbite. All children, according to parental interview, with a posterior crossbite had a history of mouth-breathing during sleep. 71.4% were continuous mouth-breathers. Interestingly, the use of a pacifier or a digit sucking habit was not correlated with crossbite.
Key points/Summary: Larger airway obstructions in young children will very often lead to posterior crossbite. Patients in crossbite who do not have a history of digit sucking or pacifier use should be evaluated for upper airway obstruction with the lateral ceph film a valuable tool.
Assessment of article: Interesting correlation and something to look out for in our population.
Brian Schmid DMD
Thursday, April 16, 2009
Pacifier Use and Breastfeeding
Resident’s Name: Joanne Lewis Date: April 17, 2009
Article title: The Effects of Early Pacifier Use on Breastfeeding Duration
Author(s): Cynthia R. Howard, MD, MPH, et al
Journal: Pediatrics
Volume (number): 103(3)
Month, Year: March 1999
Major topic: Pacifier use, breastfeeding
Type of Article: Prospective study
Main Purpose: To evaluate the effects of pacifier use and the timing of pacifier introduction on breastfeeding duration, problems, and frequency.
Overview of method of research: 265 breastfeeding mother-infant dyads were followed. Maternal interviews were conducted at delivery, 2, 6, 12, and 24 weeks, and thereafter every 90 days until breastfeeding ended. At each interview, information was gathered regarding breastfeeding frequency, duration, and maternal or infant problems, proportion of diet composed of breast milk, use of supplemental foods/liquids, and pacifier use. Breasting duration is defined by the following categories: full and overall. Full breastfeeding means that the infants are primarily breastfed and do not receive daily supplements. Overall breastfeeding is defined as the length of time an infant receives any breastfeedings.
Findings: 15% of mothers began pacifier use before leaving the hospital, another 36% began use by 2 weeks postpartum, another 17% began use by 6 weeks postpartum, and by the time the infants were 6 months of age, 74% of the mothers had initiated pacifier use. Women who introduced pacifiers to their infants compared with those who did not tended to be 1st-time mothers, to have shorter goals for breastfeeding, and to be slightly younger. Pacifier introduction by 6 weeks was associated with a significant increased risk for shortened duration of full breastfeeding and overall breastfeeding. Breastfeeding frequency was significantly decreased at 2 weeks postpartum in women who had initiated pacifier use by 2 weeks and at 12 weeks postpartum in women who had initiated pacifier use by 6 weeks. Mothers who had initiated pacifier use by 6 weeks were significantly more likely at 12 weeks postpartum to report that breastfeeding was inconvenient and that they had experienced problems with not producing enough milk.
Key points/Summary: Pacifier use in the first 6 weeks was associated with decreased full and overall duration; however, pacifier use in this study was associated primarily with long-term breastfeeding duration and did not affect short-term outcomes. There was no significant correlation between pacifier use and breastfeeding duration up to 3 months postpartum.
Assessment of article: Interesting article – the statistical analysis was difficult for me to understand.
Article title: The Effects of Early Pacifier Use on Breastfeeding Duration
Author(s): Cynthia R. Howard, MD, MPH, et al
Journal: Pediatrics
Volume (number): 103(3)
Month, Year: March 1999
Major topic: Pacifier use, breastfeeding
Type of Article: Prospective study
Main Purpose: To evaluate the effects of pacifier use and the timing of pacifier introduction on breastfeeding duration, problems, and frequency.
Overview of method of research: 265 breastfeeding mother-infant dyads were followed. Maternal interviews were conducted at delivery, 2, 6, 12, and 24 weeks, and thereafter every 90 days until breastfeeding ended. At each interview, information was gathered regarding breastfeeding frequency, duration, and maternal or infant problems, proportion of diet composed of breast milk, use of supplemental foods/liquids, and pacifier use. Breasting duration is defined by the following categories: full and overall. Full breastfeeding means that the infants are primarily breastfed and do not receive daily supplements. Overall breastfeeding is defined as the length of time an infant receives any breastfeedings.
Findings: 15% of mothers began pacifier use before leaving the hospital, another 36% began use by 2 weeks postpartum, another 17% began use by 6 weeks postpartum, and by the time the infants were 6 months of age, 74% of the mothers had initiated pacifier use. Women who introduced pacifiers to their infants compared with those who did not tended to be 1st-time mothers, to have shorter goals for breastfeeding, and to be slightly younger. Pacifier introduction by 6 weeks was associated with a significant increased risk for shortened duration of full breastfeeding and overall breastfeeding. Breastfeeding frequency was significantly decreased at 2 weeks postpartum in women who had initiated pacifier use by 2 weeks and at 12 weeks postpartum in women who had initiated pacifier use by 6 weeks. Mothers who had initiated pacifier use by 6 weeks were significantly more likely at 12 weeks postpartum to report that breastfeeding was inconvenient and that they had experienced problems with not producing enough milk.
Key points/Summary: Pacifier use in the first 6 weeks was associated with decreased full and overall duration; however, pacifier use in this study was associated primarily with long-term breastfeeding duration and did not affect short-term outcomes. There was no significant correlation between pacifier use and breastfeeding duration up to 3 months postpartum.
Assessment of article: Interesting article – the statistical analysis was difficult for me to understand.
Bruxing and Non-Bruxing Children: A Comparison of Their Personality Traits
Department of Pediatric Dentistry
Lutheran Medical Center
Resident's Name: Kris Hendricks Date: 4/17/09
Article title: Bruxing and Non-Bruxing Children: A Comparison of Their Personality Traits
Author(s): Kuch EV, Till MJ, Messer LB
Journal: Pediatric Dentsitry
Volume (number): 1 (3)
Month, Year: 1979
Major topic: Bruxism
Type of Study: Survey and Clinical Examination
Methods:
358 kindergarten children from suburban Minnesota were used for this study. All children were Caucasian, between the ages of 5 and 6. Inclusion criteria was low DEFS score, no anterior or posterior cross-bite, absence of mobile primary teeth and premature occlusal contacts or high restorations.
Parents were sent a questionnaire concerning the presence of bruxing in the child and family. Children were also given a clinical exam using a reclined chair at the school. Personalities of the children were assessed using the Missouri Children’s Picture Series. The data from the personality tests was then correlated with the presence or absence of bruxing.
Findings:
15% of children had a report of bruxing from their parents, which was confirmed by clinical findings. Another 15.4% of children had some type of clinical manifestation of bruxing, but the parents were unaware. No psychological correlation was made and it was concluded that childhood bruxism is of little psychological significance.
Discussion:
There was no difference noted between boys and girls. In “normal” occlusions, there were no occlusal features which identified bruxers. It had been suggested that bruxing is a manifestation of unresolved person problems in children. It had also been linked to aggressive personalities in the 60s. This study refutes both of those claims.
Assessment of article:
Good article because a lot of parents are very concerned when they hear bruxing in their children, or when they see the occlusal wear. My (limited) experience is that the parents don’t generally associate bruxism with psychological problems at this age, but are just concerned about the child’s dentition.
Lutheran Medical Center
Resident's Name: Kris Hendricks Date: 4/17/09
Article title: Bruxing and Non-Bruxing Children: A Comparison of Their Personality Traits
Author(s): Kuch EV, Till MJ, Messer LB
Journal: Pediatric Dentsitry
Volume (number): 1 (3)
Month, Year: 1979
Major topic: Bruxism
Type of Study: Survey and Clinical Examination
Methods:
358 kindergarten children from suburban Minnesota were used for this study. All children were Caucasian, between the ages of 5 and 6. Inclusion criteria was low DEFS score, no anterior or posterior cross-bite, absence of mobile primary teeth and premature occlusal contacts or high restorations.
Parents were sent a questionnaire concerning the presence of bruxing in the child and family. Children were also given a clinical exam using a reclined chair at the school. Personalities of the children were assessed using the Missouri Children’s Picture Series. The data from the personality tests was then correlated with the presence or absence of bruxing.
Findings:
15% of children had a report of bruxing from their parents, which was confirmed by clinical findings. Another 15.4% of children had some type of clinical manifestation of bruxing, but the parents were unaware. No psychological correlation was made and it was concluded that childhood bruxism is of little psychological significance.
Discussion:
There was no difference noted between boys and girls. In “normal” occlusions, there were no occlusal features which identified bruxers. It had been suggested that bruxing is a manifestation of unresolved person problems in children. It had also been linked to aggressive personalities in the 60s. This study refutes both of those claims.
Assessment of article:
Good article because a lot of parents are very concerned when they hear bruxing in their children, or when they see the occlusal wear. My (limited) experience is that the parents don’t generally associate bruxism with psychological problems at this age, but are just concerned about the child’s dentition.
Use of Pacifiers is Associated With Decreased Breast-Feeding Duration
Department of Pediatric Dentistry
Lutheran Medical Center
Resident's Name: Dan Boboia Date: 4/17/09
Article title: Use of Pacifiers is Associated With Decreased Breast-Feeding Duration
Author(s): F.C. Barros et al
Journal: Pediatrics
Volume (number): 95 (4)
Month, Year: April 1995
Major topic: Determine the relationship between pacifier use at 1 month of age to the duration of breast-feeding to 6 months of age
Type of Study: Longitudinal Study
Methods:
605 infants were followed from birth to 6 months of age
Mothers answered a baseline questionnaire, perinatal information was collected, and hospital records were also used
Follow-up home visits were conducted at 1, 4, and 6 months of age
Only infants breast-fed by 1 month of age were considered for this study
Results:
8.2% could not be located at 1-month follow-up visit
Additional 3.3% could not be located at 4-month follow-up visit
A cumulative of 14.5% could not be located at 6-month follow-up visit
Risk for weaning between 1 and 6 months of age was 3.84 for pacifier users at 1 month of age compared with nonusers; this dropped to 2.87 after Cox analysis adjustment
Discussion:
The 14.5% infants that dropped out from the study are unlikely to have biased the study because they were similar to infants who did not drop out
It is unknown if pacifier use is causally related to weaning or simply a marker of poor sucking or other undetermined variables. It is possible that several factors, including pacifier use, influence duration and frequency for breast-feeding
Infants using pacifiers at 1 month were three times more likely to be weaned by 6 months of age
Pacifier use is highly correlated with early weaning, even after controlling for possible confounders; these results suggest that the pacifier use should not be recommended for breast-fed infants
Assessment of article: Good article
Lutheran Medical Center
Resident's Name: Dan Boboia Date: 4/17/09
Article title: Use of Pacifiers is Associated With Decreased Breast-Feeding Duration
Author(s): F.C. Barros et al
Journal: Pediatrics
Volume (number): 95 (4)
Month, Year: April 1995
Major topic: Determine the relationship between pacifier use at 1 month of age to the duration of breast-feeding to 6 months of age
Type of Study: Longitudinal Study
Methods:
605 infants were followed from birth to 6 months of age
Mothers answered a baseline questionnaire, perinatal information was collected, and hospital records were also used
Follow-up home visits were conducted at 1, 4, and 6 months of age
Only infants breast-fed by 1 month of age were considered for this study
Results:
8.2% could not be located at 1-month follow-up visit
Additional 3.3% could not be located at 4-month follow-up visit
A cumulative of 14.5% could not be located at 6-month follow-up visit
Risk for weaning between 1 and 6 months of age was 3.84 for pacifier users at 1 month of age compared with nonusers; this dropped to 2.87 after Cox analysis adjustment
Discussion:
The 14.5% infants that dropped out from the study are unlikely to have biased the study because they were similar to infants who did not drop out
It is unknown if pacifier use is causally related to weaning or simply a marker of poor sucking or other undetermined variables. It is possible that several factors, including pacifier use, influence duration and frequency for breast-feeding
Infants using pacifiers at 1 month were three times more likely to be weaned by 6 months of age
Pacifier use is highly correlated with early weaning, even after controlling for possible confounders; these results suggest that the pacifier use should not be recommended for breast-fed infants
Assessment of article: Good article
Pacifier Use and the Occurrence of Otitis Media in the First Year of Life
Resident’s Name: Anna Haritos Date: April 17, 2009
Article title: Pacifier Use and the Occurrence of Otitis Media in the First Year of Life
Author(s): Warren, J. et al
Journal: Pediatric Dentistry
Volume (number): 23 (2)
Month, Year: 2001
Major topic: pacifier use
Minor topic(s): n/a
Type of Article: research article
Main Purpose(s): to assess the risk of otitis media with pacifier use
Overview of method of research: longitudinal study with data collected during the Iowa Fluoride Study; questionnaires regarding non-nutritive sucking, feeding practices, and illnesses were sent to participants of the study at 6 weeks, 3 months, 6 mo, 9 mo and 12 mo. Over 1300 respondents participated; there was an equal distribution by gender, and 95% of the respondents were Caucasian. Two thirds of parents had attended college, and over half of the children attended some form of daycare outside the home.
Findings: The overall occurrence of otitis media during the first year of life is 72%, with otitis media occurring more during the second half of the first year of life. Otitis media significantly increased with parental education level, family income, daycare attendance, and race (Caucasians having increased occurrence). Risk factors for developing otitis media are: age, sex (male prediliction), duration spent in daycare, and use of pacifier. Multivariate analysis found that otitis media occurrence was significantly associated with pacifier use during the first year of life
Key points/Summary: Pacifier was a risk factor for the occurrence of otitis media during the first year of life; the non-nutritive sucking habit of pacifier use may alter the formation of the Eustachian tubes,
Assessment of article: very useful!
Article title: Pacifier Use and the Occurrence of Otitis Media in the First Year of Life
Author(s): Warren, J. et al
Journal: Pediatric Dentistry
Volume (number): 23 (2)
Month, Year: 2001
Major topic: pacifier use
Minor topic(s): n/a
Type of Article: research article
Main Purpose(s): to assess the risk of otitis media with pacifier use
Overview of method of research: longitudinal study with data collected during the Iowa Fluoride Study; questionnaires regarding non-nutritive sucking, feeding practices, and illnesses were sent to participants of the study at 6 weeks, 3 months, 6 mo, 9 mo and 12 mo. Over 1300 respondents participated; there was an equal distribution by gender, and 95% of the respondents were Caucasian. Two thirds of parents had attended college, and over half of the children attended some form of daycare outside the home.
Findings: The overall occurrence of otitis media during the first year of life is 72%, with otitis media occurring more during the second half of the first year of life. Otitis media significantly increased with parental education level, family income, daycare attendance, and race (Caucasians having increased occurrence). Risk factors for developing otitis media are: age, sex (male prediliction), duration spent in daycare, and use of pacifier. Multivariate analysis found that otitis media occurrence was significantly associated with pacifier use during the first year of life
Key points/Summary: Pacifier was a risk factor for the occurrence of otitis media during the first year of life; the non-nutritive sucking habit of pacifier use may alter the formation of the Eustachian tubes,
Assessment of article: very useful!
Wednesday, April 15, 2009
Effects of current and former pacifier use on the dentition of 24 to 59 month old children
Resident’s Name: Chad Abby Date: 4/17/2009
Article title: Effects of current and former pacifier use on the dentition of 24 to 59 month old children
Author(s): Steven M. Adair, Michael Milano, Isabel Lorenzo, Carl Russell
Journal: American Academy of Pediatric Dentistry
Volume (number): 17:7
Month, Year: 1995
Major topic: pacifier use
Minor topic(s): effects of current and former pacifier use on the dentition
Type of Article: Scientific article
Main Purpose: purposes of this study include: compare the occlusions of 24-59 mnth old current and former pacifier users to children of the same age with no pacifier habits, the effects on the occlusion of conventional pacifiers and functional exercisers, the effects of pacifier use time on the occlusion, differences between current and former pacifier users, and differences between pacifier use patterns of European-Americans and African-Americans.
Overview of method of research: 218 children ages 24-59 months participated in a study. A questionnaire was used to gain info on habit hx. 82 children were current or former users of functional exercisers, 38 had a hx of conventional pacifier use, and 98 had no hx of oral habits. Primary canine relationships, terminal plane relationships, overbite and openbite, overjet, and posterior crossbite were all recorded.
Findings: It has been reported that non-nutritive sucking habits occurs between 61 and 95%. The prevalence of malocclusions among children with the habit has been reported to be 38-94%. Anterior opentbites have been reported in as many as 74%. Increased overjet has been noted in 79% of pacifier users. An increased prevalence of class 2 canines and distal step primary molars also has been reported.
Key points/Summary: It was found that children with a history of pacifier use had a significantly larger mean overjet, as well as significantly higher occurrence of class 2 primary canines, distal step molars, openbite, and posterior crossbite compared to children with no habit. Pacifier use time in months was significantly higher for children with openbite and posterior crossbite. Compared to former pacifier users, those with current habits had a significantly higher prevalence of openbite and posterior crossbite, and a greater mean openbite. African-American and European-American children began their habits at about the same age and used their pacifiers for an equivalent number of hours per day. Among those who discontinued their habits, African –American children had a maintained theirs for a significantly shorter period, leading to a longer elapsed time between habit discontinuation and the examination.
Assessment of article: What are functional exercisers? I suppose they are a non-conventional pacifiers
Article title: Effects of current and former pacifier use on the dentition of 24 to 59 month old children
Author(s): Steven M. Adair, Michael Milano, Isabel Lorenzo, Carl Russell
Journal: American Academy of Pediatric Dentistry
Volume (number): 17:7
Month, Year: 1995
Major topic: pacifier use
Minor topic(s): effects of current and former pacifier use on the dentition
Type of Article: Scientific article
Main Purpose: purposes of this study include: compare the occlusions of 24-59 mnth old current and former pacifier users to children of the same age with no pacifier habits, the effects on the occlusion of conventional pacifiers and functional exercisers, the effects of pacifier use time on the occlusion, differences between current and former pacifier users, and differences between pacifier use patterns of European-Americans and African-Americans.
Overview of method of research: 218 children ages 24-59 months participated in a study. A questionnaire was used to gain info on habit hx. 82 children were current or former users of functional exercisers, 38 had a hx of conventional pacifier use, and 98 had no hx of oral habits. Primary canine relationships, terminal plane relationships, overbite and openbite, overjet, and posterior crossbite were all recorded.
Findings: It has been reported that non-nutritive sucking habits occurs between 61 and 95%. The prevalence of malocclusions among children with the habit has been reported to be 38-94%. Anterior opentbites have been reported in as many as 74%. Increased overjet has been noted in 79% of pacifier users. An increased prevalence of class 2 canines and distal step primary molars also has been reported.
Key points/Summary: It was found that children with a history of pacifier use had a significantly larger mean overjet, as well as significantly higher occurrence of class 2 primary canines, distal step molars, openbite, and posterior crossbite compared to children with no habit. Pacifier use time in months was significantly higher for children with openbite and posterior crossbite. Compared to former pacifier users, those with current habits had a significantly higher prevalence of openbite and posterior crossbite, and a greater mean openbite. African-American and European-American children began their habits at about the same age and used their pacifiers for an equivalent number of hours per day. Among those who discontinued their habits, African –American children had a maintained theirs for a significantly shorter period, leading to a longer elapsed time between habit discontinuation and the examination.
Assessment of article: What are functional exercisers? I suppose they are a non-conventional pacifiers
Prevalence of Pacifier-sucking Habits and Successful Methods to Eliminate Them – A Preliminary Study
Author(s): Viviane Degan SLP, MSc PhD & Regina M. Puppin-Rontani DDS MSc PhD
Journal: Journal of Dentistry for Children
Month, Year: 2004
Major topic: Habit cessation efficacy
Type of Article: Survey
Findings: Non nutritive sucking has been shown to be prevalent in many populations but practically no existent in others. Children most often develop an attachment to a pacifier when parents use it to calm the child and the effects it has depend on the intensity, frequency and duration of the habit, most commonly the open bite. The highest percentages of non-nutritive sucking habit was 18% in the 60-71 month age group and 41% in the 72-83 month group. Breast-feeding was most common in the first 3 onths of life, gradually lessened and abruptly dropped off at 1 year of age. Bottle feeding grew rapidly until the 36-47 month age but did continue to 71 months. Sixty three percent of children used a pacifier. Pacifier cessation was observed most frequently in the 36-47 month group and the 24-35 month group using unpalatable substances and throwing the pacifier out respectively. Interestingly, the longer the child breast fed, the less likely they were to use a pacifier. Many parents do not find it necessary to attempt stopping the habit. Explanation by professionals was the most successful cessation protocol, but it was the least used. ‘Abrupt interruption’ was the most commonly used method and it had a 64% success rate
Key points/Summary: The ‘professional explanation’ showed the highest success rate but no information is included as to who spoke to the child and what was presented. Spontaneous removal at 36-47 months and substances on the pacifier at 24-35 months also showed promise as habit cessation techniques.
Assessment of article: Could have used more detail on the techniques. Would love to see this study in an American clinic.
Brian Schmid DMD
Journal: Journal of Dentistry for Children
Month, Year: 2004
Major topic: Habit cessation efficacy
Type of Article: Survey
Findings: Non nutritive sucking has been shown to be prevalent in many populations but practically no existent in others. Children most often develop an attachment to a pacifier when parents use it to calm the child and the effects it has depend on the intensity, frequency and duration of the habit, most commonly the open bite. The highest percentages of non-nutritive sucking habit was 18% in the 60-71 month age group and 41% in the 72-83 month group. Breast-feeding was most common in the first 3 onths of life, gradually lessened and abruptly dropped off at 1 year of age. Bottle feeding grew rapidly until the 36-47 month age but did continue to 71 months. Sixty three percent of children used a pacifier. Pacifier cessation was observed most frequently in the 36-47 month group and the 24-35 month group using unpalatable substances and throwing the pacifier out respectively. Interestingly, the longer the child breast fed, the less likely they were to use a pacifier. Many parents do not find it necessary to attempt stopping the habit. Explanation by professionals was the most successful cessation protocol, but it was the least used. ‘Abrupt interruption’ was the most commonly used method and it had a 64% success rate
Key points/Summary: The ‘professional explanation’ showed the highest success rate but no information is included as to who spoke to the child and what was presented. Spontaneous removal at 36-47 months and substances on the pacifier at 24-35 months also showed promise as habit cessation techniques.
Assessment of article: Could have used more detail on the techniques. Would love to see this study in an American clinic.
Brian Schmid DMD
Tuesday, April 14, 2009
Pacifier use and the occurrence of otitis media in the first year of life
Resident’s Name: Laura Randazzo Sabnani Date: April 17, 2009
Article title:Pacifier use and the occurrence of otitis media in the first year of life
Author(s): Warren J, et. al
Journal: Pediatric Dentistry
Volume (number):23:2
Month, Year: 2001
Major topic / Main purpose: To access pacifier use as a risk of otitis media for children up to 1 year.
Methods and Materials: Data was collected as part of the Iowa Fluoride Study which recruited 1882 new mothers from 8 Iowa hospitals. Of the 1882, 502 did not provide any data during the 12 month study. 1375 parents did respond at 6 weeks, 2, 6, 9 and 12 months of age. Questions were asked regarding specific childhood illnesses such as otitis media, pneumonia, bladder infection, and skin infections. Parents were also asked about child sucking habits including the object the child sucked on and the frequency and duration.
Result/Summary: 70% of the children experienced one or more episodes of otitis media during their first year of life, with the second six months having more common occurrence. Pacifier use, age, male sex, greater number of childcare days, and higher family incomes were significantly associated otitis media.
Assessment of article: Interesting article. I wonder if the higher occurrence of otitis media in children of families with high incomes is associated with an increased awareness (or a more reliable reporter) and/or increase in the parents who responded to the surveys.
Friday, April 10, 2009
Localization of the unerupted maxillary canine: How to and when to
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Chad Abby Date: 3/13/2009
Article title: Localization of the unerupted maxillary canine: How to and when to
Author(s): Stanley G Jacobs
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Volume (number): Volume 115, Number 3
Month, Year: March 1999
Major topic: unerupted maxillary canines
Minor topic(s): localization of unerupted maxillary canines – reasons for localizing impacted maxillary canines and methods of localization are described
Type of Article: Literature / clinical review
Main Purpose: To summarize current literature about the localization of the impacted maxillary canine and to provide further information on this subject
Overview of method of research: Method of research was to simply describe the method of localization and explain the importance
Findings: Three reasons make it important to localize impacted canines: 1) never extract a well-placed tooth in order to make space for a poorly positioned one. If a well-placed tooth is preserved, treatment time may be shortened considerably, and the result will be more certain. 2) Because of an error in localization, a flap could be raised and an uncovering or a removal attempted in the wrong area. 3) The clinician must be able to estimate the difficulty involved in uncovering a displaced canine. 4) If suitable clinical conditions exist, a palatally impacted canine may be induced to erupt in the line of the arch, and the only treatment is extraction of the deciduous canine.
Key points/Summary: There are three methods of localization of impacted canines: inspection, palpation and radiography – Inspection – clinician may see the bulge of the unerupted canine and observe the position of the adjacent lateral incisor is being influenced by the impacted canine. If the Impacted Maxillary Canine (IMC) is palatally placed, it may press on the root of the lateral incisor and push the root labially, and the crown moves palatally. Palpation – frequently IMC can be palpated Radiography – Parallax method – the apparent displacement of an image, relative to the image of a reference object, caused by an actual change in the angulation of the x-ray beam. Tube shifts can be done in both horizontal or vertical planes. For horizontal two occlusal radiographs are taken, for a vertical an occlusal and a pano are taken. A reference object of the radiograph is used and the tooth that is farther away from the x-ray tube moves in the same direction as the tube, and the image of the tooth closer to the x-ray tube moves in the opposite direction of the tube. Indications to suspect palatal impaction may occur in the future if the patient is less than 10 years of age and there is a family history of palatally IMCs or small peg-shaped, or missing lateral incisors or other missing teeth. Indications to suspect impaction may have occurred if the patient is more than 10 years of age if: 1) Asymmetry in palpation or a pronounced difference in eruption of canines between the left and right side. 2) The canines cannot be palpated and occlusal development is advanced suggesting an abnormal path of eruption 3) The lateral incisor is proclined and tipped distally, which may indicate a labial impaction of the canine.
Lutheran Medical Center
Resident’s Name: Chad Abby Date: 3/13/2009
Article title: Localization of the unerupted maxillary canine: How to and when to
Author(s): Stanley G Jacobs
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Volume (number): Volume 115, Number 3
Month, Year: March 1999
Major topic: unerupted maxillary canines
Minor topic(s): localization of unerupted maxillary canines – reasons for localizing impacted maxillary canines and methods of localization are described
Type of Article: Literature / clinical review
Main Purpose: To summarize current literature about the localization of the impacted maxillary canine and to provide further information on this subject
Overview of method of research: Method of research was to simply describe the method of localization and explain the importance
Findings: Three reasons make it important to localize impacted canines: 1) never extract a well-placed tooth in order to make space for a poorly positioned one. If a well-placed tooth is preserved, treatment time may be shortened considerably, and the result will be more certain. 2) Because of an error in localization, a flap could be raised and an uncovering or a removal attempted in the wrong area. 3) The clinician must be able to estimate the difficulty involved in uncovering a displaced canine. 4) If suitable clinical conditions exist, a palatally impacted canine may be induced to erupt in the line of the arch, and the only treatment is extraction of the deciduous canine.
Key points/Summary: There are three methods of localization of impacted canines: inspection, palpation and radiography – Inspection – clinician may see the bulge of the unerupted canine and observe the position of the adjacent lateral incisor is being influenced by the impacted canine. If the Impacted Maxillary Canine (IMC) is palatally placed, it may press on the root of the lateral incisor and push the root labially, and the crown moves palatally. Palpation – frequently IMC can be palpated Radiography – Parallax method – the apparent displacement of an image, relative to the image of a reference object, caused by an actual change in the angulation of the x-ray beam. Tube shifts can be done in both horizontal or vertical planes. For horizontal two occlusal radiographs are taken, for a vertical an occlusal and a pano are taken. A reference object of the radiograph is used and the tooth that is farther away from the x-ray tube moves in the same direction as the tube, and the image of the tooth closer to the x-ray tube moves in the opposite direction of the tube. Indications to suspect palatal impaction may occur in the future if the patient is less than 10 years of age and there is a family history of palatally IMCs or small peg-shaped, or missing lateral incisors or other missing teeth. Indications to suspect impaction may have occurred if the patient is more than 10 years of age if: 1) Asymmetry in palpation or a pronounced difference in eruption of canines between the left and right side. 2) The canines cannot be palpated and occlusal development is advanced suggesting an abnormal path of eruption 3) The lateral incisor is proclined and tipped distally, which may indicate a labial impaction of the canine.
Thursday, April 9, 2009
Primary failure of eruption of primary molars: A review and case report
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Laura Randazzo Sabnani Date: April 10, 2009
Article title: Primary failure of eruption of primay: A review and case report
Author(s): Mai Diab, DDS
Journal: Quintessence International
Volume (number): 32, Number 1
Month, Year: 2001
Major topic: Failure of eruption of primary molars
Minor topic(s:
Type of Article: Review and Case report
Main Purpose: To review the characteristics, etiology, and sequelae, of primary failure of eruption of primary molars and to describe a case of an unerupted mandibular primary second molar in a healthy 5 year old girl
Overview of method of research: N/A
Findings:N/A
Key points/Summary: Primary failure of eruption also known as primary retention is an abnormality of tooth eruption causing cessation of eruption before the tooth comes into the mouth and causing it to be deeply embedded in the alveolar bone. Secondary failure of eruption is a termination of the eruptive process after the tooth has emerged into the oral cavity, resulting in infraocclusion associated with impaired growth of the alveolar bone. Possible complications of primary failure of eruption of primary molars include malformation, impaction, or ectopic eruption of the succeeding premolars. It may also cause inversion of the between the premolar and embedded primary molar and/or ectopic eruption of the permanent first molars. The case report followed a 5 year old female who had the embedded first molar surgically extracted and a space maintainer placed and regular follow-ups. Assessment of article: Great article
Lutheran Medical Center
Resident’s Name: Laura Randazzo Sabnani Date: April 10, 2009
Article title: Primary failure of eruption of primay: A review and case report
Author(s): Mai Diab, DDS
Journal: Quintessence International
Volume (number): 32, Number 1
Month, Year: 2001
Major topic: Failure of eruption of primary molars
Minor topic(s:
Type of Article: Review and Case report
Main Purpose: To review the characteristics, etiology, and sequelae, of primary failure of eruption of primary molars and to describe a case of an unerupted mandibular primary second molar in a healthy 5 year old girl
Overview of method of research: N/A
Findings:N/A
Key points/Summary: Primary failure of eruption also known as primary retention is an abnormality of tooth eruption causing cessation of eruption before the tooth comes into the mouth and causing it to be deeply embedded in the alveolar bone. Secondary failure of eruption is a termination of the eruptive process after the tooth has emerged into the oral cavity, resulting in infraocclusion associated with impaired growth of the alveolar bone. Possible complications of primary failure of eruption of primary molars include malformation, impaction, or ectopic eruption of the succeeding premolars. It may also cause inversion of the between the premolar and embedded primary molar and/or ectopic eruption of the permanent first molars. The case report followed a 5 year old female who had the embedded first molar surgically extracted and a space maintainer placed and regular follow-ups. Assessment of article: Great article
Friday, April 3, 2009
The clinical management of ectopically erupting first permanent molars
Resident’s Name: Anna Haritos Date: April 2, 2009
Article title: The clinical management of ectopically erupting first permanent molars
Author(s): Kennedy, David B. et al
Journal: Am. J. Orthod.Dentofac. Orthop.
Volume (number): 92 (4)
Month, Year: October 1987
Major topic: ectopically erupting first molars
Minor topic(s): n/a
Type of Article: literature review
Main Purpose(s): to review the literature on ectopically erupting 1st permanent molars; to discuss a variety of treatment approaches along with a diagnostic rationale and clinical guidelines.
Overview of method of research: literature review
Findings:
*clinical signs: canting of the occlusal plane of the 2nd primary molar
* causes: - skeletal involvement (lacking arch length, smaller maxilla, retroposition of maxilla relative to cranial base); - large molar width - steeper angle of molar eruption
* self-correction: - 66% of 1st permanent molar cases (less so in left-lip/palate) - resorption of disto-buccal root of 2nd primary molar
* intervention techniques when entrapment of permanent molar is 1 mm or less: - surgical uncovering of unerupted impacted permanent molar (no documented clinical trials) - placement of separator (brass ligature, elastic separator, spring-type de-impactor) with reciprocal anchorage * intervention techniques when entrapment of permanent molar is 2 mm or more: - active appliance therapy (band on 2nd primary molar with active spring or arm to the distal) aka Humphry appliance
* loss of 2nd primary molar due to extensive resorption: - space regaining: removable appliances, external traction (cervical headgear), contraindicated if missing 2nd premolar - space closure: especially useful when there is significant arch length shortage * disk distal of 2nd primary molar and then monitor for future extraction * extract 2nd primary molar and then place space maintainer until make future decision
Key points/Summary: 3-4% of the population experience ectopically erupting 1st permanent molars; this is occurs at a higher frequency in siblings as well as in children with cleft lip and palate. There is no sex or race variation. Many resorbed 2nd primary molars remain in place until exfoliation. First treatment goal is to distalize ectopically erupting 1st permanent molar. Must consider skeletal pattern, Angle classification and facial profile.
Assessment of article: Make a copy of the chart on page 338 – It’s great
Article title: The clinical management of ectopically erupting first permanent molars
Author(s): Kennedy, David B. et al
Journal: Am. J. Orthod.Dentofac. Orthop.
Volume (number): 92 (4)
Month, Year: October 1987
Major topic: ectopically erupting first molars
Minor topic(s): n/a
Type of Article: literature review
Main Purpose(s): to review the literature on ectopically erupting 1st permanent molars; to discuss a variety of treatment approaches along with a diagnostic rationale and clinical guidelines.
Overview of method of research: literature review
Findings:
*clinical signs: canting of the occlusal plane of the 2nd primary molar
* causes: - skeletal involvement (lacking arch length, smaller maxilla, retroposition of maxilla relative to cranial base); - large molar width - steeper angle of molar eruption
* self-correction: - 66% of 1st permanent molar cases (less so in left-lip/palate) - resorption of disto-buccal root of 2nd primary molar
* intervention techniques when entrapment of permanent molar is 1 mm or less: - surgical uncovering of unerupted impacted permanent molar (no documented clinical trials) - placement of separator (brass ligature, elastic separator, spring-type de-impactor) with reciprocal anchorage * intervention techniques when entrapment of permanent molar is 2 mm or more: - active appliance therapy (band on 2nd primary molar with active spring or arm to the distal) aka Humphry appliance
* loss of 2nd primary molar due to extensive resorption: - space regaining: removable appliances, external traction (cervical headgear), contraindicated if missing 2nd premolar - space closure: especially useful when there is significant arch length shortage * disk distal of 2nd primary molar and then monitor for future extraction * extract 2nd primary molar and then place space maintainer until make future decision
Key points/Summary: 3-4% of the population experience ectopically erupting 1st permanent molars; this is occurs at a higher frequency in siblings as well as in children with cleft lip and palate. There is no sex or race variation. Many resorbed 2nd primary molars remain in place until exfoliation. First treatment goal is to distalize ectopically erupting 1st permanent molar. Must consider skeletal pattern, Angle classification and facial profile.
Assessment of article: Make a copy of the chart on page 338 – It’s great
Thursday, April 2, 2009
The effect of extraction of infrao-ccluded deciduous molars: A longitudinal study.
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/3/2009
Article title: The effect of extraction of infrao-ccluded deciduous molars: A longitudinal study.
Author(s): Kurol J, Koch G.
Journal: Am. J. Orthod. 87 (1)
Volume (number): 46-53
Date: January 1985
Major topic: Extraction of ankylosed primary molars
Type of Article: Prospective Research article
Main Purpose: This study evaluated the effect of unilateral extractionof submerged mandibular primary molars longitudinally. Comparisons were made between contralateral sides in terms of eruption of permanent successors, alveolar bone level and development of the dental arch.
Materials and Methods: 15 children, mean age of 10.1 years with bilateral infraocclusion and no missing successor teeth were included in the study. Unilateral extractions of the infra-occluded molar were compared to the contralateral side of the same arch. 55 deciduous molars were infra-occluded, 23 pairs in the lower arch. Clinical and radiographic measurements were made as well as photos were taken. The children were examined every 6 months until the permanent successors erupted with an average observation period of 2.6 years. The radiographs were standardized and examined for bone level, eruption pattern of permanent teeth and root resorption of the primary tooth. Casts were measured for infraocclusion and arch perimeter. The extracted teeth were randomly selected and no space maintainer was placed for the duration of the study.
Findings: The degree of infra-occlusion increased in 10 of the 23 molars on the non-extracted side. However the molars exfoliated within the normal time. Alveolar bone height was the same after eruption of successsors on both sides. There was no difference in eruption time between the extraction and non-extraction side, and were within a normal range. Radiographs indicate no difference in root development of successors for either side. Removal of ankylosed teeth resulted in 8 children having 10 residual root fragments left in the bone. In 6 of the 8 children, root fragments were also noted on the contra-lateral side. Most of the root fragments resorbed on the extraction side and all root fragments were still present on the non-extraction side throughout the observation period. Arch length decreased gradually in 14 out of 15 children on the extraction side while arch length increased in 9 out of 15 children and decreased minimally in 6 children. No mesial tipping was noted on either side.
Key points/Summary : No major differences were noted in eruption time of successors, or in marginal alveolar bone height between the extraction and non-extraction sides. The frequency of residual deciduous root fragments was similar between sides. The results indicate that conservative observation rather than extraction of infra-occluded molars is the preferred treatment.
Assessment of article: Good article. Fairly small sample size.
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/3/2009
Article title: The effect of extraction of infrao-ccluded deciduous molars: A longitudinal study.
Author(s): Kurol J, Koch G.
Journal: Am. J. Orthod. 87 (1)
Volume (number): 46-53
Date: January 1985
Major topic: Extraction of ankylosed primary molars
Type of Article: Prospective Research article
Main Purpose: This study evaluated the effect of unilateral extractionof submerged mandibular primary molars longitudinally. Comparisons were made between contralateral sides in terms of eruption of permanent successors, alveolar bone level and development of the dental arch.
Materials and Methods: 15 children, mean age of 10.1 years with bilateral infraocclusion and no missing successor teeth were included in the study. Unilateral extractions of the infra-occluded molar were compared to the contralateral side of the same arch. 55 deciduous molars were infra-occluded, 23 pairs in the lower arch. Clinical and radiographic measurements were made as well as photos were taken. The children were examined every 6 months until the permanent successors erupted with an average observation period of 2.6 years. The radiographs were standardized and examined for bone level, eruption pattern of permanent teeth and root resorption of the primary tooth. Casts were measured for infraocclusion and arch perimeter. The extracted teeth were randomly selected and no space maintainer was placed for the duration of the study.
Findings: The degree of infra-occlusion increased in 10 of the 23 molars on the non-extracted side. However the molars exfoliated within the normal time. Alveolar bone height was the same after eruption of successsors on both sides. There was no difference in eruption time between the extraction and non-extraction side, and were within a normal range. Radiographs indicate no difference in root development of successors for either side. Removal of ankylosed teeth resulted in 8 children having 10 residual root fragments left in the bone. In 6 of the 8 children, root fragments were also noted on the contra-lateral side. Most of the root fragments resorbed on the extraction side and all root fragments were still present on the non-extraction side throughout the observation period. Arch length decreased gradually in 14 out of 15 children on the extraction side while arch length increased in 9 out of 15 children and decreased minimally in 6 children. No mesial tipping was noted on either side.
Key points/Summary : No major differences were noted in eruption time of successors, or in marginal alveolar bone height between the extraction and non-extraction sides. The frequency of residual deciduous root fragments was similar between sides. The results indicate that conservative observation rather than extraction of infra-occluded molars is the preferred treatment.
Assessment of article: Good article. Fairly small sample size.
Eruption of the permanent upper canine: A radiologic study
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/3/2009
Article title: Eruption of the permanent upper canine: A radiologic study.
Author(s): Fernandez E., Bravo LA. Canteras M.
Journal: Am. J. Orthod. 113 (4)
Volume (number): 414-20
Date: April 1998
Major topic: Eruption path of permanent upper cuspids
Type of Article: Retrospective Research article
Main Purpose: This study analyzed the eruption of the upper canines in terms of inclination and relation to the lateral incisor.
Materials and Methods: Panoramic radiographs of 305 children with a range in age of 4-12 years of age were studied in terms of canine inclination (CI), relation of the canine to the lateral incisor (RCLI), and development of the lateral incisor (DLI). Canine inclination was determined by an angle from a line connecting suborbital points on a panorex. Greater than 90 degrees indicates mesial inclination towards the lateral incisor. Relation of the canine to the lateral indicated either overlap of the crown of the cuspid to the lateral root or not., and lastly the root development of the lateral.
Findings: Canine inclination was measured in two groups, before root formation began, and angle at emergence of the tooth. CI was 91 degrees before root formation of the lateral incisor and reduced to 88 degrees at emergence. RCLI was analyzed and it was found that up to age 6 overlapping was significantly more frequent, then at age 7, differences were no longer seen, and after 8,the cuspid moved distally away from the root of the lateral. Therefore an incomplete DLI was more related to a mesial RCLI while a complete DLI was related to a distal RCLI.. It is thought the DLI is a good reference for defining when radiographic overlapping of the crown with the root of the lateral indicates a true sign of altered cuspid eruption.
Key points/Summary : Overlapping of the canine and lateral incisor in a panorex when the incisor has completed development may be a sign of an eruption problem, which may necessitate preventive treatment such as the extraction of the primary cuspids
Assessment of article: Offers good guidelines for the pediatric dentist in determining the need to extract primary cuspids..
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 4/3/2009
Article title: Eruption of the permanent upper canine: A radiologic study.
Author(s): Fernandez E., Bravo LA. Canteras M.
Journal: Am. J. Orthod. 113 (4)
Volume (number): 414-20
Date: April 1998
Major topic: Eruption path of permanent upper cuspids
Type of Article: Retrospective Research article
Main Purpose: This study analyzed the eruption of the upper canines in terms of inclination and relation to the lateral incisor.
Materials and Methods: Panoramic radiographs of 305 children with a range in age of 4-12 years of age were studied in terms of canine inclination (CI), relation of the canine to the lateral incisor (RCLI), and development of the lateral incisor (DLI). Canine inclination was determined by an angle from a line connecting suborbital points on a panorex. Greater than 90 degrees indicates mesial inclination towards the lateral incisor. Relation of the canine to the lateral indicated either overlap of the crown of the cuspid to the lateral root or not., and lastly the root development of the lateral.
Findings: Canine inclination was measured in two groups, before root formation began, and angle at emergence of the tooth. CI was 91 degrees before root formation of the lateral incisor and reduced to 88 degrees at emergence. RCLI was analyzed and it was found that up to age 6 overlapping was significantly more frequent, then at age 7, differences were no longer seen, and after 8,the cuspid moved distally away from the root of the lateral. Therefore an incomplete DLI was more related to a mesial RCLI while a complete DLI was related to a distal RCLI.. It is thought the DLI is a good reference for defining when radiographic overlapping of the crown with the root of the lateral indicates a true sign of altered cuspid eruption.
Key points/Summary : Overlapping of the canine and lateral incisor in a panorex when the incisor has completed development may be a sign of an eruption problem, which may necessitate preventive treatment such as the extraction of the primary cuspids
Assessment of article: Offers good guidelines for the pediatric dentist in determining the need to extract primary cuspids..
conservative treatment mand. crowding
Resident’s Name: Joanne Lewis Date: April 3, 2009
Article title: Conservative treatment for malaligned permanent mandibular incisors in the early mixed dentition.
Author(s): Milton E. Gellin, DDS
Journal: Journal of Dentistry for Children
Volume (number):
Month, Year: July/August 1989
Major topic: extraction of mandibular primary incisors during the early mixed dentition.
Type of Article: literature review
Main Purpose: to point out that extraction of the mandibular primary incisors during the early mixed dentition can prevent this area from reaching maximum intercanine dimensional growth.
Overview of method of research: The author observed 44 children who had 57 lingually erupted permanent mandibular incisors to determine the outcome of lingual eruption. For cases involving crowding and rotation, the author reviewed the current literature to determine proper treatment and outcomes.
Findings: In all cases the author observed involving lingual eruption, labial migration and acceptable alignment occurred without the need to extract a primary incisor. The data suggests that removal of retained primary incisors should not be considered until 8.4 years of age. For crowding and rotation, research shows that the initial crowding is normal (1.6 mm in males and 1.8 mm in females), transitory and is improved by normal developmental processes. Proper alignment occurs with the transverse widening of the mandibular anterior arch when the permanent incisors begin their eruption. The strongest impulse for lateral growth of the mandibular alveolar process occurs with the eruption of the lateral incisors. When the lateral incisors are fully erupted, the intercanine width is complete. No data exists to indicate that the rotations of permanent mandibular incisors are signs of crowding; they can spontaneous self-correct. One study found that the best predictor of spacing or crowding in the permanent dentition is the sum of the spaces between the primary teeth at three to four years of age. The presence of the primary incisors and canines contribute to the optimal development of the mandibular intercanine width sufficient enough to accommodate the initial crowding of the mandibular permanent incisors.
Key points/Summary: When a mandibular permanent incisor has erupted to the lingual of a primary incisor, the dentist should reassure the parent that the primary incisor should exfoliate by 8 years of age. If it does not, it should be considered overretained and extraction is indicated. When the mandibular permanent incisors first erupt, some degree of crowding occurs. The alleviation of this crowding is brought about by many factors, including the increase of intercanine width and growth of the alveolar process. The continued presence of the mandibular primary incisors and canines insures that these increases do occur.
Assessment of article: The author makes a good case for not removing “shark teeth”…..but of course parents will still want it.
Article title: Conservative treatment for malaligned permanent mandibular incisors in the early mixed dentition.
Author(s): Milton E. Gellin, DDS
Journal: Journal of Dentistry for Children
Volume (number):
Month, Year: July/August 1989
Major topic: extraction of mandibular primary incisors during the early mixed dentition.
Type of Article: literature review
Main Purpose: to point out that extraction of the mandibular primary incisors during the early mixed dentition can prevent this area from reaching maximum intercanine dimensional growth.
Overview of method of research: The author observed 44 children who had 57 lingually erupted permanent mandibular incisors to determine the outcome of lingual eruption. For cases involving crowding and rotation, the author reviewed the current literature to determine proper treatment and outcomes.
Findings: In all cases the author observed involving lingual eruption, labial migration and acceptable alignment occurred without the need to extract a primary incisor. The data suggests that removal of retained primary incisors should not be considered until 8.4 years of age. For crowding and rotation, research shows that the initial crowding is normal (1.6 mm in males and 1.8 mm in females), transitory and is improved by normal developmental processes. Proper alignment occurs with the transverse widening of the mandibular anterior arch when the permanent incisors begin their eruption. The strongest impulse for lateral growth of the mandibular alveolar process occurs with the eruption of the lateral incisors. When the lateral incisors are fully erupted, the intercanine width is complete. No data exists to indicate that the rotations of permanent mandibular incisors are signs of crowding; they can spontaneous self-correct. One study found that the best predictor of spacing or crowding in the permanent dentition is the sum of the spaces between the primary teeth at three to four years of age. The presence of the primary incisors and canines contribute to the optimal development of the mandibular intercanine width sufficient enough to accommodate the initial crowding of the mandibular permanent incisors.
Key points/Summary: When a mandibular permanent incisor has erupted to the lingual of a primary incisor, the dentist should reassure the parent that the primary incisor should exfoliate by 8 years of age. If it does not, it should be considered overretained and extraction is indicated. When the mandibular permanent incisors first erupt, some degree of crowding occurs. The alleviation of this crowding is brought about by many factors, including the increase of intercanine width and growth of the alveolar process. The continued presence of the mandibular primary incisors and canines insures that these increases do occur.
Assessment of article: The author makes a good case for not removing “shark teeth”…..but of course parents will still want it.
Management of lower incisor crowding in the early mixed dentition
Author(s): Timothy Foley DDS MCID, Gerald Z Wright DDS MSD, Sergio Weinberger DDS MCID
Journal: Journal of Dentistry for Children
Month, Year: May-June 1996
Major topic: discussion of different philosophies and techniques concerning lower incisor crowding
Type of Article: Literature Review
Findings: There is a strong correlation between crowding of the lower incisors and eventual crowding of the permanent mandibular dentition. Most commonly the lateral incisors erupt lingually, pushing the centrals labially and the canines posteriorly or not at all which can complicate eventual orthodontic treatment of the whole arch. By dental age 8.5 years, 85% and 100% of mandibualr intercanine distance is present in males and females respectively. It was noted that an intercanine distance of 28mm or more showed very little risk of crowding and no spontaneous resolution of crowding will occur after complete eruption of the laterals. The permanent teeth are typically 6mm larger than the primary teeth, this difference is called ‘incisor liability’. If there is less than 2 mm of crowding, it is recommended that you simply observe; these cases are usually self evident. With 3-4 mm of crowding, discing is recommended and is completed with or without local anesthesia using a 169L bur in a high speed handpiece, followed by a composite polisher. For 4-9mm of crowding, primary canine extraction is recommended to allow the incisors to unravel. This can also cause a decreased arch length and deepening of the bite, so the use of a horseshoe LHA is recommended. Crowding of greater than 10mm will typically require extraction and referral.
Key points/Summary: There are many ways to deal with lower incisor crowding in the mixed dentition and it is essential to determine the severity before deciding on a treatment plan. One should not perform extractions if you are unable to complete the patients treatment.
Assessment of article: Good stuff.
Journal: Journal of Dentistry for Children
Month, Year: May-June 1996
Major topic: discussion of different philosophies and techniques concerning lower incisor crowding
Type of Article: Literature Review
Findings: There is a strong correlation between crowding of the lower incisors and eventual crowding of the permanent mandibular dentition. Most commonly the lateral incisors erupt lingually, pushing the centrals labially and the canines posteriorly or not at all which can complicate eventual orthodontic treatment of the whole arch. By dental age 8.5 years, 85% and 100% of mandibualr intercanine distance is present in males and females respectively. It was noted that an intercanine distance of 28mm or more showed very little risk of crowding and no spontaneous resolution of crowding will occur after complete eruption of the laterals. The permanent teeth are typically 6mm larger than the primary teeth, this difference is called ‘incisor liability’. If there is less than 2 mm of crowding, it is recommended that you simply observe; these cases are usually self evident. With 3-4 mm of crowding, discing is recommended and is completed with or without local anesthesia using a 169L bur in a high speed handpiece, followed by a composite polisher. For 4-9mm of crowding, primary canine extraction is recommended to allow the incisors to unravel. This can also cause a decreased arch length and deepening of the bite, so the use of a horseshoe LHA is recommended. Crowding of greater than 10mm will typically require extraction and referral.
Key points/Summary: There are many ways to deal with lower incisor crowding in the mixed dentition and it is essential to determine the severity before deciding on a treatment plan. One should not perform extractions if you are unable to complete the patients treatment.
Assessment of article: Good stuff.
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