Dental Erosion in Children: A literature review

Meghan Sullivan Walsh December 21, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Dental Erosion in Children: A literature review

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Dental Erosion in Children: A literature review

Authors:Vivienne Linnett, BDSc, MDSc; W. Kim Seow, BDSc, DDSc, PhD, FRACDS

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 23:1, 2001, pages 37-43

Major Topic: Review of Dental Erosion; diagnosis, causative factors, prevention and restorations.

Overview of Method of Research: Literature Review.

Findings: Studies have shown the prevalence of dental erosion in children to range from 2-57%. Dental erosion can cause tooth sensitivity, occlusal problems and even pulp exposures and abcesses in severe cases. The paper compiled literature regarding dental erosion to help establish the prevalence, clinical manifestation and etiology of pediatric dental erosion and to provide guidelines for patients and their restorative dentist.

Prevalence: Four studies were looked at with a wide range of prevalence on dental erosion in both primary and permanent dentition. All of these studies had a relatively small number of subjects which may have accounted for the wide range of numbers. In compiling the numbers, erosion in dentin showed prevalence of 30% in primary molars of 5 year olds and 2% in incisal surfaces of permanent incisors in 14 year olds. Children with CP showed a nigh prevalence of tooth erosion which was attributed to both parafunctional activity and GERD.

Clinical manifestation:

Appearance: Initially the tooth may show slight loss of surface luster when the enamel is clean and dry or show sensitivity or fracturing of thinned incisal edges. Once the erosion process has progressed the tooth will have a dished out, hard, smooth appearance where the dentin may be exposed. One scoring method for dental erosion in children with GERD scores the tooth from 0-3 where 0 is no erosion to 3 where dentin is exposed at the bottom of the holes on the occlusal surfaces.

Complications: Severe erosion can cause enamel fracture and compromise esthetics. Loss of tooth structure can also account for tooth shortening and loss of VDO. Dentin sensitivity, problems with eating, pulpal inflammation and pulpal exposures also account for a person with a more severe case of erosion.

Etiology: A source of intrinsic or extrinsic acid acting of the tooth structure as well as parafunctional habits all contribute to tooth wear.

Extrinsic sources: Workers in factories with toxic acidic fumes or aerosols, wine tasters or competitive swimmers all have shown tooth wear due to occupational exposure of acid. Dehydration following sports, followed by consumption of acidic drinks, chewable Vitamin C tablets and persons who chew Aspirin over long periods of time also have shown to have dental erosion.

Titratable acidity of foods and drinks: As the pH in the oral cavity falls below 5.5, or the critical pH, erosion will occur. The actual H+ concentration of acidic substances has been found to be more important than the actual pH of the food or drink.

Types of acidic foods and drinks associated with erosion: A study of acidic drinks reported that the first appearance of enamel wear occurred between the fourth and sixth weeks of use. Orange juice was found to cause less erosion than grapefruit juice or carbonated cola. Sports drinks are also found to be highly erosive.

Frequency: Those who consumed these acidic drinks more than twice a day or consumed at bedtime showed the highest signs of erosion.

Intrinsic sources: GERD is the most common source of intrinsic acids in the mouth. Findings have shown that clinical symptoms are not seen until gastric acid has acted on the teeth for a period of 1-2 years. Other conditions have shown erosion such as metabolic and endocrine disorders, medication side effects, drug abuse, and psychosomatic disorders such as stress induces vomiting, bulimia, anorexia, and rumination.

Factors modifying erosion: Swallowing habits, buffering capacity of saliva, chemical makeup of enamel, shape and contour of teeth, duration of contact.

Saliva: Saliva is known to have the most important properties in prevention of dental erosion, but the nature of the role is not completely understood.

Oral hygiene: Erosion is frequently seen in individuals with a high level of oral hygiene. Also, brushing immediately following consumption of acidic beverages is strongly discouraged.

Fluoride: Addition of fluoride to acid solutions decreases the erosion. Applying sodium fluoride solutions immediately before tooth brushing reduces abrasion.

GUIDELINES:

Diagnosis: Thorough medical and dietary history of several days to elicit causative factors. Referral to a gastroenterologist is desirable is GERD is suspected.

Monitoring: Determining if your diagnosis is correct and if the erosive process is ongoing or decreasing. The author suggests study models, clinical photographs and rubber indexes as well as 6 month recalls.

Dietary modification: Decreasing the total acid intake or allowing time for remineralization in between meals. In addition finishing meals with something neutral or alkaline has proven beneficial. Also patients should be told to avoid brushing immediately after consuming acidic foods.

Fluoride: Used to minimize tooth loss and diminish sensitivity.

Restorative Treatment: Primary teeth are often restored with SSCs and composites to improve esthetics, restore VDO, prevent sensitivity and early exfoliation.

Key Points: Summary: Dental erosion can be caused by acidic foods, drinks, environmental exposures or GERD. The manifestation of erosion can be sensitivity, loss of VDO and poor esthetics. Children should be evaluated to identify the source of the acid and appropriate referrals and restorative care should be made.

Assessment of the Article:

The was a great overview of dental erosion. They broke the process down into the many factors which cause erosion, what we as clinicians should look for and appropriate care for these patients. The article was titled as Erosion for Children, however, the paper was really written more as a general assessment on erosion.

Oral Pyogenic Granuloma: A Review

Resident: Swan

Article Title: Oral Pyogenic Granuloma: A review

Author: Jafarzadeh, et al.

Journal: Journal of Oral Science

Volume (Number): Vol 48, No. 4 pgs 167-175, 2006

Major Topic: A complete review of published information about pyogenic granulomas, including the most recent approaches for treatment

Key Points/Summary:

In General: Pyogenic granuloma is a type of inflammatory hyperplasia (made up of inflamed fibrous and granulation tissues histologically). It’s title is a misnomer because it doesn’t have pus and isn’t a granuloma. It is a common tumor-like growth that is non-neoplasitc, and is usually found on keratinized tissue in the mouth. It is especially common in pregnant women.

Etiology: PG is generally considered to be a reactive tumor-like lesion that arises in response to different stimuli like chronic low-grade irritation, trauma (1/3 of all PGs), hormonal factors, or certain drugs (Cyclosporine). Poor oral hygiene can be a precipitating factor for PGs. They have been reported as being a result of injury to a primary tooth, iatrogenic therapies (GTR), and after bone marrow transplantation. It may occur in all ages but is most common in females in their second decade (probably hormonally related). Gingival lesions account for 75% of all PGs, followed by the lips, tongue, and buccal musoca. Max>Mand, Ant>Post. Mostly found on marginal gingival

Clinical Features: PG is a smooth, lobulated, exophytic lesion. It manifests as small, red, usually pedunculated but sometimes sessile, with a base that is hemorrhagic and compressible. Size is anywhere from a few mm to several cm. Clinical development is slow, asymptomatic, and painless, although it can grow rapidly. Its surface is usually ulcerated and friable, and it may be covered by a yellow, fibrinous membrane. It’s color ranges from pink to red to purple. Younger lesions are more vascular and appear more reddish-purple; they will bleed a lot if traumatized. Older lesions are more collagenized and pink.

Pregnancy Correlation: Gingival PGs develop in about 5% of pregnancies (pregnancy tumor). They come about as a result of hormonal imbalances that promote pregnancy gingivitis. If the cases go uncontrolled, PGs may develop. The reasons behind the regression of PGs after childbirth are unclear.

Histology: PGs show a highly vascular make up that resembles granulation tissue. There are two types of PG—Lobular Capillary Hemangioma type (LCH) and non-LCH type.

Differential Diagnosis: Biopsy confirms PG, but the differential would include peripheral giant cell granuloma, peripheral ossifying fibroma, metastatic cancer, hemangioma, conventional granulation tissue, hyperplastic gingival inflammation, Kaposi’s sarcoma, angiosarcoma, and NH Lymphoma. PCCG is more bluish-purple compared to the typical bright red PG. Ossifying fibromas are generally much lighter in color (not much vasculature). Metastatic tumors to the mouth are rare, but the attached gingiva is the most common affected soft tissue (30%). These are usually diagnosed much later in life. PGs may be clinically indistinguishable from hemangiomas, so biopsy is the only definitive way to differentiate. However, hemangiomas typically occur on the tongue, are multinodular, and bluish red.

Treatment: Excisional biopsy is the treatment of choice, unless it would produce a large deformity. Excision should extend down to the periosteum. Recently, successful excision of PGs using a Nd:YAG laser has been described.The laser has superior coagulation ability and results in less chance of bleeding. Other successful techniques that have been described include cryogenesis and injection of ethanol or sodium tetradecyl sulfate into the lesion. After surgery, recurrence is about 16%.

Assessment of Article: Great comprehensive review of the literature on PGs. I especially liked how it went down the list of differential diagnoses and described how PGs are different from each of the listed lesions.

Early Onset of Hereditary Gingival Fibromatosis in a 28-month-old

Resident’s Name: Jessica Wilson

Article title: Early Onset of Hereditary Gingival Fibromatosis in a 28-month-old

Author(s): Breen et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2009. 31:4. 286-288.

Major topic: Hereditary Gingival Fibromatosis

Overview of method of research: Case Report

Background:
Hereditary Gingival Fibromatosis (HGF) is also known as idiopathic gingival hyperplasia. This condition can present as part of a syndrome or as an isolated disorder. It is usually an autosomal dominant condition, but has also been shown to be autosomal recessive at times. HGF presents as benign, asymptomatic gingival enlargement. There is little to no bleeding of the dense gingiva which is normal pink in color. HGF can be isolated to one quadrant or generalized throughout the entire mouth. While the underlying bone is not affected, the firm nodular gingiva resembles bone when palpated.
HGF usually manifests along with the eruption of the permanent dentition, but less commonly with the eruption of the primary dentition. In rare cases it can be present at birth. Severe forms can displace teeth and delay eruption. Some syndromes including Zimmerman-Laband, Jones, Ramon, Murray-Puretic Drescher, Cowden, Cross, Rutherford, and prune belly exhibit HGF. The most common characteristics associated with HGF when reviewing these syndromes are mental retardation, epilepsy and hypertichosis.

Case Report:
A 28-month-old Caucasian male presented with a non-contributory medical history, 4 partially erupted mandibular teeth and no visible maxillary teeth. There was significant gingival overgrowth throughout the maxillary arch with the outline of the absent dentition visible and palpable. The mandibular arch was similar and there were no other abnormal intraoral findings. The patient had an older brother diagnosed with HGF who had undergone several gingival reduction surgeries. To confirm his suspected diagnosis of HGF, he was evaluated at a Craniofacial Anomalies Clinic. They also suspected a diagnosis of nonsyndromic HGF.
The patient was referred to an oral surgeon for electrocautery surgical gingival excision under general anesthesia. The buccal and lingual/palatal gingiva was removed from 1st primary molar to 1st primary molar in both arches to the level of the CEJ as well as part of the tissue covering the posterior tuberosities so the patient could occlude. The tissue was biopsied and came back with normal HGF findings. The patient tolerated the procedure well and returned for follow –up appointments with normal healing.

Key points/Summary:
HGF is incurable, but can be treated with professional prophylaxis, scaling and good oral hygiene for mild presentations or surgical intervention for more severe cases.

Assessment of Article:
Short and sweet review of an interesting disorder. Me likey. Have a great holiday everyone!!!!!

Compound Odontoma - Diagnosis and Treatment: Three Case Reports

Resident: Adam J. Bottrill
Date: 22DEC10
Region: Providence
Article title: Compound Odontoma - Diagnosis and Treatment:
Author(s): Branca Heloisa de Oliveira
Journal: Pediatric Dentistry
Page #s: 151-157
Vol:No Date: 23:2 2001
Major topic: Compound Odontoma
Minor topic(s): NA
Type of Article: Case Studies
Main Purpose: This paper describes 3 cases of compound odontomas diagnosed in children due to dislodgement or over-retention of primary anterior teeth and/or swelling of the cortical bone.

Key points in the article discussion:

I. General:

A. Odontomas: developmental anomolies formed of enamel and dentin with possible , variable amounts of pulpal and cement tissue. Can show anatomical similarity to teeth, in which case it labeled "compound." When it forms an irregular mass, described as "complex"

B. Major Characteristics of Compound and Complex Odontomas:




















C. Ameloblastic fibro-odontoma: General features of ameloblastic fibroma but with evidence of enamel and dentin.
1. 10yo
2. Central/Intraosseous tumors
3. Posterior Mandible
4. Well-defined, uni/multilocular radiolucent defect with variable amount of (dental) radiodense material.
5. Tx: Conservative surgical enucleation with GREAT prognosis.

D. Ameloblastic Fibrosarcoma: malignant counterpart of the ameloblastic fibroma. Usually a "re-diagnosis" of a progressing existing lesion.
1. 27.5 yo
2. Ill-defined, destructive radiolucent lesion that suggests malignant process.
3. Pain and swelling along with rapid clinical growth.
4. Tx: Radical surgical excision.
5. Long-term prognosis unsure.

E. Odontoameloblastoma: VERY RARE... with ameloblastomatous components with odontoma-like component.
1. Mandible of young patients
2. Radiolucent, destructive process that contains calcified structures.
3. Tx: Surgical resection. (curettaged lesions may reccur)
4. RARE... no known prognosis

II. Case I

A. 5 yo white female.
B. Presented with changing position of upper left primary central incisor (labially displaced and intruded). No Hx of trauma.
C. Radiographic exam: compound odontomas in palate.
D. Tx: Surgical resection. 3 tooth-like structures found within lesions.
E. When permanent teeth erupted, upper incisors proclined and midline is shifted.
F. Removable appliance used to improve position.

III. Case II

A. 12 yo female
B. Presented complaining of excess volume of gingiva in the area of upper right anterior region. No Hx of trauma.
C. Radiographic exam: compound odontoma buccal to the root of upper permanent lateral incisor.
D. Tx: Surgical resection. 7 tooth-like structures found.
E. 1 yr F/U confirmed that lateral incisor had returned to normal position. No recurrence of lesion.

IV. Case III

A. 11 yo male.
B. CC of overretained primary central incisor despite presence of permanent dentition elsewhere in the mouth.
C. Radiographic exam: odontoma-like lesion in the buccal region of primary incisor root.
D. Impacted corresponding permanent incisor.
E. Tx: Surgical removal with multiple tooth-like structures present.
F. Orthodontic device used to expose and guide tooth into place.
G. 3 years to bring into place with uneven gingival margins and incisal edge.

V. Discussion

A. The three cases were all diagnosed early and radiographically prior to excision. All found in the anterior maxilla.
B. One patient suffered trauma in the area. Some researchers claim trauma may contribute to odontoma development.
C. Delayed diagnosis (evident in case III) may result in complete root formation/impaction and necessitate surgical exposure.
D. Ideally, surgical removal of odontomas should occur when the roots of adjacent permanent teth are about half-formed.

VI. Conclusions

A. Evidence suggests that an individualized radiographic examination of any pediatric patient that presents clinical evidence of delayed permanent tooth eruption or temporary tooth displacement should be performed.
B. Early diagnosis of odontomas allows adoption of a less complex and less expensive treatment and ensures better prognosis.

Assessment of article: Good background and history of the pathology. I don't believe the author overstepped any bounds or made any rash conclusions based on these three cases. I know this may be hard to believe, but I don't have any complaints. Likey.

Recurrent Apthous Ulcers: A Review of Diagnosis and Treatment

Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Recurrent Apthous Ulcers: A Review of Diagnosis and Treatment
Author(s): Sook- Bin Woo DMD, MMSC. Stephen Sonis DMD DMSC
Journal: JADA
Year. Volume (number). Page #’s: 1996. Vol. 127 1202-1213
Major topic: Recurrent Apthous Ulcers (RAU)
Overview of method of research: Clinical Review

Findings:
RAU, or canker sores, are oral mucosal conditions commonly seen by both dentists and physicians. Almost 20% of the population are affected by RAU in some way. RAU occur only on non-keratinized mucosa. While patients may demonstrate lymphadenopathy, fever is rare. RAU can be broken down into three categories: minor, major, and herpetiform.
RAU Minor- Composes 70-87% of all RAU forms. Appears as discrete, painful, shallow, recurrent ulcers covered by a yellow-gray pseudomembrane and surrounded by an erythematous halo. There are usually 1-5 ulcers at any one time, each measuring <1 cm.
RAU Major- Coalescent ulcers 1-10 at a time, usually >1cm and persists for weeks to months.
Herpetiform RAU- Occurs in crops of 10-100 at a time usually in the posterior of the mouth.

There are numerous factors that can play a role in a patient having RAU.

Genetics
About 50% of first degree relatives of patients with RAU also suffer from the condition.

Food Hypersensitivity
Strict elimination diets resulted in improvement/resolution of otherwise persistent RAU’s. A double blind study showed people eating a gluten free diet made a significant difference in ameliorating their symptoms.

Stress and Menses
May or may not play a significant role. Studies are fairly split on this, with some saying it matters, others saying it doesn’t.

Trauma
Pts affected with RAU are predisposed to have ulcers at sites of trauma.

Smoking
Several reports have documented the negative association between smoking and the occurrence of RAU. An absorbed substance such as nicotine may play a role in preventing the occurrence of RAU. Also, tobacco may increase keratinized gingival, thus rendering the tissue less susceptible to RAU.

Infection
Researchers are torn on the role microorganisms play in RAU. Strep ‘may’ play a role, and Varicella zoster virus has been linked to RAU. Pts treated with large doses of acyclovir, 800mg twice a day for 10 weeks seemed to help 66% of the pts studied.

Immune Dysregulation
Studies have found expressions of class 1 and class 2 major histocompatibility complex antigens in the epithelium during all stages of RAU ulcer development. These antigens cause the epithelial cell to be seen as foreign by T cells, which then kill it. This expression fails to cease after the ulcers have healed. However, RAU is not an autoimmune phenomenon, and these findings are described as non specific.

Management
The first step in RAU management is to rule it out as an oral manifestation of systemic disease. Blood tests should be done to rule out iron, b12, or folate deficiency as well as CBC. With that said, most pts with RAU are healthy. Management should be focused on control of the disease in order to reduce pain while maintaining function and reducing frequency and severity with a goal of prolonged remission.

Topical Meds
Variably successful. Do not prevent occurrence. Strictly palliative. Meds such as benzocaine, diclonine hydrocloride, benzy-damine hydrochloride, and magic mouthwash.
Other topical txs work via antimicrobial or anti inflammatory agents. Tetracycline or chlortetracycline rinses and topical cyclosporine may reduce lesion size, duration and pain. Chlorhexidine gluconate may also work.
Immunomodulating agents have been the mainstay of tx of RAU. Pain is reduced, but not frequency. Topical triamcinolone and clobetasol are the usual suspects used.

Systemic Meds
Prednisone works well, however once the pt is off the cycle the ulcers return. Other meds used are azathioprine, colchicines, and levamisole hydrochloride, and azelastine. Thalidomide seems to work best overall.

Systemic Conditions Assoc w/ RAU
Behcet’s
Multisystem disorder seen mostly in Mediterranean, Middle Eastern, and Japanese men.

Hemantinic Def.
Pts w/ Iron, folate, or any vitamin B def. are more affected by RAU. Vitamin replacement therapy works well.

GI disorders
Pts w/ Celiac and Crohn’s can present with RAU.

HIV
Ulcers assoc. w/ RAU tend to follow the traits of RA minor, however the are often larger, usually >1cm.

Neutropenic Ulcers
Ulcers are often assoc. w/ fever, malaise, furunculosis, and cellulitis.

FAPA syndrome
Syndrome of periodic fever, apthous ulcers, pharyngitis and cervical adenitis. Ulcers look like RAU minor, and usually affect children by age 5.

HSV infection in immunocompromised pts
Commonly mistaken for RAU

Key points/Summary: RAU takes many forms, can be caused by/assoc w/ many things, and tx is essentially palliative. Know the difference between the 3 forms. A good history is key in proper diagnosis.

Assessment of Article: Good review. Boring as hell. Worst/longest lit review I’ve had to write up since I’ve been here. I pray that this is on the board reading list.

Pediatric Squamous Cell Carcinoma: Case Report and Literature Review

Resident: Roberts

Date: 12/22/10

Title: Pediatric Squamous Cell Carcinoma: Case Report and Literature Review

Author: Sidell, Douglas, et al

Journal: Laryngoscope

Year: 2009

volume: 119

pages: 1538 - 1541

Case report and Discussion:

A six year old male was referred to the University of California, Los Angeles head and neck clinic by oral surgery with a 2 month history of an enlarging oral lesion involving the anterior gingiva with extension to the hard palate. The lesion was initially noted by the patients dentist, who extracted a tooth near the mass. Persistence of the lesion after tooth extraction led to a consultation by oral surgery for biopsy. The biopsy results were initially interpreted as SCC. A follow up review was performed by a multidisciplinary team and a second review of the biopsy revealed an inconclusive result as to the diagnosis. A second deep tissue biopsy was obtained, This biopsy indicated invasive, well-differentiated, exophytic SCC with perineural and angiolymphatic invasion. An MRI and CT scan performed demonstrated a 2.7 x 3.0 cm poorly marginated infiltrative mass involving the gingival aspect of the superior alveolar ridge and the adjacent bony marrow, to the right of the midline. Evaluation of the neck revealed multiple small sub-centimeter lymph nodes. The patient denied dysphagia, pain, weight loss, bleeding or loosing of teeth.

There are several differences with regard to adult and pediatric SCC of the oral cavity that have been described. Unlike adults, there is no sexual predilection for children. It has also been described as being more aggressive and is thought to carry a worse prognosis than the adult version. Although exposures such as alcohol and tobacco are commonly suggested as possible links to the etiology, this is not the case in pediatrics. Some identified possible causes have been linked to some genetic conditions such as xeroderma pigmentosum, keratitis, icthyosis, and deafness syndrome. A condition called Fanconi anemia, an aplastic anemia is said to add a 50 fold increase to all cancers. Other predisposing factors include polyvinyl chloride(found in plastics), the Epstein Barr virus and the human papilloma virus.

In pediatric populations, SCC accounts for fewer than 2% of all head and neck malignancies. The most frequent location for it to be found is on the tongue or the lip. The diagnosis of SCC is based on a histological biopsy and the method of treatment is a wide local resection while attempting to avoid the significant impact of radiotherapy in the pediatric population. This case documents the youngest person to have been found with SCC.

Assessment: Good article, I hope to never have to tell some poor mom or dad that their child has this.

Diseases of the salivary glands in infants and adolescents

Resident: Cho

Author(s): Ellies et al.

Journal: Head & Face Medicine

Year. Volume (number). Page #’s: 2010. 6. 1-7.

Major topic: Acute and Chronic Sialadenitis, Sialolithiasis, Neoplasms

Type of Article: Review Article

Main Purpose: To review salivary gland diseases in infants and adolescents.

Key points/Summary: Salivary gland diseases are rare in infants and children (with the exception of viral diseases such as parotitis epidemica aka mumps and cytomegaly – abnormal enlargement of cells). Therefore, it is difficult to establish universally valid therapeutic guidelines.

The predominant cause of parotid swelling in infancy is mumps. Evidence of Staph. Aureus with an underlying systemic disease accompanied by fever, dehydration, immunosuppression and general morbidity is seen. The predominant cause of acute swelling in the submandibular gland is due to a congenital anomaly of a salivary duct or an excretory duct obstruction. However, sialolithiasis (salivary duct stones) are rare in children. In a review covering 100 years, there were only 21 documents cases of sialolithiasis of the submandibular gland in children. As in adults, the leading symptom of sialolithiasis is painful swelling of the afflicted gland that is most painful at mealtimes. Treatment of sialolithiasis is submandibulectomy or slitting of the Wharton’s duct to remove the stones.

Acute and chronic sialadenitis (inflammation of the salivary gland) require surgical treatment most of the time. Acute forms of sialadenitis are mainly caused by viral or bacterial infections, such as group A streptococci and Staph. Aureus. In childhood, the parotid gland is most frequently affected by acute bacterial inflammation. Chronic sialadenitis are mostly caused by secretion disorders and immunological reactions. Chronic recurrent sialadenitis can heal spontaneously close to the age of puberty, however, frequent and extremely prolonged incidences require surgery. When total parotidectomy is performed to treat chronic recurrent parotitis, there is a risk of temporary facial paresis (impaired movement) and the development of Frey’s disease (sweating on one side of face when eating).

Salivary gland tumors are rare in children and adolescents compared to salivary gland inflammations. The incidences are 1 to 2 tumor cases in 100,000 persons. 79% of all benign lesions were in the parotid gland, with pleomorphic adenoma being the most common epithelial benign tumor. The most common nonepithelial benign neoplasms were hemangioma and lymphangioma. 66.6% of hemangiomas and lymphangiomas were seen in infants.

80-90% of all malignant lesions of salivary glands in children are made up by mucoepidermoid carcinomas, adenoid-cystic carcinomas, and acinic cell carcinomas. Malignant salivary gland tumors are more frequent in young persons than adults, therefore, should be diagnosed early.

Assessment of Article: Good overview of salivary gland diseases. Would have liked more information on signs and symptoms and diagnosis of the diseases. This article focused more on the treatment modalities of the diseases.

12/22/2010 Delayed tooth eruption associated with an ameloblastic fibro-odontoma (AF-O)

Resident: J. Hencler
Date: 12/22/2010

Article title: Delayed tooth eruption associated with an ameloblastic fibro-odontoma (AF-O)
Author: Flaitz DDS, MS; Hicks MD, DDS, MS, PhD

Journal: Pediatric Dentistry-23:3, 2001
Major topic: Oral Pathology
Type of Article: Case Report

Main Purpose:
Describe the clinical and radiographic features of an AF-O in a young child and discuss an age appropriate differential diagnosis.

Case History:
A healthy, 31 month-old Hispanic boy was referred for evaluation of an unerupted left mandibular primary canine (#M). EOE revealed mild facial asymmetry of the lower1/3. IOE revealed both buccal and lingual cortical expansion of the left mandible with lingual displacement of the lateral incisor and distal displacement of the molars. Palpation revealed an asymptomatic, hard enlargement covered by normal mucosa. A periapical radiograph demonstrated a localized radioluceny with dilacerations of the mesial root of the primary first molar and posterior displacement of the developing premolar. An occlusal radiograph reveals an expansile, mixed radiolucent/radiopaque lesion surrounding the crown of an inferiorly displaced, unerupted canine. Based on these findings, the child was referred for surgical excision under GA. Histopathological finding included a tumor with cords/islands of odontogenic epithelium, conglomerate foci of enamel and dentin, and tiny tooth-like structures. Loose and cellular connective tissue stroma resembled a dental papilla and a well formed primary canine was associated with the tumor. A diagnosis of AF-O was made on these microscopic findings.

Key points in the article discussion:
The AF-O is an uncommon odontogenic tumor that resembles an ameloblastic fibroma and a complex odontoma. Most cases occur in children with a mean age between 8-11 years-old but cases as young as 9 months have been reported. AF-O occurs equally in both jaws but favors the anterior region in the maxilla and the posterior region in the mandible. Typically, a slow growing tumor, common clinical findings include painless swelling and failure of one or more teeth to erupt. Radiographic presentation varies from unilocular to multilocular radiolucency with well-defined margins and variable amounts of radiopaque material. The irregular or globular calcifications are usually located in the center of the lesion. Treatment of AF-O usually involves conservative curettage. Large lesions may require a surgical splint to prevent jaw fracture. Recurrences following conservative surgery are uncommon and the prognosis is excellent for this tumor.

Differential Diagnosis:
Other odontogenis lesions in children that present as radiolucent lesions with irregularto globular radiopacities include the adenomatoid odontogenic tumor (AOT), the calcifying odontogenic cyst (COC), and the complex odontoma.
(1) The complex odontoma is the most common and usually occurs in the first 2 decades of life. Considered to be a developmental anomaly or hamartoma the complex odontoma has a predilection for the pericoronal molar region. Most odontomas are asymptomatic and are diagnosed because of delayed eruption of a tooth. A developing odontoma may be difficult to distinguish from an AF-O, both radiographically and microscopically. An important difference between an odontoma and AF-O is that odontoma is smaller and minimally expansile. Local curettage is recommended treatment and recurrence is rare.
(2) AOT occurs predominantly in children during the 2nd decade with delayed tooth eruption as a symptom. This benign tumor has a distinct preference for the anterior jaws, in particular, the maxillary canine region. Many AOTs are small and don’t produce clinically significant distortion of the surrounding bone. AOTs typically present as a well-delineated, unilocular radiolucency around the crown of a developing tooth with fine flecks of calcification referred to as a “snowflake appearance”. EXT of involved tooth and enucleation of the tumor are the recommended treatment. Recurrences are rare.
(3) COC is an uncommon lesion that exhibits variable clinical presentation. Although cystic, benign and malignant neoplastic subtypes are defines. When COC occurs in young children, the cystic type is most common and usually associated with an odontoma. This cystic lesion usually occurs in the anterior region of the jaws with a peak incidence in the second and third decades. Radiographic features of COC include a unilocular or multilocular radiolucency that is associated with an unerupted tooth in 1/3 of cases. Approximately half of all COCs are associated with irregular or tooth-like opacities; however, if associated with an odontoma, calcifications are a constant feature. Asymptomatic expansion of the cortical bone, along with root resorption or divergence may be seen. In general, COC occurring in young children are treated by simple enucleation with uncommon recurrence.

Assessment of article: Very interesting case report including a detailed differential diagnosis. This was a good review of oral lesions that we should consider when a patient presents with an unerupted primary tooth.

12/15/2010 Retention of Veneered SSCs on Replicated Typodont Primary Incisors: An In Vitro Study

Resident: J. Hencler
Date: 12/15/2010

Article title: Retention of Veneered SSCs on Replicated Typodont Primary Incisors: An In Vitro Study
Source: Pediatric Dentistry-25:3, 2003
Author: Guelmann et al.
Major topic: Retention of veneered SSCs
Type of Article: Scientific
Main Purpose: To determine the effect of crimping and cementation on retention veneered SSCs.

Overview of method of research:
120 crowns (90 nusmile) and (30 plain) were assessed for retention. An ortho wire was soldered perpendicular to the incisal edge and the crowns were fitted to acrylic replicas of ideal crown preps and were divided into 3 grps. Grp 1 crown crimp only, grp 2 crown cemented only, and grp 3 crowns crimped and cemented. An Instron machine recorded the amount of force necessary to dislodge the crowns.

Findings:
Grp 3 was statistically more retentive than grps 1 or 2 and Grp 2 was statistically more retentive than grp 1. In grp 1, Unitek crowns were more retentive than veneered crowns. In grp 2, NuSmile crowns showed less retention than all other brands, and in grp 3, Kinder Krowns showed better retention than all other brands.

Key points in the article discussion:
This study confirmed other reports that SSC retention is largely dependent on cement and demonstrated the beneficial effects of crimping in conjunction w/ cementation. Unitek crowns were more retentive in the “crimping only” grp as a direct result of the “snug fit” obtained from the internal walls of the crown being in direct contact w/ the tooth. The Dura Crown manufacturer clains crimping on both facial and lingual is possible w/out compromising the veneer integrity but this study found it was a challenge to crimp the facial margin w/out damaging the facings in some way. Kinder Krowns allowed crimping on the lingual surface only. These crowns are designed with an “incisal lock” technology to provide additional retention of the esthetic facings by mechanically forcing a portion of the facing material through openings on the incisofacial edge to the internal aspect of the crown. This prevented the Kinder Krowns from fully seating on the ideal tooth prep used in this study. Significant metal-cement bond failure for NuSmile primary crowns in the cementation only grp was difficult to explain. The use of natural teeth and a different luting cement may have a different impact on the results of this study.

Summary of conclusions:
Crimping does have a significant effect on retention of SSCs to acrylic replicas of primary teeth. The presence of cement significantly improved crown retention. Higher retention values were obtained for all brands tested when crimping and cement were combined. Crowns w/ veneer facings were significantly more retentive than the no-veneer (Unitek) crowns when cement and crimp were combined.

Assessment of article: Good article, nothing groundbreaking.

An In Vitro Comparrison of Marginal Microleakage of ART and Conventional Glass Ionomer Restorations in Extracted Permanent Molars

Resident: Adam J. Bottrill
Date: 15DEC10
Region: Providence
Article title: An In Vitro Comparrison of Marginal Microleakage of ART (Alternative Restorative Treatment) and Conventional Glass Ionomer Restorations in Extracted Permanent Molars
Author(s): Wadenya, Rose BDS, MS, DMD et al
Journal: Pediatric Dentistry
Page #s: 303-307
Date: V29/No4 Jul/Aug 07
Major topic: Microleakage, ART, Margins, Glass Ionomer
Minor topic(s): NA
Type of Article: In vitro comparison
Main Purpose: The objective of this study was to compare the marginal leakage of cervical restorations made using Alternative Restorative Treatment (ART) and conventional glass ionomer restorations.

Key points in the article discussion:

I. General:

A. ART, formerly "Atraumatic Restorative Treatment", was introduced to assist in the need to prevent progression of dental caries in countries where conventional dental care was not available... Tanzania.

B. AAPD recognizes ART as useful and beneficial for:
1. Young pts
2. Uncooperative pts
3. Special needs pts
4. Situations where traditional cavity preparation and restoration is not possible

C. Glass ionomer cements:
1. Fl release
2. Low shrinkage
3. Pulpal biocompatability

II. Methods:

A. 16 permanent max and mand 1st molars extracted for perio reasons with cl V caries... ART used.

B. 29 noncarious extracted molars with cl V preparations using high speed handpiece.

C. All teeth restored with Glass Ionomer cement (GIC).

D. Thermally stressed for 300 cycles and stained with methylene blue... JUST LIKE A REAL
MOUTH!

E. Sectioned and evaluated for microleakage.

III. Results:

A. No significant difference between the ART and conventional GIC restorations.

IV. Conclustions:

A. ART with GIC shows comparable marginal leakage to conventionally restored teeth.

B. For conventional restorations, more leakage is higher at the dentinal margins when compared to the enamel margins.

Assessment of article: I believe I've already explained my "raised eyebrow" opinion of some in vitro studies... this is no different for me. ALSO... I would ave appreciated a primary tooth, occlusal surface ART study more than this PERMANENT tooth, Cl V study... huh?

The influence of medical history on restorative procedure failure rates following dental rehabilitation

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center - Providence

Article title: The influence of medical history on restorative procedure failure rates following dental rehabilitation.

Author(s): Ng et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2001. 23:6. 487-490.

Overview of method of research: Scientific Article

Purpose:
To evaluate the relationship between patient medical history and success of restorative treatments performed under general anesthesia.

Methods:
Dental records of 504 patients who received comprehensive dental treatment under general anesthesia at either Children’s Hospital in Boston (1990-1992) or Children’s National Medical Center in DC (1994-1998) were reviewed. All treatment was performed by pediatric dental residents under the supervision of attending. Only patients who returned at least 6 months after treatment for follow-up were used in the study (241 patients). Failure was defined as need for restoration replacement due to structural breakdown (including perforation of SSCs due to wear-through), pulpal/dentoalveolar infection or recurrent decay.
Patients were grouped into 2 different categories: healthy or having a significant medical history (having a classified developmental disability, asthma requiring chronic meds, bleeding disorders, cancer, cleft lip/palate, diabetes, endocrine disorders, GI/liver disease, heart disease requiring meds, HIV infection, kidney disease, seizure disorder, sickle cell disease or any syndrome). Patients were also categorized as having a developmental disability (autism, cerebral palsy, emotional disability, learning disability or mental retardation) or having no developmental disability.
In addition, a subgroup of records was reviewed to determine the association between medical history and failure of restorations placed on patients in full primary dentition (FPD) (206 patients).

Findings for patients in FPD:
Amalgam restorations had a significantly higher failure rate than SSCs and the highest failure rates were found in composite restorations.
Although there was a slightly higher failure rate of restorations in patients with significant medical histories that healthy patients, the only statistically significant finding was a 16% failure rate of SSCs in patients with developmental disabilities compared to a 7% failure rate in patients without disabilities. It was reported that the majority of the failures in patients with developmental disabilities was due to excessive occlusal wear leading to perforation.
There were no significant differences found in amalgam or composite failure rates in patients with or without significant medical histories or developmental disabilities. There was also no statistical difference when comparing DC and Boston patients.

Key points/Summary:
1. SSCs are the most reliable restorations for primary teeth in patients treated under GA with amalgam restorations being slightly less reliable and composite restorations including strip crowns the least reliable.
2. Amalgam and composite restorations have similar failure rates in patients with or without significant medical histories or developmental disabilities.
3. SSC failures are more likely to occur in patients with developmental disabilities, but not necessarily significant medical histories than healthy patients.
4. SSC failure rates in patients with developmental disabilities were similar to that of amalgam restorations.

Assessment of Article:
I am not sure why they only evaluated patients in the subgroup (FPD) rather than all patients who were present for follow-up appointments. Nevertheless, these were interesting findings that I will keep in the back of my mind as I am treatment planning.

The Use of umalgam in pediatric dentistry: review of the literature

Resident: Swan

Article Title: The Use of Dental Amalgam in Pediatric Dentistry: Review of the Literature

Author: Osborne, et al.

Journal: Pediatric Dentistry

Volume (Number): 24:5 2002

Major Topic: Amalgam use in Primary and Permanent teeth

Type of Article: Literature Review

Main Purpose: Confirm the use of amalgam as a safe, long-lasting, cost-efficient restorative material

Key Points/Summary: The authors presented a brief history of amalgam as a restorative material, detailing the advent of the current high-copper amalgams which exhibit much less corrosion and porosity than earlier amalgams.

Use of Amalgam in Primary Teeth: The authors conclude that while amalgams perform very well in primary teeth, recent material improvements in both resin based composites and RMGI cements have made them very attractive restorative options as well. It was interesting to me that in their lit review promoting the use of amalgam, one of the principal studies cited was a clinical trial that found a 9% failure rate of amalgam restorations, an 8% failure rate of GI restorations, and a 7% failure rate for RMGI restorations. Obviously, tooth colored restorations are achieving clinical success. The authors point out that amalgam is a good restorative option when isolation or patient cooperation is difficult.

Conservative Dentistry: In a 10 year study comparing traditional amalgam restorations through occlusal fissures to resin composite restorations, the two performed equally as well. However, when the traditional amalgam and resin composite restorations were compared with amalgam restorations placed only where carious dentin had been removed, then remaining fissures sealed, the latter restoration performed much better (2% failure rate over 10 years compared to 17% failure and 14% failure for traditional amalgam and composite, respectively.

Amalgam safety: The authors cited 24 studies that confirm amalgam’s safety. One study showed that for every 12 amalgam restorations in the mouth, the rate of release of mercury is 1.7 micrograms per day, or 10% of the daily intake of mercury from all sources (air, water, diet). This is less than .2% of the toxic level.

Assessment of Article: Thorough, well-researched lit review that concludes what we all know to be true: amalgam is a good thing.