Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Trichodental Dysplasia: A Rare Syndrome With Distinct Dental Findings
Author(s): Montalvan DMD, Ericka. Christina Mazzone, DMD. Nanci Tofsky, DMD, MM, DMD
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2006. 28:4. 345-349
Major topic: Presentation of Trichodental Dysplasia(TD)
Minor topic(s): Ectodermal Dysplasia and it’s MANY variants
Main Purpose: To present the clinical, radiographic, and genetic features of a 4yo child w/ TD that will add to the exsisting knowledge of this rare syndrome
Overview of method of research: Case Report
Findings: Congenital absence of 1 or more teeth w/o any anomalies is common, happening in up to 8% of the human population. A rarer cause of missing teeth is ectodermal dysplasia. With ED, hair, nails, skin, and teeth can all be affected at the same time. TD is a rare autosomal dominant variant of ED that affects only the teeth and hair. TD has been described in a number of families. Only a small handful of cases have been reported. Teeth in children with TD are described as having normal enamel, extremely thin dentin, very large pulps, and short roots. They have been described as ‘shell teeth’, or ‘Ghost teeth’. Hair in patients with TD is fine, lusterless, sparse, and slow growing. The lateral ends of the eyebrows are thin as well. Other possible signs are microcephaly, frontal bossing, and mild retardation.
In this case, a 4 yo Hispanic male presented to UMDNJ. He had thin sparse hair, frontal bossing, thin eyebrows, and a fairly large head. His mom said a CT scan was performed to assess the size/shape of his head, and that everything came back normal. The boy did not have any abnormal sweating, and no history of any fractures. His fingernails had some creasing, and mild clubbing. Intra orally, pulp chambers were visible through the lingual surfaces of his maxillary incisors, and through the occlusal of the molars. There was extensive attrition, and he had 6 abscessed teeth. Radiographically, it could be seen that his permanent teeth was of the same variety. The boy was sent to a geneticist, for evaluation, and the geneticist confirmed the original diagnosis of TD.
Treatment under GA was decided on. The 6 abscessed teeth were extracted. All of the other molars got SSC’s. The anterior teeth were left alone for fear of pulpal exposure. He was put on frequent recalls for eval, as well as daily Fl regiment.
Key points/Summary: While TD is rare, it is not uncommon to see children with ED. Treatment should include protecting the teeth best as possible with crowns, frequent recall visits.
Assessment of Article: Good case report. Nothing too Earth shattering
Friday, June 11, 2010
Otodental Syndrome: A Case Report
Resident: Adam J. Bottrill
Date: 11JUN10
Region: Providence
Article title: Otodental Syndrome
Author(s): Colter, J.D. et al
Journal: Pediatric Dentistry
Page #s: pp. 482-485
Year: 2005, 27:6
Major topic: Otodental Syndrome
Minor topic(s): NA
Type of Article: Case Report
Main Purpose: Present a case report of the rare Otodental Syndrome
Key points in the article discussion:
I. Otodental Syndrome
A. Abnormalities in dental crown morphology
1. Max/Man primary and permanent incisors normal
2. Canines and molars large and bulbous in both dentitions
3. Canines of both dentitions present with yellow hypoplastic areas on labial surf.
4. Cusps of affected molars separated by deep vertical enamel fissures.
5. Abnormal molars MAY be result of fusion.
6. Pulp chambers of molars often duplicated. (difficult endo)
7. Absent or micro premolars.
8. Conical supernumeraries and odontomas.
B. Hearing
1. Loss of hearing typically above 1,000Hz.
2. Can start as early as 2-3 yo or as late as puberty.
3. Not all patients present with hearing loss.
C. Etiology
1. Inherited... Autosomal dominant.
2. Variable penetrance and expressivity.
3. Genes: BMP4, MSX1, FGF8, BARX1, DLX1/2
D. Case
1. 9 yo male, NSMH (hearing was not effected),
2. DH: ext of Max left prim 2nd molar due to ectopic eruption of perm molar.
3. Exam: Multiple carious lesions, canines and molars large, spherical and bulbous in perm and prim dentition, deep vert enamel fissures, 6-8 cusps on each tooth, hypoplastic areas on labial surfaces of canines, duplicated pulp chambers, supernumeraries or odontomas, micro premolars, 4. Hearing test not performed.
E. Dental Concerns
1. Dx from dentist (semper vigilans!!!)
2. Future endo concerns
3. OH and preventative care EXTREMELY IMPORTANT
Assessment of article: If I were to do a case presentation on otodental syndrome, I probably would have waited for the hearing tests to be done before I published... shenanigans.
Date: 11JUN10
Region: Providence
Article title: Otodental Syndrome
Author(s): Colter, J.D. et al
Journal: Pediatric Dentistry
Page #s: pp. 482-485
Year: 2005, 27:6
Major topic: Otodental Syndrome
Minor topic(s): NA
Type of Article: Case Report
Main Purpose: Present a case report of the rare Otodental Syndrome
Key points in the article discussion:
I. Otodental Syndrome
A. Abnormalities in dental crown morphology
1. Max/Man primary and permanent incisors normal
2. Canines and molars large and bulbous in both dentitions
3. Canines of both dentitions present with yellow hypoplastic areas on labial surf.
4. Cusps of affected molars separated by deep vertical enamel fissures.
5. Abnormal molars MAY be result of fusion.
6. Pulp chambers of molars often duplicated. (difficult endo)
7. Absent or micro premolars.
8. Conical supernumeraries and odontomas.
B. Hearing
1. Loss of hearing typically above 1,000Hz.
2. Can start as early as 2-3 yo or as late as puberty.
3. Not all patients present with hearing loss.
C. Etiology
1. Inherited... Autosomal dominant.
2. Variable penetrance and expressivity.
3. Genes: BMP4, MSX1, FGF8, BARX1, DLX1/2
D. Case
1. 9 yo male, NSMH (hearing was not effected),
2. DH: ext of Max left prim 2nd molar due to ectopic eruption of perm molar.
3. Exam: Multiple carious lesions, canines and molars large, spherical and bulbous in perm and prim dentition, deep vert enamel fissures, 6-8 cusps on each tooth, hypoplastic areas on labial surfaces of canines, duplicated pulp chambers, supernumeraries or odontomas, micro premolars, 4. Hearing test not performed.
E. Dental Concerns
1. Dx from dentist (semper vigilans!!!)
2. Future endo concerns
3. OH and preventative care EXTREMELY IMPORTANT
Assessment of article: If I were to do a case presentation on otodental syndrome, I probably would have waited for the hearing tests to be done before I published... shenanigans.
Thursday, June 10, 2010
Severe Periodontitis in a 5 year old Girl with Hyperimmunoglublin E Syndrome
Resident: Roberts
Date: 6/11/10
Article title: Severe Periodontitis in a 5 year old Girl with Hyperimmunoglublin E Syndrome
Author: Tsang, P et al.
Journal: Pediatric Dentistry
Volume: 27:1 pages: 73
Year: 2005
Type of article: Case report
Discussion:
Hyperimmunoglobulin E syndrome is a multisystem(HIES) disorder that affects the 1. dentition 2. skeleton 3. connective tissues 4. immune system. This disorder is also known as Jobs syndrome and Buckley’s syndrome. It can be autosomal dominant or recessive or may not have any apparent genetic link at all. Major manifestations of the disease include elevated serum E levels, chronic eczematoid dermatitis, recurrent skin abcesses, prominant forehead, deep set eyes, broad nasal bridge, mild prognathism, scoliosis, joint hyperextensibility and decreased bone density. Retention of primary teeth is a feature found in Autosomal dominant patients. In the recessive form skeletal and dental abnormalities are not usually present.
Case report
A 5 year old girl who has suspected autosomal recessive HIES syndrome presented with profuse bleeding, painful gingiva and generalized aggressive periodontitis. A microbiological examination detected P. gingivalis, T. forsythia, P, nigrescens, T. denticola, E. corrodens, and C. rectus but did not show the presence of A. A. All teeth except E, F, G showed 5 mm or more of probing depths and class 3 mobility. Advanced alveolar bone loss was present and only minor interproximal lesions present. Treatment included extraction of all primary teeth which resulted in elimination of soft tissue inflammation. Main management strategies are 1. Prophylatic antibiotics, 2. timely treatment of infections, 3. surgical intervention as necessary.
Trisomy 9
Resident’s Name: Joanne Lewis Date: June 11, 2010
Article title: Dental Management of a Child With Trisomy 9 Mosaicism: A Case Report
Author(s): Moti Moskovitz, DMD, PhD, et al
Journal: Pediatric Dentistry – 28:3 2006
Type of Article: case report
Summary: Affected patients present with congenital heart disease, skeletal and genito-urinary anomalies, abnormal palmar creases, failure to thrive, hypotonia, and mental retardation. Facial/oral manifestations include upward-slanted eyes, small palpebral fissures, microphthalmos, broad base and prominent tip of the nose, low-set malformed ears, microcephaly, micrognathia, protruding upper lip, pouched cheeks, cleft lip/palate, narrow high-arched palate, small mouth, and down-turned mouth. Mosaicism for trisomy 9 predicts longer survival than non mosaic trisomy 9. The patient in this case report was born at 37 weeks gestation after an uncomplicated pregnancy to Ashkenazi Jewish parents who have 4 other healthy children. Facial dysmorphic features include: narrow high arched palate, short philtrum, low set ears. Oral findings include a supernumerary tooth, and opalescent color change in maxillary central incisors. Also, severe psychomotor retardation and short stature. The patient was treated at age 11 under GA, and again at age 13 under oral conscience sedation. Skeletal abnormalities and tendency to vomit were reasons to treat in a more upright position and to use constant suction during treatment.
Dental Treatment of a Child with Rubinstein-Taybi Syndrome
Department of Pediatric Dentistry
Lutheran Medical Center
Kris Hendricks Date: 6-11-10
Article title: Dental Treatment of a Child with Rubinstein-Taybi Syndrome
Author(s): Davidovish, Eimerl, Peretz
Journal: Pediatric Dentistry
Volume (number): 27/5
Month, Year: 2005
Major topic: Rubinstein-Taybi syndrome (RTS)
Minor topics: N/A
Type of Article: Case Report
Main Purpose:
Demonstrate the oral and dental manifestations of a 12-year old girl with RTS and discuss her dental treatment with emphasis on her medical consideration.
Findings:
RTS is a genetic disorder characterized by mental retardation, and physical abnormalities including broad thumbs, big and broad toes, short stature and craniofacial abnormalities.
The oral manifestations include small opening, pouting lower lip, retro/micrognathia and higher arched, narrow palate.
Key points/Summary :
There are very few reports of this syndrome in the dental literature.
Rarely this syndrome can present with clefting.
This patient had to be treated under GA.
The anesthesia was complicated, so they used fiberoptic endoscopy.
This patient had significant crowding and an orthodontist recommended premolar extractions to alleviate crowding, but the foster parents did not choose to do that.
The foster parents were unable to convince the dental team that they could care for the child’s needs.
Assessment of article:
Nice article.
Dental findings associated with the malformations of CHARGE
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 6/11/2010
Article title: Dental findings associated with the malformations of CHARGE
Author(s): Sheneifi TA, Cottrell DA, Hughes C..
Journal: Ped Dent: 24:1
Month, Year: 2002 43-6
Major topic: CHARGE
Type of Article: Case Report
What is affected in this syndrome? Major criteria for diagnosis include Colomba of the eye, Atresia of Choanae, multiple cranial nerve deficits including deafness, vision impairment, poor swallowing; and Ear abnormalities involving the inner, middle, and outer ear. The choanal atresia causes breathing difficulties and cyanosis within the first hour of life and requires surgical intervention early in life. Minor criteria include Heart defects like tetralogy of Fallot, septal defects or valvular stenosis, genital hypoplasia, orofacial clefting, trachoesophageal fistulas requiring a feeding tube, short stature and developmental delays.
Etiology: Unknown. Affects 1 in 10,000 live births
When is the diagnosis made? Diagnosis is usually made in infancy based on a clustering of congenital malformations. In cases of bilateral severe choanal atresia the patients turn blue in early infancy when resting.
What are the systemic or medical conditions associated with the syndrome that are critical concerns for dental work? Several conditions affect the methodology used to treat patients with CHARGE. Children usually have developmental delays affecting management of the patient. The patient in the case report exhibited behavioral difficulties requiring general anesthesia to manage the patient. Choanal atresia may affect airway management, Cardiac septal defects require antibiotic coverage because of the risk of endocarditis.
What factors influence dental care or cause the need for dental treatment? Because of behavior issues, the patients frequently have poor oral hygiene, and associated gingivitis. Rampant decay is a frequent finding. Delayed eruption of the permanent teeth and mandibular retrognatia have also been reported. In the case report, impacted teeth and congenitally missing teeth were noted as well as an odontogenic fibroma of the mandible.
New information? Genetic tests are available which have a limited degree of success in diagnosis because some children have a negative test, yet have CHARGE. Early intervention is a key element to success in encouraging development of the child. In many cases, intelligence is normal, but with vision and hearing loss this can be masked.
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 6/11/2010
Article title: Dental findings associated with the malformations of CHARGE
Author(s): Sheneifi TA, Cottrell DA, Hughes C..
Journal: Ped Dent: 24:1
Month, Year: 2002 43-6
Major topic: CHARGE
Type of Article: Case Report
What is affected in this syndrome? Major criteria for diagnosis include Colomba of the eye, Atresia of Choanae, multiple cranial nerve deficits including deafness, vision impairment, poor swallowing; and Ear abnormalities involving the inner, middle, and outer ear. The choanal atresia causes breathing difficulties and cyanosis within the first hour of life and requires surgical intervention early in life. Minor criteria include Heart defects like tetralogy of Fallot, septal defects or valvular stenosis, genital hypoplasia, orofacial clefting, trachoesophageal fistulas requiring a feeding tube, short stature and developmental delays.
Etiology: Unknown. Affects 1 in 10,000 live births
When is the diagnosis made? Diagnosis is usually made in infancy based on a clustering of congenital malformations. In cases of bilateral severe choanal atresia the patients turn blue in early infancy when resting.
What are the systemic or medical conditions associated with the syndrome that are critical concerns for dental work? Several conditions affect the methodology used to treat patients with CHARGE. Children usually have developmental delays affecting management of the patient. The patient in the case report exhibited behavioral difficulties requiring general anesthesia to manage the patient. Choanal atresia may affect airway management, Cardiac septal defects require antibiotic coverage because of the risk of endocarditis.
What factors influence dental care or cause the need for dental treatment? Because of behavior issues, the patients frequently have poor oral hygiene, and associated gingivitis. Rampant decay is a frequent finding. Delayed eruption of the permanent teeth and mandibular retrognatia have also been reported. In the case report, impacted teeth and congenitally missing teeth were noted as well as an odontogenic fibroma of the mandible.
New information? Genetic tests are available which have a limited degree of success in diagnosis because some children have a negative test, yet have CHARGE. Early intervention is a key element to success in encouraging development of the child. In many cases, intelligence is normal, but with vision and hearing loss this can be masked.
Arnold-Chiari Malformation
A Chiari Malformation consists of a displacement of the cerebellar tonsils through the foramen magnum and sometimes causes hydrocephalus as a result of obstruction of cerebrospinal fluid drainage. It can cause headaches, fatigue, muscle weakness in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. Incidence ranges between 1:1000 and 1:5000.
There are 4 types of increasing severity with Type III and IV being exceedingly rare.
Type I (most common): Headaches, fatigue, muscle in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. Usually adult onset, is treatable, not curable and rarely fatal.
There is a hereditary version which is related to connective tissue dysfunction. Patients with hypermobility or connective tissue deficiency such as Ehlers Danlos and Marfan syndrom may develop a Chiari malformation.
Type II: Type I plus a myelomeningocele which causes paralysis below the spinal defect; 15% of patients die within 2 years of birth.
Type III: Severe neurodevelopmental defects in addition to above symptoms
Type IV: Lack of cerebellar development; Type III and IV patients typically do not live beyond 2-3 years of life.
What we'll see in the chair:
-mild to moderate mental retardation
-dysphagia
-facial pain
-nystagmus
-vertigo
-tachycardia
-headaches secondary to Valsalva maneuvers
Treatment:
Decompression surgery to relieve the buildup of CSF is the most common treatment. Shunts and removal of occipital bone have also been used. There has also been success with transnasal endoscopic surgery.
Summary:
While it is most often adult onset, with a relatively high incidence we will almost certainly see this in our chair at some point. With my minimal exposure, I would compare the behavior and mental status to a patient with Aspergers and/or ADHD. The nystagmus for both of my patients was also very salient.
There are 4 types of increasing severity with Type III and IV being exceedingly rare.
Type I (most common): Headaches, fatigue, muscle in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. Usually adult onset, is treatable, not curable and rarely fatal.
There is a hereditary version which is related to connective tissue dysfunction. Patients with hypermobility or connective tissue deficiency such as Ehlers Danlos and Marfan syndrom may develop a Chiari malformation.
Type II: Type I plus a myelomeningocele which causes paralysis below the spinal defect; 15% of patients die within 2 years of birth.
Type III: Severe neurodevelopmental defects in addition to above symptoms
Type IV: Lack of cerebellar development; Type III and IV patients typically do not live beyond 2-3 years of life.
What we'll see in the chair:
-mild to moderate mental retardation
-dysphagia
-facial pain
-nystagmus
-vertigo
-tachycardia
-headaches secondary to Valsalva maneuvers
Treatment:
Decompression surgery to relieve the buildup of CSF is the most common treatment. Shunts and removal of occipital bone have also been used. There has also been success with transnasal endoscopic surgery.
Summary:
While it is most often adult onset, with a relatively high incidence we will almost certainly see this in our chair at some point. With my minimal exposure, I would compare the behavior and mental status to a patient with Aspergers and/or ADHD. The nystagmus for both of my patients was also very salient.
06/11/2010 A Preventative Approach to Oral Self-mutilation in Lesch-Nyhan Syndrome: A Case Report
Resident: Hencler
Date: 06/11/2010
Article title: A Preventative Approach to Oral Self-mutilation in Lesch-Nyhan Syndrome- A Case Report
Author(s): Jeong et al.
Journal: Pediatric Dentistry-28:4 2006
Major topic: Oral Self-mutilation in Lesch-Nyhan Syndrome
Type of Article: Case Report
Main Purpose:
To present and discuss a Lesch-Nyhan syndrome patient who was treated successfully w/ noninvasive approaches, including a soft mouthguard and psychiatric pharmacologic therapy to prevent further damage of perioral soft tissues.
Background:
Lesch-Nyhan syndrome is a disorder of purine metabolism causing accumulation of sodium urate crystal in the joints, kidneys, CNS, and other tissues. Clinical symptoms include impaired kidney function, joint pain, and a progressive neurological disorder, resulting in retardation of mental and motor development. The most distressing aspect of the syndrome is the compulsive urge for self mutilation.
Case Description:
4 yo male w/ Lesch-Nyhan Syndrome and cerebral palsy receiving 2 mg diazepam daily to relieve biting action with limited success. EOE: Self-mutilated wounds noted on the lower lip and finger caused by primary central incisors. IOE: Revealed caries free intact primary dentition. A maxillary impression taken under sedation and a soft mouthguard was fabricated. Simultaneously, a psychiatric analysis was conducted. Child was biting lower lip since 12 months old whenever frustrated to control anxiety and express aggression. Sertraline and risperidone was prescribed to control the anxiety and self-mutilating behavior. After doubling dosages self-injurious behavior was markedly reduced at day 15. Continued pharmacological therapy at 1 month resulted in 1 attempts to self-mutilate per wk and at 4 months self-mutilating behavior ceased. At recall visits the lower lip was healed, mom was highly satisfied, and the patient appeared to be comfortable and less agitated.
Discussion:
Self-mutilation can result in destruction of the lower lip. EXT of primary and permanent incisors are frequently advocated as a solution, however, canines and perhaps premolars may also be involved. Oral devices to prevent self-mutilation include soft mouthguard, bite block, various types of shields that guard the tongue and lips, and lip bumpers. These methods have an advantage of preserving the teeth, but patient compliance is poor. Also, devices covering the skin may result in dermatitis. In this case, after 6 months the soft mouthguard was ill fitting due to wear and needed replacing. It is important to maintain POEs to reassess integrity of any oral appliance.
Summary of conclusions:
There are no standard methods for the prevention of self-mutilation. Appropriate preventative methods need to be developed on an individual patient basis. As an alternative treatment to EXT, a therapy combining psychiatric, pharmacologic, and dental soft mouth guard treatment may be a ideal option in treating transient and acute episodes of self-injurious behavior involving the lower lip.
Assessment of article:
Interesting case. If the medication can reduce oral self-mutilation, then combination with a soft mouthguard would be a great alternative to EXTs, just as long as the compliance is there. It would be important to preserve the models for appliance fabrication for as long as possible because to get an accurate impression on this patient population would indicate impressing under sedation of some kind. Captain obvious signing off.
Date: 06/11/2010
Article title: A Preventative Approach to Oral Self-mutilation in Lesch-Nyhan Syndrome- A Case Report
Author(s): Jeong et al.
Journal: Pediatric Dentistry-28:4 2006
Major topic: Oral Self-mutilation in Lesch-Nyhan Syndrome
Type of Article: Case Report
Main Purpose:
To present and discuss a Lesch-Nyhan syndrome patient who was treated successfully w/ noninvasive approaches, including a soft mouthguard and psychiatric pharmacologic therapy to prevent further damage of perioral soft tissues.
Background:
Lesch-Nyhan syndrome is a disorder of purine metabolism causing accumulation of sodium urate crystal in the joints, kidneys, CNS, and other tissues. Clinical symptoms include impaired kidney function, joint pain, and a progressive neurological disorder, resulting in retardation of mental and motor development. The most distressing aspect of the syndrome is the compulsive urge for self mutilation.
Case Description:
4 yo male w/ Lesch-Nyhan Syndrome and cerebral palsy receiving 2 mg diazepam daily to relieve biting action with limited success. EOE: Self-mutilated wounds noted on the lower lip and finger caused by primary central incisors. IOE: Revealed caries free intact primary dentition. A maxillary impression taken under sedation and a soft mouthguard was fabricated. Simultaneously, a psychiatric analysis was conducted. Child was biting lower lip since 12 months old whenever frustrated to control anxiety and express aggression. Sertraline and risperidone was prescribed to control the anxiety and self-mutilating behavior. After doubling dosages self-injurious behavior was markedly reduced at day 15. Continued pharmacological therapy at 1 month resulted in 1 attempts to self-mutilate per wk and at 4 months self-mutilating behavior ceased. At recall visits the lower lip was healed, mom was highly satisfied, and the patient appeared to be comfortable and less agitated.
Discussion:
Self-mutilation can result in destruction of the lower lip. EXT of primary and permanent incisors are frequently advocated as a solution, however, canines and perhaps premolars may also be involved. Oral devices to prevent self-mutilation include soft mouthguard, bite block, various types of shields that guard the tongue and lips, and lip bumpers. These methods have an advantage of preserving the teeth, but patient compliance is poor. Also, devices covering the skin may result in dermatitis. In this case, after 6 months the soft mouthguard was ill fitting due to wear and needed replacing. It is important to maintain POEs to reassess integrity of any oral appliance.
Summary of conclusions:
There are no standard methods for the prevention of self-mutilation. Appropriate preventative methods need to be developed on an individual patient basis. As an alternative treatment to EXT, a therapy combining psychiatric, pharmacologic, and dental soft mouth guard treatment may be a ideal option in treating transient and acute episodes of self-injurious behavior involving the lower lip.
Assessment of article:
Interesting case. If the medication can reduce oral self-mutilation, then combination with a soft mouthguard would be a great alternative to EXTs, just as long as the compliance is there. It would be important to preserve the models for appliance fabrication for as long as possible because to get an accurate impression on this patient population would indicate impressing under sedation of some kind. Captain obvious signing off.
Arnold-Chiari Malformation
A Chiari Malformation consists of a displacement of the cerebellar tonsils through the foramen magnum and sometimes causes hydrocephalus as a result of obstruction of cerebrospinal fluid drainage. It can cause headaches, fatigue, muscle weakness in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. Incidence ranges between 1:1000 and 1:5000.
There are 4 types of increasing severity with Type III and IV being exceedingly rare.
Type I (most common): Headaches, fatigue, muscle in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. Usually adult onset, is treatable, not curable and rarely fatal.
There is a hereditary version which is related to connective tissue dysfunction. Patients with hypermobility or connective tissue deficiency such as Ehlers Danlos and Marfan syndrom may develop a Chiari malformation.
Type II: Type I plus a myelomeningocele which causes paralysis below the spinal defect; 15% of patients die within 2 years of birth.
Type III: Severe neurodevelopmental defects in addition to above symptoms
Type IV: Lack of cerebellar development; Type III and IV patients typically do not live beyond 2-3 years of life.
What we'll see in the chair:
-mild to moderate mental retardation
-dysphagia
-facial pain
-nystagmus
-vertigo
-tachycardia
-headaches secondary to Valsalva maneuvers
Treatment:
Decompression surgery to relieve the buildup of CSF is the most common treatment. Shunts and removal of occipital bone have also been used. There has also been success with transnasal endoscopic surgery.
Summary:
While it is most often adult onset, with a relatively high incidence we will almost certainly see this in our chair at some point. With my minimal exposure, I would compare the behavior and mental status to a patient with Aspergers and/or ADHD. The nystagmus for both of my patients was also very salient.
There are 4 types of increasing severity with Type III and IV being exceedingly rare.
Type I (most common): Headaches, fatigue, muscle in the head and face, difficulty swallowing, dizziness, nausea, impaired coordination, and, in severe cases, paralysis. Usually adult onset, is treatable, not curable and rarely fatal.
There is a hereditary version which is related to connective tissue dysfunction. Patients with hypermobility or connective tissue deficiency such as Ehlers Danlos and Marfan syndrom may develop a Chiari malformation.
Type II: Type I plus a myelomeningocele which causes paralysis below the spinal defect; 15% of patients die within 2 years of birth.
Type III: Severe neurodevelopmental defects in addition to above symptoms
Type IV: Lack of cerebellar development; Type III and IV patients typically do not live beyond 2-3 years of life.
What we'll see in the chair:
-mild to moderate mental retardation
-dysphagia
-facial pain
-nystagmus
-vertigo
-tachycardia
-headaches secondary to Valsalva maneuvers
Treatment:
Decompression surgery to relieve the buildup of CSF is the most common treatment. Shunts and removal of occipital bone have also been used. There has also been success with transnasal endoscopic surgery.
Summary:
While it is most often adult onset, with a relatively high incidence we will almost certainly see this in our chair at some point. With my minimal exposure, I would compare the behavior and mental status to a patient with Aspergers and/or ADHD. The nystagmus for both of my patients was also very salient.
Wednesday, June 9, 2010
Taurodontism and Learning Disabilities in Patients With Klinefelter syndrome
Dan Boboia 6/11/10 Lit. Review
Title:
Taurodontism and Learning Disabilities in Patients With Klinefelter syndrome
Author: Schulman et al
Purpose:
Determine the prevalence rates of taurodontism and learning disabilities in a sample of patients with Klinefelter syndrome
Methods:
Questionnaires and dental radiographs of KS patients were obtained and reviewed. Prevalence rates were determined for taurodontism and learning disabilities in the sample population and compared to the general population.
Results:
Taurodontism found in 75% of the participants
Learning disabilities found in 83% of the participants
Conslusions:
84% positive predictive value for KS in a male with taurodontism and learning disability.
This article suggests that dentists should recommend that patient be karyotyped for KS when encountering taurodontism with learning disability
Title:
Taurodontism and Learning Disabilities in Patients With Klinefelter syndrome
Author: Schulman et al
Purpose:
Determine the prevalence rates of taurodontism and learning disabilities in a sample of patients with Klinefelter syndrome
Methods:
Questionnaires and dental radiographs of KS patients were obtained and reviewed. Prevalence rates were determined for taurodontism and learning disabilities in the sample population and compared to the general population.
Results:
Taurodontism found in 75% of the participants
Learning disabilities found in 83% of the participants
Conslusions:
84% positive predictive value for KS in a male with taurodontism and learning disability.
This article suggests that dentists should recommend that patient be karyotyped for KS when encountering taurodontism with learning disability
Friday, June 4, 2010
Dental caries and prolonged breast-feeding in 18-month old Swedish children
Resident’s Name: Joanne Lewis Date: June 4, 2010
Article title: Dental caries and prolonged breast feeding in 18-month-old Swedish children
Author(s): A. L. Hallonsten, et al
Journal: International Journal of Paediatric Dentistry 1995; 5:149-155
Type of Article: research
Main Purpose: to study the prevalence of dental caries and prolonged breastfeeding in 18-month-old infants.
Methods: 3000 infants were screened for dental caries and ongoing breast-feeding at welfare centers throughout Sweden. 200 were selected for a more comprehensive examination including dietary and hygiene habits, use of fluoride, and salivary levels of strep mutans and lactobacilli. The 200 children were divided into 4 groups – 1.) children with caries but not breast fed 2.) children with caries being breast fed 3.) caries-free children being breast fed. 4.) reference group – age and gender matched, no caries, not breast-fed.
Results: 63 (2.1%) of the 3000 children had caries and 61 (2.0%) were still being breast-feed. 12 (19.7%) of the 61 children still being breast-fed had caries; 51 (1.7%) of the 2939 children not being breast-feed had caries. 85% of the children had their teeth brushed daily; 39% used fluoride tablets daily. Groups 1, 2 and 3 had a significantly higher number of food intakes per day than the reference group. Regardless of breast-feeding, caries-free children (groups 3 and 4) had a significantly lower level of strep mutans and lactobacilli than children with caries.
Key points/Summary: Children with prolonged breast-feeding have a tendency to develop unsuitable dietary habits which put them at risk for ECC.
Thursday, June 3, 2010
Caries Risk Assessment Appropriate for the Age 1 Visit(infants and toddlers).
Resident: Roberts
Date: 6/04/10
Article title: Caries Risk Assessment Appropriate for the Age 1 Visit(infants and toddlers).
Author: Ramos-Gomez, Francisco
Journal: CDA Journal
Volume: 35 Number 10
Year: 2007
Discussion
Caries remains the most prevelant childhood disease in the United States – five times more common than asthma. Eight percent of children have 75 percent of the disease. Kids found within low socioeconomic circumstances and are minority are at greatest risk. The AAPD currently recommends that children be seen by their first birthday in order to assess their risk factor for ECC. Caries risk assessment and subsequent management of the disease in children is crucial due to the known fact that caries in the primary dentition is a strong predictor of caries in the permanent dentition. Today many assessment forms are available to providers to aid in this process. Cambra, a caries risk assessment form is designed to clearly identify desease indicators and caries risk factors. A comprehensive protocol includes the following: 1. A parent interview 2. Examination of the child 3. Assignment of caries risk level 4. Individualized treatment based on risk level 5. Bacterial culture on parent or caregiver of child 6. Individualized home care recommendations 7. Motivational interview/strategies for caries control 8. Setting of self magagement goals with parent/child 9. Anticipatory guidance according to a specific age category 10. Determine the interval for POE 11. Collaboration with other health care professionals.
As pediatric dentist our responsibility is to be proactive in seeking out ways to improve the lives of young children. A risk assessment form is one way to to aid us in evaluating the potential risk that our patients face at a very young age.
Date: 6/04/10
Article title: Caries Risk Assessment Appropriate for the Age 1 Visit(infants and toddlers).
Author: Ramos-Gomez, Francisco
Journal: CDA Journal
Volume: 35 Number 10
Year: 2007
Discussion
Caries remains the most prevelant childhood disease in the United States – five times more common than asthma. Eight percent of children have 75 percent of the disease. Kids found within low socioeconomic circumstances and are minority are at greatest risk. The AAPD currently recommends that children be seen by their first birthday in order to assess their risk factor for ECC. Caries risk assessment and subsequent management of the disease in children is crucial due to the known fact that caries in the primary dentition is a strong predictor of caries in the permanent dentition. Today many assessment forms are available to providers to aid in this process. Cambra, a caries risk assessment form is designed to clearly identify desease indicators and caries risk factors. A comprehensive protocol includes the following: 1. A parent interview 2. Examination of the child 3. Assignment of caries risk level 4. Individualized treatment based on risk level 5. Bacterial culture on parent or caregiver of child 6. Individualized home care recommendations 7. Motivational interview/strategies for caries control 8. Setting of self magagement goals with parent/child 9. Anticipatory guidance according to a specific age category 10. Determine the interval for POE 11. Collaboration with other health care professionals.
As pediatric dentist our responsibility is to be proactive in seeking out ways to improve the lives of young children. A risk assessment form is one way to to aid us in evaluating the potential risk that our patients face at a very young age.
Examining the Cost Effectiveness of Early Dental Visits
Resident: Adam J. Bottrill
Date: 04JUN10
Region: Providence
Article title: Examining the Cost Effectiveness of Early Dental Visits
Author(s): Lee, Jessica Y. et al
Journal: Pediatric Dentistry
Page #s: pp. 102-104
Year: 2006, 28:2
Major topic: Cost, Early Dental Visits
Minor topic(s): Anticipatory Guidance
Type of Article: Topic summary
Main Purpose: To review the scientific evidenceand rationale for early dental visits.
Overview of method of research: Pseudo Meta Analysis
Key points in the article discussion:
I. General
A. AAPD, ADA and AAPHD all currently recommend all children have their first dental visit within the first year of life. AAP recommends the same early visit, but only for children who are at high risk for dental caries.
B. This early visit offers an opportunity to educate and inform parents about oral health and home care (anticipatory guidance)… similar to the “well child” visit to the pediatrician.
II. Dental Home
A. Evidence suggests that in order to prevent oral disease, preventive intervention must begin early in life.
B. A “dental home” is where a qualified dental health specialist delivers or supervises primary dental health care theat is comprehensive, continuously accessible, family centered, coordinated, compassionate, and culturally competent.
C. Studies show that many pediatricians and physicians recommend a low-risk child starting dental visits around 3yo.
II. Early Dental Visit
A. Children under age 6 have less than half the dental visits of those between 6 and 18yo.
B. By age 1, <>1yo accounted for MANY more of the restorative and emergency visits. Whereas children who began care at <1yo were much more likely to only have preventative visits.
C. This study also concluded that the children who began care later than age 1yo had much higher dental care-related costs.
D. This study may be flawed due to the fact that children who began care at <1yo likely had parents who were more motivated were thus likely to have better oral health.
E. What the authors would LIKE to think is that this improved oral health was due to the anticipatory guidance received by parents at such an early age.
Assessment of article: I think it is pretty safe to assume that the AAPD generally knows what they’re talking about. Kids should get to the dentist by age 1yo…. Period.
Date: 04JUN10
Region: Providence
Article title: Examining the Cost Effectiveness of Early Dental Visits
Author(s): Lee, Jessica Y. et al
Journal: Pediatric Dentistry
Page #s: pp. 102-104
Year: 2006, 28:2
Major topic: Cost, Early Dental Visits
Minor topic(s): Anticipatory Guidance
Type of Article: Topic summary
Main Purpose: To review the scientific evidenceand rationale for early dental visits.
Overview of method of research: Pseudo Meta Analysis
Key points in the article discussion:
I. General
A. AAPD, ADA and AAPHD all currently recommend all children have their first dental visit within the first year of life. AAP recommends the same early visit, but only for children who are at high risk for dental caries.
B. This early visit offers an opportunity to educate and inform parents about oral health and home care (anticipatory guidance)… similar to the “well child” visit to the pediatrician.
II. Dental Home
A. Evidence suggests that in order to prevent oral disease, preventive intervention must begin early in life.
B. A “dental home” is where a qualified dental health specialist delivers or supervises primary dental health care theat is comprehensive, continuously accessible, family centered, coordinated, compassionate, and culturally competent.
C. Studies show that many pediatricians and physicians recommend a low-risk child starting dental visits around 3yo.
II. Early Dental Visit
A. Children under age 6 have less than half the dental visits of those between 6 and 18yo.
B. By age 1, <>1yo accounted for MANY more of the restorative and emergency visits. Whereas children who began care at <1yo were much more likely to only have preventative visits.
C. This study also concluded that the children who began care later than age 1yo had much higher dental care-related costs.
D. This study may be flawed due to the fact that children who began care at <1yo likely had parents who were more motivated were thus likely to have better oral health.
E. What the authors would LIKE to think is that this improved oral health was due to the anticipatory guidance received by parents at such an early age.
Assessment of article: I think it is pretty safe to assume that the AAPD generally knows what they’re talking about. Kids should get to the dentist by age 1yo…. Period.
The Effect of Prolonged and Exclusive Breast-Feeding on Dental Caries in Early School-Age Children
The Effect of Prolonged and Exclusive Breast-Feeding on Dental Caries in Early School-Age ChildrenNew Evidence from a Large Randomized Trial
Authors: Kramer, Vanilovich, et. al.
Journal: Caries Research
2007;41:484-488
Major Topic: Effect of prolonged breast-feeding on caries in young children.
Findings: This was the largest randomized trial ever conducted in the area of human lactation and it found no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early age.
Stuff: There has been mixed findings in the past concerning breast-feeding and cariogenicity. This article sites several of these articles, but most of the research has been purely observational. That is what makes this randomized trial so special.
The study was performed at health clinics in Belarus. There were two groups, with one as a control and the other receiving a pro-breast-feeding intervention--basically breast-feeding motivational interviewing. The result was that the experimental group did a lot more breast-feeding and for longer periods of time.
In all, 13,889 children were followed over a 6.5 year period. Dental examinations were performed using mirror only and the DMFT surfaces were recorded.
Conclusions: Although there were some weaknesses in the study, which the authors point out in the beginning, it's nice to see have some more data on this subject. Let's just let the moms breast-feed.
Association Between Infant Breastfeeding and Early Childhood Caries
Brian Schmid DMD
Journal: Pediatrics
Authors: Hiroko Iida, Peggy Auingerm, Ronald J Billings and Michael Weitzman
Date: 2007
Summary:
Data from the NHANES health survey was collected and analyzed pertaining to children 2-5 years old. Criteria included: whether the child was ever breastfed, age upon stoppage of breastfeeding, the age of first being fed something other than breastmilk or water and when the child began regular daily feedings of something besides breastmilk or water. Results: There was no statistical difference in rates of ECC between those exclusively breastfed more or less than 9 months. ECC rates increased with age while severe ECC rates did not. Family income below the poverty line and being Mexican American were associated with higher rates of ECC and severe ECC. Maternal smoking during pregnancy was related to higher ECC. 36.3% of children who had a dental visit within the last year had ECC while 18.5% who had ECC had not been to the dentist in the last year. Having been breastfed had no independent correlation with ECC while the following did: increased child age, Mexican heritage, living below the poverty line, maternal smoking during pregnancy and have had a dental visit within the last year.
Smoking may be developmentally related to weaker enamel or environmentally due to a higher risk of poor dietary and health decision on the part of the mother. Low SES has long been known to be a risk factor for ECC due mainly to education, diet and access to dental care. In children 2-5 years old, parents are more likely to bring their child to the dentist with overt concerns, while those without visible decay will often delay the initial dental visit.
Breastfeeding does not cause dental caries. Going to the dentist causes dental caries. It's science.
Journal: Pediatrics
Authors: Hiroko Iida, Peggy Auingerm, Ronald J Billings and Michael Weitzman
Date: 2007
Summary:
Data from the NHANES health survey was collected and analyzed pertaining to children 2-5 years old. Criteria included: whether the child was ever breastfed, age upon stoppage of breastfeeding, the age of first being fed something other than breastmilk or water and when the child began regular daily feedings of something besides breastmilk or water. Results: There was no statistical difference in rates of ECC between those exclusively breastfed more or less than 9 months. ECC rates increased with age while severe ECC rates did not. Family income below the poverty line and being Mexican American were associated with higher rates of ECC and severe ECC. Maternal smoking during pregnancy was related to higher ECC. 36.3% of children who had a dental visit within the last year had ECC while 18.5% who had ECC had not been to the dentist in the last year. Having been breastfed had no independent correlation with ECC while the following did: increased child age, Mexican heritage, living below the poverty line, maternal smoking during pregnancy and have had a dental visit within the last year.
Smoking may be developmentally related to weaker enamel or environmentally due to a higher risk of poor dietary and health decision on the part of the mother. Low SES has long been known to be a risk factor for ECC due mainly to education, diet and access to dental care. In children 2-5 years old, parents are more likely to bring their child to the dentist with overt concerns, while those without visible decay will often delay the initial dental visit.
Breastfeeding does not cause dental caries. Going to the dentist causes dental caries. It's science.
06/04/2010 Association of Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants
Resident: Hencler
Date: 06/04/2010
Article title: Association of Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants
Author(s): Wan Et Al
Journal: J Dent Res 80(10): 1945-1948, 2001
Major topic: Streptococcus mutans Infection and Oral Developmental Nodules
Type of Article: Observational
Main Purpose:
Investigate a possible association between Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants
Overview of method of research:
60 pre-term and 128 full-term infants were examined at 3 and 6 months old for oral developmental nodules and salivary samples were taken and cultured for S. mutans levels.
Findings:
56 infants had S. mutans. Full-term infants were 2.1 times likely to have S. mutans. Oral nodules were present in 103 infants and less prevalent in pre-term infants. Of the 56 infants that had S. mutans, 47 (84%) also had nodules. S. mutans infection was strongly associated with nodules. Infants with S. mutans were grouped according to their bacteria levels and compared to the numbers of nodules found. There was a positive “dose response” association between S. mutans and nodules
Key points in the article discussion:
The present study showed that S. mutans could be isolated in pre-dentate infants as early as 3 months old. The level of S. mutans found in each of the 56 infants was relatively low and is likely due the lack of teeth. This study found that the potential for infection of a pre-dentate infant is proportional to the S. mutans levels in the mother. Full-term children were found to have a higher prevalence of S. mutans probably due to the fact that pre-term children having less personal contact with their mothers or more likely that their oral tissues are less mature and are not optimal for colonization. Pre-term infants were found to have a lower prevalence of developmental oral nodules which may be related to delayed or disrupted fetal development, resulting in less epithelial maturation and a reduced propensity to form epithelial remnants and microcysts. Analysis of the data showed a strong dose-response relationship between nodules and S. mutans infection, and risk analyses suggested that those with oral nodules were over 7 times more likely to be colonized with S. mutans. Since full-term children showed a higher prevalence of nodule, this may explain their higher infection rate of S. mutans compared with pre-term children who had a lower prevalence of nodules.
Summary of conclusions:
The association between nodules and S. mutans may be related to a reduced turnover of mucosal cells which encourage developmental nodule formation and also better adhesion and retention of S. mutans.
Assessment of article:
Interesting article. After reading this it seems there may be more of an individual association between the reduced turnover of mucosal cells and nodules or S. mutans, rather than an association between S. mutans and nodules. I don’t think this research showed a proportional relationship where oral nodules may be associated with S. mutans infection. There may be wishful shenanigans afoot.
Date: 06/04/2010
Article title: Association of Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants
Author(s): Wan Et Al
Journal: J Dent Res 80(10): 1945-1948, 2001
Major topic: Streptococcus mutans Infection and Oral Developmental Nodules
Type of Article: Observational
Main Purpose:
Investigate a possible association between Streptococcus mutans Infection and Oral Developmental Nodules in Pre-dentate Infants
Overview of method of research:
60 pre-term and 128 full-term infants were examined at 3 and 6 months old for oral developmental nodules and salivary samples were taken and cultured for S. mutans levels.
Findings:
56 infants had S. mutans. Full-term infants were 2.1 times likely to have S. mutans. Oral nodules were present in 103 infants and less prevalent in pre-term infants. Of the 56 infants that had S. mutans, 47 (84%) also had nodules. S. mutans infection was strongly associated with nodules. Infants with S. mutans were grouped according to their bacteria levels and compared to the numbers of nodules found. There was a positive “dose response” association between S. mutans and nodules
Key points in the article discussion:
The present study showed that S. mutans could be isolated in pre-dentate infants as early as 3 months old. The level of S. mutans found in each of the 56 infants was relatively low and is likely due the lack of teeth. This study found that the potential for infection of a pre-dentate infant is proportional to the S. mutans levels in the mother. Full-term children were found to have a higher prevalence of S. mutans probably due to the fact that pre-term children having less personal contact with their mothers or more likely that their oral tissues are less mature and are not optimal for colonization. Pre-term infants were found to have a lower prevalence of developmental oral nodules which may be related to delayed or disrupted fetal development, resulting in less epithelial maturation and a reduced propensity to form epithelial remnants and microcysts. Analysis of the data showed a strong dose-response relationship between nodules and S. mutans infection, and risk analyses suggested that those with oral nodules were over 7 times more likely to be colonized with S. mutans. Since full-term children showed a higher prevalence of nodule, this may explain their higher infection rate of S. mutans compared with pre-term children who had a lower prevalence of nodules.
Summary of conclusions:
The association between nodules and S. mutans may be related to a reduced turnover of mucosal cells which encourage developmental nodule formation and also better adhesion and retention of S. mutans.
Assessment of article:
Interesting article. After reading this it seems there may be more of an individual association between the reduced turnover of mucosal cells and nodules or S. mutans, rather than an association between S. mutans and nodules. I don’t think this research showed a proportional relationship where oral nodules may be associated with S. mutans infection. There may be wishful shenanigans afoot.
Wednesday, June 2, 2010
Mutans Streptococci: Acquisition and Transmission 6/4/2010
Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 6/04/2010
Article title: Mutans Streptococci: Acquisition and Transmission
Author(s): Berkowitz, RJ.
Journal: Ped Dent: 28:2
Month, Year: 2006, 106-9
Major topic: Acquisition and transmission of Strep mutans.
Type of Article: Literature review
Purpose: This article describes other studies to explain the caries relationship with Strep mutans and how it is acquired.
Overview: Initially it was thought that the acquisition of Strep mutans required a hard tissue oral surface such as a tooth. However it was determined that in fact Strep mutans is acquired by approximately 9 months of age perhaps by the organism surviving in the furrows of the tongue. This early acqution of MS is a major risk factor for early childhood caries and future caries experience. One study demonstrated that 89% of children with MS colonization by age 2 had dental caries by age 4 A major source of MS was from mothers therefore vertical transmission was a evident. Berkowitz reported that mothers with greater than 105 CFU’s of MS per ml in the saliva, had an infant infection rate of 59%. However, mothers with 103 CFU’s of MS per ml had a low infection rate for infants (9%). Neonatal factors such as C-section acquired MS earlier than infants delivered vaginally Horizontal transmission appears to be another significant factor in determining caries risk. Other family members as well as children in a daycare center were at increased risk of transmitting MS between children. Both vertical and horizontal transmission has clinical relevance. For example, when mothers with high MS levels consumed habitual amounts of daily Xylitol, the rate of infection was severely diminished. Other factors include education to reduce saliva sharing feeding activities, use of fluoridated dentrifice by infants, dietary counseling, and infant oral health examination.
Summary: 1. Primary oral infection by MS may occur in predentate infants, 2. Vertical and Horizontal transmission of MS, 3. Prevention of MS infection significantly reduces early childhood caries.
Assessment of article: Good article which was short and to the point..
Lutheran Medical Center
Resident’s Name: Craig Elice Date: 6/04/2010
Article title: Mutans Streptococci: Acquisition and Transmission
Author(s): Berkowitz, RJ.
Journal: Ped Dent: 28:2
Month, Year: 2006, 106-9
Major topic: Acquisition and transmission of Strep mutans.
Type of Article: Literature review
Purpose: This article describes other studies to explain the caries relationship with Strep mutans and how it is acquired.
Overview: Initially it was thought that the acquisition of Strep mutans required a hard tissue oral surface such as a tooth. However it was determined that in fact Strep mutans is acquired by approximately 9 months of age perhaps by the organism surviving in the furrows of the tongue. This early acqution of MS is a major risk factor for early childhood caries and future caries experience. One study demonstrated that 89% of children with MS colonization by age 2 had dental caries by age 4 A major source of MS was from mothers therefore vertical transmission was a evident. Berkowitz reported that mothers with greater than 105 CFU’s of MS per ml in the saliva, had an infant infection rate of 59%. However, mothers with 103 CFU’s of MS per ml had a low infection rate for infants (9%). Neonatal factors such as C-section acquired MS earlier than infants delivered vaginally Horizontal transmission appears to be another significant factor in determining caries risk. Other family members as well as children in a daycare center were at increased risk of transmitting MS between children. Both vertical and horizontal transmission has clinical relevance. For example, when mothers with high MS levels consumed habitual amounts of daily Xylitol, the rate of infection was severely diminished. Other factors include education to reduce saliva sharing feeding activities, use of fluoridated dentrifice by infants, dietary counseling, and infant oral health examination.
Summary: 1. Primary oral infection by MS may occur in predentate infants, 2. Vertical and Horizontal transmission of MS, 3. Prevention of MS infection significantly reduces early childhood caries.
Assessment of article: Good article which was short and to the point..
Caries Risk Assessment: methods available to clinicians for caries detection 6/4/10
Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Caries Risk Assessment: methods available to clinicians for caries detection
Author(s): Tranaeus, Sofia. Xie Qi Shi, et al.
Journal: Community Dentistry and Oral Epidemiology
Year. Volume (number). Page #’s: 2005. 33. 265-273
Major topic: Detecting Caries
Overview of method of research: Review
Findings: Management of dental caries has three basic components, prevention, control and treatment. These are all based on proper diagnosis of the initial lesion. The diagnosis of caries is usually synonymous with the signs of tissue damage. 1st molars are usually the first sites of decay in the permanent dentition.
Traditional diagnostic methods such as visual inspection have very low sensitivity and high specificity. Detection with an explorer also has low sensitivity. A number of reports have demonstrated that using a sharp explorer may actually cause a cavitation.
Fiber optic trans-illumination FOTI has been used since the 70’s. Basically the surface of the tooth is examined with transmitted light, and areas of decay appear dark.
Bitewings are acceptable for interproximal decay, but not so much for occlusal decay.
New Methods
Qualitative light induced Fluorescence (QLF) yellow orange light
Demineralized areas appear as dark spots. A sensitive, reproducible method, but depth of lesion detection is limited.
DIAGNOdent (DD) near infrared
In the presence of caries fluorescence increase. Good to excellent sensitivity and reproducibility.
Electrical Impedance
This technique is based on the theory that sound dental tissue shows high electrical resistance. Demineralized enamel, is porous, and filled with saliva, thus making it’s conductance higher. The more demineralized the tissue is, the less resistance there is.
Electric Caries Monitor
Used for occlusal surfaces. Shows promise, but more research is needed.
Key points/Summary: While all of these new technologies are exciting and interesting, there is still not enough evidence for any of the reviewed diagnostic systems to be recommended as a substitute for traditional techniques.
Assessment of Article: While it’s of the utmost importance that we as healthcare professionals stay current on literature and new techniques….this article was painful to read. Wicked bad.
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Caries Risk Assessment: methods available to clinicians for caries detection
Author(s): Tranaeus, Sofia. Xie Qi Shi, et al.
Journal: Community Dentistry and Oral Epidemiology
Year. Volume (number). Page #’s: 2005. 33. 265-273
Major topic: Detecting Caries
Overview of method of research: Review
Findings: Management of dental caries has three basic components, prevention, control and treatment. These are all based on proper diagnosis of the initial lesion. The diagnosis of caries is usually synonymous with the signs of tissue damage. 1st molars are usually the first sites of decay in the permanent dentition.
Traditional diagnostic methods such as visual inspection have very low sensitivity and high specificity. Detection with an explorer also has low sensitivity. A number of reports have demonstrated that using a sharp explorer may actually cause a cavitation.
Fiber optic trans-illumination FOTI has been used since the 70’s. Basically the surface of the tooth is examined with transmitted light, and areas of decay appear dark.
Bitewings are acceptable for interproximal decay, but not so much for occlusal decay.
New Methods
Qualitative light induced Fluorescence (QLF) yellow orange light
Demineralized areas appear as dark spots. A sensitive, reproducible method, but depth of lesion detection is limited.
DIAGNOdent (DD) near infrared
In the presence of caries fluorescence increase. Good to excellent sensitivity and reproducibility.
Electrical Impedance
This technique is based on the theory that sound dental tissue shows high electrical resistance. Demineralized enamel, is porous, and filled with saliva, thus making it’s conductance higher. The more demineralized the tissue is, the less resistance there is.
Electric Caries Monitor
Used for occlusal surfaces. Shows promise, but more research is needed.
Key points/Summary: While all of these new technologies are exciting and interesting, there is still not enough evidence for any of the reviewed diagnostic systems to be recommended as a substitute for traditional techniques.
Assessment of Article: While it’s of the utmost importance that we as healthcare professionals stay current on literature and new techniques….this article was painful to read. Wicked bad.
The Assessment of Nursing Caries and Its Relationship to High Caries in the Permanent Dentition
Dan Boboia 6/4/10 Lit. Review
Title: The Assessment of Nursing Caries and Its Relationship to High Caries in the Permanent Dentition
Author: Kaste et al
Purpose:
Compare prevalence rates of nursing caries obtained by using different nursing caries classification schemes; study the relationship of prior nursing caries to current high caries level determined by a clinical exam in the same children approximately ten years later.
Conclusion:
Different classification schemes yielded different prevalence rates. Classification of nursing caries by buccal or lingual caries in the maxillary incisors found 45% of children with the disorder vs. 61% if measured by 3 or more carious maxillary incisors, or 76% if two or more carious incisors. Nursing caries in these Head Start children showed no increased risk. The Head Start children classified as having caries by 2, 3 or more decayed maxillary anterior teeth had relative risks of 1.6 and 1.4 for high caries 10 years later, whereas the RR for children with a dmft > 5 was 2.4. Maxillary incisor classification shows a positive relationship to the presentation of high caries in the permanent dentition, which was not found when measuring nursing caries by buccal or lingual caries of the maxillary incisors.
Title: The Assessment of Nursing Caries and Its Relationship to High Caries in the Permanent Dentition
Author: Kaste et al
Purpose:
Compare prevalence rates of nursing caries obtained by using different nursing caries classification schemes; study the relationship of prior nursing caries to current high caries level determined by a clinical exam in the same children approximately ten years later.
Conclusion:
Different classification schemes yielded different prevalence rates. Classification of nursing caries by buccal or lingual caries in the maxillary incisors found 45% of children with the disorder vs. 61% if measured by 3 or more carious maxillary incisors, or 76% if two or more carious incisors. Nursing caries in these Head Start children showed no increased risk. The Head Start children classified as having caries by 2, 3 or more decayed maxillary anterior teeth had relative risks of 1.6 and 1.4 for high caries 10 years later, whereas the RR for children with a dmft > 5 was 2.4. Maxillary incisor classification shows a positive relationship to the presentation of high caries in the permanent dentition, which was not found when measuring nursing caries by buccal or lingual caries of the maxillary incisors.
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