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.

An update in diabetes mellitus

Department of Pediatric Dentistry
St Joseph Hospital

Resident’s Name: Craig Elice Date: May 29, 2009
Article title: An update in diabetes mellitus
Author(s): Dahms, WT
Journal: Pediatric Dentistry
Volume (number): 13(2)
Month, Year: 1991
Major topic: Discussion of dental implications of diabetes
Minor topic(s): n/a
Type of Article: review article
Main Purpose: Reviews concepts of Diabetes Mellitus and its treatment and implications in dentistry
Overview of method of research: Type I (aka Insulin Dependent Diabetes Mellitus-IDDM) affects mostly children with only 10% having onset over 21. It affects 1 in 700 children at 16 years of age. Treatment consists of two injections of NPH or insulin per day. The Beta cells of the islets in the pancreas are destroyed by the body’s autoimmune system over at least several years before symptoms appear. Symptoms include significant variables in blood sugars and both hypoglycemia and ketoacidosis.
Type II or adult onset diabetes is more common affecting 5 % of the population, mostly affecting patients over 40, and is related to obesity and a positive family history. It can be controlled by diet or hypoglycemic agents. Normal number of islets are noted but they are sluggish.
Several advances in the management of diabetes have occurred. Self blood glucose monitoring allows patients to monitor blood glucose levels during daily activity. Insulin pumps permit more predictable blood glucose control. Highly purified insulin prevents allergic reactions. Different techniques have been developed to determine the success of regulating blood glucose control. These include blood glycosylated hemoglobin in the form of total glycosylated hemoglobin, GgA1c, and HgA1. Treatment investigations under review include immuno-suppression to prevent an autoimmune response.
Dental implications: Diabetes does not increase the risk of dental decay. However, the frequency and severity of periodontal disease increased with age. Gingival inflammation appears related to patients with diabetes who have poor metabolic control. It is uncertain if chronic inflammation is related to decreased salivary flow, elevated salivary glucose concentration, or poor oral hygiene. There is some speculation that hyperglycemia can produce neutrophil dysfunction. Patients with diabetes have chronic hyperglycemia which causes poor neutrophil function and may make the diabetic patient more susceptible to periodontal disease.
Dental Treatment: In case of limited ability to eat, patients should have ready access to rapidly acting carbohydrates like sugar, orange juice, candy bars, etc. In general anesthesia cases, modifications should be made in cases of long periods of fasting like early AM surgeries, larger bedtime snacks, or less NPH before dinner and lastly postponement of AM insulin until after surgery.
Assessment of article: good summary, but needs updating.