Mostrando entradas con la etiqueta Articles of dentistry. Mostrar todas las entradas
Mostrando entradas con la etiqueta Articles of dentistry. Mostrar todas las entradas


CLINICAL CASE : Brain abscess secondary to a dental infection in an 11 year old child

Clinical Case

A primary molar dental abscess was implicated as the cause of a brain abscess in an 11-year-old boy.

This case report describes the neurological signs and symptoms, and acute management of a brain abscess in a child.

A brain abscess is provisionally diagnosed from the patient’s medical history, as well as the presence of signs and symptoms such as fever, headache, nausea, vomiting, focal neurological deficit, altered mentation, speech alterations, papillary edema, and neck stiffness or seizures.

A definitive diagnosis of brain abscess is confirmed through imaging.

The dental source of infection is identified by the exclusion of more probable foci such as the ears, heart, lungs, eyes or sinuses.

Read Also: EMERGENCY : Multidisciplinary approach in the immediate replantation of a maxillary central incisor

Introduction : Dental abscesses and facial cellulitis put dentists on alert for potentially life-threatening conditions such as sepsis or airway obstruction, but the risk of a brain abscess is a complication of odontogenic infection that dentists rarely consider.

This report describes the case of an 11-year-old boy whose brain abscess and associated neurological signs were most likely attributable to an abscessed primary molar.

The description of the neurological signs and symptoms, and the history and management of this case will inform dentists about the real possibility of a brain abscess of dental origin.


°Canadian Dental Association
°Dr. Hibberd / Dr. Nguyen


ORTHODONTIC : Guiding Unerupted Teeth into Occlusion: Case Report


Tooth eruption is considered to be delayed if emergence of a tooth into the oral cavity occurs at a time deviating significantly from norms established for the person’s sex and ethnic background.

Generally, a permanent tooth should erupt no later than 6 months after natural exfoliation of its predecessor, but a delay of up to 12 months may be of little or no importance in an otherwise healthy child.

Therefore, most practitioners consider eruption delayed only if the interval extends to more than 1 year.

Eruption of a tooth is considered to be delayed (i.e., the tooth is impacted) when all of the following conditions exist:

a. The normal time for eruption has been exceeded.
b. The tooth is not present in the dental arch and shows no potential for eruption.
c. The root of the unerupted tooth is completely formed.
d. The homologous tooth has been erupted for at least 6 months.

Read Also: DENTAL TRAUMA : A story of dental injury and orthodontics

Case Report . Diagnosis
A preadolescent girl (9 years, 2 months of age) and her mother presented to a private practice. The patient was “missing a front permanent tooth,” a situation that was esthetically displeasing to both the child and the mother.

A supernumerary tooth had been extracted when the patient was 7 years of age, and she had been advised to await eruption of the permanent successor tooth.

Clinical examination at the time of the current presentation revealed good oral health and mixed dentition.

Seema B. Shah, BDS, MFDS RCS (Eng); Gajanan Kulkarni, BDS, LLB, MSc, D Ped Dent, PhD, FRCD(C)


Do antibiotics during pregnancy affect the health of premature infants?


The use of antibiotics during pregnancy cannot always be avoided. Researchers investigating the impact of antibiotic use on the health of premature infants recently published their findings in the Journal of Pediatrics.

Babies born prematurely are extremely vulnerable even in the protective environment provided by neonatal intensive care units.

Approximately 33% of infants born before 32-weeks gestation develop late-onset sepsis (LOS), which occurs when the bloodstream becomes infected with bacteria.

Fewer infants (7%) develop necrotizing enterocolitis (NEC), a serious condition with a relatively high mortality rate in which sections of the bowel die.

Past studies suggested that the risk of developing these diseases, or even dying, is increased in premature infants who are given antibiotics for an extended period from birth.

Read Also: When do kids need to go to the orthodontist?

Antibiotics during pregnancy can affect an infant’s microbial population
An emerging concern is that infants are developing infections that are resistant to the antibiotics taken by their mothers during pregnancy. This prompted a team in the USA to ask whether fetal exposure to antibiotics during pregnancy could increase the incidence of post-birth bacterial infections, such as LOS and NEC, in premature babies.

The team gathered data from 580 infants born before 32-weeks gestation. These infants had been placed into one of three level-III neonatal intensive care units in Ohio or Alabama in the United States. They were monitored for 120 days or until they were discharged, transferred, or died.


° By Natasha Tetlow


An Interdisciplinary Approach for Rehabilitating a Patient with Amelogenesis Imperfecta: A Case Report

Amelogenesis Imperfecta

Amelogenesis imperfecta (AI) has been defined as a group of hereditary enamel defects. It can be characterized by enamel hypoplasia, hypomaturation, or hypocalcification of the teeth.

AI may be associated with some other dental and skeletal developmental defects. Restoration for patients with this condition should be oriented toward the functional and esthetic rehabilitation.

This clinical report describes the oral rehabilitation of a young patient diagnosed with the hypoplastic type of AI in posterior teeth and hypomatured type of AI in anterior teeth.

Introduction : Amelogenesis imperfecta (AI) is a diverse group of hereditary disorders that primarily affect the quantity, structure, and composition of enamel. The inheritance pattern of AI may be autosomal dominant, autosomal recessive, or X-linked.

Read Also: Clinical Management of Regional Odontodysplasia. Clinical Case

According to the Witkop classification system, there are four main forms of AI: type I hypoplastic enamel, type II hypomatured enamel, type III hypocalcified enamel, and type IV hypomatured-hypoplastic enamel with taurodontism.

Clinical presentation of AI varies considerably among the different AI types. In the hypomature type, the affected teeth exhibit mottled, opaque white-brown or yellow discolored enamel, which is softer than normal.


° Niloufar Khodaeian / Mahmoud Sabouhi / Ebrahim Ataei


How Breastfeeding Could Improve Babies’ Dental Health

Oral Health

The more babies breast-feed, the less likely it is that they will develop any kind of misalignment in their teeth later on, a new study shows.

But pacifiers can negate some of that potential benefit, even if the children are breast-feeding, the Australian researchers said.

“While most benefits of breast-feeding can be attributed to the breast-milk, this study highlights one of the ways that the actual act of breast-feeding imparts its own benefits,” said Dr. Joanna Pierro, a pediatric chief resident at Staten Island University Hospital in New York City.

“While it is well established that exclusively breast-fed babies are at a decreased risk of dental malocclusion [misalignment], this study revealed the differences between those exclusively breast-fed versus those who are predominantly breast-fed,” said Pierro, who was not involved in the study.

“Since many breast-fed babies today are partially fed breast-milk from a bottle, this research reveals how this difference affects the oral cavity,” she added.

The researchers, led by Karen Peres at the University of Adelaide in Australia, tracked just over 1,300 children for five years, including how much they breast-fed at 3 months, 1 year and 2 years old. The study authors also asked how often the children used a pacifier, if at all, when the kids were 3 months, 1 year, 2 and 4. About 40 percent of the children used a pacifier daily for four years.

When the children were 5, the researchers determined which of them had various types of misaligned teeth or jaw conditions, including open bite, crossbite, overbite or a moderate to severe misalignment.

The risk of overbite was one-third lower for those who exclusively breast-fed for three to six months compared to those who didn’t, the findings showed. If they breast-fed at least six months or more, the risk of overbite dropped by 44 percent.

Similarly, children who exclusively breast-fed for three months to six months were 41 percent less likely to have moderate to severe misalignment of the teeth. Breast-feeding six months or longer reduced their risk by 72 percent.

Read Also: CARIES : Does Breastfeeding Increase Risk of Early Childhood Caries?

The findings were published online June 15 in the journal Pediatrics. While the study found an association between breast-feeding and dental health, it did not prove a cause-and-effect link.

But Peres offered some possible explanations for the association.

“The plausible mechanisms which may explain the association between exclusive breast-feeding and lower risk of having [misaligned teeth or jaws] . . . include the adequate development of the orofacial structures in children who are breast-fed, such as proper muscular tone and nasal breathing,” Peres said. “In addition, children who are breast-fed are less likely to use a pacifier, which is considered a risk factor for malocclusion.”

Pierro explained it this way.

“Unlike feeding with a bottle, breast-feeding requires the baby to move her jaw and tongue in ways that help develop the oral cavity,” she said. “So long before baby breaks her first tooth, she is creating the foundation for proper alignment of the teeth.”

The findings may also reflect the effects of a baby getting regular jaw exercise through the act of breast-feeding, suggested Dr. Danelle Fisher, vice chair of pediatrics at Providence Saint John’s Health Center in Santa Monica, Calif.

“Breast-feeding requires the use of jaw muscles more so than bottle-feeding, so the mechanics of breast-feeding stimulate muscle tone in the jaw,” Fisher said.

Open bite, overbite and moderate to severe misalignment were generally less common overall among the children who mostly or exclusively breast-fed. Children who mostly breast-fed but also used pacifiers, however, were slightly more likely to have one of these misalignment issues, the study found.

“Pacifiers are used for non-nutritive sucking but when overused, they can put pressure on the developing jaw and lead to more problems in older children with malocclusion [teeth/jaw misalignment],” Fisher said.

That does not mean parents need to toss the pacifiers, however. The American Academy of Pediatrics recommends that parents consider using a pacifier for an infant’s first six months because pacifiers are associated with a reduced risk of sudden infant death syndrome (SIDS).

“Most infants need to suck for comfort or non-nutritive sucking,” Fisher said. “Pacifiers can be helpful in the newborn period and even help reduce incidents of SIDS in infants who sleep with them.”

Instead, parents should simply limit pacifier use, she said. In addition, pacifiers are not needed past the first six to 12 months, Fisher said, so parents can begin weaning after that time.


When do kids need to go to the orthodontist?


Previously orthodontic treatment was carried out on children in their teenage years.

Today, however, many children start orthodontic treatment at a much younger age.

There are also large numbers of adults receiving orthodontic treatment.

At what age do you consider braces?

Traditional “train-track” braces are fitted to a child’s adult teeth and are used to move, realign and/or rotate a tooth or teeth into the correct position.

This is why you'll usually see children 10 years and older wearing these types of braces. However, crowded/crooked/skew adult teeth usually manifest because of a space shortage and/or a problem with jaw growth and/or jaw relationships.

Read Also: PERIODONTICS : Gingivitis in Children and Adolescents

This can usually be identified in young children, even before many of their adult teeth start coming through.

The big shift in orthodontics has been to check children at a much younger age, identify these issues earlier and intervene before the arrival of the adult teeth.

In many cases, early intervention can provide future adult teeth with all the space they need and the child may not have to wear conventional braces at all.

Dr Simon Reeves


ORTHODONTIC : Association between oral habits, mouth breathing and malocclusion


The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth.

While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion.

Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion.

The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions.

Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite.

Read Also: ORAL MEDICINE : How to treat oral thrush in newborns

Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points.

Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.


C. Grippaudo, G. Antonini, R. Saulle, G. La Torre, and R. Deli


What you Need to Know About a Pulpectomy


Pulpectomy is a procedure to remove all the pulp from the crown and roots of a tooth.

Pulp is the soft inner material that contains connective tissue, blood vessels, and nerves.

Pulpectomy is usually performed in children to save a severely infected baby (primary) tooth, and is sometimes called a “baby root canal.” In permanent teeth, pulpectomy is the first part of the root canal procedure.

Pulpectomy vs. root canal

A pulpectomy is complete removal of pulp from the crown and roots. The tooth is then filled with material that can be reabsorbed by the body. It’s usually performed on baby teeth.

Read Also: ORAL REHABILITATION : Stainless steel crown prep on a primary molar

A root canal starts with a pulpectomy, but the tooth gets a permanent filling or crown. It’s usually performed on permanent teeth.

Pulpectomy can be performed in one visit with these basic steps:

° X-rays are taken to look for signs of infection in surrounding areas and to get a look at the shape of the root canals

° A local anesthetic is used to numb the area

° A hole is drilled into the tooth...


° Image : Healthline


DENTAL TRAUMA : Treatment options for broken down permanent teeth in the mixed dentition

Dental Trauma

Management of cariously involved and traumatized permanent teeth in the mixed dentition depends on many factors.

This article will seek to identify the factors involved in the treatment planning of permanent dentition that require root canal therapy due to trauma or caries.

Immature permanent dentition requiring endodontic intervention can be researched by following the lifetime work of Jens Ove Andreasen or by reading the landmark research of Mejare Cvek and are beyond the scope of this review.

Of principal concern in the management is the mean time to permanent restoration.

In general, the permanent restoration is desired after full growth of the individual. Individual growth can be measured by taking a hand wrist film or two consecutive cephalometric radiographs that confirm no further dental growth is seen.


When considering a candidate for dental restoration, the first step is to determine the etiology of the disease. If dental caries is determined to be the primary cause of necessary endodontic intervention, the individual and guardian must be educated about the etiology of dental decay.

Dietary modification, oral hygiene instruction, and topical or systemic flouride therapy where indicated are necessary in the further prevention of the disease. Sealant therapy on at-risk teeth should be treatment planned.

Orthodontic considerations that impede proper hygiene and serve as food entrapment should be considered as well.


°Dismay with kid decay: treatment options for broken down permanent teeth in the mixed dentition
°By Joseph F. DiBernardo, DDS, and Doreen Toskos, DMD


Developing Class III malocclusions: challenges and solutions


Class III malocclusion represents a growth-related dentofacial deformity with mandibular prognathism in relation to the maxilla and/or cranial base.

Its prevalence varies greatly among and within different races, ethnic groups, and geographic regions studied.

Class III malocclusion has a multifactorial etiology, which is the expression of a moderate distortion of normal development as a result of interaction between innate factors or genetic hereditary with environmental factors.

Various skeletal topographies of underlying Class III malocclusion are due to discrepancy in the maxillary and mandibular growth along with vertical and/or transverse problems apart from sagittal malformations.

Read Also: PERIODONTICS : Guidelines for periodontal screening and management of children

The spectrum of complications for Class III malocclusion ranges in gravity from dentoalveolar problems with functional anterior shift of the mandible to true skeletal problems with serious maxillomandibular discrepancies, which makes its diagnosis highly challenging in growing children.


°Edlira Zere / Prabhat Kumar Chaudhari / Jitendra Sharan / Kunaal Dhingra / Nitesh Tiwari
°Foto: Clinica Dental Herrera


Oral rehabilitation of primary dentition affected by amelogenesis imperfecta

Emergency Pediatric Dentistry

The purpose of the case report was to describe the treatment of a 4(1/2)-year-old boy with amelogenesis imperfect (AI) in the primary dentition.

AI is a hereditary condition that affects the development of enamel, causing quantity, structural, and compositional anomalies involving all dentitions.

Consequently, the effects can extend to both the primary and secondary dentitions.

A 4(1/2)-year-old boy was brought to the dental clinic complaining of tooth hypersensitivity during meals. The medical history and clinical examination were used to arrive at the diagnosis of amelogenesis imperfecta.

Read Also: Deformity of the tongue in an infant: Riga-Fede disease

The treatment was oral rehabilitation of the primary molars with stainless steel crowns and resin-filled celluloid forms of both maxillary and mandibular primary incisors and canines.

Improvements in the patient's psychological behavior and the elimination of tooth sensitiveness were observed, and the reestablishment of a normal occlusion resulted in improved eating habits.


°The journal of contemporary dental practice
°Cintia Maria de Souza-E-Silva / Thaís Manzano Parisotto / Carolina Steiner-Oliveira / Maria Beatriz Gavião


Dental infections in kids tied to heart disease risk in adulthood

Dental infections

Children who develop cavities and gum disease may be more likely to develop risk factors for heart attacks and strokes decades later than kids who have good oral health, a recent study suggests.

Researchers did dental exams for 755 children in 1980, when they were eight years old on average, then followed them through 2007 to see how many of them developed risk factors for heart attacks and strokes like high blood pressure, elevated cholesterol, high blood sugar, and hardening of the arteries.

Overall, just 33 kids, or 4.5 percent, had no signs of bleeding, cavities, fillings, or pockets around teeth that can signal gum disease.

Almost six percent of the kids had one of these four signs of oral infections, while 17 percent had two signs, 38 percent had three signs, and 34 percent had all four signs.

Kids who had even one sign of oral infection were 87 percent more likely to develop what’s known as subclinical atherosclerosis: structural changes and thickening in the artery walls that isn’t yet serious enough to cause complications.

Children with all four signs of poor oral health were 95 percent more likely to develop this type of artery damage.

Oral infections are among the most common causes of inflammation-induced diseases worldwide, and periodontal disease in adults have long been linked to an increased risk of cardiovascular disease, researchers note in JAMA Network Open.

Most people get cavities and gum disease for the first time in childhood, and these conditions can develop into more serious infections and tooth loss if they aren’t properly treated, the study authors note. Treating these oral health problems in childhood can also reduce inflammation and other risk factors for hardening of the arteries.

Read Also: ORAL MEDICINE : How to manage a pediatric patient with oral ulcers

“This emphasizes how important good oral hygiene and frequent check-ups with a dentist starting early in life are for general health,” said lead study author Pirkko Pussinen of the University of Helsinki in Finland.

“The children with a healthy mouth had a better cardiovascular risk profile (lower blood pressure, body mass index, glucose, and cholesterol) throughout the whole follow-up period,” Pussinen said by email.

More than four in five kids had cavities and fillings, and 68 percent of them also had bleeding during dental exams. Slight pocketing around the gums was observed in 54 percent of the kids, although it was more often found in boys than in girls.

Both cavities and pocketing that can signal gum disease were associated with thickening of walls of the carotid arteries, blood vessels in the neck that carry blood from the heart to the brain. This indicates the progression of atherosclerosis and an increased risk for heart attacks and strokes.

The study wasn’t a controlled experiment designed to prove whether or how cavities or other oral health problems might directly cause heart attacks or strokes. Not everyone with subclinical atherosclerosis or other risk factors will go on to have a heart attack or stroke.

Poor oral health in childhood was also associated with an increase in blood pressure and body mass index in early adulthood, noted co-author of an accompanying editorial Dr. Salim Virani of Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston.

“These could themselves be associated with poor heart health in adulthood,” Virani said by email. Systemic inflammation associated with poor oral health is also linked to heart disease and stroke, Virani added.

“Either the relationship shown in this study is causal or there are yet unmeasured confounders (risk factors) that are associated with both poor oral health as well as future risk of cardiovascular disease,” Virani said. “For example, could poor oral health be a marker of poor nutrition which itself is associated with cardiovascular disease, or could poor oral health be a marker of lower socioeconomic status which itself may be associated with higher risk of cardiovascular disease in the future?”

SOURCE : / JAMA Network Open, online April 26, 2019.


ORAL PATHOLOGY : Pre-eruptive causes for intrinsic discoloration

stainless steel crown

Discoloration of the tooth can erode the sparkle from a smile.

There are many factors that contribute to tooth staining.

It is important to understand that in some cases staining can be prevented but in others it cannot.

There are two types of tooth discoloration: extrinsic which affects teeth from the outside and intrinsic which affects the teeth from the inside.

Pre-eruptive causes for intrinsic discoloration :

Alkaptonuria: This inborn error of metabolism results in incomplete metabolism of tyrosine and phenylalanine. This affects the permanent dentition by causing a brown discoloration.

Congenital erythropoietic porphyria: This is a rare, recessive, autosomal, metabolic disorder in which there is an error in porphyrin metabolism leading to the accumulation of porphyrins in bone marrow, red blood cells, urine and teeth. A red-brown discoloration of the teeth is the result and the affected teeth show a red fluorescence under ultra-violet light.

Read Also: Hypoplastic Enamel Treatment in Permanent Anterior Teeth of a Child

Congenital hyperbilirubinaemia: The breakdown products of haemolysis will cause a yellow-green discoloration. Mild neonatal jaundice is relatively common, but in rhesus incompatibility massive haemolysis will lead to deposition of bile pigments in the calcifying dental hard tissues, particularly at the neonatal line.

Amelogenesis imperfect : In this hereditary condition, enamel formation is disturbed with regard to mineralization or matrix formation and is classified accordingly. There are 14 different subtypes; the majority is inherited as an autosomal dominant or x-linked trait with varying degrees of expressivity. The appearance varies from the relatively mild hypomature ‘snow-capped’ enamel to the more severe hereditary hypoplasia with thin, hard enamel which has a yellow to yellow-brown appearance.

Dentinogenesis imperfect : The condition is hereditary and there is no treatment. Dentinogenesis imperfect has been classified into three types for diagnostic purposes:

Type I refers to affected teeth in patients who also have osteogenesis imperfect.
Type II refers to affected teeth as an isolated dental trait.
Type III refers exclusively to affected teeth of a racial isolate in southern Maryland, and is known as the “Brandywine Isolate”.

The main condition related to the dentine alone is Dentinogenesis imperfect II (hereditary opalescent dentine). Both dentitions are affected, the primary dentition usually more severely.

The teeth are usually bluish or brown in color, and demonstrate opalescence on transillumination. Once the dentine is exposed, teeth rapidly show brown discoloration, presumably by absorption of chromogens into the porous dentine.

In this condition, the teeth may be outwardly similar to both types I and II of Dentinogenesis imperfect. Radiographically, the teeth may take on the appearance of ‘shell teeth’ as dentine production ceases after the mantle layer has formed.

°Dental News Articles
°Dr. Sawsan Nasreddine, Dr. Fida Sayah, Dr. Fady Kassir, and Pr. Mounir Doumit, of the Lebanese University, School of Dentistry


ORTHODONTIC : Space Maintenance


It is essential that children be evaluated for missing primary teeth in order to determine if any space maintenance is necessary.

As a general rule of thumb, it is recommended that all space created by a missing primary tooth should be maintained. When in doubt, maintain space.

If there is an early loss of a primary molar and the first permanent molar has erupted, space maintenance must be employed as soon as possible.

Doing so will prevent the first permanent molar from drifting mesially. If the first molar is allowed to drift mesially, it will not only eat up the Leeway space, but it can potentially interfere with the eruption of the premolars or canines.

Posterior Space Maintenance

Space maintainers are very important to keep this Leeway space intact until eruption of the permanent teeth occurs. There are two basic categories of space maintainers: fixed and removable.

As a rule, fixed appliances are generally used as space maintainers. The two types are unilateral and bilateral.

The unilateral space maintainer can be used in very young children who have lost a single primary posterior tooth but only when you are sure that the successor tooth will not erupt for many years. Otherwise when using a space maintainer consider using a bilateral space maintainer because:

Read Also: ORTHODONTIC : Diagnosing Early Interceptive Orthodontic Problems – Part 1

1. If a permanent tooth is erupting a properly designed bilateral space maintainer will not cause you to have to remove the new appliance you just placed.

2. If there is need for other space maintenance on the other side of the arch, a bilateral appliance would be a better choice.

This is where the mixed dentition analysis and the panoramic radiograph become useful.

Analyses such as the Tanaka and Johnston method measure one half of the mesiodistal width of the four lower incisors. Then by adding 10.5 mm to this number the space needed for the mandibular canine and premolars in one quadrant can be estimated.

Add 11 mm to estimate the space required for the maxillary canine and premolars in a maxillary quadrant. This method has good accuracy for children of European descent.

This method will overestimate the required space for Caucasian females in both arches and underestimate the space required in the lower arch for African-American males.

The lower lingual holding arch (LLHA) in the mixed dentition is readily used to maintain the Leeway space in children with minor to moderate crowding. Note the Leeway space maintained on the lower right segment between the first premolar and the cuspid.

The transpalatal arch appliance is used in the maxillary arch as a bilateral space maintainer.

If maximum anchorage is needed, a Nance button can be added to a maxillary appliance which touches the palate, preventing mesial movement of the maxillary molars.

The following case demonstrates a maxillary arch with no crowding and with a normal eruption pattern. In the mandibular arch, there is minor crowding that will be resolved by using the Leeway space that is maintained by using a fixed lingual holding arch.

When a patient receives a fixed lower lingual holding arch, it maintains the space that the primary cuspids and primary molars are occupying. Once exfoliation occurs, the anterior crowding can be distalized into the Leeway space. From the mixed dentition analysis, the following were labeled:

A. Corrected lateral position, which corrects for excess space or crowding in the anteriors, demonstrating the space the laterals will occupy when uncrowded and properly aligned.

B. True available space, which is measured from the mesial of the first molar to the the corrected later position.

Anterior Space Maintenance

There are three categories of anterior space maintainers: fixed, removable-functional, and removable-static. Anterior space needs to be maintained for esthetics, normal speech and phonetic development, and to allow normal oral maxillofacial development.

The best fixed appliance for anterior space maintenance in arches that do not need arch development is the Groper appliance.

When arch development is needed, removable-functional appliances like the Schwarz can be used, delivering esthetics during arch development.

The next category, removable-static, is represented by Hawley-type appliances that have an artificial tooth placed.

As permanent teeth erupt, adjust the acrylic to accommodate the needed space. Its main use is in trauma cases and cases that have congenitally missing teeth (for example, lateral incisors). A labial bow can be used to add retention if desired.

°Diagnosis Early Interceptive Orthodontic Problems - Part 1
°Michael Florman


Fluoride varnish in primary dentition positively affects caries prevention


Whereas caries in adults and adolescents in Germany is declining, research has found that about 14 per cent of 3-year-olds in the country have cavities in their primary dentition.

According to a report by the Institute for Quality and Efficiency in Health Care (IQWiG), fluoride varnish is effective in remineralisation of the tooth surface and prevents the development and progression of caries.

Permanent teeth may be affected by caries at an early stage in the case of caries-affected primary teeth, as the enamel has not yet fully hardened.

Because oral hygiene and caries prevention can be challenging in young children, the use of fluoride varnish can be beneficial.

For this reason, the IQWiG researchers investigated whether the application of fluoride varnish to primary dentition has advantages in comparison with standard care without fluoride application by comparing the findings of 15 randomised controlled trials.

Read Also: PERIODONTICS : Guidelines for periodontal screening and management of children

In these, a total of 5,002 children were treated with fluoride varnish, and 4,705 children received no such treatment, being the control group.

Children aged up to 6 years with or without caries of their primary teeth were included in the research.

In several of the studies, further measures for caries prevention in addition to the application of fluoride varnish were offered. These included training on oral hygiene, instruction on the correct toothbrushing technique, and the provision of toothbrushes and fluoridated toothpaste. The follow-up observation period was mostly two years.

The development of caries was investigated in all 15 studies; side-effects were investigated in nearly all of the studies. However, owing to a lack of conclusive data, it is unclear whether fluoride application also has advantages regarding further patient-relevant outcomes, such as tooth preservation, toothache or dental abscesses. There was no data on oral health-related quality of life.

A clear advantage of fluoride varnish was determined despite the very heterogeneous study results. After the application of fluoride varnish, caries in primary teeth was less frequent.

More precisely, the fluoride treatment could completely prevent caries in approximately every tenth child and would at least reduce progression of caries in further children. Apparently, whether the children already had caries or whether their teeth were completely intact made no difference regarding the benefit of fluoride varnish application.

The report, titled “Assessment of the application of fluoride varnish on milk teeth to prevent the development and progression of initial caries or new carious lesions”, was published online by IQWiG on 26 April 2018.


ORAL HEALTH : Oral, dental problems may be sign of child abuse, neglect

Oral Health

A new report by the American Academy of Pediatrics cautions that problems in a child's teeth, gums or mouth could be a sign of abuse or neglect.

Research from the American Academy of Pediatrics and the American Academy of Pediatric Dentistry showed that injuries and infections in and around the mouth often appear in children who are abused or neglected.

Across the United States, healthcare providers, including dentists, are mandated to report any suspected cases of abuse or neglect to social service or law enforcement agencies.

The study, published in the August issue of Pediatrics, identified symptoms of possible abuse or neglect such as bruises on the lips, gums, tongue or soft tissue from forced feedings, burns or blisters from scalding liquids or fractures to teeth or facial bones from physical abuse.

Other injuries could include skin irritation, bruising or scarring at corners of the mouth, or bite marks.

Read Also: CARIES : Does Breastfeeding Increase Risk of Early Childhood Caries?

Untreated cavities and gum disease are also signs of neglect and can interfere with a child's ability to eat, communicate, grow and develop.

Researchers point out that it is important for healthcare providers to be able to recognize the symptoms of child abuse or neglect and be educated in what to do if they suspect abuse in one of their patients.

"Medical providers with experience or expertise in child abuse and neglect can make themselves available to dentists and dental organizations as consultants and educators," researchers wrote in the study.

"Such efforts will strengthen our ability to prevent and detect child abuse and neglect and enhance our ability to care for and protect children."
By Amy Wallace