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Aesthetic changes with four anterior units.
Cosmetic dentistry has evolved with the advent of more robust porcelain materials and ever-stronger bonding agents. This series of three articles aims to provide a practical overview of what is now possible both functionally and cosmetically from the preparation of a small number of teeth, through a whole smile, to full mouth rehabilitation. A complete diagnosis is the starting point to planning any cosmetic or functional changes. Guidance is given on the techniques used but adequate training must be considered essential before embarking upon modification in occlusal schemes or even minor adjustments in smile design. Conservative use of porcelain laminate veneers can result in significant aesthetic improvements to a patient's smile and it is not always necessary to prepare all the teeth visible in a smile.
In vitro comparison of different types of sodium perborate used for intracoronal bleaching of discoloured teeth.
AIM: To compare the bleaching efficacy of three different types of sodium perborate (SP) commonly used for intracoronal bleaching of discoloured non-vital teeth. METHODOLOGY: Sixty-five extracted human maxillary central incisors with intact crowns were used. Following obturation with gutta-percha and a root canal sealer using a lateral condensation technique, the coronal aspects of the root canal fillings were covered with a 1-mm thick protective base placed to a level 1 mm apical to the labial cemento-enamel junction (CEJ). The teeth were than stained artificially with fresh blood over a period of 18 days. One or other of the bleaching materials (group 1: SP monohydrate + water, group 2: SP trihydrate + water, group 3: SP tetrahydrate + water, group 4: SP monohydrate + hydrogen peroxide (HP), group 5: SP trihydrate + HP, group 6: SP tetrahydrate + HP) were placed in the pulp chamber of the discoloured teeth and sealed with Cavit for 21 days. They were replaced with fresh preparations after 3, 7 and 14 days. The shades of the tooth crowns were evaluated at baseline and at 7, 14 and 21 days. Comparison of tooth shades was completed at each interval and analysed statistically using the chi-squared test. RESULTS: There was no statistically significant difference between the groups at 7, 14, 21 days. Period of bleaching significantly affected the outcome (P < 0.01). No colour changes were noted in the control teeth. CONCLUSION: The data obtained from this study demonstrate that sodium perborate can be used mixed with water rather than with hydrogen peroxide for bleaching discoloured teeth.
Antibiotics and other anti-infective agents in pregnancy and lactation.
Serum levels of many drugs are lower in pregnancy compared with the nonpregnant state. Their renal clearance is higher and the maternal intravascular volume is expanded. Most antibiotics are safe for use in pregnancy and lactation. Tetracyclines cause fetal tooth discoloration and inhibition of bone growth if used in the second and third trimesters. Aminoglycosides carry a small risk of fetal ototoxicity. Quinolones may cause arthropathies in children, and so are currently not recommended for use in pregnancy. Most drugs are secreted into breast milk in very small amounts, not enough to have any therapeutic effect. The only antibiotics which may be of concern in nursing infants are sulfonamides and quinolones, and possibly metronidazole.
A newly recognized syndrome of skeletal dysplasia with opalescent and rootless teeth.
A Thai girl with skeletal dysplasia and dental anomalies was seen. Her anomalies consisted of disproportionately short stature, short neck, broad and depressed nasal bridge, broad chest in the anteroposterior dimension, kyphosis, widely spaced nipples, and protruded abdomen. Radiographic testing indicated that she had a large sella turcica, platyspondyly, hypoplastic acetabulum, and a small body of mandible. Both her deciduous and permanent teeth were equally opalescent, and most were rootless, with root development of the mandibular teeth more severely affected. Some maxillary roots were extremely short and tapered. Hypodontia was also observed. These findings represent a unique and hitherto undescribed syndrome of skeletal dysplasia with concomitant dental anomalies.
Effects of 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid on the prevention of alveolar osteitis following mandibular third molar extractions.
OBJECTIVE: The purpose of this study was to evaluate the use of a 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid combination as a prophylactic therapy for the prevention of alveolar osteitis after mandibular third molar extractions and to investigate adverse reactions to chlorhexidine. STUDY DESIGN: This randomized, placebo-controlled, parallel group study was conducted in a group of 177 subjects, from which 3 groups were formed. The first group (n = 62) received 0.2% chlorhexidine gluconate, the second group (n = 56) received a 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid combination, and the third group (n = 59) received 0.09% sterile saline solution. All patients were recalled for the diagnosis of alveolar osteitis on the third and seventh postoperative days. RESULTS: When patients in the antibiotic group were compared with those in the other 2 groups, a significant reduction in alveolar osteitis was noted (P <.05). An alteration in taste, the bad taste of the solution, and staining of dentures and oral tissues were the major complaints about chlorhexidine. CONCLUSION: It would be more beneficial to use chlorhexidine solution with a beta-lactamase inhibitor-containing antibiotic to enhance its effectiveness for the prevention of alveolar osteitis.
Dental aberrations in children and adolescents with osteogenesis imperfecta.
The aim of this investigation was to study dental aberrations in a large sample of unrelated patients with different types and forms of osteogenesis imperfecta (OI). Sixty-eight non-related index patients aged 0.3 to 20 years (mean, 10 years) were examined clinically. Panoramic radiographs from 49 patients were analyzed. Dentinogenesis imperfecta (DI) type I was found in 27 of 65 patients and was significantly more common in OI type III than in types I and IV and in patients with a severe form of the disease. The presence or absence of DI showed almost complete accordance between affected parents and children and between affected siblings. Moreover, agenesis was found in 11 of 49 patients, apically extended pulp chambers in 20 of 48 patients, and impaction of second permanent molars in 7 of 19 patients older than 15 years. The percentage of patients with no apparent dental aberrations was approximately the same in patients with OI type I and type III and in patients with mild and severe form of the disease. The high prevalence of dental aberrations in OI stresses the importance of clinical and radiographic odontologic examination as part of the clinical investigation. In patients with mild forms of the disease, in whom the medical diagnosis is uncertain, demonstration of disturbances in dental development can be crucial for establishing the OI diagnosis. C
Oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old Finnish schoolchildren with different oral health behaviors.
The aim of this study was to explore oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old schoolchildren with favorable, moderate, or poor behavior related to oral health. The data were gathered by questionnaire. Recommendations commonly used in Finland in oral health education were chosen as the criteria for selection of groups of children with favorable, moderate, and poor oral health behavior. Differences between groups were analyzed using crosstabulations and factors related to unfavorable behavior using logistic regression analysis. The percentage of children with appropriate knowledge was higher in the good behavior group (GB) than in the other groups. The groups differed most in the children's knowledge of the recommendation to use fluoride toothpaste at least twice a day. Most children in the GB group considered it important to brush their teeth for the fresh feeling this gave. The majority of children in all groups considered it important to brush their teeth when going to the dentist. The majority also considered brushing important for avoiding tooth decay and tooth discoloration as well as for having fresh breath. Unfavorable knowledge, attitudes, beliefs, and behavior tended to accumulate in the same children. Factors associated with unfavorable behavior were male sex, mother's low skill occupation level, and child's poor knowledge of oral health-related facts.
Effect on deciduous and permanent teeth of tetracycline deposition in utero.
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Roxithromycin treatment of scrub typhus (tsutsugamushi disease) in children.
BACKGROUND: Although chloramphenicol and doxycycline have been used for the treatment of scrub typhus, a difficulty exists in determining which drug to use in treating children because of such potential complications as aplastic anemia or tooth discoloration. We evaluated the effect of roxithromycin, a macrolide antibiotic, on scrub typhus in children. METHODS: A retrospective analysis was conducted on 39 children with scrub typhus who were treated with doxycycline (DC), chloramphenicol (CM) or roxithromycin (RM) between 1991 and 2000. We divided the patients into the DC-treated group (DC group; 16 children), CM-treated group (CM group; 14 children) and RM- treated group (RM group; 9 children) and compared these groups. RESULTS: Most cases (97%) occurred in October and November. Fever and rash were observed in all 39 cases, and an eschar was noted in 36 cases (92%). No statistical differences could be found between the 3 groups in mean age, duration of fever before admission, white blood cell (WBC) count and complications including abnormal liver enzymes. In most cases defervescence after treatment was within 24 h (34 cases, 87%) and during 24 to 48 h in 2 cases in the DC group, 1 case in the CM group and 2 cases in the RM group (no statistical difference). CONCLUSION: Roxithromycin was as effective as conventional doxycycline or chloramphenicol in children with scrub typhus and may be safer to use.
Congenital erythropoietic porphyria. Report of a case.
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A scanning electron and confocal laser microscope investigation of tetracycline-affected human dentine.
Because of the well reported dental side-effects of tetracycline administration, the drug should not be administered to children. However, it and its derivatives are often administered over a prolonged period for treatment of acne in young adults. Dental side effects are also noticed in these patients. The aim of this study was to examine with scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) the root dentine of a tooth from a young adult affected by tetracycline therapy. The palatal root of an upper third molar, demonstrating distinct areas of tetracycline staining, was removed from the crown and sectioned longitudinally to produce two samples. The pulp tissue was peeled off the dentine and any remaining non-mineralized tissues were removed with sodium hypochlorite. One sample was prepared for SEM and the other as a ground section which was examined with a CLSM. It was demonstrated by SEM that the mineralizing front of unaffected dentine was of a normal calcospherite appearance; in contrast, the mineralizing front of the tetracycline-affected dentine was devoid of calcospherite formation and many surface defects were apparent. In addition, the number of dentinal tubules associated with the defects was reduced. It was shown by CLSM that tetracycline bands were made up of numerous smaller bands and that peritubular dentine not associated with fluorescent bands had incorporated tetracycline. The CLSM examination of the mineralization front of the affected dentine revealed that fluorescence of dentine was restricted to the peritubular dentine. The results confirm that dentine mineralization is affected by systemic tetracycline therapy and that tetracycline can be incorporated into peritubular dentine after mineralization of the primary dentine matrix.
Extraradicular diffusion of hydrogen peroxide and pH changes associated with intracoronal bleaching of discoloured teeth using different bleaching agents.
AIM: To evaluate the extraradicular pH and hydrogen peroxide (HP) diffusion when either 35% carbamide peroxide (CP), 35% HP or sodium perborate (SP) is used for intracoronal bleaching of artificially discoloured teeth. METHODOLOGY: Single rooted extracted human premolars were stained with whole blood cells. After shaping and cleaning, they were root filled and a base cement placed 1 mm below the buccal cementoenamel junction (CEJ). Four cemental defects were prepared just below the CEJ on each root surface. The teeth were randomly divided into four groups of 11 specimens, and intracoronally bleached using CP, HP, SP or distilled water (CL). Each tooth was suspended in a vial of distilled water and bleached for 7 days. The pH of the extraradicular distilled water was tested at 0, 1, 2 and 7 days and the HP that diffused through the root quantified using the Ferrous Oxidation-Xylenol Orange 2 Assay. The results were analysed using the one-way anova and Scheffe tests. RESULTS: Carbamide peroxide produced the greatest increase and HP the least pH change (P < 0.05 except day 1), SP was intermediate. From day 1 onwards, radicular diffusion of HP was greatest with HP and least with CP (P < 0.01), again SP was intermediate. There was no significant difference between CP and SP. CONCLUSIONS: Carbamide peroxide had very low levels of extraradicular diffusion of HP, in the presence of cemental defects. It could be an alternative to the other intracoronal bleaching agents.
Benign mucous membrane pemphigoid presenting as desquamative gingivitis in a 14-year-old child.
A 14-year-old girl presented with painful, erythematous gingivae, which occasionally developed blisters. There were no other mucosal or skin lesions. Clinical, histopathological and immunofluorescence studies suggested a diagnosis of benign mucous membrane (cicatricial) pemphigoid, presenting as desquamative gingivitis. Benign mucous membrane pemphigoid in childhood is rare and only a few cases with exclusive oral mucosal involvement have been reported in the literature. The desquamative gingivitis responded well to a topical steroid regimen.
Bleaching of a discoloured non-vital tooth: use of a sodium perborate/water paste as the bleaching agent.
Bleaching materials containing hydrogen peroxide have been used successfully for the treatment of discoloured non-vital teeth; however, their use has occasionally been associated with external root resorption. Some evidence exists that sodium perborate mixed with water is as effective as sodium perborate mixed with hydrogen peroxide. A case is presented which supports this and a step-by-step technique is described.
Cervical enamel: a danger zone.
The British Standards Institutions's document (1974) recommending toothpaste specifications states that 'There is no evidence that any toothpaste ever produces a level of abrasion causing harm to dental enamel'. This paper questions the assumption that the enamel crown, especially at the cervical margin, is able to cope with modern dietary insult and a 'good' oral hygiene regimen, regardless of the enamel abrasivity of the dentifrice used. Once the enamel crown is breached the underlying dentine is sensitive and vulnerable to physical damage. In this work the potential rates of erosive and abrasive loss are related to the thickness of the protective enamel and to the relevance of fluoride treatments for adults. It is suggested that improvements in dental care and an increased tooth life expectancy now make the loss of tooth tissues at the cervical margin more important than is apparent at first sight.
Experimental dentigerous cysts and enamel hypoplasia: their possible significance in explaining the pathogenesis of human dentigerous cysts.
Cysts lined by epithelium were often found in association with tooth-germ isografts in hamster cheek pouch. They developed from odontogenic epithelium and were in close relation to the crowns of involved teeth. Cysts associated with tooth-germ isografts from 5-day-old animals (17 out of 36) commenced their formation shortly after transplantation as a result of enamel organ degeneration. Teeth associated with these cysts often showed enamel hypoplasia. Accordingly, 86 teeth involved in human dentigerous cysts were examined and 43 were found to possess areas of enamel hypoplasia on their occlusal surfaces or incisal edges. It is suggested that the pathological process initiating cystic degeneration in the enamel organ was also accompanied by degeneration of ameloblasts. When tooth germs from 2-day-old hamsters were transplanted, cystic spaces developed only after completion of enamel formation, 6 weeks following transplantation (in six out of 11 transplants), as a result of separation between the cells of the reduced enamel epithelium. Enamel hypoplasia was not a conspicuous feature. These experimental and clinical observations suggest that there may be at least two types of dentigerous cyst, perhaps with different causes, arising at different stages of tooth development.
Mild forms of dentinogenesis imperfecta in association with osteogenesis imperfecta as characterized by light and transmission electron microscopy.
Osteogenesis imperfecta (OI) results from various gene mutations leading to defects in type I collagen, which is the major component of both bone and dentin. Yet dentinogenesis imperfecta (DI) is found only in half of the patients with OI. Here we document patients from three families with OI and DI lacking the clinical and radiographic features of DI in permanent teeth. However, light and transmission electron microscopic studies of dentin of deciduous and permanent teeth revealed various changes in the morphology of the dentinal tubules and collagen fibers. In one family, diagnosis of DI preceded that of OI. The grade of severity of dentinal manifestations in patients with OI apparently forms a continuum from normal dentin structure to severe DI, and the marked difficulty in diagnosing mild DI may have led to underestimating its frequency. Furthermore, patients with DI should be carefully examined for the possible presence of OI.