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Sotos syndrome, or cerebral gigantism, is a rare genetic condition characterized by tall stature, gigantism, dolichocephaly, advanced bone age and learning disability. The purpose of this case report is to highlight the dental management of a 10-year-old boy with Sotos syndrome who presented with hypodontia and dental caries.
This study represents an attempt to introduce a system for the longitudinal evaluation of the severity and the rate of progression of tooth wear. The material comprised a selected group of 10 males and 10 females, examined twice within an 18-month period. The subjects were predisposed to advanced occlusal wear and had a mean age of 32 years within the range of 16-56 years. Evaluation of occlusal wear was performed on a tooth-by-tooth basis, on study casts, using two ordinal scales, one for assessing the severity, and the other the progression of occlusal wear. The reliability of the scales was assessed by percentage inter-observer concordances. The sample exhibited higher occlusal wear scores in the incisor and canine regions compared to the posterior region. It was found that the overall progression in an 18-month follow-up period was slow. The inter-observer concordance in the evaluation of the severity of wear was 88%, and 91% in the progression of wear. Within the limitations of the described system, the scales may be utilized for determining the severity of occlusal wear and the rate of its deterioration in an individual's dentition. From a clinical standpoint, the need for future treatment may be based on such a evaluation of the progression of wear.
The topic of occlusion presents a conundrum to many practitioners. To some the topic is very complex and yet to others, although important, it illustrates how adaptive the dentition is to change. This commentary presents some arguments as to how the importance of occlusion and its understanding have evolved since the Journal of Oral Rehabilitation was first published.
PURPOSE: This study was performed to investigate the effect of a carbonated beverage on the wear of human enamel and three dental ceramics: a conventional porcelain (Vitadur Alpha), a hydrothermal low-fusing ceramic (Duceram-LFC), and a machinable ceramic (Vita Mark II). MATERIALS AND METHODS: Tooth-against-ceramic specimens (10 per group) were tested in a wear machine under a load of 40 N, at a rate of 80 cycles per minute, and for a total of 25,000 cycles. The test was performed in distilled water or with intermittent exposure to a carbonated beverage (Coca-Cola). Wear was determined by measuring the height reduction of the tooth specimens and the depth of wear track in the ceramic specimens. RESULTS: ANOVA revealed a significant difference among the groups for both enamel and ceramic wear (p < .001). When tested in water, Alpha porcelain caused significantly more enamel wear and also exhibited greater wear than Duceram-LFC and Vita Mark II. However, with exposure to the carbonated beverage, the enamel wear produced by Duceram-LFC did not differ significantly from that produced by Alpha porcelain, and Vita Mark II produced the least amount of enamel wear. Overall, exposure to the carbonated beverage significantly increased the enamel wear. The wear of Duceram-LFC and Vita Mark II increased with exposure to the carbonated beverage. CONCLUSIONS: It was concluded that exposure to the carbonated beverage accelerated the enamel wear and decreased the wear resistance of Duceram-LFC and Vita Mark II ceramics. Overall, Vita Mark II was shown to be the most resistant to wear and also significantly less abrasive than conventional Alpha porcelain.
Patients requiring extensive restorative care frequently exhibit significant loss of tooth structure. Specific clinical findings in an extremely worn dentition may vary widely and are often confusing. Severe wear can result from a mechanical cause, a chemical cause, or a combination of causes. The location of the wear, the accompanying symptoms and signs, and information gained from the patient interview are essential components in determining the etiology. A diagnostic decision tree facilitates a systematic analysis and diagnosis of dental wear.
2 strontium chloride hexahydrate-containing dentifrices (SCH), similar except for their respective abrasive systems, were compared in a 2-month randomised double-blind parallel clinical study to evaluate their comparative effectiveness in terms of cervical dentinal hypersensitivity. 2 groups of 20 subjects, each with cervical dentinal hypersensitivity, were evaluated for tactile sensitivity by Yeaple probe, air sensitivity using a dental air syringe and subjective perception of pain by means of a visual analogue scale. There was no difference between the dentifrices as regards reduction of cervical dentinal hypersensitivity at each time point. The response to both dentifrices was evident within 4 weeks of use and the degree of improvement increased throughout the 8-week study period. The results support the conclusion that changing the abrasive component of SCH dentifrices did not significantly increase or decrease the (desensitizing) activity of the original product.
The effect of reducing the abrasivity of toothpaste on dental caries was observed in a 3-year clinical trial involving 1106 11-13-year-old Berkshire schoolchildren were divided into three groups; Group 1 were allocated a low abrasivity paste containing 0.8% sodium monofluorophosphate, Group 2 a paste of conventional abrasivity also containing 0.8% sodium monofluorophosphate and Group 3 a low abrasivity non-fluoride paste. After 3 years the net DMFS increments (clinical and radiographic scores combined) were 4.22 in Group 1, 4.72 in Group 2 and 6.43 in Group 3. The differences between Groups 1 and 3 and between Groups 2 and 3 were highly significant (P less than 0.001). The mean increment in Group 1 was lower than in Group 2 but did not reach statistical significance. Reducing the abrasivity of the toothpaste had no meaningful effect on the standard of oral hygiene and prevalence of gingivitis as measured by the Gingival and Plaque Indices.
The effect of inorganic and organic acid fumes on teeth was explored in a cross-sectional study using blind dental examinations. A sample of 180 workers from two factories was randomly drawn. Among the 169 workers who participated in the survey, 88 were exposed to acid fumes and 81 were controls. The percentage of inorganic acid workers with tooth surface loss was 63.2%, while that for the controls was 37.7% (P less than 0.005). The corresponding figures in the organic acid company were 50.0% and 14.3% (P less than 0.02). In both companies the acid workers had significantly more often teeth with surface loss in the maxilla than their controls (P less than 0.02). Both anteriors and posteriors were affected. On the basis of the findings. it can be concluded that acid fumes at work are strongly associated with tooth surface loss.
With a greater number of people living longer and tending to retain many natural teeth, the problems associated with tooth wear are likely to place greater demands upon dental professionals in the future. Several attempts have been made to develop an index to measure tooth wear, for use at both the individual and population level. A review of these indices is undertaken, and difficulties experienced with the tooth wear index (TWI) of Smith & Knight (1984) in a large adult dental health survey is discussed. In the elderly population the scoring criteria of the TWI proved to be difficult to apply without additional qualification, and in cases of extreme wear a five-point ordinal scale was found to be inadequate to describe the range of wear observed. The concept of "pathological" levels of wear proposed by the TWI are challenged and modification to the index suggested for use among the elderly population.
UNLABELLED: Ecstasy users have reported that dry mouth, jaw tension and tooth grinding were common side effects of its use although the influence of these effects upon toothwear have not been previously investigated. OBJECTIVE: This study aimed to compare incisal and occlusal toothwear in Ecstasy users and a group of non-users of Ecstasy but users of other drugs. METHODS: Groups were established by a snowball peer information network from visitors to the "drop-in" Maryland Centre in Liverpool. Volunteers completed a questionnaire about social life, drug use and diet. Clinical examination for wear on the incisal edges and on canine tips was conducted with a mirror and probe, whereas occlusal wear was recorded in impressions and subsequently scored from stone replica casts. The degree of toothwear was scored according to the criteria of the Tooth Wear Index (Smith & Knight, Br Dent J 1984;157:16). RESULTS: Ecstasy users (n = 30) were compared with non-users (n = 28). Toothwear through the enamel into the underlying dentine occurred in 18 (60%) Ecstasy users but in only three (11%) non-users. The overall mean toothwear score in Ecstasy users was 0.63 compared with 0.16 in non-users (t = 4.34, P < 0.001). Dry mouth was reported by 93% of Ecstasy users whilst 89% stated that they clenched or ground their teeth after taking the drug. Tooth grinding commonly continued into the following morning. Carbonated (acidic) beverages were consumed by 93% of the users with a mean of three cans per "trip". CONCLUSION: The severity of toothwear and the number of teeth affected were greater in Ecstasy users than in a group of non-users. The occlusal surfaces were more commonly affected than the incisal, which may indicate jaw clenching rather than grinding as a feature of Ecstasy-induced muscle hyperactivity.
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Cervical abrasion/erosion lesions were restored without any form of mechanical cavity preparation with an anhydrous glass ionomer cement. To study the effect of dentin pretreatment on the bonding between dentin and glass ionomer cement three cleaning methods were tested: 1) mechanical cleaning with a prophylaxis paste, 2) scrubbing with a surface active cavity cleanser (Tubulicid) for 60 seconds, or 3) a 10-15 s application of a 40% polyacrylic acid solution. During a 3-yr period, 193 restorations were evaluated every 6 months. Cumulative loss rates after 3 yr were 11.6%, 12.3%, and 17.9% respectively. One restoration showed secondary caries during the evaluation period.
An atypical, rapidly proceeding abrasion/erosion of the labial enamel surfaces of the maxillary and mandibular incisors and canines in a 27-yr-old man is reported. Ultrastructural examination of a replica of the teeth showed a practically structureless enamel surface both at the initial examination and after 12 months. However, at the end of the period, minor areas of dentin tubules became visible, indicating that a substantial loss of the tooth substance had taken place. The patient's occupation involved daily environmental contact with proteolytic enzymes. In vitro study of enamel exposed to one of the actual proteolytic enzymes showed dissolution of enamel substance, and it cannot be excluded that enzymatic decomposition of the organic enamel matrix is a contributing cause of the observed exaggerated loss of tooth substance.
To optimize the bonding of glass polyalkenoate (ionomer) cement to dentin, different conditioning methods have been suggested. The effect of two easily applied conditioning methods, a 10-15 seconds cleaning with a 10% polyacrylic acid or rinsing with copious amounts of water, was compared in class V abrasion/erosion lesions. The cervical lesions were restored, without any form of mechanical cavity preparation, with an anhydrous glass ionomer cement. During a 4-yr period, 137 restorations were evaluated every 6 months. Cumulative loss rates after 4 yr were 15.6% for the polyacrylic acid group and 21.9% for the water rinsing group. The difference was not significant. No secondary caries was registered.
A 3-yr randomized, controlled prospective study evaluated the clinical effectiveness of a mild two-step self-etch adhesive, Clearfil SE, in Class-V non-carious lesions. The hypothesis tested was that prior selective etching of enamel with phosphoric acid does not affect the 3-yr clinical performance of this adhesive. A total of 100 lesions in 29 patients were randomly restored in one or two pairs, according to two experimental protocols: (i) application of Clearfil SE according to the instructions of the manufacturer (C-SE non-etch); and (ii) similar application of Clearfil SE with prior etching of enamel cavity margins with phosphoric acid (C-SE etch). Clearfil AP-X was used as a restorative material. At 3 yr, 90% of the restorations were examined for retention, marginal integrity, marginal discoloration, caries recurrence, postoperative sensitivity, and preservation of tooth vitality. An excellent retention rate (100%) was noted after 3 yr of clinical functioning. Only one restoration of the C-SE etch group was clinically unacceptable owing to the presence of a severe cervical marginal defect. A pairwise comparison between both groups showed a significant difference only in the number of small marginal defects at the enamel side, which was higher in the C-SE non-etch group. These incisal defects were small and clinically irrelevant. Superficial marginal discoloration increased slightly in the C-SE non-etch group and was related to the higher frequency of small incisal marginal defects. In this latter group, localized marginal discoloration was observed significantly more in smokers. In conclusion, the clinical performance of the mild two-step self-etch adhesive, Clearfil SE, remained excellent after 3 yr of clinical functioning. Additional etching of the enamel cavity margins was not critical for its clinical performance.
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Gingival recessions and noncarious cervical lesions are frequent and closely related defects which can be successfully treated by mucogingival surgery and restorative therapy techniques either used alone or in combination depending on the defect characteristics. Proper treatment planning is guided by careful clinical diagnosis. A selection of treatment modalities are presented and useful hints proposed: the long term success is always strictly bound to the identification and elimination of the etiologic factors, to a correct treatment and a meticulous maintenance program.