Paediatric Dentistry

Abstract Klippel-Trenaunay-Weber Syndrome (KTWS) is a rare condition and presents the main characteristics of cutaneous hemangiomas, the presence of varicose veins, and hyperplasia of the soft and hard tissues on different parts of the body. This syndrome is characterized by an extreme individual variability, given that the majority of patients do not clearly present this classic trio. This condition is diagnosed at birth or in the first years of life, defined as a non-hereditary, but congenital, abnormality caused by a gene mutation in one autosomal dominant or recessive gene. The clinical signs are present at birth and are highly variable according to their severity. A female patient, 6 years of age, sought out an orthodontist, complaining of a facial asymmetry and presenting a history of ectopic eruptions. In the anamnesis, the patient's guardian reported that the child suffers from KTWS. This condition is characterized by an extreme degree of variability when it affects the craniofacial region, with the majority of patients not showing the classic trio of signs. KTWS is a rare and unknown condition; however, it does require interdisciplinary knowledge, considering, first and foremost, the diverse vascular changes associated with other maxillofacial and dental needs.

Background:  The aim of this study was to determine the range of histologically diagnosed lesions in 44 000 oral and maxillofacial pathology specimens, from adults 17 years and older, submitted for diagnosis to our laboratory over a 30-year period (1973–2002).Materials:  All entries for specimens from the patients were retrieved and compiled into 12 diagnostic categories.Results:  During the period, 44 007 specimens comprised a male-to-female ratio of 0.9:1. The diagnostic category with the largest number of specimens was mucosal pathology (36.0%) followed by odontogenic cysts (13.8%). Malignant tumours accounted for 5.4% of all specimens and benign tumours 4.6%.Conclusion:  This survey showed that while the majority of diagnoses are benign, approximately one in 19 cases required major head and neck surgery for malignant disease.

Background.  The relationship between parental and child dental fear has been studied for over a century. During this time, the concept of dental fear as well as methodological approaches to studying dental fear in children have evolved considerably.

Aim.  To provide an overview of the published empirical evidence on the link between parental and child dental fear.

Design.  A structured literature review and meta-analysis.

Results.  Forty-three experimental studies from across the six continents were included in the review. The studies ranged widely with respect to research design, methods used, age of children included, and the reported link between parental and child dental fear. The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 and under. A meta-analysis of the available data also confirmed an association between parental and child dental fear.

Conclusion.  The narrative synthesis as well as the meta-analysis demonstrate a significant relationship between parental and child dental fear, particularly in children 8 years and younger.

This study evaluated the effect of pumice prophylaxis on the level of microleakage around and between the sealant and enamel. A total of 32 freshly extracted sound upper first premolars, assigned as suitable for sealant application, were chosen and divided randomly into two groups: (1) a test group, without prophylaxis; and (2) a control group, with prophylaxis. Sealant was applied to all teeth using the same conventional technique, with prophylaxis being omitted in the test group. The sealed teeth were thermocycled (120 x 30 s, 5 and 55 degrees C cycles) and then immersed in 2% Basic Fuchsin solution for 72 h. Each tooth was sectioned and examined for dye penetration under a stereomicroscope (x 60 magnification). No dye penetration was seen in 19 (29.6%) of the teeth in the test group and 36 (56.2%) of the teeth in the control group. Dye had penetrated to the base of the fissure in 31 (48.4%) of the teeth in the test group and 23 (35.9%) of the teeth in the control group. Using a c...

Very little is known about children's everyday pains and dental treatment pains. A child's gender, age, and level of dental anxiety are factors that could interplay with the perception of pain and are thus worth studying. The objectives of this study were to investigate the frequency and reported intensity levels of children's everyday- and dental-pain experiences, and to study the reported pains in relation to gender, age, and dental anxiety. Three hundred and sixty-eight consecutive patients (8-19 years, mean age 13.5 years) from three different Public Dental Service were recruited. Pain ratings were obtained using McGrath's Children's Pain Inventory list and some additional items. Dental anxiety was estimated by the Dental Anxiety Scale. Most frequently experienced everyday pains were headache and tummy/stomach ache. Among dental treatment events, dental injection was reported to be most often ranked as painful, and more frequently by girls. Both dental and ev...

International Journal of Paediatric Dentistry 2010; 20: 132–143Background.  Recent reports have suggested that dental caries among some young children is increasing in the United States.Aim.  To describe changes in paediatric caries prevalence by poverty status in the United States.Design.  National Health and Nutrition Examination Survey (NHANES) data for children aged 2–11 years for 1988–1994 and 1999–2004 were used.Results.  Caries in the primary dentition increased among poor and non-poor boys aged 2–8 years (45–53% and 23–31%, respectively) and among non-poor boys aged 2–5 years (13–21%) from 1988–1994 to 1999–2004. Caries experience also increased on buccal-lingual, mesio-distal, and occlusal primary dental surfaces among poor children aged 2–8 years and this increase may be attributed to an increase in the number of dental surfaces restored. In the mixed dentition, caries remains relatively unchanged. Caries continues to decline in the permanent dentition for many children, but is increasing among poor non-Hispanic whites aged 6–8 years (8–22%) and poor Mexican-Americans aged 9–11 years (38–55%).Conclusions.  For many older children, caries continues to decline or remain unchanged. Nevertheless, for a subgroup of younger children, caries is increasing and this increase is impacting some traditionally low-risk groups of children.

Dental fear has been singled out as one of the most troublesome problems facing paediatric dentistry today. Children with dental fear may avoid visiting dentists; therefore, their oral health protection is often compromised. However, the aetiology of dental fear is still not entirely understood. This study investigated the dental visiting habit, the previous dental experiences, the conditioning pathway, and the clinically related predictors of dental fear in children. The dental history of 247 children (2-10 years old) was obtained when they came to a dental clinic for treatment. The level of dental fear in these children was assessed using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Observers rated the clinically anxious responses and uncooperative behaviour towards dental treatment in these children. Three stepwise regression analyses were performed to determine significant predictors of CFSS-DS score, clinically anxious responses, and uncooperative behaviou...

BackgroundThis study aimed to assess factors associated with occurrence of pulp necrosis (PN) in traumatized primary incisors, which may contribute to the prognosis of this outcome.This study aimed to assess factors associated with occurrence of pulp necrosis (PN) in traumatized primary incisors, which may contribute to the prognosis of this outcome.DesignData were collected by single examiner through the analysis of clinical files of traumatized patients. The occurrence of PN in traumatized teeth was the evaluated outcome. Poisson regression analysis was applied to calculate the relative risk (RR) and the respective 95% confidence interval.Data were collected by single examiner through the analysis of clinical files of traumatized patients. The occurrence of PN in traumatized teeth was the evaluated outcome. Poisson regression analysis was applied to calculate the relative risk (RR) and the respective 95% confidence interval.ResultsFive hundred and twenty-one files were assessed, summing up 727 traumatized primary incisors. The proportion of teeth affected by PN was 23.8%. Multiple regression analysis indicated the following factors as positively associated with PN: trauma with displacement, pulp exposure fracture, self-report of pain, yellow, grey and brown crown discoloration, internal root resorption, and bone loss. Trauma in 4- to 5-year old and more than 5-year-old children, pulp canal obliteration, and external root resorption with bone formation were negatively associated with PN.Five hundred and twenty-one files were assessed, summing up 727 traumatized primary incisors. The proportion of teeth affected by PN was 23.8%. Multiple regression analysis indicated the following factors as positively associated with PN: trauma with displacement, pulp exposure fracture, self-report of pain, yellow, grey and brown crown discoloration, internal root resorption, and bone loss. Trauma in 4- to 5-year old and more than 5-year-old children, pulp canal obliteration, and external root resorption with bone formation were negatively associated with PN.ConclusionsTeeth that suffered more aggressive injuries, pain, some types of discoloration, and other radiographic findings (for instance, internal root resorption) are positively associated with the occurrence of PN. On the other hand, trauma in older children, canal obliteration, or external resorption show less probability of PN.Teeth that suffered more aggressive injuries, pain, some types of discoloration, and other radiographic findings (for instance, internal root resorption) are positively associated with the occurrence of PN. On the other hand, trauma in older children, canal obliteration, or external resorption show less probability of PN.

Caries is still a prevalent condition in 5-year-old children. At present, knowledge regarding some aetiological factors, like deciduous molar hypomineralization (DMH), is limited. To investigate aetiological factors both directly and indirectly associated with caries in second primary molars. Of 974 children invited to participate in the study, 386 children were examined clinically with visual detection of caries. Only carious lesions determined to have reached the dentine were recorded. Information about tooth brushing frequency, education level of the mother, and country of birth of mother and child, was collected by means of a multiple-choice questionnaire. Parents of 452 children filled in the questionnaire. Complete clinical and questionnaire data were available for 242 children. Statistical analysis of the effect of the independent variables was undertaken using the Pearson's chi-squared test. Deciduous molar hypomineralization (P = 0.02) and the country of birth of the mo...

Knowledge about the influence of the interaction between child, parent, and dentist and the referral pattern is very limited. This study intended to assess to what extent the pathways of Rachman could clarify why a child is being referred to a specialist in paediatric dentistry and if other aspects in the interaction between child, parent, and dentist play a role in the referral. The referral letters of 500 children referred to a Special Dental Care Centre in Amsterdam were examined. All parents filled out the Children's Fear Survey Schedule-Dental Subscale, on behalf of the child. Information about interaction and the referral was collected from the referral letter and a semistructured interview with the parent and dentist separately. Eighty pairs of parents and dentists of referred children participated in a semistructured interview. Child factors seem to contribute the most to the referral. For the cause of referral the pathways of Rachman and communication were often combine...

Summary. Self Injurious Behaviour (SIB) is a deliberate harm to the body that may lead to factitial injuries. Its origin may be functional or biological and it has a higher prevalence in females and in psychologically impaired individuals. Seventy per cent of autistic patients have SIB. Seventy-five per cent of factitial injuries are located in the head and neck region. A paediatric case report concerning a 4-year-old autistic female is presented. Detailed medical history, physical examination, clinical intraoral and radiographic examination, incisional biopsy, neuropaediatrical, psychological and speech evaluation were undertaken. Diagnosis included hypochromic macrocytic anaemia, caries, coronal fracture, factitial ulcer, factitial periodontitis, self-extraction of primary teeth and permanent teeth buds, non-specific oral ulcer with inflammatory reaction, mild mental retardation, speech impairment, autistic syndrome and self injurious behaviour consisting of putting fingers and foreign objects in the gingiva, fingernail biting and hair pulling. Differential diagnosis included hystiocitosis X, prepuberal periodontitis and leukocyte adhesion deficiency. Dental preventive and restorative treatment was performed. Non-contingent reinforcement therapy was successfully used to diminish SIB. Treatment of factitial oral injuries must be interdisciplinary and requires cooperation of the patient, the parents, health care providers, and medical team.