Dental Disturbances Research Articles

A Comparative Analysis of Sector Classification and the Impacted Canine Grading System by Kumar and Daigavane in Patients With Unilateral Cleft Lip and Palate Utilizing Orthopantomogram (OPG) as a Diagnostic Tool.

Introduction Non-syndromic oral clefts, affecting one in 700 newborns in India, are the most prevalent craniofacial anomalies, with genetic or environmental causes impacting various life aspects. Studies indicate higher dental disturbances, particularly impacted canines, in cleft lip and palate (CLP) patients compared to non-cleft individuals. Impacted canines, trapped by hard tissues, require early diagnosis to prevent orthodontic issues. The widely used Ericson and Kurol method employs orthopantomograms (OPGs) to classify canine impaction in typical children. However, diagnosing canines in CLP patients is challenging due to palate defects and post-grafting complications. This study aims to compare the utility of the Kumar and Daigavane (KD) grading system and the sector classification to determine the best method for diagnosing impacted canine eruption paths. Method This cross-sectional comparative observational study was conducted at Sharad Pawar Dental College's Department of Orthodontics and Dentofacial Orthopaedics. The sample size, calculated using a significance level of 5% and a prevalence of 1%, required a minimum of 16 participants aged 9-11 years with non-syndromic clefts and impacted canines. Patients with systemic diseases or over 12 years of age were excluded. The sectoral and KD classification systems collected and evaluated OPGs from qualifying cleft patients. Sector classification considered the angle between the occlusal plane or canine tip and the adjacent tooth's long axis, while KD's classification considered the Frankfort horizontal plane, occlusal plane, vertical height from the occlusal plane, canine apex root position, and canine exposure to the cleft defect. Results The study found an 81.25% agreement between the KD grading system and the sector classification, with a Cohen's kappa value of 0.586, indicating a moderate agreement. The KD system showed 81.82% sensitivity and 80.00% specificity, with positive and negative predictive values of 90.00% and 66.67%, respectively. The receiver operating characteristic (ROC) curve analysis revealed the KD system's superior performance in identifying impacted and non-impacted canines compared to the sector classification. Conclusion The KD grading system demonstrated higher efficacy than the sector classification for evaluating the impacted canines in children with unilateral cleft lip and palate (UCLP). The KD system's high sensitivity and specificity make it a valuable tool for predicting canine eruption paths and addressing anatomical challenges in cleft conditions. This study highlights the need for accurate diagnostic tools tailored to cleft patients and contributes to advancing orthodontic treatment outcomes through improved classification systems.

Systemic Anticancer Therapy Details and Dental Adverse Effects in Children

An idea of therapy intensification in order to make anticancer treatment more effective is still being investigated. The study aimed to estimate the impact of the chemotherapy dose levels and treatment duration on the risk for dental development disturbance. The clinical examination and OPG analysis were carried out in 37 cancer survivors and germ agenesis, microdontia, size reduction, taurodontism, root and enamel abnormalities were identified. An analysis of anticancer treatment was carried out separately for vincristine (VCR), doxorubicin (DXR), cyclophosphamide (CP), etoposide (VP-16), carboplatin (CBDCA) and actinomycin D (ACTD) recipients in terms of treatment duration and drug doses administered. Individuals aged between three years and ten months, and seven years and four months, at diagnosis presented with no severe dental abnormalities, regardless of treatment duration and increasing cytotoxic drug doses. The largest number of abnormalities per one person was noted in the survivors treated with the highest single doses of VCR, DXR, CP and ACTD. No similar observation was made in the cases of cumulative and weekly doses analyzed. Moreover, there were no significant differences between the mean number of abnormalities across all the drug groups.

Dental development in children born to Zikv-infected mothers: a case-based study

BackgroundIn Brazil, in October 2015, an outbreak of Zika virus (ZIKV) infection and an increase in newborns with microcephaly suggested a relationship between maternal infection and microcephaly in children. ObjectiveFirst, to assess the presence of dental bud sin 13 infants with a confirmed diagnosis of congenital ZIKV syndrome, born to mothers infected with the virus during pregnancy; second, to evaluate the dental development of these children at a 36-month follow-up. DesignCase-based longitudinal study. ResultsDental radiographs in the first semester showed that all children had dental buds. Along with the study, the individuals presented with various dental disturbances. At the end of the evaluation period, some children still had incomplete deciduous dentition. ConclusionThe abnormal chronology of dental eruption and dental development disturbances in children with microcephaly infected with ZIKV born to infected mothers indicate a possible role of the virus in odontogenesis.

Agenesis of the Maxillary First Permanent Molars: A Clinical and Radiographic Evaluation of a Rare Case

Congenitally missing first permanent maxillary molars is a rare finding in any given population. The reported prevalence rate of maxillary first molar agenesis ranges from 0.2 to 1.5%. The exact aetiology of this dental anomaly is not clearly documented. Generally, it can occur in association with other dental disturbances. The purpose of this article is to describe the clinical and radiographic evaluation of a case with bilateral congenitally missing first permanent molars and its association with dental anomalies such as microdontia and hypodontia.

Measuring inside your mouth! Measurement approaches, design considerations, and one example for tongue pressure monitoring

The tongue is an important muscular organ, and its interaction with the hard palate is fundamental during speech and deglutition (the act or process of swallowing). For example, typical complications of cerebrovascular diseases are speech and deglutition disorders due to limited range of motion and tongue weaknesses. Different measurement approaches of these limitations are described in the literature. The development of low-invasive measuring systems is currently considered a priority. In this paper, we describe different approaches, design considerations, and one example: a new implantable intraoral device that we developed to measure tongue pressure [1]. This paper was first submitted to the IEEE MeMeA Symposium 2014 (© 2014 IEEE, in Proc. IEEE MeMeA, used with permission, [1].) This new device measures tongue pressure on the hard palate directly inside the oral cavity and transmits the data via a wireless link. Since no cable links the pressure sensors inside the oral cavity and the readout unit is located outside of the mouth, this device is low invasive, which represents an important feature for this type of device. We describe a typical experimental setup to study the mechanical behavior of these devices in the laboratory and specific test protocols. The field of application of these devices is the treatment of patients with deglutition and speech disorders or with gnathological (related to the entire chewing apparatus) and dental disturbances.

Long-term dental follow-up in hematological stem cells transplantation children

Objective: The aim of this paper is to update the current published content about the craniofacial long-term development disturbances of childhood hematopoietic stem-cell transplantation (HSCT) and the preparative regimens for the onco-hematological malignancies treatments. Material and Methods: Two authors independently reviewed the published articles about long-term effects of childhood HSCT that fitted in to predetermined inclusion/exclusion criteria: clear definition of exposure or intervention, standard outcomes measurement and appropriate statistical analysis. Results: Twelve papers matched all the previous established eligibility criteria and were included in this review. The children’s age at HSCT were related to a higher risk of dental development disturbances, such as agenesis, dental hypoplasia, root stunting, crown-root proportion alterations, and microdontia. Craniofacial vertical growth was impaired in the irradiated patients without antero-posterior or latero-lateral impairment. Temporomandibular joint dysfunction was found to be more prevalent in the patients who was diagnosed with graft-versus-host disease. Conclusion: The late effects of craniofacial development disturbances leads to several aesthetic and functional impairment, periodontal bone resorption with consequent impairment of chewing ability, and risk of early tooth loss often associated with life’s quality impairment. Further investigations should be performed to provide accurate information for patients, parents and health care professionals. Keywords: Dental development. Craniofacial growth. Bone marrow transplantation. Hematopoietic stem-cell transplantation. Chemotherapy. Radiotherapy.

Oral Rehabilitation of a Child with Goldenhar syndrome

Goldenhar syndrome (GS) is a rare abnormality affecting the craniofacial region having extra cranial manifestations as well. The first observation of the anomaly was reported by Arlt F in 1881. Dr Maurice Goldenhar in 1952 gave the name Goldenhar syndrome. The etiology of this disease still remains unclear and occurs as sporadic. However, some researchers have suggested multifactorial inheritance caused by the interaction of many genes, possibly in combination with environmental factors. The incidence has been reported to range from 1 in 3,500 to 1 in 5,600 live births; however, in children with congenital deafness, it is much higher at 1 in 1000. Patients with this syndrome may exhibit a wide range of anomalies that includes eye anomalies (micropthalmos, coloboma, epibulbar dermoid and lipodermoid malformations); ear anomalies (microtia, atresia, ear appendices and fistulas); vertebral and congenital heart anomalies; cleft lip/cleft palate, facial asymmetry, developmental dental disturbances and mental retardation. VATER (Vertebral anomalies, Anal atresia, Tracheoesophageal fistula, Esophageal atresia, Renal anomalies and Radial Dysplasia) or CHARGE (Coloboma, Heart defects, Atresia chooanae. This case report presents the dental management of a 7 year old boy with characteristic combination of external ear anomalies and ipsilateral facial underdevelopment the hallmark of this syndrome. Key words: Corneal opacities, Goldenhar syndrome, Mandibular hypoplasia, Oral Rehabilitation, Periauricular tags.

Orthodontic traction of impacted upper central incisors related to mesiodens

Although maxillary central incisors impaction is not a high frequent clinical condition, it is responsible for some undesirable aspects of patients smile from esthetic and functional points of view. There are some etiologic factors associated to this dental disturbance but the scientific literature is consensual on determining the importance of the early diagnosis and proper intervention. This manuscript consists on the case report of a 10 years old boy with Class I malocclusion, who showed during the mixed dentition phase, impaction of maxillary central incisors related to deciduous teeth retention and due to the presence of 2 mesiodens. The treatment proposed involved the surgical removal of the mesiodens, bonding of orthodontic accessories to the impacted incisors crowns followed by orthodontic traction with a removable orthodontic appliance. Regardless the development stage of the dentition was not ideal for this intervention, once the diagnosis should have been done as earlier as possible, favorable esthetic and functional results were attained.

Effect of nutritional rickets on dental development in North Indian children: A prospective study

Rickets is a disorder caused by a lack of Vitamin D, calcium or phosphate. It leads to softening and weakening of the bones. Dental manifestation of rickets includes enamel hypoplasia and delayed tooth eruption. The present prospective study was carried out to report various dental anomalies caused due to rickets in children. The present study was carried out on 120 pediatric subjects between the age-group of group 6-18 years of age with history of rickets in infancy as reported by pediatrician. The developmental defect of enamel index was used for recording enamel lesions along with radiographs. Statistical analysis was done using SPSS version 16 (SPSS, Chicago, IL, USA). Enamel hypoplasia was detected in 90 cases, missing teeth were detected in 45 cases, bilaterally missing mandibular second premolars were detected in 30 cases, seven cases were found with bilaterally missing maxillary first premolars, maxillary canines, and mandibular second premolars. Significant dental disturbances, e.g., hypoplasia, missing teeth can occur in children suffering from rickets in infancy. Careful and thorough management of this disorder can be done by conservative dental treatments such as composite sealant restorations and other preventive dental treatments.

Concomitant hypodontia and unusual dental anomalies in families

Certain human dental anomalies occur frequently together which supports the accumulated evidence of the shared genetic control of dental developmental disturbances. The present study reports an interesting case series of two families where parent and offspring having hypodontia also showed rare dental abnormalities like talons cusp and macrodontia. The absence of teeth in young patients can cause aesthetic, functional and psychological problems, particularly if the teeth of the anterior region are involved. Diagnosing dental abnormality early can alert healthcare professional to the possible development of others in the same patient or other family members, sometimes, facilitating appropriate treatment intervention.

Eruption of odontomas into the oral cavity: a report of 2 cases.

Odontomas are the commonest odontogenic tumors of the oral cavity and are by nature asymptomatic. They consist mainly of dental tissue that may or may not be arranged in an orderly fashion. Their presence is often detected accidentally or due to the presence of a dental disturbance such as an unerupted tooth. The very rarity of odontomas erupting into the oral cavity validates the need for more current literature on the phenomenon. Our report of two cases aims to present and discuss the rare event of an erupting odontoma with the dental community.

Long-term Effects of Chemotherapy on Dental Status of Children Cancer Survivors

Background: The aim of this study was to investigate the long-term effects of chemotherapy on the dental and gingival health and dental disturbance parameters of children cancer survivors. Procedure: Thirty-eight children (mean age 12.2 ± 0.5 years) who underwent chemotherapy at 4.29 ± 1.71 years of age formed the study group. Forty age- and gender-matched healthy children with a similar socioeconomic background served as controls. Subjects’ caries status (number of decayed, missing, or filled permanent teeth [DMF-T]) was recorded according to World Health Organization criteria. Subjects’ periodontal status was recorded according to the community periodontal index system. Radiographic dental examination was used to analyze dental malformations. Results: DMF-T, D-T (number of decayed permanent teeth), and F-T (number of filled permanent teeth) were significantly higher in the study group compared to the controls (4.61 ± 3.71, 3.97 ± 4.45, respectively, and 0.58 ± 0.14 vs. 2.21 ± 1.01, 0.84 ± 1.82, and 1.18 ±1.07, respectively. The most frequent dental disturbances were root malformation (52.6%) and agenesis (47.4%). Conclusions: According to our examination dental status of long-term survivors is worse than in controls. Hence proper oral hygiene for children cancer survivors (CCS) is critical. In order to meet the need for dental care in CCS health authorities are encouraged to revitalize the dental services Long-term follow-up of CCS is necessary to monitor their dental growth and oral health.

Disturbed dental development of permanent teeth in children with solid tumors and lymphomas

Deficient dental root development has been reported after conventional pediatric anticancer therapy but less information is available on children with solid tumors and lymphomas. We examined dental development from panoramic radiographs (PRGs) of 37 childhood cancer survivors (CCS) treated under the age of 10 years with multimodal chemotherapy (CT) and/or head and neck radiotherapy (RT). A novel defect index (DeI) was used to describe the total damage to permanent dentition. The DeI was also tested in matched controls. All CCS had dental disturbances including abnormal root development (86.4%), microdontia (13.5%) and tooth agenesis (16.2%). Testing the controls gave the mean DeI value 1.9 ± 2.7 (range, 0-12), while the index scores in the study group varied from 0 to 49 (mean 10.8 ± 11.2) (P < 0.01). The statistical differences in the mean DeI values were insignificant between CT and CT and RT groups (P > 0.05). Children treated for solid tumors and lymphomas are at considerable risk of some disturbances in developing dental structures. RT increased the severity of disturbances induced by CT. Studies should further elucidate dose-, age and time-related effects of anticancer treatment on dental development.

Association of cyclophosphamide use with dental developmental defects and salivary gland dysfunction in recipients of childhood antineoplastic therapy

The aim of this study was to examine the effect of antineoplastic therapy on dental development and saliva function in recipients of childhood antineoplastic therapy. Patients attending the long-term follow-up clinic at Children's Hospital at Westmead, NSW, Australia, were included if they had received treatment prior to 16 years of age and were in remission for more than 5 years. A dental examination and saliva test were performed for each participant. Holtta's Defect Index (HDI) was used to assess tooth aplasia, microdontia, and root-crown ratio on an orthopantomogram (OPG). Multivariable-adjusted regression analyses were used to estimate the association of patient characteristics and treatment modalities with dental outcomes. One hundred six participants (61% male) were recruited (response rate = 88%). The mean HDI score was 24.7 ± 17.8. A cumulative dose of cyclophosphamide >7500 mg/m(2) increased the HDI score by 13.06 (P = .01). Recipients of cyclophosphamide also had significantly increased odds of exhibiting very low saliva flow (<0.7 mL/min) (odds ratio = 12.43; 95% confidence interval, 2.08-74.35; P = .006). Children and adolescents who received high doses of cyclophosphamide were at increased risk of dental disturbances. Cyclophosphamide recipients were also at greater risk of exhibiting very low saliva flow. This study applied the HDI to patients receiving all forms of antineoplastic treatment and highlights the dose-dependent relation between cumulative dose of cyclophosphamide and dental disturbances.

Long-term effects of chemotherapy on caries formation, dental development, and salivary factors in childhood cancer survivors

The aim of this study was to investigate the long-term effects of chemotherapy on oral health and dental development in childhood cancer survivors (CCS). Ninety-six CCS patients with a mean age of 10.8 years and 96 healthy children of the same age and sex and social background composed the study group. The caries experience of the children was recorded according to the criteria of the World Health Organization, and plaque-gingival status was evaluated according to the Silness-Loe Index. The children were also investigated for stimulated salivary flow rate, buffer capacity, salivary mutans streptococci, and lactobacilli. Disturbances of enamel mineralization were recorded according to the index of developmental defects in dental enamel. Dental development disturbances were diagnosed on panoramic radiographs. The caries experience, mutans streptococci, and lactobacilli colonization in CCS children were found significantly higher than in the healthy subjects (P < .05). White/cream colored opacities were the most frequent enamel mineralization disturbances (69.8 %). The occurrence of arrested root development with short V-shaped root malformation was significantly higher in CCS children than in the healthy subjects (P < .05). No statistically significant difference was found between group <or=5 years and >5 years. This current investigation has shown that CCS children are at an increased risk of caries and developmental dental disturbances.

Non-endocrine late complications of bone marrow transplantation in childhood: part II.

Non-endocrine late complications of bone marrow transplantation in childhood: part II.

Isolated Soft Tissue Cleft Lip: The Influence on the Nasal Cavity and Supernumerary Laterals

The purpose of this investigation was to estimate the vertical deviation of the nasal floor and to register dental disturbances (i.e., hypo- and hyperdontia) in patients with an isolated soft tissue cleft lip. Thirty patients with isolated cleft lips were randomly selected from the files of the Department of Maxillo-Facial Surgery and Jaw Orthopedics. As a matched control group, 30 patients were selected from the files of the Department of Orthodontics. Panoramic radiographs were analyzed and the lowest point of the floor of the left and right nasal cavity was measured to the nearest 0.5 mm. The presence of supernumerary (deciduous or permanent) or missing lateral incisors was recorded from the patient's journals. The vertical position of the nasal floor differed significantly between the cleft and the non-cleft side (p < 0.001). Supernumerary, deciduous, and permanent laterals were recorded in 73% of the subjects in the cleft lip group (22 patients). In the control group, no differences were found between the position of the nasal floor on the left and right side and no supernumerary laterals were recorded. Missing laterals were not noted in any of the individuals investigated. Isolated cleft lips were in most cases associated with: (1) lowering of the nasal floor on the cleft side and (2) supernumerary primary or permanent lateral incisors on the cleft side. Panoramic radiographs can be used to detect differences in the vertical position of the floor of the nasal cavity in patients with isolated cleft lips and to diagnose supernumerary laterals.

Isolated Soft Tissue Cleft Lip: The Influence on the Nasal Cavity and Supernumerary Laterals

Objective: The purpose of this investigation was to estimate the vertical deviation of the nasal floor and to register dental disturbances (i.e., hypo- and hyperdontia) in patients with an isolated soft tissue cleft lip. Design: Thirty patients with isolated cleft lips were randomly selected from the files of the Department of Maxillo-Facial Surgery and Jaw Orthopedics. As a matched control group, 30 patients were selected from the files of the Department of Orthodontics. Panoramic radiographs were analyzed and the lowest point of the floor of the left and right nasal cavity was measured to the nearest 0.5 mm. The presence of supernumerary (deciduous or permanent) or missing lateral incisors was recorded from the patient's journals. Results:The vertical position of the nasal floor differed significantly between the cleft and the noncleft side (p < 0.001). Supernumerary, deciduous, and permanent laterals were recorded in 73% of the subjects in the cleft lip group (22 patients). In the control group, no differences were found between the position of the nasal floor on the left and right side and no supernumerary laterals were recorded. Missing laterals were not noted in any of the individuals investigated. Conclusions: Isolated cleft lips were in most cases associated with: (1) lowering of the nasal floor on the cleft side and (2) supernumerary primary or permanent lateral incisors on the cleft side. Panoramic radiographs can be used to detect differences in the vertical position of the floor of the nasal cavity in patients with isolated cleft lips and to diagnose supernumerary laterals. (Less)

Evidence of Intrafamilial Variability of CBFA1/RUNX2 Expression in Cleidocranial Dysplasia – a Family Study

To investigate the phenotypical expression of an identical mutation of the CBFA1/RUNX2 gene within a family with cleidocranial dysplasia. A five-member family underwent clinical examination. Two members, father and son, showed dissimilar symptoms of cleidocranial dysplasia. The two affected patients were examined for syndrome-typical symptoms, and the genotype was determined by molecular-genetic analysis. In both patients an identical missense mutation (G146R) in exon 2 of the CBFA1/RUNX2 gene was identified. In father and son the dental disturbances were similarly clearly expressed. However, the craniofacial skeleton of the son exhibited fewer dysostotic ossification features than that of the father. In the three clinically healthy family-members no mutation of the CBFA1/RUNX2 gene was found. In two patients with cleidocranial dysplasia an identical missense mutation in the CBFA1/RUNX2 gene leading to a divergent craniofacial phenotype was determined. The results indicate marked variability in the phenotypical expression of CBFA1/RUNX2 mutations.

Skeletal and dental disturbances in children after facial burns and pressure garment use: a 4-year follow-up.

Pressure garment use alters facial growth during rehabilitation after a facial burn injury. We previously studied 3 children with full facial burns and 3 children with partial facial burns who wore pressure garments for 1 year, and we found that maxillary horizontal growth and mandibular anterior-inferior growth are inhibited during the time of pressure garment use. The purpose of this follow-up study was to prospectively document skeletal and dental changes after pressure garment use was discontinued. We found that although the growth and development of the facial bones seem to return to normal, lasting changes remain. The use of pressure garments after skin grafting is still recommended. However, it is also recommended that an orthodontist be included in the team of burn care specialists for children with facial burns to monitor facial and dental development. Close attention to facial development during and after pressure garment use is necessary to maintain normal dental and facial relationships.