Early Exfoliation Research Articles

Report of Two Dental Patients Diagnosed with Hypophosphatasia

Hypophosphatasia is a rare inherited skeletal disorder characterized by defective bone mineralization and tissue non-specific alkaline phosphatase (TNSALP) deficiency, with mutations in the gene encoding the TNSALP isozyme the cause. As for dental manifestations, premature loss of primary teeth due to disturbed cementum formation is well known and tooth roots in affected patients are not able to adequately attach to absorbed alveolar bone due to malformed cementum. We report spontaneous early exfoliation along with mild to severe mobility of primary anterior teeth in 2 child patients referred to pediatric dentists from a general dental practitioner. Case 1 was a 1-year-7- month-old boy with 3 mandibular incisors exfoliated, while Case 2 was a 3-year-3-month-old girl with 1 mandibular central incisor exfoliated. The possibility of hypophosphatasia was considered and the patients were referred to the Pediatric Clinic of Osaka University Medical Hospital, where each was diagnosed with hypophosphatasia (odonto type). We performed repeated periodontal treatments and applied removable partial dentures in both cases, which solved esthetic and functional problems. Although the incidence is quite low, it is important to diagnose hypophosphatasia as early as possible for planning general and dental preventive approaches. In patients with mild forms, such as odonto and childhood types, early exfoliation of primary teeth identified in a dental examination can occasionally lead to early diagnosis of hypophosphatasia. In addition, dental findings obtained by a dentist are useful to identify patients with a risk of hypophosphatasia, who can then be immediately referred to a pediatrician for more detailed systemic examinations. Thus, a cooperative relationship between pediatricians and pediatric dentists should be regarded as necessary. This is the first known report to describe cases of hypophosphatasia diagnosed after referral from a pediatric dentist because of typical dental findings for the disorder.

Dentin Dysplasia Type I: A Rare Case

Dentin dysplasia is a rare autosomal dominant disturbance of dentin formation which results in either bulbous, discoloured crowns or early exfoliation of the teeth. It has been classified into two types; type I or radicular dentin and type II or coronal dentin dysplasia. Here we present a case of dentin dysplasia type I in a 12 year old patient highlighting the clinical and radiographic features.

Radicular dentin dysplasia: A case report

Dentin dysplasias form a rare group of hereditary dentin malformations characterized clinically by normal appearing crowns but extreme mobility of teeth due to defective root formation. Both deciduous and permanent teeth may be affected. Delayed eruption and malocclusion may be associated features. This disorder is broadly classified into two types: Type I (radicular dentin dysplasia) and Type II (coronal dentin dysplasia). Type I is more common and is known by the term rootless teeth. The difficulties encountered with rootless teeth are obvious: there is no anchorage, there is compromised blood supply, deranged homeostatic mechanisms of the tooth as well as overload of masticatory and other stresses on the crowns leading to their early exfoliation. This paper discusses a case report of Type I dentin dysplasia and attempts to project the existing data in a concise form.

A new type of dental anomaly: molar-incisor malformation (MIM).

A molar-incisor malformation (MIM) is a newly discovered type of dental anomaly of the permanent first molars, deciduous second molars, and permanent maxillary central incisors. MIM anomalies of the permanent first molars and deciduous second molars may include normal crowns with a constricted cervical region and thin, narrow, and short roots, whereas the affected maxillary central incisors may exhibit a hypoplastic enamel notch near the cervical third of the clinical crown. Although the etiology of MIM remains to be determined, it is thought to be attributable to an epigenetic factor linked to brain- and central nervous system-related systemic diseases at around age 1 to 2 years. MIM teeth are associated with clinical problems such as impaction, early exfoliation, space loss, spontaneous pain, periapical abscess, and poor incisor esthetics. Children with MIM teeth should be observed closely with respect to their medical history, and dentists should formulate a wider-ranging treatment plan.

Premature loss of primary anterior teeth due to trauma – potential short‐ and long‐term sequelae

Traumatic dental injuries (TDIs) can result in the premature loss of primary anterior teeth due to an immediate avulsion, extraction later after the injury because of poor prognosis or late complications, or early exfoliation. There are a number of potential considerations or sequelae as a result of this premature loss that have been cited in the dental literature, which include esthetics, quality of life, eating, speech development, arch integrity (space loss), development and eruption of the permanent successors, and development of oral habits. This article provides a comprehensive review of the dental literature on the possible consequences of premature loss of maxillary primary incisors following TDI.

ЦИТОЭМБРИОЛОГИЧЕСКИЕ АСПЕКТЫ НЕСОВМЕСТИМОСТИ У ФОРМ РОДА Cerasus Mill. ПРИ ОТДАЛЕННЫХ СКРЕЩИВАНИЯХ В СВЯЗИ С СЕЛЕКЦИЕЙ НА УСТОЙЧИВОСТЬ К КОККОМИКОЗУ

The harmful fungal disease caused by Blumeriella jaapii (Rehm) Arx (syn. Coccomyces hiemalis Higgins) results in an early exfoliation, an attenuation of trees, a reduction of productivity, an abatement of resistance to cold. The most virulent population of disease agent was revealed in Krasnodar region. In Northern Caucasian Zonal Scientific Research Institute of Orchard Culture and Viticulture the authors crossed a slightly infected varieties of cherries and crab cherries with immune samples of Eastern-Asiatic species — Cerasus lannesiana № 2, C. serrulata Hally Tolivetta, C. subhirtella Pendula. They carried out also a comparative cytoembryological analysis of different crossing combinations. The authors investigated the pollen fertility, the growth of pollen tubes in pistil tissues and embryogenesis. The most compatible combinations of crossing at the progamic stage of fertilization were Nord Star × C. subhirtella Pendula, Nord Star × 3-116 (seedling from free pollination C. serrulata Hally Tolivetta × Polyanka), Molodezhnaya × ( C. lannesiana № 2 × Frants Iosif). The abnormalities in development of hybrid embryos were appeared after 18-25 days from pollination on a stage of the heart. This period is recommended for isolation of embryos with subsequent growing in vitro in order to overcome the postgamic incompatibility.

Prevalence of malocclusion among adolescents in South Indian population.

Objective:To record prevalence of malocclusion among 2,400 adolescents in Karnataka state, India and to define difference in malocclusion status in urban and rural population.Design:Randomized cross-sectional study.Setting:School students of Karnataka state, 24 August 2011 to 30 March 2012.Participants:School students in the age group of 13-17 years.Materials and Methods:Each individual was assessed for occlusal traits - sagittal occlusion, overjet, overbite, crowding, midline diastema, and crossbite.Statistical Analysis Used:Examinations were computerized and analyzed using Statistical Package for Social Sciences version 16. Chi-square test was used for computing statistical significance.Results:87.79% of population had malocclusion. Out of which 89.45% had class I, 8.37% had class II, and 2.14% had class III malocclusion. Normal overjet and overbite was seen in 48.22 and 49.87% of subjects, respectively. Frequency of crowding was 58.12% and 15.43% of subjects had midline diastema. Anterior crossbite was present in 8.48% and posterior crossbite in 0.99%. Urban population had twice the class II sagittal occlusion, and increased overjet as compared to rural population.Conclusions:Malocclusion is widely spread among population of Karnataka state, with greater prevalence in urban population. Early exfoliation of deciduous teeth and refined diet can be considered as viable etiological factors.

Oral manifestations of patients with hypophosphatasia

Abstract Hypophosphatasia is a rare inherited disorder characterized by defective bone mineralization and deficiency of tissue non-specific alkaline phosphatase (TNSALP) activity. The disease is caused by mutations in the liver/bone/kidney alkaline phosphatase gene ( ALPL ) encoding TNSALP. As for dental manifestations, premature loss of deciduous teeth due to disturbed cementum formation is well known. However, few reports of multiple cases have been presented. The oral manifestations of patients diagnosed with hypophosphatasia were analyzed by collecting clinical records of cases from a nationwide survey of pediatric dentistry clinics affiliated with 29 university dental hospitals in Japan. We inquired regarding the number of cases and clinical findings of diagnosed patients. We obtained information for 9 children diagnosed with hypophosphatasia from our university and 10 from 6 other universities. The main oral manifestation was early exfoliation of deciduous teeth, which was found in 15 of the 19 cases. Early exfoliation of mandibular deciduous anterior teeth was recognized in 14, whereas there were no cases of early exfoliation of a permanent tooth. The main oral finding of hypophosphatasia was early exfoliation of deciduous teeth, predominantly in the mandibular anterior region of children aged 1 to 4 years old.

Premature exfoliation of primary teeth in a 4-year-old child, a diagnostic dilemma

Premature exfoliation of primary teeth is an important diagnostic event warranting urgent investigation. The majority of conditions presenting with early loss of teeth are serious and in some cases fatal. This is a case of premature exfoliation of primary teeth in a 4-yr-old female. On presentation her teeth were mobile and there was a history of gingival bleeding when biting into food. Hair loss and fatigue were also reported. Her medical history revealed she had dry skin but was otherwise fit and healthy. Extra-oral examination was unremarkable. Dental examination revealed she had a full complement of primary teeth with unusual spacing, generalised tooth mobility, halitosis and an orange extrinsic dicolouration. Her gingivae were inflamed in the 84 region. Radiographic examination revealed severe generalised bone loss. She received periodontal care including regular scaling, a short course of metronidazole, preventative advice and continued monitoring. She was also sequentially referred to the departments of Dermatology, Paediatric Haematology, Immunology, Oral Microbiology and Oral Pathology for further investigation. Underlying disorders known to cause premature tooth loss were ruled out. Two years on, there has been early exfoliation of her 54, 51, 61, 62, 64, 71, 84 and 81 with no new progressive mobility of her remaining primary teeth. The commonest causes of premature tooth loss have been eliminated including Papillion-Lefevre syndrome, Chediak-Higashi syndrome, hypophosphatasia, Langerhans' cell histiocytosis, neutropenia and leukemia. Therefore, this fit and healthy 4-yr-old has an aggressive early onset periodontal condition with associated fatigue and hair loss. Diagnosis of associated systemic conditions is not straightforward in these cases and requires multi-disciplinary input.

콘크리트 표층부 품질이 SL재의 하자에 미치는 영향 - SL재의 하자 발생에 영향을 미치는 콘크리트 표층부의 품질 평가방법(II) -

The use of Self-Leveling material is increasing recently. This paper assesses the quality of surface layer of concrete floor when Self-Leveling material is defective. The paper shows how to predict the defect of SL material before construction begins. The relationship between the quality of surface layer of concrete floor and the defect of SL material was determined and the quality of surface layer of concrete floor was then estimated. The relations between the quality of surface layer and the defect of SL material were determine considering surface strength, moisture, and consistency of surface layer. Absorbing amount was used as the indicator of consistency and the absorbing amount of test material was measured. Then the relations between the test material and surface strength were determined. Generally concrete floor with greater consistency has greater surface strength, however in this study, we hound that high impact concrete floor could have lower surface strength as the consistency gets bigger. The relations between the level of defect occurred in SL material and the quality of surface layer were examined and we clarified that the surface layer with lower consistency gets higher possibility to occur exfoliation in early stage, one or two weeks after constructing SL material. When the consistency is sufficient, the occurring situation of defect depends upon the moisture of surface layer. Little amount of moisture gets higher possibility not to occur the defect. As the amount increases, fissure generates and early exfoliation may occur. In addition, the level of fissure is highly related with the surface strength.

Clinical and microbiological evaluations of children with hypophosphatasia affected by periodontitis

Four patients with hypophosphatasia, including twin brothers and younger and older sisters, were analyzed longitudinally. Ten periodontitisrelated bacterial species in dental plaque were detected using a Polymerase chain reaction (PCR) method with species-specific sets of primers. Further, clinical parameters related to periodontal conditions were recorded at each visit. One of the twins, who had experienced early exfoliation of the primary teeth, had a greater number of bacterial species than his brother, who had no alveolar bone loss. Both of the sisters experienced early exfoliation of their primary teeth, and the average numbers of tested bacterial species were higher in other subjects of the same age. Our results indicate that impaired cementum tissue caused by hypophosphatasia may produce favorable sites for colonization of periodontitis-related bacteria.

Dentin Dysplasia Type I Treated with Onlay Bone Grafting, Sinus Augmentation, and Osseointegrated Implants

Dentin dysplasia is a defect of dentin development that was classified by Shields as type I and type II. The teeth in dentin dysplasia type I are characterized by normal enamel and abnormal dentin in the crown and root. For that reason, this disorder is characterized by dental caries, early exfoliation of the teeth and, consequently, maxillomandibular bony atrophy. In this report, we present a case of a young girl affected by dentin dysplasia type I, treated with a combination of onlay bone grafting and a sinus lift technique to accomplish implant placement. This case showed that onlay autogenous grafting and a sinus lift technique are well-tested methods of bony augmentation and can be useful in patients with congenital dentin defects, such as dentin dysplasia.

Prevention of oral disease in children: concepts and practices.

Many of the dental traits exhibit continuous variation due to the multifactorial nature of dental development. Genetic and environmental disorders can result in further variation in specific dental traits. Identification of a dental anomaly can, at times, lead to the initial diagnosis of an underlying disorder and portend the patient's future health risks. Examples include the specific pattern of hypodontia seen before the development of iris dysplasia in Rieger syndrome, and the presence of supernumerary teeth and facial osteomas preceding malignant transformation of intestinal polyps in Gardner syndrome. In addition, dental anomalies can be useful in evaluating a patient's past medical history. A horizontal line of structural alteration in teeth can be used as a kymographic record of the causative metabolic disturbance and help pinpoint the active period of the disturbance. Normal eruption times of primary and permanent teeth also show a broad range of individual variation. Many disorders can cause extreme alterations in the eruption times of primary and permanent teeth or act to cause their premature exfoliation through disruption of their supporting tissues. The disruption of the eruption and integrity of the dentition can function as an indicator of the existent disease state. For example, the early exfoliation of primary teeth may be the presenting symptom of a patient with leukemia. Recognition of dental anomalies, distinct from normal variation can, therefore, be useful to the physician in the diagnosis of a patient's underlying condition and lead to a more thorough understanding of the mechanism of these disorders.

Dental anomaly: early exfoliation of deciduous and permanent teeth

Dental anomaly: early exfoliation of deciduous and permanent teeth