Premature Loss Of Deciduous Teeth Research Articles

Diagnosis and initial management of children presenting with premature loss of primary teeth associated with a systemic condition: A scoping review and development of clinical aid.

Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists. To identify systemic conditions associated with PLPT and develop a clinical aid. OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English-language full text. Seven hundred and ninety-one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty-one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon-Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach. A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral.

Comparative evaluation of stress generation in primary teeth restored with zirconia and BioFlx crowns: A finite element analysis

Background: Maintaining the functional integrity of primary teeth is important, as these teeth are integral in vital functions such as mastication, speech development, and space maintenance for permanent teeth; hence, premature loss of primary teeth can affect a child’s quality of life. Various restorative materials are available to restore the function of grossly decayed teeth. Stainless steel crowns and zirconia crowns are widely used in pediatric dentistry; however, there are certain disadvantages associated with these materials. Recently introduced BioFlx crowns provide acceptable esthetics with a conservative approach. Nevertheless, there is a lack of evidence regarding their strength and clinical acceptability. Finite element analysis measures the physical response of teeth and assesses the stress generation, which is important to estimate the integrity of the restorations and crowns. Purpose: The aim of this in vitro study was to evaluate and compare stress generation in primary teeth restored with zirconia and BioFlx crowns using finite element analysis. Methods: Models of extracted teeth restored with zirconia and BioFlx crowns were used for the study. The finite element analysis of these models was carried out through Analysis of Systems (ANSYS) software. The models were subjected to a simulated occlusal loading force of 245 N. Results: Von Mises stress generated in BioFlx crowns along with underlying dentin was much less compared to that which was generated in zirconia crowns. Conclusion: Restoring the functional integrity of carious teeth is essential. BioFlx crowns can be used as full coverage restorations and can be a suitable alternative to zirconia crowns and traditional stainless steel crowns.

Chairside digital design and manufacturing method for children's band and loop space maintainers.

This study proposes a chairside digital design and manufacturing method for band and loop space maintainers and preliminarily validates its clinical feasibility. Clinical cases of 10 children requiring space maintenance caused by premature loss of primary teeth were collected. Intraoral scan data of the affected children were also collected to establish digital models of the missing teeth. Using a pediatric band and loop space maintainer design software developed by our research team, a rapid personalized design of band and loop structures was achieved, and a digital model of an integrated band and loop space maintainer was ultimately generated. A chairside space maintainer was manufactured through metal computer numerical control machining for the experimental group, whereas metal 3D printing in the dental laboratory was used for the control group. A model fitting assessment was conducted for the space maintainers of both groups, and senior pediatric dental experts were invited to evaluate the clinical feasibility of the space maintainers with regard to fit and stability using the visual analogue scale scoring system. Statistical analysis was also performed. The time spent in designing and manufacturing the 10 space maintainers of the experimental group was all less than 1 h. Statistical analysis of expert ratings showed that the experimental group outperformed the control group with regard to fit and stability. Both types of space maintainers met clinical requirements. The chairside digital design and manufacturing method for pediatric band and loop space maintainers proposed in this study can achieve same-day fitting of space maintainers at the first appointment, demonstrating good clinical feasibility and significant potential for clinical application.

FABRICATION OF MAYNE’S SPACE MAINTAINER FOR PREMATURE LOSS OF DECIDUOUS TEETH

Background: Premature loss for deciduous teeth is defined as the teeth that fall out before approaching the time of eruption of their replacement permanent teeth regardless of the reason for the loss of the teeth. The premature loss of deciduous teeth can cause the teeth next to the edentulous area to shift and lose arch space causing permanent teeth to grow abnormally. Prevention can be done by using Mayne's space maintainer so that the negative impact of premature loss does not occur. Purpose: Report the fabrication of Mayne's space maintainer in premature loss case. Case analysis: The laboratory accepted a working model with a case of premature loss in tooth 74 and was asked to make the Mayne's space maintainer. Result: This appliance consists of a molar band attached to tooth 75 with a 0.9 mm loop that is soldered on the buccal of the molar band. Conclusion: It is concluded that fabrication of Mayne's space maintainer in the case of premature loss of tooth 74 includes the preparation of a working model, adjustment of the molar band on tooth 75, making the loop, followed by soldering the loop to the molar band, finally the finishing and polishing.

Effect of premature loss of primary teeth on prevalence of malocclusion in permanent dentition: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the effect of premature loss of primary teeth in children of mixed dentition age on the prevalence of malocclusion in permanent dentition. A search was conducted in Medline through PubMed, Cochrane databases, Google Scholar, and Directory of Open Access Journals (DOAJ) through March 2023. All observational studies that evaluated the association between premature loss of primary teeth and malocclusion in permanent dentition were included for analysis. Quality of studies was evaluated using the Newcastle-Ottawa tool. Meta-analysis was conducted using Cochrane Review Manager (RevMan) Version 5.3. The association between different categories of malocclusion and premature loss of primary teeth was assessed using a random-effects model. Heterogeneity was explored through sensitivity analysis. Certainty of evidence was evaluated using GRADE analysis. This meta-analysis showed that the premature loss of primary teeth significantly increases the prevalence of overall malocclusion in permanent dentition (OR=2.54, P=0.003; I2: 83%). Subgroup analysis showed an insignificant relationship of premature loss of primary teeth with Class I malocclusion (OR=1.14, P=0.45; I2: 63%) and Class II malocclusion (OR=1.63, P=0.18; I2: 87%) but statistically significant relationship with Class III malocclusion (OR=3.73, P=0.006; I2: 71%). Sensitivity analysis reflected a significant reduction in I2 values. This meta-analysis provides substantial evidence supporting the relationship between premature loss of primary teeth and malocclusion in permanent dentition. Notably, Class III malocclusions exhibited a significant association with premature loss of primary teeth.

THU457 Variable Presentations Of Hypophosphatasia In Two Patients In The Outpatient Setting

Abstract Disclosure: A. Elmaaz: None. S. Batool: None. P. Dandona: None. Introduction: Hypophosphatasia is a rare disorder characterized by defective mineralization of bone and teeth which is caused by an autosomal inherited mutation in the tissue nonspecific alkaline phosphatase (ALP) encoding genes. Here we present two cases of multiple dental and bony defects secondary to low ALP enzyme activity due to hypophosphatasia. Case 1: A 27-year-old female with history of mitochondrial disease, gastroparesis, malabsorption syndrome, and autonomic dysfunction was referred to Endocrinology clinic because of persistently low serum ALP levels associated with recurrent muscle, joint, and bone pain since the age of 13. She had history of multiple tooth extractions because of dental developmental abnormalities and fractures. She also reported history of fractures of three of her fingers in both hands during her childhood and teenage years. The patient was adopted and was unaware of any biological family history. Physical examination was remarkable for short-statured female, 4'8". Notably, the middle phalanges in little fingers bilaterally were shorter than the other fingers. Workup showed vitamin D level of 21 (30-80) ng/ml, despite being on 50,000 IU twice a week for 6 months with normal PTH and ionized calcium levels. The repeated serum level of ALP was 24 (31-125) U/L with bone and liver isoenzymes levels of 42% and 58 % respectively. Vitamin B6 level was 13.2 (2.1-21.7) ng/ml. Bone mineral density was unremarkable. Case 2: A 53-year-old female with history of congenital left hip dysplasia, hypertension, and dyslipidemia was seen by Endocrinology service for evaluation of decreased ALP levels. She denied any history of falls or fractures. However, she reported chronic bone pain, especially in bilateral hip joints with history of multiple surgeries in her left hip joint. She had required teeth braces and multiple dental surgeries during her childhood due to dental maldevelopment. Her height was 4'8". Laboratory workup was remarkable for low serum ALP level of 30 U/L with bone isoenzyme of 24 %. Vitamin B6 level was 206.7 (2.1-21.7) ng/ml. She had elevated serum phosphorus levels with normal calcium, PTH, and vitamin D levels. Pyridoxal-5- Phosphate level was high. Bone mineral density revealed osteopenia. Conclusion: Hypophosphatasia is a rare disease, hence it could be easily missed due to high variability in clinical presentations and severity of symptoms. Low serum levels of ALP with history of bone pain, recurrent fractures, premature loss of deciduous teeth, or loss of adult dentition should raise the suspicion of hypophosphatasia. Resistance to vitamin D supplementation is another clue to the diagnosis. A multidisciplinary approach is required for appropriate management. Presentation: Thursday, June 15, 2023

OR29-02 Energy Deficient Osteoblasts Inefficiently Mineralize Developing Bone In Sheep With Hypophosphatasia

Abstract Disclosure: J.C. Bertels: None. M. McCord: None. L.G. White: None. S. Huggins: None. D. Landrock: None. E.D. Giles: None. L.J. Suva: None. D. Gaddy: None. Hypophosphatasia (HPP) is a rare genetic disorder characterized by low enzymatic activity of tissue nonspecific alkaline phosphatase (TNSALP), resulting in decreased bone mineralization, muscle weakness, and premature loss of deciduous teeth. All HPP phenotypes have been characterized in our CRISPR/Cas9 gene-edited sheep model of HPP. Previous studies identified small, abnormal mitochondria in HPP sheep cells, leading to the hypothesis that reduced bone mineralization may result from decreased osteoblast (OB) differentiation and cellular energetics. To test this idea, iliac crest bone biopsies and sternal bone marrow stromal cells (BMSCs) were harvested from 1 yr old WT and HPP sheep (n=3 per genotype). Histomorphometric analysis of bone biopsies from HPP sheep revealed increased unmineralized osteoid matrix compared to WT, indicative of decreased OB activity, whereas osteoblast and osteoclast number were unchanged. To determine whether BMSCs from HPP sheep were altered from WT in regard to differentiation capacity toward the adipocyte (AD) or OB lineage, 21 day cultures of BMSCs in OB or AD differentiation medium were performed. HPP BMSCs had significantly increased AD differentiation and similar OB differentiation compared to WT. Next, high resolution respirometry of undifferentiated and differentiating cells toward either the OB or AD lineage using Seahorse XF analysis to measure oxidative respiration and glycolysis on days 0, 7, 14 and 21 of both OB and AD differentiation was performed. Results demonstrated that both undifferentiated and differentiating HPP cells (to OB and AD) had significantly decreased oxygen consumption rates (OCR) and extracellular acidification rates (ECAR), reflective of diminished maximal and ATP-linked oxidative respiration and glycolysis. When measured, intracellular ATP levels in differentiating BMSCs, both undergoing osteoblastogenic and adiopogenic differentiation, showed a higher accumulation of ATP. Collectively, these data provide the first evidence that decreased bone mineralization in HPP sheep results from decreased BMSC and OB energetics through both oxidative respiration and glycolysis. In addition, the data demonstrate that reduced TNSALP activity also leads to enhanced bone marrow adipogenesis. Coupled with our previous results demonstrating reduced oxidative respiration and glycolysis in sheep skeletal muscle, these findings demonstrate a fundamental requirement for TNSALP activity in the maintenance of normal cellular respiration and purinergic metabolism in cells of the musculoskeletal system. Moreover, they provide important insight into the potential for targeting increased cellular respiration to alleviate the deleterious effects of HPP. Presentation: Sunday, June 18, 2023

Effects of Premature Primary Tooth Loss on Midline Deviation and Asymmetric Molar Relationship in the Context of Orthodontic Treatment.

The aim of this retrospective pilot study was to investigate the effects of premature loss of primary teeth on molar relationships and midline discrepancies in young patients and explore its potential implications for dental treatments, including orthodontics. A total of 550 study models from individuals seeking orthodontic treatment were evaluated, and 175 models met the inclusion criteria of mixed dentition. Each study model was examined for midline discrepancies, asymmetricmolar relationships, and the impact of net premature tooth loss on the midline shift. Four investigators analyzed the data, and the error was minimized to less than 5%. The study revealed that premature loss of primary first molars was significantly associated with the midline shift, while premature loss of canines and second molars did not show substantial associations with midline discrepancies. The concordance analysis between observed and expected molar classifications based on premature tooth loss indicated relatively low concordance for all three molar classes, with higher concordance observed in Class II molar relationships. Notably, premature loss of primary second molars showed higher concordance than premature loss of primary first molars. This retrospective pilot study highlights the potential dental complications associated with premature loss of primary teeth. Premature loss of primary first molars was found to be significantly linked to the midline shift, while the premature loss of canines and second molars did not demonstrate significant midline discrepancies. The concordance analysis revealed limited agreement between observed and expected molar classifications based on premature tooth loss, with higher concordance observed in Class II molar relationships and primary second molars. Further research with larger prospective cohorts and digital model analyses is warranted to gain a better understanding of the impact of premature tooth loss on dental treatment outcomes. The findings underscore the importance of early detection and appropriate intervention to mitigate potential adverse effects on dental arch development and malocclusion.

Gambaran Tingkat Pengetahuan Orang Tua Tentang Space Maintainer pada Anak

Background: Many parents think that primary teeth are not important because they will be replaced by permanent teeth. This view needs to be straightened out because even though primary teeth are temporary, primary teeth have an important function for children. Space maintainer is a tool that functions to maintain space due to premature loss of primary teeth so that permanent teeth can erupt in their place. Purpose: To describe the level of knowledge of parents about space maintainers in children. Methods: This type of research was observational descriptive with a cross-sectional design. Data collection was carried out to 100 people using consecutive sampling technique using a questionnaire on parents' knowledge about space maintainers in children which was directly distributed by the researcher to the respondents. Results: The results of the study were 50 respondents (50%) showing a good level of knowledge and 50 respondents (50%) had a less knowledge level related to space maintainers. Conclusion: The level of parental knowledge about dental and oral health is quite good, parental knowledge about teeth development is still lacking, and parental knowledge about space maintainers is quite good.

Abstract #1377932: An Inherited Metabolic Disorder That Masquerades as Osteoporosis

Hypophosphatasia is a rare genetic disorder caused by loss-of-function mutations in the ALPL gene, which encodes tissue non-specific alkaline phosphatase. The enzyme defect results in the accumulation of substrates like inorganic pyrophosphate, thereby inhibiting mineralization of bones and teeth. Clinical features include premature loss of deciduous teeth, bowed legs, lower extremity stress fractures, bone pain and impaired mobility. Serum alkaline phosphatase (ALP) is a marker of bone turnover. Low ALP, high serum vitamin B6 and high urine phosphoethanolamine are diagnostic hallmarks of hypophosphatasia. A 54-year-old lady was referred to the endocrinology clinic for severe osteoporosis, characterized by an olecranon fracture and low bone mineral density (T score -3.0 at the left femoral neck). Bone disease risk factors included premature menopause at age 38 years and maternal history of hip fracture. There was no personal or family history of recurrent fractures, impaired mobility, or unexplained tooth loss. Despite treatment with ibandronate, zoledronic acid and teriparatide, her bone mineral density declined over the course of a decade. Physical examination revealed low BMI (18.07 kg/m2), normal gait and intact muscle strength. Lab testing disclosed low serum alkaline phosphatase (ALP) 18 units/L [reference 45 to 117 units/L], high serum vitamin B6 131.8 nmol/L [reference 20.0 to 125.0 nmol/L] and high urine phosphoethanolamine 104 nmol/mg Cr [reference < 48]. ALP results prior to bisphosphonate exposure were unavailable. Vitamin D status, thyroid function, parathyroid hormone, corrected serum calcium, ceruloplasmin and zinc levels were normal. Exome sequencing identified a pathogenic heterozygous nonsense ALPL gene mutation, c.1282C >T (p.Arg428X). She was counselled to avoid bisphosphonate therapy indefinitely. ALP measurement was advised for her blood relatives since hypophosphatasia is an autosomal recessive or dominant disorder. With asfotase alfa, the only FDA-approved therapy for juvenile-onset hypophosphatasia, there have been no further fractures to date, and her mobility remains unimpaired. Hypophosphatasia can be mistaken for osteoporosis since both conditions present with low bone mineral density on DEXA scan. Furthermore, bisphosphonate therapy and hypophosphatasia are mutually exclusive entities that can present with low ALP. Thus, bisphosphonate exposure may pose a diagnostic quandary when distinguishing between osteoporosis and hypophosphatasia. This case highlights the importance of assessing ALP when evaluating osteoporosis with atypical features such as age of onset under fifty years, remarkably low bone mineral density, fracture(s), and inadequate response to anti-osteoporosis agents. Moreover, if ALP is low, some index of suspicion for hypophosphatasia ought to be maintained, even if dental or lower extremity bone symptoms are absent. Genetic testing is confirmatory. Bisphosphonate therapy and parathyroid hormone analogs are not established treatment modalities for hypophosphatasia. Instead, enzyme replacement with asfotase alfa is recommended.

A unique case of childhood hypophosphatasia caused by a novel heterozygous 51-bp in-frame deletion in the &lt;i&gt;ALPL&lt;/i&gt; gene

Hypophosphatasia (HPP) is caused by inactivating variants of the ALPL gene, which encodes tissue non-specific alkaline phosphatase (TNSALP). Among the six subtypes of HPP, childhood HPP presents after 6 months and before 18 yr of age, and is inherited in both autosomal dominant and autosomal recessive manners. Patients with childhood HPP have variable symptoms, including rickets-like bone changes, low bone mineral density (BMD), short stature, muscle weakness, craniosynostosis, and premature loss of deciduous teeth. Here, we describe a 7-yr-old boy with childhood HPP who showed short stature, impaired ossification of the carpal bones, and low BMD. Genetic testing identified a novel heterozygous 51-bp in-frame deletion in the ALPL gene (c.1482_1532del51), leading to the lack of 17 amino acids between Gly495 and Leu511 (p.Gly495_Leu511del). In vitro transfection experiments revealed the loss of enzymatic activity and the dominant-negative effect of the TNSALP[p.Gly495_Leu511del] variant; thus, the patient was diagnosed as having autosomal dominant HPP. The TNSALP[p.Gly495_Leu511del] variant was localized to the plasma membrane as was the wild-type TNSALP (TNSALP[WT]): however, co-immunoprecipitation experiments suggested a reduced dimerization between TNSALP[p.Gly495_Leu511del] and TNSALP[WT]. This case expands the variable clinical manifestation of childhood HPP and sheds light on the molecular bases underlying the dominant-negative effects of some TNSALP variants.

ODP057 The Unusual Case of Hypercortisolism in a Patient with Juvenile Onset Hypophosphatasia

Abstract Juvenile onset hypophosphatasia is a rare, genetic disease that is caused by inactivating mutations in the ALPL gene which encodes tissue non-specific alkaline phosphatase (TNSALP). This leads to decreased activity of the TNSALP enzyme in target tissues and accumulation of TNSALP substrates, including inorganic pyrophosphate, an inhibitor of mineralization. This disease is characterized by low levels of alkaline phosphatase in serum and bone, osteomalacia, and periodontal disease. Patients with juvenile onset hypophosphatasia present with premature loss of primary teeth, delayed walking, and a waddling gait. These symptoms may improve spontaneously after puberty and recur later in life. Here we report the case of a 51 year old male who presented initially to endocrinology clinic with a metatarsal stress fracture with subsequent diagnosis of osteoporosis, periodontal infections, and associated myopathy and joint calcifications. The patient also had a prior history of a low alkaline phosphatase level as a child. Genetic testing showed a single variant of undetermined significance found in the ALPA gene. Of note, recent lab work for the patient showed AM cortisol 27.7 mcg/dL (reference range 4. 0-22. 0 mcg/dL) with ACTH 60 pg/mL (reference range 6 - 50 pg/mL). Prior 24 hour urine free cortisol measurements with LC/MS have demonstrated elevated values 159 mcg/24 hr and 256 mcg/24 hr (reference range 4. 0 - 50. 0 mcg/24 hr) . However, most recent testing demonstrated 24 hour urine free cortisol 3.6 mcg/24 hr, and the majority of midnight salivary cortisol tests were within normal. Pituitary MRI demonstrated no abnormalities. The patient has in the past reported findings of a dorsocervical fat pad, abdominal striae, and weight gain. There is no history of diabetes mellitus or hypertension, and the patient at this time reports stable weight without current presence of a fat pad or striae. There are no clinical features of Cushing's syndrome on exam. To our knowledge, this is the second case in the literature detailing hypercortisolism in a patient with hypophosphatasia. The etiology of the hypercortisolism is likely multifactorial, with unknown association with hypophosphatasia. Based on the clinical data it appears that the patient's chronic stress, pain, and anxiety are contributing to the hypercortisolism, and that this is not a true Cushing's or cyclical Cushing's case. Repeated midnight salivary cortisol tests have excluded the possibility of Cushing's as well. Presentation: No date and time listed

Prevalence of premature loss of deciduous teeth and its relationship with gender among children from Acapulco, Guerrero: a cross-sectional study.

Premature loss of deciduous teeth is the exfoliation or extraction before physiological replacement with < 50% or < 75% of the root of the substitute tooth formed or if there is > 1 mm of alveolar bone covering the permanent successor tooth organ. This study aimed to estimate the prevalence of premature tooth loss in children and identify associated factors in a health center in Acapulco, Guerrero. We conducted a cross-sectional study in which we collected information from 109 clinical records of children examined from January 2019 to August 2021. Sociodemographic data of the children and parents were collected: socioeconomic level, non-pathological personal history, and the history of premature deciduous tooth loss. Multivariate analysis to identify factors associated with premature deciduous tooth loss was performed with CIETmap statistical software. Odds ratio (OR) and 95% confidence interval (CI) were calculated to estimate the strength of the association. The prevalence of premature loss of primary teeth was 40% (43/109). The leading cause was caries (84%, 36/43). The tooth organ with the highest loss occurrence was the lower right second molar (33%, 14/43). Gender was identified as an associated factor, with males having a higher risk of loss (ORa = 2.97; CI95% = 1.33-6.65). Our results were similar to those reported in other studies. Strategies aimed at health promotion directed at parents and children should be reinforced.

Parent’s knowledge, attitude and behaviour of the important role of primary teeth among children with special need

Premature loss (early loss) of primary teeth will disrupt the eruption of permanent teeth due to reduced space for eruption of the permanent teeth. Lack of space causes permanent teeth to erupt outside the correct dental arch, or push against neighboring teeth causing malocclusion in children. Dental caries is one of the main factors causing premature loss of primary teeth, especially in children with low levels of oral hygiene. Children with disabilities tend to have higher rates of dental caries and premature loss of teeth than children without disabilities. The role of parents is much greater in maintaining dental and oral health, considering the limitations of children to carry out dental and oral care independently. The low awareness and attitude of parents in an effort to maintain primary teeth is influenced by the wrong stigma that primary teeth will be replaced by permanent teeth so that there is no need for optimal care or maintenance. This study aims to describe the level of knowledge, attitudes, and behavior of parents of children with special needs regarding the importance of the role of children's primary teeth in the Special Elementary School (SDLB) Surabaya. This type of research is observational analytic with a cross-sectional approach. The results obtained in this study are 44.6% of respondents have a fairly good knowledge, 58.4% of respondents have a fairly good attitude, and 37.6% of respondents in the category of behavior are quite good.

Body Image in Preschool Children Following Premature Loss of Primary Teeth: A Cross-sectional Study.

IntroductionPediatric dentists often see a good number of children under 6 years of age and are likely to encounter a child with missing anterior teeth. Here the parents are more concerned about the facial esthetics of the child and also about the timing of permanent teeth to erupt.AimTo know the impact on self-esteem or body image of preschool children following the premature loss of primary anterior teeth.Materials and methodsThe present cross-sectional study was conducted among 780 children in the age group of 4–6 years. The COHIP-SF 19 was utilized to know the social well-being of the child following the premature loss of anterior teeth. The descriptive and inferential analysis of the data was done by using IBM SPSS software.ResultsThere was a statistically significant association between gender and social well-being. More number of boys were concerned about their looks (p = 0.054). However, girls were found to be significantly more (p = 0.003) shy or withdrawn as compared to boys. There was a statistically significant association between a child's age and social well-being. More number of children between the ages of 4 years (23.1%) and 6 years (25.8%) were worried or anxious due to premature loss of an anterior tooth. Significantly more no of children of age 5 years (48.6%) was uncomfortable when asked about the missing tooth as compared to 4- and 6-year-old children. No statistically significant (p > 0.05) difference in the mean social well-being scores between boys and girls. No statistically significant difference in the mean social well-being scores between children of ages 4, 5, and 6 years (p > 0.05).ConclusionThere is an association between the self-image of younger children and missing anterior teeth.How to cite this articleAcharya S, Biswas R. Body Image in Preschool Children Following Premature Loss of Primary Teeth: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(3):293-298.

Assessment of Parental Knowledge towards Space Maintainer as an Essential Intervention after Premature Extraction of Primary Teeth.

This study assessed parents’ knowledge about space maintainers as an interceptive strategy after premature loss of primary teeth. Methods and Material: A cross-sectional questionnaire-based descriptive study was conducted on a sample of 600 parents; 456 (76%) were females, and 144 (24%) were males, recruited from an outpatient dental clinic at Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. The questionnaire consisted of two sections; the first section collected sociodemographic data of participants, and the second section gathered parental knowledge of space maintainers. The research ethics committee granted ethical approval, and informed consent was obtained before participation. Results: 600 parents participated in this study. The total mean knowledge score regarding space maintainers was 7.97 ± 3.38. The mean knowledge score was 7.06 ± 2.99 for male parents and 8.26 ± 3.45 for female parents. The difference in the mean knowledge score between female and male parents was statistically significant (p < 0.001). Additionally, there was a statistically significant difference in the knowledge score and parents’ age groups, with parents having the highest knowledge in the 30–40 age group (p = 0.0197). There was a positive correlation between knowledge scores and the number of children. Parents with one child showed less knowledge than those with two to four children (p = 0.0121). Conclusions: Participants’ knowledge regarding space maintainers was 49.8%, which is considered inadequate. It was deemed essential to increase knowledge among parents about space maintainers as an interceptive approach after premature loss of primary teeth.

Investigating the Factors Affecting the Need for Unilateral Space Maintainer for First Primary Molars in Late Mixed Dentition.

Background Premature loss of deciduous teeth can lead to loss of space and have a negative effect on occlusion. The use of space maintainers can reduce the severity of problems such as crowding. However, the literature is controversial regarding the effects of early loss of primary first molars The aim of this study was to determine the factors affecting the need for unilateral space maintainer for the first deciduous molars in late mixed dentition. In this cross-sectional study, fifty children between 6 to 8 years who had lost a primary first molar unilaterally later than 6 months ago were randomly selected. Midline deviation, molar and canine relationships at both sides, facial growth pattern, and the amount of space loss were all assessed. Data were analyzed using SPSS version 25 via one-sample t-test, paired t-test, and linear regression (alpha = 0.05). Methods In this cross-sectional study, 47 children aged 8 to 10 years with early unilaterally loss of first primary molar in the past 6 months were randomly selected. First, the type of occlusion based on the angle molar relationship and the growth pattern of face based on the Hall and Farkas and midline were assessed. Anterior crowding was measured. SPSS 25 program and Chi-square, t-test, ANOVA, and linear regression were used to analyze the data. A significance level of 0.05 was considered. Results The results showed that the amount of space loss is 0.56 mm (maxilla = 0.54 and mandible = 0.58), which is not clinically significant, and there is no need for space maintainer. Increasing age (p = 0.021) and increasing the percentage ratio of facial pattern (p = 0.009) significantly reduced the space loss and increased the duration of tooth loss (p = 0.002), and molar relationship in the control side (p = 0.05) and increasing the canine to lateral distance (p = 0.016) significantly increased the space loss. Other factors such as crowding, midline deviation, and canine relationship on the control side did not have significant effects on space loss. Conclusion Space loss due to extraction of the first primary molars in late mixed dentition was neither statistically nor clinically significant. However, in cases of severe crowding, the vertical growth pattern of the face, and molar relationship, further studies are needed, and follow-up of patients is recommended.

Premature Loss of Deciduous Teeth as a Symptom of Systemic Disease: A Narrative Literature Review.

Background: Premature loss of primary teeth can occur as a consequence of dental trauma, neonatal tooth extraction, early childhood caries, or periodontal problems, or it can be a manifestation of systemic disease. This review aims to present systemic disorders that can lead to premature loss of deciduous teeth in children and to provide a comprehensive resource for clinical practice for both physicians and dentists. Methods: This study is a narrative review of original studies and case reports published in English and Polish between 1957 and 2021 that was conducted by searching electronic scientific resources: PubMed, Google Scholar, Web of Science, and Science Direct. The schema of the qualification process is represented by a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). In total, 196 articles were identified; after provisional assessment of the titles and abstracts by two reviewers, 46 were found to be relevant to the topic, including 1 review, 16 original papers, and 27 case reports regarding systemic disease resulting in premature tooth loss. Results: In this study, 16 systemic diseases were linked to premature primary tooth loss in children: Papillon–Lefèvre syndrome, mucocutaneous dyskeratosis, Coffin–Lowry syndrome, congenital adrenal hyperplasia, Langerhans cell histiocytosis, cherubism, hypophosphatasia, acatalasia, Chediak–Higashi syndrome, cyclic neutropenia, erythromelalgia, Down syndrome, Hajdu–Cheney syndrome, short bowel syndrome, leukocyte adhesion deficiency type 1 (LAD-1), and Wiedemann–Steiner syndrome (WSS).

Causes of lower premolar impaction in pediatric patients. Case series.

Impacted teeth are frequently observed in clinical practice. However, the presence of impacted premolars is a rarely reported dental anomaly. It is known of a genetic relationship between the presence of several dental anomalies in the same patient as well as in the same family. Among the anomalies associated with lower premolar impactions are palatal impacted cuspids and upper lateral incisors with alteration in shape or number. This investigation aimed to describe the causes associated with lower premolar impaction through a series of 6 cases, between 11 and 15 years of age. The results found suggest the causes associated with the impaction of lower premolars were prolonged retention of primary teeth, altered eruptive pattern, presence of supernumeraries, premature loss of primary teeth and delayed eruption associated with hormonal factors. It is concluded that the presence of premolar impaction points to an association of several causes that converge, observing not only one but several dental anomalies.

Lesion sterilization and tissue repair therapy using GAM antibiotic paste

Despite the efforts to prevent dental caries among children, premature loss of primary teeth due to pulp and periapical diseases is a common problem. The effect of this premature loss on the development of dentition is a matter of great interest. Importantly, the primary teeth are considered as natural space maintainers and therefore should be retained until their natural exfoliation. Based on these issues and concerns, the concept of “Lesion sterilization and tissue repair (LSTR)” therapy proposed by the Cariology Research Unit of the Niigata University School of Dentistry, would be preferable to current endodontic treatments.