Oral medicine A survey of cases of cancrum oris seen in Ile-Ife, Nigeria

Oginni FO, Oginni AO et al. Int J Paediatr Dent 1999; 9: 75–80

Many of a large group of patients, all with evidence of malnutrition, failed to complete treatment.

Over the 15 years up to 1996, 133 patients attending a large teaching hospital were diagnosed with cancrum oris, and 13 with post-cancrum oris defects. All but 4 (in the latter subgroup) were below 17 years old, and 80% of all cases occurred before age 7. In addition to malnutrition, almost all had poor oral hygiene. The authors note that peak incidence was at a time of social deprivation in Nigeria.

The disease affected the maxilla in more than 2/3 cases. Almost all subjects completed initial treatment with antibacterial medication and nutritional supplementation, but nearly half failed to complete further surgical and prosthetic treatment. The complications noted included TMJ ankylosis, lost tooth buds, soft tissue defects and fistulae; one subject had otitis media. The authors note that no patients died during their attendance at the hospital, but point out that they had no details of those who dropped out of treatment, or of those who might have died without being seen.

Paediatric dentistry; otolaryngology Pacifier use and otitis media in infants twelve months of age or younger

Jackson JM, Mourino AP Pediatr Dent 1999; 21: 256–261

Though the immediate causes of otitis media are not fully understood, there is a greater risk with pacifiers, bottle-feeding or attendance at a day care centre.

The pharyngotympanic tube is normally closed, opening during swallowing or mouth opening. The middle ear is protected from nasopharynx secretion reflux by tube closure. Parents and guardians of 200 children were approached over a 6 month period in a university paediatric facility in Virginia, and all completed questionnaires.

The study included approximately equal numbers of male and female children, mean age 5.1 months.Afro-caribbeans accounted for 75% and Caucasians for 22%. There were 67 children who had used pacifiers, and 24 (36%) of them had had otitis media; of the other 133, only 30 (23%) had experienced the condition.

After controlling for other possible risk factors (feeding methods, thumb sucking, day care, parental smoking and education level), the use of a pacifier remained significant, doubling the risk. Bottle feeding and day care centre attendance each increased the risk of otitis media associated with a pacifier to five times the level in other children.

Sports medicine; trauma Orofacial injuries in youth soccer

McFadyen JA, Shulman JD Pediatr Dent 1999; 21: 192–196

Soccer, which over 18 million Americans were playing by 1994, appears to be relatively safe in respect of facial injury.

This study reports a survey which aimed to assess orofacial injuries in 8 soccer leagues in Dallas during the winter of 1995-6. Children aged 3–12 were involved, and questionnaires were sent to 552 coaches via the confidential system of the youth organization concerned. The response rate was low at 22% (122), and the confidential system precluded follow-up mailing.

A total of nearly 45,000 hours of play was reported, 3/4 of which was practice. There were 2483 players, of whom 994 were female. Only 17 injuries were reported, of which 6 were in females. The data were too small for any statistical comparisons, but most male injuries were in the 4–6 age group, and most female injuries in the 6–9 age group. No serious injury was reported. The authors comment that mouthguards probably were used by very few players, perhaps less than 4%.

Preventive dentistry Toothbrushing habits and caries experience

Ashley PF, Attrill DC et al. Caries Res 1999; 33: 401–402

This is further evidence that fluoride toothpaste should be used twice daily with little or no rinsing afterwards for the greatest benefit.

Data has accumulated to suggest that rinsing after brushing reduces the efficacy of a fluoride toothpaste. In this study, a questionnaire was administered under supervision to 2888 15–16 year-olds in the Manchester area who had used a 1000 ppm F dentifrice for 3 years. All were examined for caries experience.

No rinsing was reported by 69 subjects, water on toothbrush by 687, water by hand or mouth by 995, and water in a cup by 1137. Respective mean DMFT (decayed, missing and filled teeth) scores were 2.91, 3.65, 3.62 and 3.97. Comparison of cup rinsers with the other 3 groups combined (DMFT = 3.61) showed a significant difference. The 2350 reporting twice or more daily brushing had mean DMFT of 3.51, again a significant difference with those who did not (DMFT = 4.79). Further analysis showed that both factors were of importance in reducing DMFT.