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Paediatric dentistry The effect of severe caries on the quality of life in young children
Low W, Tan S et al. Pediatr Dent 1999; 21: 325–326
Treatment of caries affected quality of life in several respects
In a children's hospital in Canada, 90 children aged 3–5.5 yrs (mean 3.7) with severe caries (rampant or nursing) were treated over a 5 month period. At the time of treatment, a questionnaire was completed by the parents and guardians. The questions related to pain, eating and sleeping habits, and social behaviour of the child. In each case, caries was present in all quadrants and at least one tooth required pulpotomy or extraction. Treatment was performed under general anaesthesia, in many cases after a 6–8 month period on a waiting list. All caries was eliminated by treatment.
After 4–8 weeks, 77 parents/guardians were contacted by telephone and the questionnaire was repeated. Other parents were excluded because of language problems and inability to contact them. After treatment, 36/37 who had earlier complained of pain no longer did so, the exception being one who complained that extraction sites were sensitive to cold. After treatment, 28/47 showed improvement in previously reported poor appetite, 19/22 improved poor sleeping, and 2/4 improved formerly aggressive behaviour at school.
Oral pathology A review of 47 cases of unerupted maxillary incisors
Betts A, Camilleri G E Int J Paediatr Dent 1999; 9: 285–292
Prognosis appeared better when the reason for eruption failure was the presence of supernumerary teeth.
Delayed eruption of permanent maxillary incisors is usually identified at age 8–10 yrs. Records from the dental department, the school dental clinic and the only two orthodontists practising in Malta were examined to identify cases of this condition. Over a period of nearly 30 years, 47 patients were found with 53 affected teeth.
About 1/3 patients came from each of the 3 sources. In almost all cases, patients had presented because of the missing tooth, and 70% were aged 10 or younger. In 22 patients, the cause was unerupted supernumerary teeth, and 9 of these had multiple supernumeraries. In 4 cases, odontomes were present; 4 teeth were dilacerated; and in 6 cases the unerupted tooth germ was malpositioned; impaction (crowding) was present in 2 cases and a cyst in one; the remainder were of unknown aetiology.
Whilst the authors point out that the lengthy time meant that clinical data were sometimes incomplete, 19 of the patients with supernumeraries were known to have had normal eruption following removal of the obstructing tooth. However, half of the teeth associated with odontomes or dilaceration were extracted.
Behavioural sciences Dementia and oral health
Ghezzi E M, Ship J A Oral Surg 2000; 89: 2–5
With the increase in older populations, dementia is also an increasing challenge for the dentist's skills.
Some estimates of dementia prevalence are around 1% at age 60 with subsequent doubling every 5 years. As many as 4/5 dementia patients may have Alzheimer disease, which involves progressive neural degeneration. There are many other possible causes, including other neurological diseases, tumours, strokes, and also metabolic, infectious, nutritional and pharmaceutical conditions. Diagnosis is important because some causes of dementia (eg vitamin B12 deficiency) are reversible.
Mild dementia shows mainly cognitive decline such as recent memory loss, learning and language problems, and disorientation even in regular activities. Moderate dementia progresses to additional problems, including speech and interpretative disturbances and potential for physical accidents. There may be marked behavioural problems. In severe dementia, there is apathy and disorientation with increased problems of behaviour.
The authors advise simple dental attention aimed at removing sources of pain and maintaining adequate nutritional intake and personal dignity. Nonrestorable teeth should be removed, and other teeth and dentures maintained. Some patients may reject dentures, and relines are often preferable to new prostheses. Hygiene should be encouraged, and sedation or GA may occasionally be of use.
Oral surgery; paediatric dentistry Long-term results of nonsurgical management of condylar fractures in children
Hovinga J, Boering G et al. Int J Oral Maxillofac Surg 1999; 28: 429–440
Almost all problems were treated adequately without surgical attention.
This study describes 25 children of mean age 8.7 yrs (range 3–16) followed up for a mean 15 yrs (5–25) after 28 condylar or subcondylar fractures. The study, in a Dutch hospital over a 20 year period, excluded 2 such patients with incomplete records.
In 5 patients who could not initially reach proper occlusion, a 2 wk course of intermaxillary fixation (IMF) was followed with elastic traction. In another 4 cases, persistent asymmetry was treated orthodontically. One 9 yr old with a low condylar fracture had a persistent malocclusion after such treatment, and at 17 received orthognathic surgery.
Of 22 patients with unilateral fractures, 17 showed zero or minimal asymmetry, but in a 7 yr old who sustained an intracapsular fracture there was a difference of 21 mm in ramus height at age 24. In 2 of 3 patients with bilateral fractures, IMF with traction was needed.
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Abstracts. Br Dent J 188, 548 (2000). https://doi.org/10.1038/sj.bdj.4800535