An injury to the teeth of a young child can have serious and long-term consequences, leading to t... more An injury to the teeth of a young child can have serious and long-term consequences, leading to their discoloration, malformation, or possible loss. The emotional impact of such an injury can be far reaching. It is therefore important that the dentist treating children is (1) knowledgeable in the techniques for managing traumatic injuries and (2) readily available during and after office hours to provide treatment. If either of these conditions cannot be met, the child suffering a dental injury should immediately be referred to a specialist. The purpose of this chapter is to provide a straightforward approach to managing dental injuries in the primary dentition. Techniques for diagnosis, treatment, and follow-up care are described. Fundamental issues covered in this chapter, such as classification of injuries, history, examination, and pathologic sequelae of trauma, pertain to both the primary and permanent dentitions. The principles gleaned from this chapter should enable the denti...
Pre-eruptive intracoronal resorption or defect is an unusual radiolucency located in the dentin, ... more Pre-eruptive intracoronal resorption or defect is an unusual radiolucency located in the dentin, just beneath the dentin-enamel junction of unerupted teeth. The pathogenesis of the phenomenon is unclear. The present case with a radiolucency that has not changed in its dimension over a period of almost 7 years, until tooth eruption, raises a question about the progressive nature of the defect that is defined as "resorption." Resorption may not be the sole explanation for a pre-eruptive intracoronal radiolucent defect. The authors also challenge the hypothesis of "local pressure" as a prime cause for the defect. The authors conclude that, when dealing with pre-eruptive intracoronal radiolucency in permanent teeth, a conservative approach with radiographic follow-up is the recommended treatment if the lesion does not seem to endanger the pulp. Intervention can be postponed until after tooth eruption when treatment does not require surgical intervention.
The purpose of the study was to compare hydroxyzine (HYD) and 0.2mg/Kg midazolam (MDZ) as sedativ... more The purpose of the study was to compare hydroxyzine (HYD) and 0.2mg/Kg midazolam (MDZ) as sedative agents for young pediatric dental patients. Twenty-nine healthy two-to-four-year-old children participated in the study. Hydroxyzine was dripped nasally 10 minutes before treatment. The patient's crying, alertness, movement and general behavior were blindly assessed and statistically analyzed. No differences were found between the mean general behavior scores nor between the first and second visits in both groups. A significant difference (p < 0.02) was found in the acceptance of the face and nasal masks by children of the midazolam group between the first and second appointments. None of the children of this group cried nor moved at the first visit. The results of the study indicate that midazolam is somewhat more effective than hydroxyzine as a sedative agent for short procedures in young pediatric dental patients.
Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which... more Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper.
The purpose of the present retrospective large-scale study is to evaluate rate of success of root... more The purpose of the present retrospective large-scale study is to evaluate rate of success of root canal treatments in primary infected molars using Endoflas F.S as a filling material. The study material consisted of 382 records of root canal treated primary molars of which 174 teeth with high quality radiographs and sufficient data comprised the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;study group&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. The technique for root canal treatment in one visit is described. Treatment was considered success if clinically the tooth was asymptomatic and radiographs showed decrease or no change in pre-existing pathologic radiolucent defects. In the total pulpectomy group there was a statistically significant difference between mandibular teeth presented with a periapical lesion prior to the treatment compared to maxillary teeth. This difference was not significant in the study group. Decrease in post treatment radicular radiographic defects was statistically significant more in the maxilla compared to the mandible. The success rate of teeth restored with a permanent restoration (stainless steel crown or amalgam filling) was statistically significant higher than those teeth left with a temporary filling. There was no statistically significant difference between success rate and the extent of root canal filling material. Rate of success was not statistically different depending on pre-existing radiolucent area prior to RCT. Endoflas F.S. can be used as an alternative root canal filling material for primary teeth. One condition for success is the prevention of microleakage. A permanent restoration should be placed as soon as possible after clinical signs and symptoms of inflammation are eliminated.
The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp ... more The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of th...
A 7-year-old girl had injured her maxillary primary incisors in a playground. One of the already-... more A 7-year-old girl had injured her maxillary primary incisors in a playground. One of the already-mobile incisors had been avulsed. The child who had a cough and breathing difficulties during sleep was diagnosed as suffering from upper respiratory infection and was treated with antibiotics. A few days later because her body temperature was elevated a chest radiograph was taken. The radiograph revealed an aspirated tooth in her right bronchus with atelectasis of the lower lobe. The tooth was removed by bronchoscopy. Dentists should suspect any tooth that has been avulsed and not found as possibly aspirated.
Crown fracture with pulp exposure in primary incisors is a rare condition. Despite the fact that ... more Crown fracture with pulp exposure in primary incisors is a rare condition. Despite the fact that the vitality of the pulp can be preserved, such teeth are usually extracted due to lack of patient cooperation. This article reports a successful conservative treatment of a fractured primary incisors with pulp exposure and undeveloped root. The child was sedated with midazolam and nitrous oxide, and partial pulpotomy was performed using calcium hydroxide. Follow-up radiographs 21 weeks later revealed closure of the apex and apposition of a dentin bridge close to the amputation site.
The Journal of Clinical Pediatric Dentistry, Feb 1, 2003
Gingival stippling is a characteristic of the healthy attached gingiva and its diminution or loss... more Gingival stippling is a characteristic of the healthy attached gingiva and its diminution or loss has been considered as a sign of gingival disease. The clinician however, must take in consideration that its pattern and extent varies in different mouth areas, among persons and with age. Reports on the prevalence of stippling in children are few and inconsistent. Therefore, the purpose of the present study was to describe the prevalence of gingival stippling in children of various ages. Fifty-five high quality anterior oral color slides of children (25 girls and 30 boys) aged 1 to 10 years, were examined for the presence of stippling. The average age of the study population was 5.1 years (S. E. = 0.3). The overall prevalence of stippling was 56.4%. Analysis of the differences between boys and girls in age (t-test) or the prevalence of stippling (Chi square) did not indicate statistical significance (p>0.05). Stippling was evident from 3 years of age and thereafter, with no particular trend of change with age. Stippling was found in 47.2% of the maxillary areas, in 41.7% of the mandibular areas and in 26.1% in both arches of the same child. The differences in distribution of stippling by gender and arch were not statistically significant (Chi square, p>0.05). In conclusion, gingival stippling was found to be a normal characteristic in 56.3% of 3 to 10-year-old children, without significant differences in prevalence related to arch, gender or age.
This study was designed to assess the sequelae and prognosis of intruded primary incisors. Of 196... more This study was designed to assess the sequelae and prognosis of intruded primary incisors. Of 196 children who visited the emergency clinic due to intrusion of 310 maxillary primary incisors, 110 children (172 teeth) were available for follow-up examination (study group). Eighty-six children (138 teeth) did not show for the follow-up examination (non-respondents group). Male/female ratio was 1.7:1. Age range of children at time of injury was 12-72 months (mean 28). Follow-up time ranged between 0 and 59 months (mean 27). Fifty-seven percent of all teeth were completely intruded. In 80%, the root was pushed labially. All but two ankylosed teeth re-erupted, and 37% of these re-erupted into an ectopic position. Completely intruded incisors re-erupted into an ectopic position in a higher percentage (45%) than partially intruded teeth (30%). Fifty-two percent of the teeth presented pulp canal obliteration (PCO). Sixty-four percent of the completely intruded incisors presented PCO compared to 40% of partially intruded teeth. Arrest of dentin apposition was found in 15% of the teeth, and was not affected by the degree of intrusion. Twenty-three teeth were extracted shortly after the injury due to suspect of contact with the developing permanent successor (19 teeth) and severe caries (4 teeth). Sixty-eight percent of the intruded teeth survived more than 36 months after the injury. Twenty-three percent were extracted due to periodontal breakdown and 5% due to repeated trauma. Antibiotic therapy did not have any effect on the survival rate. The majority of intruded primary incisors may re-erupt and survive with no complications after more than 36 months post trauma even in cases of complete intrusion and fracture of the labial bone plate.
The treatment options of enamel dentin crown fractures with pulpal exposure in the primary dentit... more The treatment options of enamel dentin crown fractures with pulpal exposure in the primary dentition traditionally consist of direct pulp capping, pulpotomy, pulpectomy, or extraction. Many clinicians disagree on the most appropriate treatment, and individual preferences exist within dentistry. Partial pulpotomy, also known as the Cvek pulpotomy, is a mode of treatment which is widely used in the permanent dentition but less so in primary teeth. This conservative technique is described and its advantages over the others are presented. In addition, a report of a case with a 2-year follow-up is also included. The purposes of this article are: (1) to present the indications and contraindications of the various treatment modalities for primary incisors with complicated crown fractures; and (2) to suggest partial pulpotomy as a conservative and more appropriate approach for primary incisors with complicated crown fracture.
Maintaining a successfully root-treated primary molar has the advantage of preserving the natural... more Maintaining a successfully root-treated primary molar has the advantage of preserving the natural tooth--the best possible space maintainer. The purpose of this study was to compare the success of endodontic treatment of nonvital primary molars using ZOE with that of KRI paste. Of 78 necrotic primary molars, 34 were filled with ZOE and 44 with an iodoform-containing paste (KRI). The canals were prepared with files, rinsed with saline and filled with one of the resorbable pastes, using a spiral Lentulo on a low-speed handpiece. A radiograph was exposed immediately postoperatively to observe whether the root filling was flush, underfilled, or overfilled. The effect of length of fill on the treatment outcome also was evaluated. Teeth were examined periodically clinically and radiographically to assess success of the treatment. Follow-up interval varied from 12 to more than 48 months. Overall success rate for KRI paste was 84% versus 65% for ZOE, which was statistically significant (P &lt; 0.05). Overfilling with ZOE led to a failure rate of 59% as opposed to 21% for KRI (P &lt; 0.02). Conversely, underfilling led to similar results, with a failure rate of 17% for ZOE and 14% for KRI. These results support the clinical efficacy of root filling with KRI paste as a treatment option for nonvital primary molars.
Two preschool children who were receiving total parenteral nutrition (TPN) for short-bowel syndro... more Two preschool children who were receiving total parenteral nutrition (TPN) for short-bowel syndrome (SBS) were noted to have radiographic evidence of alveolar bone loss in their primary dentition. Tooth mobility, gingival recession, and premature tooth loss were clinical findings in these children. Both had a 2-year history of recurrent infections and fluctuating serum electrolytes prior to identification of their dental problems.
An injury to the teeth of a young child can have serious and long-term consequences, leading to t... more An injury to the teeth of a young child can have serious and long-term consequences, leading to their discoloration, malformation, or possible loss. The emotional impact of such an injury can be far reaching. It is therefore important that the dentist treating children is (1) knowledgeable in the techniques for managing traumatic injuries and (2) readily available during and after office hours to provide treatment. If either of these conditions cannot be met, the child suffering a dental injury should immediately be referred to a specialist. The purpose of this chapter is to provide a straightforward approach to managing dental injuries in the primary dentition. Techniques for diagnosis, treatment, and follow-up care are described. Fundamental issues covered in this chapter, such as classification of injuries, history, examination, and pathologic sequelae of trauma, pertain to both the primary and permanent dentitions. The principles gleaned from this chapter should enable the denti...
Pre-eruptive intracoronal resorption or defect is an unusual radiolucency located in the dentin, ... more Pre-eruptive intracoronal resorption or defect is an unusual radiolucency located in the dentin, just beneath the dentin-enamel junction of unerupted teeth. The pathogenesis of the phenomenon is unclear. The present case with a radiolucency that has not changed in its dimension over a period of almost 7 years, until tooth eruption, raises a question about the progressive nature of the defect that is defined as "resorption." Resorption may not be the sole explanation for a pre-eruptive intracoronal radiolucent defect. The authors also challenge the hypothesis of "local pressure" as a prime cause for the defect. The authors conclude that, when dealing with pre-eruptive intracoronal radiolucency in permanent teeth, a conservative approach with radiographic follow-up is the recommended treatment if the lesion does not seem to endanger the pulp. Intervention can be postponed until after tooth eruption when treatment does not require surgical intervention.
The purpose of the study was to compare hydroxyzine (HYD) and 0.2mg/Kg midazolam (MDZ) as sedativ... more The purpose of the study was to compare hydroxyzine (HYD) and 0.2mg/Kg midazolam (MDZ) as sedative agents for young pediatric dental patients. Twenty-nine healthy two-to-four-year-old children participated in the study. Hydroxyzine was dripped nasally 10 minutes before treatment. The patient's crying, alertness, movement and general behavior were blindly assessed and statistically analyzed. No differences were found between the mean general behavior scores nor between the first and second visits in both groups. A significant difference (p < 0.02) was found in the acceptance of the face and nasal masks by children of the midazolam group between the first and second appointments. None of the children of this group cried nor moved at the first visit. The results of the study indicate that midazolam is somewhat more effective than hydroxyzine as a sedative agent for short procedures in young pediatric dental patients.
Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which... more Traumatic injuries to the chin are not uncommon in children. Nevertheless, crown fractures, which are common sequelae to this type of injury, might be overlooked, especially if dental care is not sought immediately after a visit to a non-dental facility. The present case report reviews the delayed diagnosis and treatment outcome of a bilateral posterior complicated crown fracture affecting mandibular second primary molars in a young child. Pharmacologic and orthodontic considerations are also discussed in the paper.
The purpose of the present retrospective large-scale study is to evaluate rate of success of root... more The purpose of the present retrospective large-scale study is to evaluate rate of success of root canal treatments in primary infected molars using Endoflas F.S as a filling material. The study material consisted of 382 records of root canal treated primary molars of which 174 teeth with high quality radiographs and sufficient data comprised the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;study group&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. The technique for root canal treatment in one visit is described. Treatment was considered success if clinically the tooth was asymptomatic and radiographs showed decrease or no change in pre-existing pathologic radiolucent defects. In the total pulpectomy group there was a statistically significant difference between mandibular teeth presented with a periapical lesion prior to the treatment compared to maxillary teeth. This difference was not significant in the study group. Decrease in post treatment radicular radiographic defects was statistically significant more in the maxilla compared to the mandible. The success rate of teeth restored with a permanent restoration (stainless steel crown or amalgam filling) was statistically significant higher than those teeth left with a temporary filling. There was no statistically significant difference between success rate and the extent of root canal filling material. Rate of success was not statistically different depending on pre-existing radiolucent area prior to RCT. Endoflas F.S. can be used as an alternative root canal filling material for primary teeth. One condition for success is the prevention of microleakage. A permanent restoration should be placed as soon as possible after clinical signs and symptoms of inflammation are eliminated.
The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp ... more The objective of this study was to assess the effect of mineral trioxide aggregate (MTA) as pulp dressing material following pulpotomy in primary molars with carious pulp exposure and compare them to those of formocresol (FC). Of 33 children, primary molars treated via a conventional pulpotomy technique were randomly assigned to the MTA group (33 teeth) or FC group (29 teeth). Clinical and radiographic follow-up ranged between 4 and 74 months. The mean follow-up time was 38 months, with no difference between the groups. Twenty-nine teeth were followed until uneventful shedding (mean=33 months). Failures were detected after a mean period of 16 months (range=4 to 30). The success rate of pulpotomy was 97% for MTA (1 failure) and 83% for FC (5 failures). Eight teeth presented internal resorption. In 4 of them (2 of each group), progress of the resorption process stopped and the pulp tissue was replaced by a radioopaque calcified tissue. Pulp canal obliteration was observed in 58% of th...
A 7-year-old girl had injured her maxillary primary incisors in a playground. One of the already-... more A 7-year-old girl had injured her maxillary primary incisors in a playground. One of the already-mobile incisors had been avulsed. The child who had a cough and breathing difficulties during sleep was diagnosed as suffering from upper respiratory infection and was treated with antibiotics. A few days later because her body temperature was elevated a chest radiograph was taken. The radiograph revealed an aspirated tooth in her right bronchus with atelectasis of the lower lobe. The tooth was removed by bronchoscopy. Dentists should suspect any tooth that has been avulsed and not found as possibly aspirated.
Crown fracture with pulp exposure in primary incisors is a rare condition. Despite the fact that ... more Crown fracture with pulp exposure in primary incisors is a rare condition. Despite the fact that the vitality of the pulp can be preserved, such teeth are usually extracted due to lack of patient cooperation. This article reports a successful conservative treatment of a fractured primary incisors with pulp exposure and undeveloped root. The child was sedated with midazolam and nitrous oxide, and partial pulpotomy was performed using calcium hydroxide. Follow-up radiographs 21 weeks later revealed closure of the apex and apposition of a dentin bridge close to the amputation site.
The Journal of Clinical Pediatric Dentistry, Feb 1, 2003
Gingival stippling is a characteristic of the healthy attached gingiva and its diminution or loss... more Gingival stippling is a characteristic of the healthy attached gingiva and its diminution or loss has been considered as a sign of gingival disease. The clinician however, must take in consideration that its pattern and extent varies in different mouth areas, among persons and with age. Reports on the prevalence of stippling in children are few and inconsistent. Therefore, the purpose of the present study was to describe the prevalence of gingival stippling in children of various ages. Fifty-five high quality anterior oral color slides of children (25 girls and 30 boys) aged 1 to 10 years, were examined for the presence of stippling. The average age of the study population was 5.1 years (S. E. = 0.3). The overall prevalence of stippling was 56.4%. Analysis of the differences between boys and girls in age (t-test) or the prevalence of stippling (Chi square) did not indicate statistical significance (p>0.05). Stippling was evident from 3 years of age and thereafter, with no particular trend of change with age. Stippling was found in 47.2% of the maxillary areas, in 41.7% of the mandibular areas and in 26.1% in both arches of the same child. The differences in distribution of stippling by gender and arch were not statistically significant (Chi square, p>0.05). In conclusion, gingival stippling was found to be a normal characteristic in 56.3% of 3 to 10-year-old children, without significant differences in prevalence related to arch, gender or age.
This study was designed to assess the sequelae and prognosis of intruded primary incisors. Of 196... more This study was designed to assess the sequelae and prognosis of intruded primary incisors. Of 196 children who visited the emergency clinic due to intrusion of 310 maxillary primary incisors, 110 children (172 teeth) were available for follow-up examination (study group). Eighty-six children (138 teeth) did not show for the follow-up examination (non-respondents group). Male/female ratio was 1.7:1. Age range of children at time of injury was 12-72 months (mean 28). Follow-up time ranged between 0 and 59 months (mean 27). Fifty-seven percent of all teeth were completely intruded. In 80%, the root was pushed labially. All but two ankylosed teeth re-erupted, and 37% of these re-erupted into an ectopic position. Completely intruded incisors re-erupted into an ectopic position in a higher percentage (45%) than partially intruded teeth (30%). Fifty-two percent of the teeth presented pulp canal obliteration (PCO). Sixty-four percent of the completely intruded incisors presented PCO compared to 40% of partially intruded teeth. Arrest of dentin apposition was found in 15% of the teeth, and was not affected by the degree of intrusion. Twenty-three teeth were extracted shortly after the injury due to suspect of contact with the developing permanent successor (19 teeth) and severe caries (4 teeth). Sixty-eight percent of the intruded teeth survived more than 36 months after the injury. Twenty-three percent were extracted due to periodontal breakdown and 5% due to repeated trauma. Antibiotic therapy did not have any effect on the survival rate. The majority of intruded primary incisors may re-erupt and survive with no complications after more than 36 months post trauma even in cases of complete intrusion and fracture of the labial bone plate.
The treatment options of enamel dentin crown fractures with pulpal exposure in the primary dentit... more The treatment options of enamel dentin crown fractures with pulpal exposure in the primary dentition traditionally consist of direct pulp capping, pulpotomy, pulpectomy, or extraction. Many clinicians disagree on the most appropriate treatment, and individual preferences exist within dentistry. Partial pulpotomy, also known as the Cvek pulpotomy, is a mode of treatment which is widely used in the permanent dentition but less so in primary teeth. This conservative technique is described and its advantages over the others are presented. In addition, a report of a case with a 2-year follow-up is also included. The purposes of this article are: (1) to present the indications and contraindications of the various treatment modalities for primary incisors with complicated crown fractures; and (2) to suggest partial pulpotomy as a conservative and more appropriate approach for primary incisors with complicated crown fracture.
Maintaining a successfully root-treated primary molar has the advantage of preserving the natural... more Maintaining a successfully root-treated primary molar has the advantage of preserving the natural tooth--the best possible space maintainer. The purpose of this study was to compare the success of endodontic treatment of nonvital primary molars using ZOE with that of KRI paste. Of 78 necrotic primary molars, 34 were filled with ZOE and 44 with an iodoform-containing paste (KRI). The canals were prepared with files, rinsed with saline and filled with one of the resorbable pastes, using a spiral Lentulo on a low-speed handpiece. A radiograph was exposed immediately postoperatively to observe whether the root filling was flush, underfilled, or overfilled. The effect of length of fill on the treatment outcome also was evaluated. Teeth were examined periodically clinically and radiographically to assess success of the treatment. Follow-up interval varied from 12 to more than 48 months. Overall success rate for KRI paste was 84% versus 65% for ZOE, which was statistically significant (P &lt; 0.05). Overfilling with ZOE led to a failure rate of 59% as opposed to 21% for KRI (P &lt; 0.02). Conversely, underfilling led to similar results, with a failure rate of 17% for ZOE and 14% for KRI. These results support the clinical efficacy of root filling with KRI paste as a treatment option for nonvital primary molars.
Two preschool children who were receiving total parenteral nutrition (TPN) for short-bowel syndro... more Two preschool children who were receiving total parenteral nutrition (TPN) for short-bowel syndrome (SBS) were noted to have radiographic evidence of alveolar bone loss in their primary dentition. Tooth mobility, gingival recession, and premature tooth loss were clinical findings in these children. Both had a 2-year history of recurrent infections and fluctuating serum electrolytes prior to identification of their dental problems.
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