This study investigated the oral problems occurring in children receiving treatment for malignant... more This study investigated the oral problems occurring in children receiving treatment for malignant disease at a regional oncology center. Forty-three children 2 to 14 years old were followed longitudinally from initial diagnosis for periods ranging from eight to 30 weeks for the development of oral and dental problems. Fifteen children had untreated decay; two required the removal of primary teeth before they began chemotherapy. Three children developed acute dental infections during treatment. Forty (93%) developed oral problems associated with their disease or treatment during the study period. Oral mucosal ulceration was the most frequently encountered problem; it was observed in 28 (65%) patients. In light of the high prevalence of dental and oral problems in these patients, this study emphasizes the need for positive dental involvement, both in pretreatment assessment and in the ongoing care of the pediatric oncology patient.
This study compares the accuracy of space prediction for the unerupted permanent canines and prem... more This study compares the accuracy of space prediction for the unerupted permanent canines and premolars by a recognized method of mixed dentition space analysis (Moyers technique) vs estimation by simple visual observation (SVO). Twenty clinicians with varying levels of dental experience and training blindly assessed study models of 4 intact arches (2 maxillary and 2 mandibular) from 3 patients in the mixed dentition using both Moyers and SVO space prediction methods. Corresponding full-mouth panoramic radiographs were available for each case. Follow-up records of the eventual outcome in the permanent dentition for each case available (ie, study models prior to any form of orthodontic intervention) served as the standard for further comparison of the space predictions made. Predictions by both methods were compared with each other as well as with the eventual space situation in the permanent dentition. The differences in overall mean space prediction between the Moyers technique (excluding molar shift) and SVO ranged between 3.67 mm to 6.9 mm (lower arches) and 4.3 mm to 4.8 mm (upper arches). Diagnostic consistency between both methods' predictions was highly variable, with correlation ranging from moderate (r = 0.53, P = .01) to very weak (r = -0.1). Generally, more crowding was estimated with the SVO method's predictions. However, the inclusion of molar shift in the Moyers analysis resulted in the prediction of more crowding in the mandible compared to SVO and eventual outcome in the permanent dentition. The range and variability in predictions were always smaller with the Moyers technique compared to SVO. Neither technique's mean space prediction more closely resembled the eventual space situation in the permanent dentition. This study demonstrated that although the Moyers technique demonstrated less variation and more reproducibility than SVO in its space predictions, neither of the techniques was any more accurate in predicting the final space outcome in the permanent dentition.
Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cem... more Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cemento-enamel junction of multiple teeth. The lesions continue to grow until they unite, thereby undermining the entire coronal structure of affected teeth. Its distribution can vary from a single region to the entire dentition and the number of teeth affected by resorption tends to increase as the condition is followed over time. The teeth themselves appear clinically normal. The aetiology of MICRR is unknown and it is considered to be a diagnosis of exclusion. The condition tends to be progressive. Consequently, root treatments/surgical curettage and restoration of the lesions have been unsuccessful at arresting the condition. Affected teeth are often extracted in anticipation of catastrophic fracture and have been replaced with partial or complete dentures. In this case report, we describe how a young female patient was dentally managed over 10 years and ultimately rehabilitated with de...
Child cancer patients require a great deal of intensive treatment and support. This paper provide... more Child cancer patients require a great deal of intensive treatment and support. This paper provides an account of the dental problems a practitioner will encounter with these children and discusses how they may be managed.
European journal of paediatric dentistry : official journal of European Academy of Paediatric Dentistry, 2003
This study investigated two methods for the restoration of permanent molars affected by amelogene... more This study investigated two methods for the restoration of permanent molars affected by amelogenesis imperfecta (AI) or severe enamel defects. A prospective clinical trial was carried out on 17 subjects affected by AI or severe enamel defects of first permanent molars. A split mouth design was used so that each right or left permanent molar in both jaws was restored using either a preformed metal crown (SSC) or a cast adhesive coping (CAC). Subjects were followed for up to 24 months and assessed for longevity and quality of the restorations. Sequential analysis was used to compare longevity. Records for 42 restorations (19 SSC; 23 CAC) were kept. The split mouth design was possible on 24 occasions (right versus left=14; maxilla versus mandible=10). Three restorations, one SSC (at 6 months) and two CAC (at 2 and 19 months) failed and required replacement. There was no significant statistical difference between the two types of restorations. While there was no difference between the t...
Children's dentistry can be a challenge for both the patient and the dentist. The way a denti... more Children's dentistry can be a challenge for both the patient and the dentist. The way a dentist interacts with the child patient will have a major influence on the success of any clinical or preventive care. In order to deliver high-quality dentistry to a child whilst also developing a positive attitude towards dental health, the dentist should have a good understanding of the factors that might affect the behaviour of children in the dental setting. A working knowledge of strategies to minimize anxiety and make positive behaviour more likely is essential, as is a grasp of how best to deal with anxiety or negative behaviour.
Bulletin of The Royal College of Surgeons of England, 2014
Mouthguards are widely advocated for children and adults engaging in contact sports, but which ty... more Mouthguards are widely advocated for children and adults engaging in contact sports, but which type is the best, who should have them and, most importantly of all, do they work?
International Journal of Paediatric Dentistry, 2012
This paper aims to review the case of a girl who presented with a number of dental anomalies, in ... more This paper aims to review the case of a girl who presented with a number of dental anomalies, in addition to unusual skin, nail and hair conditions. Tragically an undiagnosed cardiomyopathy caused unexpected sudden death. The case is discussed with reference to a number of dermatological and oral conditions which were considered as possible diagnoses. AW had been under long term dental care for prepubertal periodontitis, premature root resorption of primary teeth, soft tissue and dental anomalies, and angular cheilitis. Separately she had also been seen by several dermatologists with respect to palmar plantar keratosis, striae keratoderma, wiry hair and abnormal finger nails. Tragically the patient suffered a sudden unexpected death and the subsequent post mortem identified an undiagnosed dilated cardiomyopathy. The most likely diagnosis is that this case is a variant of Carvajal Syndrome with additional dental anomalies. To date we have been unable to identify mutations in the desoplakin gene. We aim to emphasise the importance of recognising these dental and dermatological signs when they present together as a potential risk factor for cardiac abnormalities.
ABSTRACT Presenting problem: We report on a child under long-term dental care for prepubertal per... more ABSTRACT Presenting problem: We report on a child under long-term dental care for prepubertal periodontitis, premature root resorption of primary teeth, granulomatous, furrowed cobblestone oral mucosa and gingivae, hypodontia and peg shaped lateral incisors, caries and angular cheilitis who suffered a sudden unexpected death. Subsequent post mortem confirmed an undiagnosed dilated cardiomyopathy. This may have triggered ventricular fibrillation, which caused her death. Prior to her death, she had also been seen by several dermatologists with respect to palmar plantar hyperkeratosis, striae keratoderma, wiry hair and abnormal finger nails.Discussion: In spite of being seen by a number of clinicians in several centres in the UK a satisfactory clinical diagnosis was never established. A detailed search of the literature revealed no previously reported link between Papillon Lefevre syndrome and cardiac pathology. This case report details the patient's specific clinical presentation, which included features similar to ectodermal dysplasia, Papillon Lefevre or oral Crohn's associated with skin pathology. Possible diagnoses are suggested. Clinicians seeing similar features in future should send the child for cardiac screening to rule out any potentially life threatening pathology.
International Journal of Paediatric …, Jan 1, 2007
Usher syndrome is a genetic disorder consisting of progressive loss of vision and hearing. The pa... more Usher syndrome is a genetic disorder consisting of progressive loss of vision and hearing. The paper describes an 8-year-old girl with Usher syndrome type I who presented with generalized defects of the permanent dentition and ectopic eruption of the right maxillary first permanent molar. A cochlear implant had been fitted for her hearing loss, and the report reviews the implications of this device for dental treatment. The impacted first permanent molar was encouraged to erupt into the correct position by shaving the distal surface of the second primary molar. This is the first report to describe in detail an association between Usher syndrome and enamel defects.
This is the fourth paper in a series on the prescribing of medicines for children by dentists wor... more This is the fourth paper in a series on the prescribing of medicines for children by dentists working in primary dental care. It deals with the prescription of antifungals and antivirals for children.
This study investigated the oral problems occurring in children receiving treatment for malignant... more This study investigated the oral problems occurring in children receiving treatment for malignant disease at a regional oncology center. Forty-three children 2 to 14 years old were followed longitudinally from initial diagnosis for periods ranging from eight to 30 weeks for the development of oral and dental problems. Fifteen children had untreated decay; two required the removal of primary teeth before they began chemotherapy. Three children developed acute dental infections during treatment. Forty (93%) developed oral problems associated with their disease or treatment during the study period. Oral mucosal ulceration was the most frequently encountered problem; it was observed in 28 (65%) patients. In light of the high prevalence of dental and oral problems in these patients, this study emphasizes the need for positive dental involvement, both in pretreatment assessment and in the ongoing care of the pediatric oncology patient.
This study compares the accuracy of space prediction for the unerupted permanent canines and prem... more This study compares the accuracy of space prediction for the unerupted permanent canines and premolars by a recognized method of mixed dentition space analysis (Moyers technique) vs estimation by simple visual observation (SVO). Twenty clinicians with varying levels of dental experience and training blindly assessed study models of 4 intact arches (2 maxillary and 2 mandibular) from 3 patients in the mixed dentition using both Moyers and SVO space prediction methods. Corresponding full-mouth panoramic radiographs were available for each case. Follow-up records of the eventual outcome in the permanent dentition for each case available (ie, study models prior to any form of orthodontic intervention) served as the standard for further comparison of the space predictions made. Predictions by both methods were compared with each other as well as with the eventual space situation in the permanent dentition. The differences in overall mean space prediction between the Moyers technique (excluding molar shift) and SVO ranged between 3.67 mm to 6.9 mm (lower arches) and 4.3 mm to 4.8 mm (upper arches). Diagnostic consistency between both methods' predictions was highly variable, with correlation ranging from moderate (r = 0.53, P = .01) to very weak (r = -0.1). Generally, more crowding was estimated with the SVO method's predictions. However, the inclusion of molar shift in the Moyers analysis resulted in the prediction of more crowding in the mandible compared to SVO and eventual outcome in the permanent dentition. The range and variability in predictions were always smaller with the Moyers technique compared to SVO. Neither technique's mean space prediction more closely resembled the eventual space situation in the permanent dentition. This study demonstrated that although the Moyers technique demonstrated less variation and more reproducibility than SVO in its space predictions, neither of the techniques was any more accurate in predicting the final space outcome in the permanent dentition.
Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cem... more Multiple Idiopathic Cervical Root Resorption (MICRR) is a rare condition. It initiates at the cemento-enamel junction of multiple teeth. The lesions continue to grow until they unite, thereby undermining the entire coronal structure of affected teeth. Its distribution can vary from a single region to the entire dentition and the number of teeth affected by resorption tends to increase as the condition is followed over time. The teeth themselves appear clinically normal. The aetiology of MICRR is unknown and it is considered to be a diagnosis of exclusion. The condition tends to be progressive. Consequently, root treatments/surgical curettage and restoration of the lesions have been unsuccessful at arresting the condition. Affected teeth are often extracted in anticipation of catastrophic fracture and have been replaced with partial or complete dentures. In this case report, we describe how a young female patient was dentally managed over 10 years and ultimately rehabilitated with de...
Child cancer patients require a great deal of intensive treatment and support. This paper provide... more Child cancer patients require a great deal of intensive treatment and support. This paper provides an account of the dental problems a practitioner will encounter with these children and discusses how they may be managed.
European journal of paediatric dentistry : official journal of European Academy of Paediatric Dentistry, 2003
This study investigated two methods for the restoration of permanent molars affected by amelogene... more This study investigated two methods for the restoration of permanent molars affected by amelogenesis imperfecta (AI) or severe enamel defects. A prospective clinical trial was carried out on 17 subjects affected by AI or severe enamel defects of first permanent molars. A split mouth design was used so that each right or left permanent molar in both jaws was restored using either a preformed metal crown (SSC) or a cast adhesive coping (CAC). Subjects were followed for up to 24 months and assessed for longevity and quality of the restorations. Sequential analysis was used to compare longevity. Records for 42 restorations (19 SSC; 23 CAC) were kept. The split mouth design was possible on 24 occasions (right versus left=14; maxilla versus mandible=10). Three restorations, one SSC (at 6 months) and two CAC (at 2 and 19 months) failed and required replacement. There was no significant statistical difference between the two types of restorations. While there was no difference between the t...
Children's dentistry can be a challenge for both the patient and the dentist. The way a denti... more Children's dentistry can be a challenge for both the patient and the dentist. The way a dentist interacts with the child patient will have a major influence on the success of any clinical or preventive care. In order to deliver high-quality dentistry to a child whilst also developing a positive attitude towards dental health, the dentist should have a good understanding of the factors that might affect the behaviour of children in the dental setting. A working knowledge of strategies to minimize anxiety and make positive behaviour more likely is essential, as is a grasp of how best to deal with anxiety or negative behaviour.
Bulletin of The Royal College of Surgeons of England, 2014
Mouthguards are widely advocated for children and adults engaging in contact sports, but which ty... more Mouthguards are widely advocated for children and adults engaging in contact sports, but which type is the best, who should have them and, most importantly of all, do they work?
International Journal of Paediatric Dentistry, 2012
This paper aims to review the case of a girl who presented with a number of dental anomalies, in ... more This paper aims to review the case of a girl who presented with a number of dental anomalies, in addition to unusual skin, nail and hair conditions. Tragically an undiagnosed cardiomyopathy caused unexpected sudden death. The case is discussed with reference to a number of dermatological and oral conditions which were considered as possible diagnoses. AW had been under long term dental care for prepubertal periodontitis, premature root resorption of primary teeth, soft tissue and dental anomalies, and angular cheilitis. Separately she had also been seen by several dermatologists with respect to palmar plantar keratosis, striae keratoderma, wiry hair and abnormal finger nails. Tragically the patient suffered a sudden unexpected death and the subsequent post mortem identified an undiagnosed dilated cardiomyopathy. The most likely diagnosis is that this case is a variant of Carvajal Syndrome with additional dental anomalies. To date we have been unable to identify mutations in the desoplakin gene. We aim to emphasise the importance of recognising these dental and dermatological signs when they present together as a potential risk factor for cardiac abnormalities.
ABSTRACT Presenting problem: We report on a child under long-term dental care for prepubertal per... more ABSTRACT Presenting problem: We report on a child under long-term dental care for prepubertal periodontitis, premature root resorption of primary teeth, granulomatous, furrowed cobblestone oral mucosa and gingivae, hypodontia and peg shaped lateral incisors, caries and angular cheilitis who suffered a sudden unexpected death. Subsequent post mortem confirmed an undiagnosed dilated cardiomyopathy. This may have triggered ventricular fibrillation, which caused her death. Prior to her death, she had also been seen by several dermatologists with respect to palmar plantar hyperkeratosis, striae keratoderma, wiry hair and abnormal finger nails.Discussion: In spite of being seen by a number of clinicians in several centres in the UK a satisfactory clinical diagnosis was never established. A detailed search of the literature revealed no previously reported link between Papillon Lefevre syndrome and cardiac pathology. This case report details the patient's specific clinical presentation, which included features similar to ectodermal dysplasia, Papillon Lefevre or oral Crohn's associated with skin pathology. Possible diagnoses are suggested. Clinicians seeing similar features in future should send the child for cardiac screening to rule out any potentially life threatening pathology.
International Journal of Paediatric …, Jan 1, 2007
Usher syndrome is a genetic disorder consisting of progressive loss of vision and hearing. The pa... more Usher syndrome is a genetic disorder consisting of progressive loss of vision and hearing. The paper describes an 8-year-old girl with Usher syndrome type I who presented with generalized defects of the permanent dentition and ectopic eruption of the right maxillary first permanent molar. A cochlear implant had been fitted for her hearing loss, and the report reviews the implications of this device for dental treatment. The impacted first permanent molar was encouraged to erupt into the correct position by shaving the distal surface of the second primary molar. This is the first report to describe in detail an association between Usher syndrome and enamel defects.
This is the fourth paper in a series on the prescribing of medicines for children by dentists wor... more This is the fourth paper in a series on the prescribing of medicines for children by dentists working in primary dental care. It deals with the prescription of antifungals and antivirals for children.
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Papers by Stephen Fayle