Esti Davidovich

The traditional practice of canine bud removal in the offspring of Ethiopian immigrants

BackgroundThe custom of canine bud removal has detrimental consequences on children’s general health and dental care. The objective of this study was to assess whether the prevalence of missing primary canines and dental defects in offspring of emigrants from Ethiopia is greater than in offspring of native Israeli parents of similar socioeconomic class.Methods477 children of Ethiopian descent and 317 offspring of native Israeli parents, from 21 nursery schools and kindergartens, underwent dental examinations aimed to determine the presence or absence of primary canines and of developmental enamel defects on adjacent teeth to the primary canines. For purposes of analysis, children were classified into two age groups: younger (ages 18–48 months) and older (ages 49–82 months).ResultsCanines were present in more Israeli than Ethiopian younger children, 87.5% vs. 42.3%, p=0.0001; and in more Israeli than Ethiopian older children, 92.6% vs. 40.4%, p=0.0001. More dental defects were detected in Ethiopian than in Israeli younger children, 32% vs. 3.9%, p=0.0001; and in more Ethiopian than Israeli older children, 31.2% vs. 5.8%, p=0.0001.ConclusionsThe prevalence of missing primary canines and dental defects was greater among offspring of parents who had emigrated from Ethiopia 15–20 years earlier than among offspring of native Israeli parents living in the same low socioeconomic neighborhoods.

The correlation between dental calculus and disturbed mineral metabolism in paediatric patients with chronic kidney disease

BACKGROUND Vascular calcifications have been documented in children with end-stage renal disease. However, only a few reports have described abundant dental calculus formation in children suffering from chronic kidney disease (CKD). Moreover, dental calculus scores (DCS) and their correlation with renal disease severity have not been studied. METHODS DCS in 74 young CKD patients were evaluated: 25 pre-dialytic (PrD), 18 on dialysis (D) and 31 with transplants (T) compared to 32 healthy participants (C). Saliva and serum analysis included creatinine (Cr), urea (U), calcium (Ca), phosphorous (P), magnesium (Mg) as well as intraoral pH levels. RESULTS All patient groups presented high DCS. DCS and pH levels were higher in the D group with a positive correlation between pH and lower incisor DCS (r = 0.56, P = 0.017). The highest salivary Ca was found in the PrD group. Salivary P in the PrD group was found to be higher than in the T and C groups. The lowest salivary Mg was found in the D group while the highest salivary Ca x P product was found in the PrD group. In all patient groups, salivary U was higher than in the C group with a 2.5-fold increase in the D group. Salivary Cr resembled the U salivary concentrations. CONCLUSIONS Alterations in salivary Ca, P, Mg, U, Cr and intraoral pH levels were observed in the patient groups. DCS correlated with renal disease severity and therefore may be a reflection of other tissue calcification pathologies found in these patients.

A comparison of the sialochemistry, oral pH, and oral health status of Down syndrome children to healthy children.

BACKGROUND The aetiology of low caries incidence in Down syndrome (DS) children is not entirely clear. Aim. To compare sialochemistry and oral mucosal pH between Down syndrome children with caries (DS-Ca) and caries free (DS-CaF), and healthy children with caries (C-Ca) and caries free (C-CaF). DESIGN The study group comprised 70 children with DS (mean age 4.41 +/- 1.9 years); 32 healthy children (mean age 9.22 +/- 2.7 years) served as control. Groups were further subdivided according to caries status: DS-Ca, DS-CaF, C-Ca and C-CaF. Sialochemistry analysis included calcium (Ca), sodium (Na), potassium (K), and chloride (Cl). Mucosal pH, plaque and gingival indices (PI and GI), and caries status were recorded. RESULTS DMFT/dmft were significantly lower in the DS group. Cl and Ca levels were significantly higher in the DS-Ca compared to the C-Ca and the C-CaF children. Na and K were significantly higher in DS-Ca group compared to DS-CaF group. PI and GI were significantly higher in DS-C children compared to DS-CaF children. CONCLUSIONS DS may manifest itself in the salivary glands. Consequently, different electrolyte salivary environment may form, leading to lower caries rates among DS children.

Sialochemistry and cortisol levels in patients with Sjogren’s syndrome

OBJECTIVES (i) To determine whether salivary cortisol and electrolyte levels differ between patients with Sjogrens syndrome (SjS) and healthy individuals. (ii) To assess correlations between whole-saliva cortisol and some clinical manifestations in patients with SjS. METHODS A total of 24 healthy women (mean age 49.3±9.8) served as controls (C) vis-à-vis 17 patients with SjS (mean age 55.5±15.7). Salivary cortisol concentration was determined, and sialochemistry analysis was performed. RESULTS Significantly lower saliva flow rates and higher salivary chloride (Cl(-) ), potassium (K(+) ), and Ca(2+) levels were found in the SjS group. No significant differences or correlations were found in other parameters, including sodium (Na(+) ), magnesium (Mg(2+) ), phosphate ((-) ), urea (U), and salivary cortisol levels. CONCLUSION Increased whole-salivary output of Cl(-) and K(+) in SjS may reflect release from apoptotic rests of acinar cells after secondary necrosis. Normal levels of salivary Na(+) , Mg(2+) , and (-) argue against concentration effect, deranged tubular function or cortisol (mineralocorticosteroid) effect as the cause for these findings. Increased salivary Ca(2+) levels probably reflect leakage of plasma Ca(2+) through the injured oral mucosa in SjS. In spite of disease-associated stress, salivary cortisol, a stress biomarker, was not increased, suggesting insufficient hypothalamus-pituitary-adrenal (HPA) axis response and/or local consumption of cortisol by lymphocyte infiltrates.

Mucosal pH, Dental Findings, and Salivary Composition in Pediatric Liver Transplant Recipients

Background Oral health and dental maintenance have become part of the standard of care for pediatric liver transplant recipients. These individuals tend to suffer particularly from dental problems, such as gingival enlargement, gingivitis, poor oral hygiene, dental hypoplasia, and caries. Saliva composition influences oral hygiene and disease states. We investigated saliva composition and its association with the oral health of young recipients of liver transplants. Methods In 70 patients, 36 liver transplant recipients (ages 2–23 years) and 34 healthy controls (ages 4–21 years), we measured the following variables: (a) oral hygiene, (b) gingival inflammation, (c) caries status, (d) dental calculus formation, (e) oral mucosal pH, and (f) salivary protein composition. Results Lower mean decayed, missing, and filled teeth index (P=0.0038), higher mean gingival index (P=0.0001), and higher mean calculus score (P=0.003) were found in the transplanted study group compared with the control. The mean mucosal pH for seven intraoral sites was higher in the transplant group (P=0.0006). The median salivary albumin concentration was significantly lower in the transplant group (P=0.01), as was the median salivary albumin/total protein ratio (P=0.0002). Conclusions In post-liver transplant pediatric recipients, low incidence of caries, together with high incidence of dental calculus, could be attributed to elevated oral mucosal pH. Salivary albumin and immunoglobulin A levels were relatively low in these patients. Clinicians should pay particular attention to the oral health and dental care of liver transplanted children.

Children's Preferences for Pediatric Dentist Attire: A Multicenter Study

BACKGROUND Data are conflicting regarding the effect of professional staff attire on children at pediatric dental clinics. AIM To compare the preferences of children and their parents in three countries, regarding the gender and attire of pediatric dentists. STUDY DESIGN A multi-centered study was conducted in pediatric dental clinics in Israel (N=100), Uruguay (N=270) and Spain (N=200). Children, aged 4-12 years, and their parents were asked to choose the pediatric dentist they preferred from 5 pictures of the same male and 5 pictures of the same female, in different attire. RESULTS In Israeli clinics, where half of the pediatric dentists were male, and they wore white coats or casual attire, these were preferred by children, with no preference regarding the dentists gender. In Spain, where the majority of dentists were females, wearing surgical scrubs, children preferred female dentists with this attire. In Uruguay, where female dentists wore surgical or pediatric scrubs, these were preferred by children. Parents more often selected female than male dentists; they preferred pediatric scrubs for their childrens dentists more often than their children preferred such attire. CONCLUSIONS Childrens preferences for the attire of pediatric dentists reflected the common wearing apparel for dentists at the clinics they attended.

Post-Discharge Events Occurring after Dental Treatment under Deep Sedation in Pediatric Patients

PURPOSE Deep sedation is often required in dentistry for treating children with uncooperative behavior. We assessed immediate post-sedation events during the first 24 hours after dental treatment under deep sedation in children, and examined correlations to a number of variables. STUDY DESIGN Information was collected from medical files for a convenience sample of children between the ages of 1 and 16, who were treated under deep sedation at one clinic (propofol alone or combined with a sedative agent). Parents were interviewed by telephone regarding the first 24 hours following treatment. RESULTS Among 32 children under age 6 years, 26 (81.3%) had at least one post sedation complication, compared to 19/22 (86.4%) aged 6 and older, p>0.05. According to parent report, 13 (59.1%) of the older children had pain, compared to 6 (18.8%) of the younger ones, p=0.002. For no patient in the younger group compared to 18.2% in the older group was dizziness reported as a complication, p=0.023. Among those who received a sedative agent, 93.3% had one or more complications; 26.7% had nausea or vomiting. The respective rates were 79.5% and 5.1% among those treated only with propofol. CONCLUSIONS Though safe, deep sedation poses complications and adverse events.

Randomised clinical study of plaque removal efficacy of a power toothbrush in a paediatric population

BACKGROUND Clinical investigations of plaque removal efficacy of power toothbrushes in children are limited. AIM To compare plaque removal of a power versus manual toothbrush in a paediatric population. DESIGN This was a randomised, replicate-use, single-brushing, examiner-blinded, two-treatment, four-period crossover clinical trial in children 8-11 years of age. Subjects were randomly assigned to a treatment sequence involving an oscillating-rotating power toothbrush and a manual toothbrush control. Subjects brushed under supervision with a NaF dentifrice. Plaque was assessed pre- (baseline) and post-brushing using the Turesky Modification of the Quigley-Hein Plaque Index by two examiners. Plaque scores were averaged for mixed and permanent dentition on a per-subject basis and analysed using a mixed-model ancova for a crossover design. RESULTS Forty-one subjects (mean 9.0 years) were randomised and completed the trial. Both the power brush and manual brush provided statistically significant mean plaque reductions versus baseline in all analyses (P < 0.001). For both examiners, plaque removal was significantly (P < 0.001) larger for the power brush in permanent and mixed dentitions. The interexaminer correlations for the permanent dentition were strong (ICC = 0.68-0.88) for pre-brushing plaque across all periods. CONCLUSIONS An oscillating-rotating power toothbrush provided superior plaque reduction versus a manual toothbrush in children.