Joseph Shapira

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.

Prevalence of Tooth Transposition, Third Molar Agenesis, and Maxillary Canine Impaction in Individuals with Down Syndrome

Alterations in the size, morphology and number of teeth are among the many inherited disorders that have been reported in individuals with Down syndrome. By contrast, third molar agenesis and tooth transposition have been largely ignored and the prevalence of canine impaction has not been reported. The intention of this study was to quantify the occurrence of these anomalies in a group of individuals with Down syndrome, using standardized records, which included a clinical examination, dental casts, and a panoramic radiograph. The results show a notably high prevalence of third molar agenesis (74% of individuals older than 14 years), canine impaction (15%), and maxillary canine/first premolar transposition (15%), compared to published figures from random population samples. These anomalies should not be seen as separate, independent entities, but as associated phenomena. The slow rate of cell growth and a consequent reduced cell number that characterize this syndrome may be responsible for the underdevelopment of the upper jaw, the delayed dental development, the reduction in teeth number and size, and the altered path of canine eruption. No explanation, other than genetics, is immediately available to explain why the maxillary canine/first premolar transposition should represent another phenotypic expression of this trisomy.

Decoronation for the management of an ankylosed young permanent tooth

Replacement resorption rate is a variable process, and is dependent on age, basal metabolic rate, extra-alveolar time, treatment prior to replantation, amount of root dentin, severity of trauma, and extent of periodontal ligament necrosis. In patients 7-16 years old a tooth is lost 3-7 years after the onset of root resorption. The complications that may develop as a consequence of ankylosis of a permanent incisor in children are due to the inevitable early loss of the traumatized tooth and local arrest of alveolar bone development. An ankylosed tooth should be removed before the changes become so pronounced that they compromise future prosthetic treatment. The treatment options may involve: interceptive regenerative treatment, early extraction of the ankylosed tooth, orthodontic space closure, intentional replantation, extraction of the ankylosed tooth followed with immediate ridge augmentation/preservation, auto-transplantation, single tooth dento-osseous osteotomy, and decoronation. The purpose of this article was to review the considerations involved in the decision-making concerning the use of the decoronation technique for the treatment of a permanent incisor diagnosed as ankylosed.

Salivary LL-37 Secretion in Individuals with Down Syndrome is Normal

Antimicrobial peptides play an important role in the innate immune response. Deficiency in salivary LL-37 antimicrobial peptide has been implicated in periodontitis in patients with morbus Kostman syndrome. Down syndrome is associated with periodontitis, diminished salivary flow, and salivary immunoglobulin deficiency. In the present study, levels of LL-37 and its hCAP18 precursor were measured in saliva samples from young individuals with Down syndrome and compared with levels in those from age-matched healthy controls. LL-37 and human cathelicidin antimicrobial protein (hCAP18) were detected in whole but not in parotid saliva. hCAP18 was more abundant than LL-37. The concentrations of salivary hCAP18 and LL-37 were found to be higher in individuals with Down syndrome than in healthy controls, but their secretion rates were similar. We concluded that, while the adaptive immunity of individuals with Down syndrome is impaired at the oral mucosa, the secretion rate of the LL-37 component of the innate immune system is normal.

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.

Severe Impairment of Secretory Ig Production in Parotid Saliva of Down Syndrome Individuals

Infections associated with Down Syndrome (DS) are prevalent in the mucosal-gastrointestinal and respiratory systems, for reasons that are uncertain. The purpose of the present study was to assess the levels of parotid salivary immunoglobulins (Ig) in a group of DS individuals as a possible factor in the susceptibility of mucosal surfaces to infections. Twenty-nine DS and 10 age- and sex-matched healthy individuals were included. Salivary flow rate and IgA, IgG, and IgM concentrations were recorded. The secretion rates of IgA and IgG were diminished by 83% (p < 0.001) and 75% (p = 0.05), respectively, whereas the secretion rate of IgM was not statistically significantly lower. Analysis of the data suggests that DS individuals are immunodeficient in the humoral mucosal immune response. This may explain, in part, the high incidence of recurrent infections in target organs of the secretory immune system in DS subjects.

Oral health status, salivary flow rate and salivary quality in children, adolescents and young adults with ADHD

BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder that presents in 3-7% of school-age children. Studies have shown that children, adolescents and young adults with ADHD are more prone to caries than those without. AIM The study investigated a possible relationship between the oral health status of children, adolescents and young adults diagnosed with ADHD, both with and without pharmacological intervention, and the following: salivary flow rate, oral mucosal pH, plaque index (PI), oral hygiene and dietary behaviour. STUDY DESIGN DMFT/dmft index (D;d-Decay, M;m-Missing; F;f-Filled,T;t-teeth), plaque index, oral mucosal pH and unstimulated whole salivary flow (USF) were examined in three groups of children, adolescents and young adults: those diagnosed with ADHD with no pharmacological intervention (N=31), those treated with medications for ADHD (N=30), and a healthy control group (N=30). Diet and oral health habits were assessed by means of questionnaires completed by parents. RESULTS Mean USF values were 0.72, 0.85 and 1.13 ml/min for participants with ADHD and without medication, with ADHD and with medication, and without ADHD, respectively (p=0.016). There were no differences in the DMFT/dmft index and in parent reported diet and oral health behaviour between the three groups. Children with ADHD demonstrated a statistically significant higher plaque index (p<0.05). CONCLUSIONS The ADHD group, with or without pharmacological intervention, showed higher plaque index and lower USF, but no difference in DMFT/dmft. The ADHD group did not differ from the non-ADHD group in their diet or oral health behaviour as assessed by parent reports.

Modified cuspal relationships of mandibular molar teeth in children with Down's syndrome

A total of 50 permanent mandibular 1st molars of 26 children with Downs syndrome (DS) were examined from dental casts and 59 permanent mandibular 1st molars of normal children were examined from 33 individuals. The following measurements were performed on both right and left molars (teeth 46 and 36 respectively): (a) the intercusp distances (mb‐db, mb‐d, mb‐dl, db‐ml, db‐d, db‐dl, db‐ml, d‐dl, d‐ml, dl‐ml); (b) the db‐mb‐ml, mb‐db‐ml, mb‐ml‐db, d‐mb‐dl, mb‐d‐dl, mb‐dl‐d angles; (c) the area of the pentagon formed by connecting the cusp tips. All intercusp distances were significantly smaller in the DS group. Stepwise logistic regression, applied to all the intercusp distances, was used to design a multivariate probability model for DS and normals. A model based on 2 distances only, mb‐dl and mb‐db, proved sufficient to discriminate between the teeth of DS and the normal population. The model for tooth 36 for example was as follows:

Oral health status and salivary properties in relation to gluten-free diet in children with celiac disease.

Background: Patients with celiac disease (CD) have a wide variety of symptoms, from being asymptomatic to having chronic diarrhea, abdominal pain, and extraintestinal symptoms. In the oral cavity, enamel defects and recurrent aphthous stomatitis are the most common symptoms. The aim of the study was to assess oral health, bacterial colonization and salivary buffering capacity of patients with CD at diagnosis were compared with patients with CD receiving a gluten-free diet (GFD) and healthy children. Methods: Three groups were prospectively investigated: newly diagnosed CD, CD treated with GFD, and a control group. All of the children were examined by pediatric dentists, and saliva samples were collected for bacterial and pH analysis. Results: Ninety children were enrolled in the study, 30 in each group. A higher prevalence of enamel hypoplasia (66%) was found in children with CD. Plaque index was significantly lower in the celiac-treated group, which correlated with oral health behavior: teeth brushing and frequency of eating between meals. Children receiving GFD brushed their teeth and used fluoride significantly more often than other children in the study. No difference between groups was found in snack consumption, mutans streptococci and lactobacilli counts in saliva, as well as pH and buffer capacity. Conclusions: A lower degree of plaque was found in children with CD receiving GFD. This finding could not be explained by salivary properties or bacteria, but rather by better oral hygiene. The results should raise the awareness of pediatric gastroenterologists toward oral health–related issues in children with CD.

Salivary bacteria and oral health status in medicated and non-medicated children and adolescents with attention deficit hyperactivity disorder (ADHD).

ObjectivesAttention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder. Studies have shown that children with ADHD are more prone to caries than those without. The study investigated children diagnosed with ADHD, both with and without pharmacological intervention, and the following: DMFT\dmft, plaque index (PI), mutans streptococci (MS) levels, lactobacilli (LB) levels, salivary flow, salivary buffer capacity, oral hygiene, and diet.Study designDMFT/dmft index, PI, MS and LB levels, salivary flow, and salivary buffer capacity were examined in three groups of children: ADHD1—diagnosed with ADHD with no pharmacological intervention (N = 31), ADHD2—treated with medications for ADHD (N = 30), and a healthy control group (N = 30). Diet and oral health habits were assessed through questionnaires completed by parents.ResultsThere were no differences in the DMFT/dmft index, MS and LB counts, salivary buffer capacity, and parent reported diet and oral health behavior between the three groups. Children with ADHD demonstrated a higher plaque index.ConclusionsAlthough children with ADHD did not report different diet and oral health behavior from children without ADHD, this group had significantly higher levels of plaque than the control group, which combined with hyposalivation may be a risk factor for caries at an older age.Clinical relevanceMedicated and non-medicated ADHD children were similar to control children in their caries rate, MS and LB counts, salivary buffer capacity, and diet and oral health behavior. They differed in the amount of plaque found on their teeth. As a group, ADHD children demonstrated hyposalivation compared with the control.