Robert P. Anthonappa

Characteristics of 283 supernumerary teeth in southern Chinese children

OBJECTIVES This was a retrospective study to determine the characteristics and distribution of supernumerary teeth in southern Chinese children. METHODS The study population consisted of 208 children aged from 2 to 16 years. RESULTS Males were more frequently affected than females in the ratio 3.1:1. Of the 283 supernumerary teeth, 95.0% were located in the premaxilla, 71.5% were conical, 70.7% were unilateral, 29.3% were bilateral, 47.7% were inverted, and 16.9% were erupted. The mean age at the time of diagnosis and removal of the supernumerary teeth was 7.3 +/- 2.7 years (the minimum age was 2.1 years) and 8.1+/- 2.7 years (the minimum age was 4.1 years), respectively. Seventy percent of the children were in the mixed dentition and 81.3% of the supernumeraries were removed under general anesthesia. CONCLUSION In accordance with previous studies, the majority of the supernumerary teeth were located in the premaxillary region, were conical shaped, and remained unerupted.

Hypohyperdontia: literature review and report of seven cases

Hypodontia in combination with hyperdontia (hypohyperdontia) is a condition of mixed numeric variation in the human dentition. A comprehensive review on the hypohyperdontia literatures reported prevalence ranges from 0.002% to 3.1%. Our seven cases of hypohyperdontia involved both the maxillary and the mandibular arches. A traditional narrative review is included to describe the prevalence, etiology, and previously reported cases on hypohyperdontia. Furthermore, we opine that comprehensive clinical and radiographic examinations are essential for recognizing such rare dental anomalies. Judicious use of radiographs not only enhances the detection of hypohyperdontia, but also leads to changes in the course of management.

Is there sufficient evidence to support the long‐term efficacy of mineral trioxide aggregate (MTA) for endodontic therapy in primary teeth?

Several papers have been published to illustrate the effectiveness of mineral trioxide aggregate (MTA) as a pulpotomy medicament. Most of these reports do not offer a critical assessment on the data quality. Therefore, this review evaluated whether the currently available evidence is of an appropriate quality to support the long-term effectiveness of MTA as a pulpotomy medicament in primary molars using a standardized assessment criterion. A comprehensive literature search of human clinical outcome studies, which employed MTA as a pulpotomy medicament in primary teeth, was conducted using the MEDLINE database. Two independent observers rated these articles using the standardized assessment criteria. Furthermore, based on the initial sample mentioned in the individual studies and the sample included for the final analysis, the drop-out rates were calculated. Twenty-two studies were included for quality assessment with an excellent interobserver agreement. None of the 22 studies obtained grade A, four studies attained grade B1, five were graded B2 and 13 received grade C. Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament. Furthermore, given the low quality of data, it is highly desirable to establish standard requisites for conducting and reporting on pulp therapy studies in primary teeth so as to benefit both researchers and clinicians to produce high-quality studies that are comparable and to prevent the misuse of clinical material and resources.

Aetiology of supernumerary teeth: a literature review.

BackgroundSupernumerary teeth are teeth, or tooth-like structures that have either erupted or remain unerupted in addition to the 20 primary and 32 permanent teeth.AimsThis paper attempts to (a) provide an overview of the proposed hypotheses and the current understanding of the aetiology of supernumerary teeth, and (b) review the published cases of supernumerary teeth occurring in families.ReviewNo studies have been able to distinguish between different aetiologies for the different locations of supernumerary teeth, while, from a developmental or molecular perspective, the proposed hypotheses may be plausible and explains the origin of different types of supernumerary teeth.ConclusionThe only clearly evident feature, based on the existing published reports, is that it is logical to state that supernumerary teeth have a genetic component in their aetiology.

Reliability of panoramic radiographs for identifying supernumerary teeth in children

OBJECTIVES. To evaluate the reliability of panoramic radiographs (PRs) for identifying supernumerary teeth (ST) and to determine whether the level of dental training of the observer influenced the identification of ST. METHODS. Seventy-five PRs were randomly selected from the patient records and 18 examiners independently rated 25 radiographs each, for specific risk factors as well as for a measure of adequacy. Subsequently, the results were paired with those of the other examiners who assessed the same set of PRs. Descriptive statistics were computed using Fishers exact test, and kappa statistics were used to assess the inter- and intra-observer reliability. RESULTS. Four hundred and fifty PRs were available for analysis. The overall sensitivity and specificity figures were 50% and 98.3%, whereas the positive and negative predictive values were 90.6% and 83.6%, respectively. The sensitivity figures for Junior House Dental Officers and Postgraduate Paediatric Dental Trainees were 39.2% and 60.8%, whereas the specificity figures were 99.4% and 95% with slight inter-examiner and moderate intra-examiner reliability. CONCLUSIONS. Panoramic radiographs are unreliable for identifying ST, and higher level of dental training is essential for identifying ST.

Diagnostic tools used to predict the prevalence of supernumerary teeth: A meta-analysis

OBJECTIVES This study sought to (i) determine the variations in prevalence figures based on the diagnostic tools employed, and (ii) provide an insight into the prevalence of supernumerary teeth. METHODS A comprehensive literature search of the prevalence reports on supernumerary teeth was conducted using two databases. Two independent observers rated these articles according to exclusion and inclusion criteria. 28 papers were included in the analysis to determine the variations in the prevalence figures in relation to the method of diagnosis, and 14 studies were included to estimate the prevalence figures for supernumerary teeth. Statistical analysis was computed using analysis of variance (ANOVA), Student Neumann-Keuls (SNK) test and multiple regression analysis. RESULTS Statistically significant differences were evident in the prevalence figures based only on a clinical examination compared with groups that also employed radiographs (p < 0.05, ANOVA, SNK). The prevalence figures for supernumerary teeth ranged from 0% to 3%. The mean prevalence value for the European white population [1.6% (±0.6)] was lower than that of the southern Chinese population [2.7% (±0.14)]. The overall prevalence of supernumerary teeth for males was significantly higher than for females [relative risk = 1.37 (1.13-1.50)]. CONCLUSIONS Clinical examination plus some types of radiograph(s) are essential for determining the prevalence of supernumerary teeth; nevertheless, it is still underestimated. Several disparities in the prevalence reports make the available data on supernumerary teeth questionable.

Changes in the oral health-related quality of life in children following comprehensive oral rehabilitation under general anaesthesia.

OBJECTIVES To assess changes in the oral health-related quality of life (OHRQoL), after comprehensive oral rehabilitation under general anaesthesia (CORGA), among children (i) <6 years using the Early Childhood Oral Health Impact Scale (ECOHIS) and (ii) aged 6-14 years using the child oral health-related quality of life (COHRQoL) instrument. METHODS A total of 136 healthy children who had CORGA were recruited over a period of 12 months. The parent or caregiver of the study participants completed the age-appropriate questionnaire prior to the dental treatment and at the subsequent follow-up appointments (2 weeks and 3 months). Data were analysed using repeated-measures anova and Bonferroni tests. RESULTS The overall ECOHIS scores decreased significantly (P < 0.001) demonstrating large effect sizes. The greatest decreases were for the domains of child oral symptoms (57.5%) and psychology (38.7%) in the child impact section (CIS) and for the domain of parental distress (38.9%) and family function (40%) in the family impact section (FIS). For COHRQoL, the overall P-CPQ and FIS scores decreased significantly for all items (P < 0.001), demonstrating large effect sizes. The greatest decreases were for the domains of oral symptoms (77.7%), functional limitations (74.3%), and the FIS (80.1%). CONCLUSIONS The OHRQoL of children in both age groups (<6 and 6-14 years) was significantly improved after CORGA.

Caries burden and efficacy of a referral pathway in a cohort of preschool refugee children

BACKGROUND This study aimed to assess the early caries experience and the efficacy of a community based dental referral pathway in preschool refugees in Western Australia. METHODS Preschool refugee children referred to the Western Australian paediatric hospital Refugee Health Clinic were prospectively screened for caries by a paediatric dentist before being referred to community dental clinics. Dental forms and medical records were audited to assess decayed, missing and filled teeth (dmft), medical data and dental services engagement. Poisson regression analysis determined the contribution of count variables to the final model. RESULTS Among the 105 screened children (54% male, median age 3.2 years, 41% Burmese), community dental clinic engagement was low (46%, n=48). Of the 62% with caries (n=65/105, mean dmft 5.2, SD 4.1), 45% were recommended for specialist dental services and 48% were treated. After adjustment for age, gender and total number of teeth, caries incidence was significantly associated with BMI-for-age Z score (p=0.02). CONCLUSIONS Preschool refugee caries burden was high. The community dental referral pathway was ineffective compared to co-located intersectorial dental screening. Specialist dental service needs are high in this cohort and require a targeted approach.

Enamel Defects in the Permanent Dentition: Prevalence and Etiology

The prevalence of developmental defects of enamel (DDE) in the permanent dentition in developed countries has been reported to be in the range of 9–68 % and with no gender predilection. Several etiological factors have been implicated as being responsible for DDE in the permanent teeth. Although local, systemic, genetic or environmental factors have been attributed to DDE frequently they are likely to be multifactorial in nature. These factors are discussed in relation to the timing of enamel development with consideration of the evidence, or lack thereof, for the association between the putative etiological factors and the nature of the subsequent abnormalities.

Novel complex disease allele mutations in cleidocranial dysplasia patients.

This study reports a novel identical complex disease allele harboring two non-synonymous mutations that were identified in two southern Chinese individuals of the same family with cleidocranial dysplasia (CCD). Blood samples were obtained from the proband, his parents, plus 100 matched control subjects. Exons 0 to 7 of the RUNX2 gene were amplified using specific primers and sequenced. Multiple sequence alignment and protein structure modeling was performed using ClustalW2 and MODBASE software while PolyPhen-2 and MutationTaster applications were employed to predict the disease-causing potential of the identified mutations. A complex disease allele in two affected individuals harboring two non-synonymous mutations in a cis-position on exons 4 (D273N) and 5 (P299L) were identified. The identified mutations were in the conserved region and changed the protein structure.