Sven Poulsen

Risk of aggressive periodontitis in adolescent carriers of the JP2 clone of Aggregatibacter (Actinobacillus) actinomycetemcomitans in Morocco: a prospective longitudinal cohort study.

BACKGROUND Periodontitis is a loss of supporting connective tissue and alveolar bone around teeth, and if it occurs in an aggressive form it can lead to tooth loss before the age of 20 years. Although the cause of periodontitis in general remains elusive, a particular clone (JP2) of the gram-negative rod Aggregatibacter (Actinobacillus) actinomycetemcomitans is considered a possible aetiological agent of the aggressive form in adolescents living in or originating from north and west Africa, where the disease is highly prevalent. We did a population-based longitudinal study of adolescents to assess the role of the JP2 clone in the initiation of aggressive periodontitis. METHODS A total of 700 adolescents from public schools in Rabat, Morocco, were enrolled in the study. We used PCR to detect A actinomycetemcomitans in plaque samples (taken from molar and incisor sites) and to differentiate between the JP2 clone and other non-JP2 genotypes of the bacterium. 18 individuals were found to already have periodontitis and were excluded. The 682 periodontally healthy adolescents (mean age 12.5 years; SD 1.0) were classified according to their A actinomycetemcomitans carrier status at baseline. After 2 years, 428 (62.8%) individuals returned for re-examination, which included recording of periodontal attachment loss measured from the cemento-enamel junction to the bottom of the periodontal pockets of all teeth present. FINDINGS Individuals who carried the JP2 clone of A actinomycetemcomitans alone (relative risk 18.0; 95% CI 7.8-41.2, p<0.0001) or together with non-JP2 clones of A actinomycetemcomitans (12.4; 5.2-29.9, p<0.0001) had a significantly increased risk of periodontal attachment loss. A much less pronounced disease risk was found in those carrying non-JP2 clones only (3.0; 1.3-7.1, p=0.012). INTERPRETATION The JP2 clone of A actinomycetemcomitans is likely to be an important aetiological agent in initiation of periodontal attachment loss in children and adolescents. Co-occurrence of non-JP2 clones of A actinomycetemcomitans reduces the risk of development of periodontitis, suggesting competition for the ecological niche between the JP2 and non-JP2 clones of this species.

Early-onset Periodontitis in Morocco is Associated with the Highly Leukotoxic Clone of Actinobacillus actinomycetemcomitans

A particular clone (JP2) of Actinobacillus actinomycetemcomitans with increased leukotoxin production has been isolated from individuals with early-onset periodontitis (EOP). The aim of this study was to determine the frequency of carriers of this clone and its association with EOP in Moroccan schoolchildren. Of 217 plaque samples, 131 (60.4%) were culture-positive for A. actinomycetemcomitans. A total of 19 of these isolates had a 530-bp deletion in the leukotoxin promoter region characteristic of the JP2 clone. A strong association between the presence of A. actinomycetemcomitans with the 530-bp deletion and EOP was found (adjusted OR = 29.4; 95% CI = 8.3 - 104.4; p < 0.0005), while no association could be demonstrated between the presence of A. actinomycetemcomitans without the deletion and EOP (adjusted OR = 1.3; 95% CI = 0.5 - 2.9; p = 0.750). The study demonstrates that the endemic presence, in a human population, of the highly leukotoxic JP2 clone may result in an unusually high prevalence of EOP.

Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children.

The aim of this study was to estimate the prevalence of dental anxiety among 6 to 8-year-old Danish children using the Childrens Fear Survey Schedule-Dental Subscale (CFSS-DS) and behavior management problems. The study was designed as a population-based cross-sectional survey of children attending the municipal dental service in four municipalities in the county of North Jutland, Denmark. In 2001, the CFSS-DS questionnaire was mailed to the parents of all children born in 1993, 1994, and 1995 (parents of 1666 children) in 4 municipalities. Data on behavior management problems were collected from the childrens dental records held by the municipal dental service. Questionnaires were returned from 1281 (76.9%) parents. The prevalence of dental anxiety (i.e. CFSS-DS S 38) was 5.7% (95% CI: 4.6%-7.1%), and the median CFSS-DS score was 22 (1st quartile 19; 3rd quartile 27). A history of behavior management problems was observed in 37.2% (95% CI: 33.3%-41.1%) of all children who had had dental treatment, but more often in children with dental anxiety.

Prevalence and distribution of demarcated opacities and their sequelae in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children

Objective. To determine the prevalence of demarcated opacities in permanent 1st molars and incisors in 7 to 13-year-old Brazilian children. Material and methods. The study population comprised 292 children from a middle social class public school in Rio de Janeiro, Brazil. Children with all 1st permanent molars erupted were eligible for participation. Clinical examination was performed by two calibrated examiners who recorded demarcated opacities, post-eruptive breakdown, atypical restorations, and extractions due to demarcated opacities. Forty-three children had at least one molar that could not be examined, which left 249 children for the data analysis. Results. One hundred children (40.2%) had one or more 1st molars with demarcated opacities with a mean number of 1.98 (SD 1.09) affected molars. The number of affected incisors increased with increasing number of affected molars. Twenty-two (18.6%) of 118 children with unaffected 1st molars had affected incisors. Demarcated opacities were the most frequent defect, and 1st molars and upper central incisors were the most frequently affected teeth. Among children with demarcated opacities in 1st molars, 20 (20%) had post-eruptive breakdown. Conclusions. A high prevalence of demarcated opacities, possibly resulting in disintegration of the tooth crown, has been found in Brazilian children.

Oligodontia in Danish schoolchildren.

Oligodontia is a rare condition, and only limited data are available on its prevalence. The present paper is based on data from Danish schoolchildren. When these data are combined with comparable data on Danish schoolchildren published previously by the senior author, it is shown that oligodontia occurs in 0.16% of the children (95% confidence interval, 0.07% to 0.30%). Two of every three congenitally missing teeth were upper or lower second premolars or upper lateral incisors. When data from Danish schoolchildren were combined with population data from similar groups of schoolchildren from the Nordic countries, the condition was found to be more frequent in girls than in boys (P = 0.05).

Marginal adaptation of a low-shrinkage silorane-based composite: 1-year randomized clinical trial

The aim of the present study was to examine the marginal adaptation of a new low-shrinkage silorane-based composite material (Filtek™ Silorane, 3M-Espe) by comparing it with a methacrylate-based composite material (CeramX™, Dentsply DeTrey). In particular, we wanted to test the hypothesis that reduced polymerization shrinkage would improve the marginal adaptation. Seventy-two patients participated in the study. A total of 158 restorations were placed in 80 premolars and 78 molars. Only Class II restorations were included, and each patient could contribute with more than one tooth. The restorations were scored at baseline and after one year. While statistical comparison of marginal adaptation at follow-up indicated better performance of CeramX™ both occlusally and approximally (p = 0.01 and p < 0.01), the low kappa value (32%) reflects the difficulty to assess marginal adaptation clinically. The reduction in polymerization shrinkage demonstrated in the laboratory was not clinically significant in the present study.

A longitudinal study of time trends in the eruption of permanent teeth in Danish children

The purpose was: (1) to estimate mean eruption times of permanent teeth in Danish schoolchildren for the birth cohorts from 1969 to 1982; and (2) to determine any time trends in eruption. For teeth with a low proportion of aplasia, the distribution of the eruption time was close to normal. For teeth with a higher proportion of aplasia there was a slight deviation from the normal distribution in the right-hand part of the distribution. For erupted teeth, the time to eruption was, however, again very close to the normal distribution. A small, but statistically significant, increase in mean eruption times was found for both sexes and almost all teeth. Averaged over all teeth the increase was 1.5 days per year (95% CI: 0.9--2.2) for boys and 2.6 days per year (95% CI: 2.2--2.9) for girls.

Amelogenesis imperfecta a systematic literature review of associated dental and oro-facial abnormalities and their impact on patients

Objective. Amelogenesis imperfecta (AI) is a disease primarily affecting amelogenesis, but other aberrations have been reported. The purposes of this review were: (1) to identify other anomalies associated with AI, and (2) to describe the impact of the disease and its associated conditions on the oral health-related quality of life of patients, and the economic consequences. Material and methods. A literature search was conducted in the following databases: PubMed, EMBASE, Bibliotek.dk, The Cochrane Library, Web of Science, and OMIM, supplemented by a search for selected authors. Based on titles and abstracts, 137 papers were identified. Results. Most articles were case reports or case series with few cases. Aberrations were reported in the eruption process, in the morphology of the crown, in the pulp-dentine organ, and in the number of teeth. Gingival conditions and oral hygiene were usually reported to be poor, and calculus was a common finding. Open bite was the most commonly reported malocclusion. A negative impact on patients’ oral health-related quality of life was described, but information was scarce. No information was found on the economic impact. Conclusions. A number of aberrations associated with AI have been reported, but not sufficiently systematic to allow for a secondary analysis and synthesis of the findings. The impact on patients in terms of reduced quality of life and economic burden needs to be studied.

Agenesis of permanent teeth in 8138 Danish schoolchildren: prevalence and intra‐oral distribution according to gender

OBJECTIVE The purpose of this study was to describe agenesis of permanent teeth in children with respect to prevalence and intra-oral distribution according to gender. METHODS AND SUBJECTS The study was population based and included all children in one district of the municipality of Aarhus, Denmark, in 1974-1979 (1657 girls and 1668 boys) and 1992-2002 (2409 girls and 2404 boys). The children underwent systematical clinical and radiographic examination. RESULTS The period prevalence rates were almost identical for the two time periods (1972-1979: 7.8%; 1992-2002: 7.1%). Girls were affected more frequently than boys, and affected girls had more congenitally missing teeth than affected boys. Unilateral agenesis of the second premolars was more frequent than bilateral agenesis. In children with only one congenitally missing tooth, agenesis of the upper lateral incisors was asymmetrical in girls, but not in boys, whereas the opposite was true for the lower second premolars in boys. CONCLUSION The prevalence of agenesis of permanent teeth in Danish schoolchildren seems to be constant over time, and similar to that found in other large, population-based studies. Intra-oral distributions of congenitally missing teeth indicate gender-specific patterns.

Prevalence and distribution of demarcated opacities in permanent 1st molars and incisors in 6 to 8-year-old Danish children

Objective. To estimate the prevalence and describe the distribution of demarcated opacities and possible consequences of this condition in permanent 1st molars and incisors in Danish children. Material and methods. Among all 6 to 8-year-old children in two municipalities, 745 (83.6%) were clinically examined for the occurrence of creamy-white or yellowish-brown demarcated opacities, posteruptive breakdown of tooth substance in relation to the opacities, atypical restorations, and extractions, i.e. restorations or extractions as a result of the occurrence of demarcated opacities. Results. In 647 children with four fully erupted permanent 1st molars, the prevalence of demarcated opacities and of lesions with loss of tooth substance due to demarcated opacities in any 1st molar was 37.3% (95% confidence interval (95% CI) 33.6–41.0%) and 6.3% (95% CI 4.7–8.5%), respectively. Permanent incisors were 2.5 times more frequently affected among children with one or more affected permanent 1st molar than among children with no such teeth. Demarcated creamy-white opacities were the type of lesion found most frequently, and the most frequently affected tooth types were the upper central incisors followed by 1st molars. Conclusions. Nearly half of the examined 6 to 8-year-old children had permanent 1st molars or incisors with demarcated opacities. More than 6% of the children had macroscopic loss of tooth substance due to demarcated opacities.