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A family is described in which two sisters and their two female fifth-cousins were cases of mandibuloacral dysplasia. This syndrome is characterized by mandibular hypoplasia, delayed cranial suture closure, dysplastic clavicles, abbreviated terminal club-shaped phalanges associated with acroosteolysis and atrophy of the skin over hands and feet. Furthermore, in this family alopecia and loss of the lower teeth were noted. We stress the importance of the cutaneous alterations and the possible existence of partial froms of the disease as in one of the patients presented.
The mandibular condyles and glenoid fossae of 93 adult skulls of known age at death were studied in skeletons exhumed from the crypt of Christ Church, Spitalfields, London. Antero-posterior and mesio-lateral dimensions were recorded, as were the shapes together with form and surface changes. In addition, the teeth present and the extent of occlusal attrition were noted. There was sexual dimorphism in the mesio-lateral size of the condyle, and although ante-mortem tooth loss was higher than in previously studied Romano-British skulls, form and surface changes of the condyle were less marked. It is concluded that tooth loss is not the main factor involved in remodelling of the condyle.
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A patient, with Papillon-Lefèvre syndrome, presented with a premature loss of both deciduous and permanent teeth and hyperkeratosis palmaris et plantaris. Other abnormalities such as psoriasiform hyperkeratosis, calcification of the falx, and frequent infections can be seen. Although no etiologic factor is known for this aberration, an autosomal recessive inheritance is established. Treatment usually consists of dental hygiene only since dermatologic therapy is usually unrewarding. A new finding resulted when fibroblasts from involved gingiva were compared with either uninvolved gingiva or controlled gingiva. The protein and collagen synthesis of the involved tissue was about twice that of the latter two groups.
The number of teeth, % of alveolar bone loss, serum IgG, and serum antibodies to Bacteroides gingivalis, Capnocytophaga ochracea and Eubacterium saburreum were recorded in 37 patients diagnosed with rheumatoid arthritis (RA) and in an age- and sex-matched control group of 37 individuals free from RA. The RA group had a significantly increased loss of teeth and loss of alveolar bone compared to the control group. The RA patients also had a significantly increased level of serum IgG. In the total material, 26% of the variation in loss of alveolar bone was accounted for by age, diagnosis of rheumatoid arthritis, and levels of antibodies against B. gingivalis and E. saburreum. In the RA group, 48% of this variation was accounted for by age, total serum IgG and IgG antibodies to B. gingivalis and E. saburreum.
Periodontal health in relation to systemic retinoid medication was evaluated retrospectively in patients with Papillon-Lefèvre Syndrome (PLS). The material consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The remaining 9 served as controls. Regardless of whether or not retinoid medication was received, every patient experienced an early and devastating periodontitis, with atypical edematous and erythematous gingiva, suppuration from deep gingival pockets and premature loss of teeth. No correlation could be found between the severity of skin involvement and the severity of periodontal involvement. An improvement with age could be seen for the cutaneous lesions but not for the periodontal condition. Systemic medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no severe complication/side effect could be seen after several years of continuous use. However, from the results of this study it can be concluded that, at least in a situation with poor compliance of daily oral home-care, no positive effect on the periodontal health in patients with PLS could be seen by the retinoid medication.
An investigation has been conducted in order to assess the oral health status and need for dental treatment among Cape Coloreds resident in homes for the aged in the Cape Peninsula of South Africa. Tooth loss was greater in females than in males (P less than 0.002) but a statistically significantly greater proportion of surviving teeth were grossly carious in men than in women (P less than 0.002). More teeth had survived in the mandible than in the maxilla (P less than 0.002) and proportionately more teeth were grossly carious in the maxilla than in the mandible (P less than 0.002). The distribution pattern of the remaining dentition according to tooth type was similar for both jaws, the canines being the most persistent teeth.
Dental history, dental status, the need for prosthetic treatment and dental treatment habits were studied in 389 men aged 21--54 years. The men were selected from a group undergoing military refresher training in the south of Sweden. One percent of the men were toothless. About 3% had full dentures in one or both jaws and an equal percentage had partial dentures. About 3% of the men had bridges in the maxilla and 2% in the mandible. Tooth loss was greatest in the mandibular molar segment, followed by the maxillary molar segment. By means of an index for dental status about 8% of the men were judged to be in great need of prosthetic treatment for aesthetic reasons and/or to improve occlusion. Age, place of birth, educational level and smoking habits were among the factors which seemed to be related to dental status. Seventy percent of the men reported that they went to the dentist once a year, while about 10% seemed rarely or never to seek dental treatment. Dental treatment habits were correlated to place of birth, number of brothers and sisters, edentulousness and the need for prosthetic treatment, among other factors.
The study describes tooth mortality levels and pattern of prosthetic treatments in a sample of 1744 Chinese aged 20-80 yr who are residents of Beijing area. Complete edentulousness was rarely seen before the age of 60 yr. Beyond this age up to 26% were edentulous, depending on age and sex. The mean number of teeth present ranged from 10.0 to 29.7 depending on age, sex, and area of residence. Below the age of 60 yr very few persons had experienced extensive loss of teeth but thereafter the number of teeth missing was substantially increased. Prosthetic treatments in the form of partial dentures, crowns, and bridges were frequently observed even in the younger age groups. In all age groups the number of teeth exhibiting caries lesions involving the pulp was much higher than the number of teeth exhibiting extensive mobility. Although many people retain a high number of teeth even late in life our findings indicate a substantial need for, in particular, relief of pain services. Concurrently, emphasis must be placed on preventive programs aiming at interfering with ongoing disease.
Oral research concerning diabetes mellitus has revealed a number of clinical implications. These include, among others, the need for more intense management of the diabetic patient with periodontal disease because tissue destruction may be accelerated, the need for rapid control of oral infection in these patients in order to prevent exacerbation of the existing metabolic imbalance, and the desirability of performing a screening for diabetes mellitus on all patients exhibiting asymptomatic parotid enlargement. Despite the explosion of knowledge concerning diabetes mellitus that has occurred since the discovery of insulin, its definitive etiology continues to elude the scientific community and its treatment remains in the realm of clinical management rather than in that of prevention and cure. In the past, research on diabetes has focused on the role of insulin in seeking the fundamental etiology of diabetes and its complications. With the progression of research, it has become apparent that the initiation and progression of the disease probably involve the interplay of a multiplicity of factors. Hereditary and immunologic factors, as suggested earlier, appear to be operated on by environmental factors, subsequently altering the body's metabolic milieu with widespread primary and secondary effects. Fertile areas for future oral research in diabetes mellitus will include, therefore, genetics, immunology, enzymology, and basement membrane pathology. On the cellular and molecular levels, particularly, the oral cavity and associated structures comprise a somewhat under-investigated area in diabetes mellitus research and, thus, hold great promise for increasing our knowledge of this complex disease.
Hypophosphatasia is an inherited disorder characterized by defective mineralization of the skeletal and dental structures of the body and deficient liver/bone/kidney alkaline phosphatase (L/B/K ALP) activity. There has been a tremendous advance in our knowledge of this condition over the last decade due to the advent of highly specific DNA probes and novel microanalytic techniques. The purpose of this paper is threefold: to review the dental aspects of current literature about this rare condition; to present a case (and family study) that was diagnosed in a 5-yr-old boy from 0.14 microliters of gingival crevicular fluid, using a new ultrasensitive chemiluminescent assay for the enzyme alkaline phosphatase; and to provide strong evidence for an autosomal dominant mode of inheritance.
The Child-OIDP index is an indicator of oral health-related quality of life, which has been validated among 12-yr-old children in Thailand. The aim of this study was to assess the reliability, validity, and applicability of this questionnaire among French children. After translation and cultural adaptation, the Child-OIDP was tested on 414 10-yr-old children in France. The children completed the Child-OIDP in face-to-face interviews, were clinically examined, and answered questions evaluating their global self-rated oral health. Parents filled in a questionnaire concerning their socio-demographic background. An oral impact on daily life was reported by 73% of the children. The mean Child-OIDP score was 6.32 [standard deviation (SD) 8.22] and the median was 3.33. The internal reliability was confirmed with a Cronbach's alpha of 0.57. The retest procedure (n = 62) showed a satisfactory reproducibility (r = 0.81, kappa = 0.75). The index was shown to be a valid instrument. Construct validity was satisfactory as the Child-OIDP score increased when the children's perceived oral health decreased. The Child-OIDP score was able to discriminate between different socio-demographic groupings and varied according to dental status. This study showed that the Child-OIDP is applicable for use among children in France. It has promising psychometric properties but further research is required to evaluate its sensitivity to change.
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