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Oral manifestations in Rett syndrome: a study of 17 cases.

Seventeen patients with a mean age of 7.33 (range 2.7-12.7) years with Rett syndrome (a progressive neurological disorder that occurs mainly in females) were evaluated for oral manifestations and habits. The most frequent habits were digit/hand sucking and/or biting (17/17), bruxism (14/17), mouth breathing (7/17), drooling (5/17), and tongue thrusting (5/17). Gingivitis (13/17) was the most common alteration of soft tissues. Only 2.7% of tooth surfaces were decayed. Nonphysiological dental attrition was present in 71% (12/17) of the children. Palatal shelving could be observed in 53% (9/17) of the children, probably related to the digit/hand sucking and/or biting habits. A high prevalence of anterior open bite (9/17) was observed. No patients exhibited anomalies of tooth number, size, form, structure, or eruption.

Bruxism↗

Dental arch space and permanent tooth size in the mixed dentition of a skeletal sample from the 14th to the 19th centuries and 3 contemporary samples.

Dental arch space and permanent tooth size in the mixed dentition were studied in 4 cohorts: (1) 48 skulls from the 14th to the 19th centuries from The Schreiner Collection in the Department of Anatomy, University of Oslo; (2) 39 boys and 34 girls of Sami origin born in the 1980s living in northern Norway; (3) 31 boys and 30 girls born in the 1960s living in southern Norway; and (4) 32 boys and 26 girls born in the 1980s living in the same part of southern Norway as the previous group. The sexes were unknown in the skeletal sample, and the groups were analyzed with the sexes pooled. The crown sizes of the permanent teeth in the mixed dentition of the Norwegian children who had lived between the 14th and the 19th centuries were smaller than those of contemporary children living in the same country. Probable reasons for this increase in tooth size include improved nutrition and reduced morbidity, because this study ruled out attrition as a major cause of the discrepancy in tooth size. The relative space (arch perimeter minus tooth size) in the group born in the 1960s deviated from that in the other 3 groups, indicating a greater degree of crowding in this group. The relative space in the skulls did not differ significantly from that in the groups born in the 1980s. This means that the improved caries situation during the last decades has changed the dental arch space in these populations. The irregularity index of the 4 mandibular permanent incisors was larger in the skulls than in the modern samples.

Analysis of Variance↗

Dates, caries, and early tooth loss during the Iron Age of Oman.

Diets high in fermentable carbohydrates are known to be highly cariogenic, particularly when contained in very sticky food such as dates. This medium allows food to remain in contact with the teeth, thereby resisting the normal flushing action of the saliva. When comprising a large portion of the diet, food such as this can lead to high caries incidence and accelerated tooth loss. This appears to be the situation found in a skeletal series from the late Iron Age in the Sultanate of Oman (100 BC-AD 893). Dental remains from 37 individuals were used in this study. Antemortem tooth loss (AMTL), caries, and dental attrition data were compiled from the 32 adult and juvenile specimens. In this sample, the caries rate is 35.5% of individuals (39.4% corrected), and 18.4% of teeth (32.4% corrected), while AMTL occurs in 100% (ten of ten) of preserved mandibles. Caries onset in permanent molars begins soon after eruption, with tooth loss and remodeling of the alveolus frequently complete by the time of third molar occlusion.

Adolescent↗

Neandertal incisor beveling.

In discussions of the Neandertals, there has been repeated emphasis on the accelerated rate of attrition and the frequent presence of labial beveling of their incisors. Interpretations of this dental attrition have related it to paramasticatory and dietary uses of their anterior teeth as well as to aspects of their facial morphology. In light of this, we examined the rate of beveling (the angle between the labial and incisal surfaces) of central incisors relative to tooth wear in samples of Neandertals, Inuits and Puebloan Amerindians. I1s show little change in the beveling angle with wear and no significant differences between the samples. I1s, however, exhibit a consistent pattern of increased beveling with dental attrition, progressing rapidly until the crown height approximates its labiolinguinal cervical diameter, and then proceeding at a slower rate. All three samples exhibit a similar pattern. However, the Neandertals have significantly greater beveling in more worn teeth than either recent human sample, and the Inuits have nonsignificantly increased beveling relative to the Puebloans in these more worn I1s. In this, it is the degree of development of beveling, not the pattern of beveling, which differentiates the Neandertals. It is hypothesized that the differences between the Neandertals and recent samples could be the product of: (1) contrast in initial incisor procumbency, (2) a labial separation of the maxillary and mandibular incisal occlusal surfaces during edge-to-edge bite, and/or (3) a greater degree of interproximal wear promoting increased "posterior tipping" of the maxillary incisors. The last appears most likely.

Animals↗

Dental attrition of Mayan Tzutujil children--a study based on longitudinal materials.

The purpose of this study was to evaluate dental attrition by measuring attrition volume on all types of teeth during facial growth, tooth shedding and eruption. Dental casts and cephalograms of 7 male and 7 female Mayan Tzutujil Indian children were used. Relationships were found between increase in vertical and horizontal facial growth and increase in attrition on the deciduous canines, first and second molars, permanent incisors and first molars in both arches and in both sexes. Significant increases in attrition were found on the deciduous second molars during eruption of the permanent first molars, and on the permanent incisors and first molars during eruption of the second molars in both arches and in both sexes. The results suggest that the function of attrition is 1) to compensate for increase in vertical and horizontal dimensions during facial growth, and 2) to adjust the occlusal surfaces during tooth eruption and occlusal development. In addition, an attritional index was developed to evaluate attrition among teeth. This index could be used in the future to make comparisons among different populations. Comparisons were made among Class I, II and III molar relations by using the attritional index, showing how it can be used to gain a better understanding of the characteristic patterns of dental attrition.

Adolescent↗

Population variation in tooth, jaw, and root size: a radiographic study of two populations in a high-attrition environment.

Radiographs were taken of the jaws of skeletal remains of two populations of different-phenotype Prehistoric Australians from Roonka and Early New Zealanders (Maoris). On these radiographs crown, root, and corpus size were measured. Corpus height was subdivided into alveolar bone height, defined as the bone superior to the mandibular canal, and basal bone height, defined as that inferior to the mandibular canal. Both between and within the two populations there was a significant and negative correlation between crown size and corpus height. The differences between the two populations in corpus height were associated with differences in alveolar bone height rather than basal bone height and support hypotheses associating continued eruption of adult teeth with growth of the alveolar bone. The findings also support previous studies that have shown only a low correlation between crown size, root size, and corpus height.

Australia↗

Oral kinesiology. A new postgraduate programme in the Netherlands.

As one of the dental differentiations in The Netherlands, temporomandibular disorders (TMD) focuses on the diagnosis and treatment of pain and dysfunction of the masticatory system. Bruxism (i.e. tooth clenching and/or grinding) is thought to play an important aetiological role in TMD. Among others, bruxism may result in TMD pain and dental attrition. The close relationship between TMD, bruxism, and attrition necessitates an integrated approach to these clinical problems. This could be achieved through the multidisciplinary differentiation 'oral kinesiology', that covers not only the diagnosis and treatment of TMD and bruxism but also the restoration of worn dentitions. This article focuses on the background of oral kinesiology, as well as on the rationale to develop a curriculum for the postgraduate training of dentist-kinesiologists in the Netherlands. Further, the oral kinesiology curriculum of the Academic Centre for Dentistry Amsterdam will be introduced. This curriculum will ensure that specialized professionals, who are able to approach the different aspects of oral kinesiology in an integrated manner, are available not only for general dental practice but also for centres for special dental care and university departments. This will lead to improved care for patients, whose management is until now dispersed between various dental specialists.

Bruxism↗

Skeletal evidence of health and disease in pre-contact Alaskan Eskimos and Aleuts.

There have been relatively few paleopathological studies of arctic populations to date, compared to other regions of North America. Studies aimed at elucidating patterns of health and disease in arctic peoples prior to contact and assessing inter- and intraregional differences in disease patterns have been particularly few. In the present study, five pre-contact skeletal samples (N = 193), representing 4 Eskimo populations from northern coastal Alaska and 1 Aleut population from the eastern Aleutian Islands, were examined macroscopically for the following indicators of health status: cribra orbitalia, porotic hyperostosis, trauma, infection, dental caries, abscesses, antemortem tooth loss, periodontal disease, and dental attrition. In addition, archeological and epidemiological data were used to help reconstruct the health of these populations. The goals of the analysis were 2-fold: 1) to assess the pre-contact health of North Alaskan Eskimos and Aleuts in order to provide a baseline comparison for the post-contact health of these groups, and 2) to determine if any differences in disease patterns exist between the Eskimos and Aleuts that might be related to differences in their physical environment, subsistence patterns, and cultural practices. The analysis revealed that both groups suffered from a variety of health problems prior to contact, including iron deficiency anemia, trauma, infection, and various forms of dental pathology. Statistical comparisons of the 2 groups revealed that Eskimos and Aleuts had different patterns of health and disease prior to contact. Most notably, the Aleuts had a significantly higher frequency of cranial trauma and infracranial infection than the Eskimos, while the latter had a significantly higher frequency of enamel hypoplasia. An examination of the physical and cultural environment of the 2 groups reveals several possible explanations for these differences, including warfare, subsistence pursuits, and housing practices. The documentation of these differences indicates that variability in pre-contact disease patterns can be identified between hunter-gatherer populations living in similar environments and exhibiting similar general lifestyles.

Alaska↗

The mandible--an analysis.

In this study, an attempt has been made to examine and analyse the ancient mandibles of people who have died several hundreds of years ago during the second and first millenium B.C. These mandibles have been recovered from the burial mounds in Bahrain (Arabian Gulf) and preserved in the National Museum and the Department of Antiquities in Bahrain. The dental conditions recorded are e.g. attrition, caries, fluorosis, periodontitis or antemortem tooth loss. The results indicate the age, sex, diet, occupation and environmental conditions that existed and even the culture of the people. A comparative study of the ancient mandibles and those of the present generation has been carried out.

Adult↗

The eternal tooth germ is formed at the apical end of continuously growing teeth.

Rodent incisors are known to be continuously growing teeth that are maintained by both the cell-proliferation at the apical end and the attrition of the incisal edge. This type of tooth had a special epithelial structure for the maintenance of stem cells, showing the bulbous epithelial protrusion at the apical end. The morphological transition of the epithelial-mesenchymal compartment by serial transverse sections of the apical end toward the incisal direction is likely to reflect the development of the tooth germ in the prenatal stage. Based on the present histological and previous molecular biological studies, the special structure at the apical end is obviously different from the cervical loop giving rise to Hertwig's epithelial root sheath (HERS), in human, mouse and rat molar tooth germs. Hence, we propose a new concept that the eternal tooth bud producing various dental progeny is formed at the apical end of continuously growing teeth, and a new term "apical bud" for indicating this specialized epithelial structure. Furthermore, BrdU labelling analysis suggested that the guinea-pig molars, which were continuously growing teeth, also possessed plural specific proliferative regions and "apical bud" at the apical end.

Animals↗

Continuing tooth eruption and alveolar crest height in an eighteenth-century population from Spitalfields, east London.

Earlier studies on dried skulls have shown that continuing eruption occurs throughout life to an extent which appears to compensate for occlusal attrition. Some investigators have interpreted the increasing distance between the tooth cervical margin and the alveolar crest as an indication of horizontal bone loss due to chronic inflammatory periodontal disease. In order to determine whether continuing eruption occurs in the absence of attrition, measurements were made on the jaws of an eighteenth-century population whose tooth wear had been minimal. Horizontal bone loss at the alveolar margin was minimal or absent. Continuing eruption had occurred, indicating that facial height probably increased throughout the life time of the individuals.

Adolescent↗

Tooth wear: an aetiological and diagnostic problem.

Tooth wear is an all-embracing term for attrition, abrasion and erosion which does not presuppose the mode of wear and allows for combined aetiology. Identification of the aetiology is essential for successful management. Known risk factors are discussed for attrition, abrasion and erosion. A combination of aetiologies complicates the diagnosis and may modify the clinical appearance or pattern of tooth wear. Examples of such cases are presented.

Acids↗

Principal axis analysis of dental attrition data from two Australian Aboriginal populations.

Dental attrition scores from two distinct Australian Aboriginal populations were compared by principal axis analysis. The first group was composed of members of the Narrinyeri group who occupied the river basin and mouth of the River Murray. The second group consisted of members of the Kaurna tribe who occupied the coastal plain to the west of the Narrinyeri. The groups were isolated both physically and culturally and as a result differences in patterns of tooth wear might be expected. In the Narrinyeri sample, attrition tended to be more rapid in females for all but the anterior teeth. The only sex difference in the Kaurna was for the maxillary central incisors, which wore more rapidly in females. Interpopulation differences in the pattern of tooth wear were also evident. The incisors, canines, and premolars of Kaurna subjects tended to wear more rapidly, while the rate of posterior tooth wear tended to be greater in the Narrinyeri. The application of the principal axis method to quantitative attrition data provided a sensitive, objective evaluation of tooth wear. The reasons for the observed differences between the two groups are still not completely clear but may reflect both functional and morphological differences between groups.

Australia↗

Increase of tooth size in prehistoric coastal Peru, 10,000 B.P.-1,000 B.P.

Teeth increase in size during a 9,000-year period in an archaeologically derived, radiocarbon dated sample of skeletons from a geographically restricted area of coastal Peru. Although cultural change is extensive, including the transition to food production and pottery making, teeth do not reduce as predicted under these conditions by Brace's Probable Mutation Effect. Since most of the dental literature dealing with size change of teeth focuses upon dental reduction, hypotheses explaining why teeth increase through time are not well developed. No obvious selective forces explaining size increase are apparent in the present data. Attrition decreases through time. The increase in tooth size in this collection may be a function of overall cranialfacial size increase, which (pending further data) may be related to a general body size increase.

Female↗

Surface ultrastructure of rat molar teeth after experimentally induced erosion and attrition.

Young Osborne-Mendel rats were given different diets for 6 weeks. Effects of soft and rough food as well as acidic sport drink on the lingual surfaces of first mandibular molars were studied. In addition, the effect of fluoride on erosion was examined. A Jeol JSM-35 scanning electron microscope was used to visualize tooth surface ultrastructure. Intact surfaces were found in the rats given soft food and distilled water. Sport drink (pH 3.2) caused severe erosion with total loss of supragingival enamel and exposure of dentin. Attrition effects were seen on the cuspal parts of the surface when rough food was given. Tooth tissue loss was greatest in the rats given rough food and sport drink; signs of both erosion and attrition could be seen. When fluoride was added to the sport drink erosion lesions were less severe and if dentin was exposed, the dentinal tubules were partly occluded. These SEM observations support earlier studies which have suggested that erosion may alter tooth surface so that it is more susceptible to attrition; in those lesions, however, clinical diagnosis of the initial causes may be difficult.

Animals↗

Crown lengthening: a clinical review.

The use of crown lengthening surgery as an adjunct to restorative therapy was first suggested by Rosen and Gitnick. This technique is designed to increase the clinical crown heights of teeth requiring restoration following extensive wear through attrition, abrasion and erosion. This loss of tooth tissue and resulting clinical crown height may be localized to a few teeth or affect the entire dentition. This clinical problem is reflected by the increasing number of reports of treatment of the worn dentition.

Crown Lengthening↗

Case report: tooth wear associated with an unusual habit.

Pathological tooth wear is an increasing problem affecting a significant proportion of the population. Although different wear mechanisms have been described, most reports in the literature concentrate on cases in which the predominant mechanisms were erosion and attrition. This article presents an unusual case of abrasive tooth wear caused by a sand eating habit which the patient had adopted as a child. Different causes of "abrasive" wear are discussed and the difficulties in management of this case are also presented.

Adult↗