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Combined orthodontic-surgical management of residual palato-alveolar cleft defects.

These cases are presented in detail from a series of fifteen cases treated in the described manner, with follow-up orthodontic documentation 2 to 5 years after PMCB grafts. The long-term results in all of the cases were excellent. Late or secondary bony reconstruction of the osseous alveolar and anterior palatal clefts may be accomplished with either an essentially nonviable autogenous graft or an autogenous particulate marrow and cancellous bone graft. The differences essentially are as follows: 1. In the nonviable graft, orthodontic movement of teeth adjacent to the cleft is undertaken at some time prior to the grafting procedure. This is opposed to the use of the autogenous PMCB graft in which active orthodontic treatment may be undertaken within 2 months after the osseous grafting procedure. 2. In the use of nonviable autogenous bone, presurgical orthopedic treatment to expand the arch is usually essential since extensive arch expansion is not usually possible after grafting. With PMCB grafts , postsurgical arch expansion may be routinely undertaken. 3. It is thought that the use of rib, solid one-piece grafts from the ilium, and other types of nonviable graft is warrented only after major growth and development of the premaxillary region has occurred. This is due to lack of ability of such a grafted area to keep pace with the growth of adjacent bone segments. This would mean that secondary grafting with such grafts would be restricted to patients over 15 years of age. This is opposed to the PMCB technique, in which the next procedure may be undertaken at any time from the age of mixed dentition to adulthood but preferably earlier than the age of 7, before the lateral incisor has erupted and been lost through exfoliation into the cleft area. Thus with these two techniques, there is a marked difference in the philosophy of grafting and a marked difference in the overall results. There is, in addition, an altered philosophical effect upon the total maxillofacial cleft palate team, with a marked difference in the type of treatment and prognosis which can be offered in terms of social rehabilitation of the patient. While the team approcah to the treatment of the cleft palate patient has done much to advance rehabilitation in terms of social and psychological problem areas, speech correction, and soft-palate and cosmetic lip restoration, much needs to be done to rehabilitate the patient completely from a dental standpoint. We believe that the prognosis of dental rehabilitation without appropraite bone-grafting procedures of the alvolar and prepalatal cleft is unfavorable. The use of the PMCB procedure in conjunction with orthondotic therapy opens new avenues to the total rehabilitation of the patient with an anterior maxillary cleft.

Adolescent↗

Successful periodontal maintenance of a case with Papillon-Lefèvre syndrome: 12-year follow-up and review of the literature.

BACKGROUND: Various approaches to treating the periodontal condition associated with Papillon-Lefèvre syndrome have been reported. These include oral hygiene instruction, use of mouthrinses, frequent debridement, multiple antibiotic regimens, periodontal surgery, extraction of hopeless teeth, and extraction of all deciduous teeth. Because Papillon-Lefèvre syndrome is rare, most publications are case reports, and very few document long-term successful treatment of the periodontal condition. METHODS: In 1986, a 3.5-year-old Indo-Canadian male was diagnosed with Papillon-Lefèvre syndrome and began periodontal treatment. Initial therapy consisted of debridement every 3 weeks, a 0.12% chlorhexidine mouthrinse, 2 regimens of metronidazole, and oral hygiene instruction for his parents. After 10 months it became apparent that the treatment was having little beneficial effect, since the periodontal destruction continued and teeth 51 and 61 exfoliated. At age 4, all remaining deciduous teeth were extracted and complete dentures inserted for the following 2-year edentulous period; then a 3-month maintenance schedule was maintained. RESULTS: The patient is now 17 years old and all his adult teeth are present with the exception of the third molars. His oral hygiene varies between moderate and good, with his most recent plaque score at 80% effectiveness. There are no probing depths greater than 4 mm, with the exception of the distal of the lower second molars where opercula are present. CONCLUSIONS: Extraction of all the deciduous teeth followed by a period of edentulousness may partially explain the fact that there has been no recurrent attachment loss in the permanent teeth up to age 17. Other explanations are discussed as part of the literature review of Papillon-Lefèvre syndrome.

Adolescent↗

Clinical performance and caries inhibition of resin-modified glass ionomer cement and amalgam restorations.

BACKGROUND: The authors clinically examined two restorative materials to evaluate their effectiveness in Class II restorations in primary molars and their ability to inhibit recurrent caries. METHODS: Forty subjects, each in need of two Class II restorations in primary molars, took part in this study. Each patient received one Class II restoration of resin-modified glass ionomer cement and one of amalgam. The authors evaluated the restorations at six-month, one-year, two-year and three-year recall appointments. On exfoliation, teeth with experimental restorations were retrieved and microscopically examined for inhibition of demineralization at restoration margins. RESULTS: The results of the clinical evaluation demonstrated no significant differences between the resin-modified glass ionomer cement restorations and the amalgam restorations (P < .05). Polarized light microscopic examination of the returned teeth that were restored as a part of this study indicated that the resin-modified glass ionomer cement had significantly less enamel demineralization at restoration margins than did amalgam (P < .0001). CONCLUSIONS: The resin-modified glass ionomer cement functioned clinically as well as amalgam for Class II restorations in primary molars. However, the resin-modified glass ionomer exhibited significantly less enamel demineralization at restoration margins than did amalgam. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement restorative material functions well for Class II restorations in primary molars and exhibits less recurrent caries at restoration margins than does amalgam.

Cariostatic Agents↗

One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth.

Atraumatic restorative treatment (ART) and minimal intervention treatment (MIT) techniques were evaluated under field conditions in 5 regions of the Western Cape Province of South Africa, where caries prevalence exceeds 60% and remains mostly untreated. The purpose of the study was to compare and evaluate results of ART and MIT techniques in the primary dentition of 6-9 year-old schoolchildren using glass-ionomer (GI) (Fuji IX) and compomer (Dyract AP) materials. At baseline 401 children were treated, and 1,119 restorations placed by 5 calibrated dentists, 53% with ART (using hand instruments only) and 47% with MIT (minimal use of slow hand-piece) techniques. Evaluations were done with a CPI periodontal probe to measure marginal defects and to detect decay. A pain assessment for the restoration procedures indicated that 80% of subjects experienced no pain, 18% discomfort and slight pain, and 2% required local anaesthetic. After one year 90.5% of subjects and 80% of restorations were followed up (11.1% lost as a result of exfoliation); of these restorations 86% were clinically acceptable (84.1% of the ART and 88% of the MIT). With the art technique 82.7% of GI restorations and 85.6%, of compomer restorations were acceptable. With the MIT technique 86.5% of GI restorations and 89.9% of compomer restorations were acceptable. Success of restorations per region varied significantly: regions 1 and 2-90%, region 3-80%, region 4-70% and region 5-95%. There were no significant statistical differences in respect of materials or methods employed. ART and MIT techniques were well accepted as complementary caries approaches by operators. One-year results show that ART and MIT techniques were successful, substantiating its use for the primary dentition in areas with high caries prevalence. Longer-term assessments are required.

Anesthesia, Dental↗

Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molar pulpotomy.

PURPOSE: Formocresol and ferric sulfate were evaluated as pulpotomy medicaments using evidence-based dentistry principles. Formocresol has been challenged as a potential carcinogen and mutagen, leading to consideration of ferric sulfate. METHODS: The PICOT statement was: (P) In human carious primary molars with reversible coronal pulpitis, (I) does a pulpotomy performed with ferric sulfate, (C) compared with formocresol, (O) result in dinical/radiographic success, (T) in time periods up to exfoliation? Relevant papers (N=894) were identified from databases and inclusion criteria were applied; 94 papers remained (randomized clinical trials [RCTs]=7; clinical trials [CTs]=28; case-control studies=14; opinions, cohort, and cross-sectional studies=4; reviews=22; irretrievable papers=19). Three RCTs and 10 CTs (total teeth: formocresol=753; ferric sulfate=90) were meta-analyzed; 1 RCT and 1 CT were tested for homogeneity (odds ratios; 95% confidence intervals); 3 RCTs and 10 CTs were examined by student's t test. RESULTS: Clinical data indicated ferric sulfate was significantly more successful than formocresol (OR=1.95; CI=1.01-3.80). Radiographic data indicated no difference between medicaments (OR=0.90; CI=0.58-1.39). Medicaments did not differ with t-tests of clinical (P>.10) and radiographic (P>.50) data. CONCLUSIONS: This evidence-based assessment concluded that, in human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate are likely to have similar clinical/radiographic success.

Child, Preschool↗

The effect of cavity disinfectants on microleakage in dentin bonding systems.

The purpose of this study was to determine the effect on microleakage of two disinfectants, one a chlorhexidine based and the other alcohol based, used as cavity washes prior to the application of one step dentin bonding systems Syntac and Prime & Bond in Class V composite restorations. Children between 10-12 years old, with noncarious second primary molars about to exfoliate, were selected for this study. Cavity preparations were treated with either Syntac or Prime & Bond, combinations of one of the two disinfectants washes with Syntac or Prime & Bond or with one of the disinfectants only and filled with Tetric composite resin. All teeth were extracted one month later, stained and sectioned to evaluate dye penetration. As a result, focal dry disinfectant when used as a cavity wash prior to the use of Prime & Bond did not effect the ability of dentin bonding agents to prevent microleakage. Chlorhexidine solution had an adverse effect on Syntac and Prime & Bond and produced significantly higher microleakage when used with these bonding systems. The use of cavity disinfectants with composite resin restorations appears to be material specific regarding the interactions with various dentin bonding systems and the ability to seal dentin.

Analysis of Variance↗

Cleidocranial dysplasia: diagnostic criteria and combined treatment.

Cleidocranial dysplasia (CCD) is an uncommon, generalized skeletal disorder characterized by delayed ossification of the skull, aplastic or hypoplastic clavicles, and serious, complex dental abnormalities. There are many difficulties in the early diagnosis of CCD because a majority of the craniofacial abnormalities becomes obvious only during adolescence. In the present case, a hypoplastic midface, a relative prognathia of the mandible, and close approximation of the shoulders in the anterior plane were the conspicuous extraoral findings. Prolonged exfoliation of the primary dentition, unerupted supernumerary teeth, and the irregularly and partially erupted secondary dentition produced occlusional anomalies. The presence of the second permanent molars together with the primary dentition and wide spacing in the lower incisor area were typical dental signs. Gradual extraction of the supernumerary teeth and over-retained primary teeth was the first step of oral surgery. This was followed by a surgical exposure of the unerupted teeth by thinning of the cortical bone. Orthodontic treatment was aimed at parallel growth of the jaws. Removable appliances were used to expand the narrow maxillary and mandibular arches, and a Delaire mask compensated for the lack of sagittal growth of the upper jaw. Temporary functional rehabilitation was solved by partial denture. When the jaws have been fully developed, implant insertions and bridges are the therapeutic measures. The reported case and the literature data support the importance of the early diagnosis and interdisciplinary treatment of CCD.

Adolescent↗

Morphology of dental enamel and dentine-enamel junction in osteogenesis imperfecta.

OBJECTIVES: The aim of this study was to examine the morphology of primary and permanent human enamel, and the dentine-enamel junction, in individuals with osteogenesis imperfecta (OI) type I, III and IV in undecalcified sections using polarized light microscopy, microradiography and scanning electron microscopy (SEM), and to relate the findings to the type of OI. SAMPLE AND METHODS: Extracted or exfoliated teeth from 15 patients representing the OI types I, III and IV (12 primary teeth from seven patients, and 11 permanent teeth from eight patients). Ten primary and nine permanent teeth from normal healthy patients served as controls. The teeth were serially cut longitudinally in a bucco-lingual direction and contact microradiographs were made. The sections were examined in polarized light. Sections of primary and permanent teeth were examined by means of SEM. RESULTS: This study shows that the permanent enamel from patients with OI exhibits few structural changes. No relationships were found between enamel morphology and the types of OI (I, III, IV). Primary enamel appeared to be slightly more irregularly mineralized, especially in cases with the additional diagnosis dentinogenesis imperfecta. The major findings were deviations in association with the dentine-enamel junction, and locally a lower degree of mineralization. CONCLUSIONS: The mesodermal disease OI might also be manifested in ectodermal enamel, probably because of suboptimal mesenchymal-ectodermal interactions during amelogenesis.

Dental Enamel↗

Assessment of marginal leakage around Class II composite restorations in retrieved primary molars.

The aim of the present investigation was to evaluate, by means of dye penetration, the microleakage around Class II composite restorations, in retrieved primary molars that functioned in the mouth for at least one year. The experimental material consisted of 13 exfoliated primary molars that had been restored with Herculite (Kerr Corporation, Romulus, Michigan 48174 USA) at least one year previously, utilizing an incremental or a bulk filling technique. The retrieved teeth were insulated with utility wax and nail polish, immersed in 2% basic fuchsin, embedded in acrylic resin, and ground off to various depths. The marginal leakage was assessed according the degree of dye penetration at the occlusal and cervical margins. No difference was observed between the two filling techniques. In most teeth, no leakage at the occlusal margins was observed; minimal leakage, limited to the enamel, was observed at the occlusal margins of two teeth, one of each filling technique. Severe penetration was evident at the cervical margin of three restorations, two of them filled incrementally and the third using the bulk technique. Mild to moderate penetration was observed at the cervical margin in the majority of the other restorations. It was concluded that an incremental filling technique could not eliminate microleakage at the cervical margins of Class II composite restorations.

Child↗

Microleakage of class 2 Superbond-lined composite restorations with and without a cervical amalgam base.

The purposes of the present study were: 1) to assess the microleakage at the cervical margin of Superbond-lined composite restorations with and without a cervical amalgam base and compare the results to cervical margins of composite restorations lined with Scotchbond 2, and 2) to compare the quality of the occlusal margins of Superbond-lined P-50 restorations with those bonded with Scotchbond 2. Forty-eight class 2 cavities were prepared in extracted or exfoliated primary molars. The teeth were randomly divided into three groups and restored as follows: Group A, amalgam + Superbond + P-50 (sandwich); Group B, Superbond + P-50; Group C, Scotchbond 2 + P-50 (control). Marginal leakage was assessed by the degree of dye penetration on sections of the restored teeth. The occlusal margins presented no or minimal leakage (degrees 0 and 1) in 53% of Group A restorations, 60% of Group B, and 44% of Group C. These differences were not statistically significant (P<0.05). The cervical margins showed moderate to severe dye penetration (degrees 2 and 3) in 94% of Group A, 47% of Group B, and 87% of Group C. These differences were statistically significant (P<0.05). The amalgam/Superbond/composite interface exhibited no leakage in 70% of the restorations. Although marginal leakage was not completely eliminated, Superbond exhibited significantly less leakage (P<0.05) at the cervical margins than Scotchbond 2 or amalgam with Superbond.

Bisphenol A-Glycidyl Methacrylate↗

Periodontal attachment responses to surgical injury in the cat. Removal of buccal bone with and without placement of foreign body at ligament periphery.

Recently, PDL progenitor cells were claimed essential for the establishment of new connective tissue attachment to root surface. To further test new periodontal attachment after surgical injury, portions of the buccal alveolar plate were removed from the canines of 4 cats. Removal of bone was carried out with or without removal of the underlying PDL, and in half of the experimental sites, dental amalgam was placed at ligament periphery. Tissue blocks were prepared for routine histologic evaluation (H & E) and specific collagen stains (Mallory Trichrome and Mallory PATH). Exfoliation of amalgam was noted in 6 experimental sites during the healing period. At all sites, plaque accumulation and marginal gingivitis were observed before sacrifice. Histologic observation demonstrated limited new connective tissue attachment to root surfaces at PDL periphery where bone, PDL and cementum had been removed. Where PDL was retained, connective tissue attachment was present which appeared to be the result of fiber interdigitation between root-inserted fiber ends and gingival wound edge fibers. "Blockage" of PDL cell migration by amalgam could not be well controlled. However, the placement of amalgam seems to have interfered with new connective tissue attachment and/or cementogenesis. In 5 specimens, root resorption had progressed into dentin. At these sites, collagen tufts appeared to arise from dentin. These tufts were in intimate contact with zones of dense inflammatory cellular infiltrate and connective tissue elements. We suggest that this observation may be a further tissue response to injury, namely: root resorption with the unmasking of dentinal collagen, which may finally lead to fiber interdigitation.

Alveolar Process↗

Enamel protein in smooth hypoplastic amelogenesis imperfecta.

Amelogenesis imperfecta (AI) remains a poorly understood group of hereditary enamel defects characterized by a wide array of clinical presentations. Although numerous reports have described the histological features of AI, knowledge concerning the biochemical composition of the affected enamel remains minimal. The purpose of this investigation was to examine the protein of smooth hypoplastic AI enamel. Exfoliated primary teeth were obtained from an individual with smooth hypoplastic AI together with exfoliated teeth from normal healthy individuals for controls. Enamel was dissected from the AI and control teeth to determine protein content and amino acid profile. The analyses showed that the hypoplastic AI teeth contained 2% protein, compared with 0.3% in normal primary enamel. The protein content of the hypoplastic AI enamel was similar to that reported for the late maturation stage of normal primary enamel. The amino acid profiles of both normal and AI enamel were similar although there appeared to be increased amounts of glycine in the AI enamel. Hypoplastic AI enamel showed an amino acid profile similar to normal mature primary enamel in contrast to hypomaturation AI that exhibits an amelogenin-like character. The amount of retained protein also was different from that reported for hypomaturation AI enamel which contains approximately 5% protein compared with the 2% seen in hypoplastic AI enamel. This study emphasizes the potential usefulness of protein characterization in delineating different AI types and illustrates how this information may lead to an understanding of the developmental defects responsible for producing abnormal enamel.

Amelogenesis Imperfecta↗

Longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth: three-year results.

The aim of this study was to compare the longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth. The materials consisted of 515 Ketac-Fil glass-ionomer restorations and 543 Dispersalloy amalgam restorations prepared in 666 children, from 3 to 13 years of age, by 14 dentists within the Danish Public Dental Health Service in the municipalities of Vaerløse and Hillerød. The restorations, of which 79% were of the Class II type, were in contact with 593 unrestored surfaces in adjacent primary and permanent teeth. After 3 years, 6% of the patients had dropped out of the study, and 33% of the teeth were exfoliated with the restoration in situ. A further 37% of the glass-ionomer and 18% of th amalgam restorations were recorded as failed (p < 0.001). The frequency of failures was highest for Class II glass-ionomer restorations, which showed a 50% median survival time of only 34 1/2 months, because of many fractures, while the 75% survival time for Class II amalgam restorations just exceeded the actual 36 months (p < 0.001). Caries progression was most often recorded in surfaces adjacent to amalgam restorations, and 21% of these surfaces needed restorative treatment vs. 12% of the surfaces adjacent to glass-ionomer restorations (p < 0.001). The three-year results indicated that conventional glass ionomer is not an appropriate alternative to amalgam for all types of restorations in primary teeth. In particular, the short longevity of Class II glass-ionomer restorations could not be compensated for by the reduced caries progression and need for restorative therapy of adjacent surfaces.

Adolescent↗

Erosive effect of an antihistamine-containing syrup on primary enamel and its reduction by fluoride dentifrice.

AIM: This study evaluated the action of an antihistamine-containing syrup (Claritin D) on enamel that was subsequently submitted or not to applications of fluoride dentifrice. METHODS; Two hundred sixty-four slices (n=44 per subgroup) prepared from exfoliated primary molars were evaluated in hardness tests. Six subgroups were submitted to different treatments for 10 days. The controls underwent pH cycling with (positive control) or without (negative control) three daily immersions in fluoride dentifrice/distilled water slurry. The test subgroups related to daytime use of the antihistamine syrup underwent pH cycling and two 5-min applications of Claritin D, coupled or not to the three daily immersions in the fluoride slurry. The subgroups related to nocturnal use of the syrup were submitted to the same procedures of daytime subgroups, respectively, but with one of the applications of Claritin D lasting for 8 h. RESULTS: The median hardness values obtained after use of the syrup were significantly lower than the initial ones. Equivalent values for subgroups submitted to fluoride applications in addition to treatment with the syrup were significantly higher. CONCLUSION: It was concluded that the antihistamine-containing syrup reduced the hardness of primary enamel and that, in this experiment, the use of fluoride dentifrice was able to diminish this erosive effect.

Cariostatic Agents↗

Microleakage in primary teeth restored by conventional or bonded amalgam technique.

The aim of this in vitro study was to evaluate marginal leakage in class V restorations in primary teeth restored with amalgam, using three different techniques. Thirty maxillary anterior primary teeth, clinically sound and naturally exfoliated, were used. In group 1 (n = 10), two thin layers of a copal varnish (Cavitine) were applied. In group 2 (n = 10), Scotchbond Multi-Purpose Plus, a dual adhesive system, was used according to manufacturer instructions. In group 3 (n = 10), One-Step adhesive system in combination with a low-viscosity resin (Resinomer) were used according to manufacturer instructions. All samples were restored with a high-copper dental amalgam alloy (GS 80, SDI). After restoration, the samples were stored in normal saline at 37 degrees C for 72 h. The specimens were polished, thermocycled (500 cycles, 5 degrees and 55 degrees C, 30-s dwell time) and impermeabilized with fingernail polish to within 1.0 mm of the restoration margins. The teeth were then placed in 0.5% methylene blue for 4 h. Finally, the samples were sectioned and evaluated for marginal leakage. The Kruskal-Wallis test showed that the filled adhesive resin (group 3) had the least microleakage. There was no significant difference between groups 1 and 2.

Composite Resins↗

Enamel ultrastructure and protein content in X-linked amelogenesis imperfecta.

X-linked amelogenesis imperfecta has been proven in a number of families to be linked to or involve a variety of mutations in the X chromosome amelogenin gene. The purpose of this study was to characterize the enamel ultrastructure and enamel protein in a kindred affected by X-linked amelogenesis imperfecta. Exfoliated primary teeth were obtained from two related persons (one male, one female) who had X-linked amelogenesis imperfecta with marked hypoplasia. Normal enamel (age and sex matched) was used as the control for all analyses. The teeth were evaluated using light microscopy, scanning electron microscopy, and microradiography. The enamel of the heterozygous female was hypoplastic and rough with marked surface depressions. Enamel beneath these depressions was poorly organized and lacked a prismatic structure. The affected male had very thin enamel (approximately 40 microns) that also lacked an organized structure. Enamel protein from the teeth of the heterozygous female and the control was characterized using amino acid analysis. The protein content of the enamel of the female with amelogenesis imperfecta was 0.40% (N = 1) whereas the control enamel ranged from 0.17% to 0.45% (N = 4; mean = 0.34%). This study indicates that although the enamel in both the male and female with X-linked amelogenesis imperfecta displayed marked structural abnormalities the enamel protein was similar in quantity and amino acid composition for normal and X-linked amelogenesis imperfecta (female) enamel.(ABSTRACT TRUNCATED AT 250 WORDS)

Amelogenesis Imperfecta↗

Ablation of composite resins using Er:YAG laser--comparison with enamel and dentin.

OBJECTIVES: The purpose of this work is to investigate comparative ablation rate between composite resins and dental hard tissues (enamel and dentin) after Er:YAG laser irradiation to verify possible development of an ultra-conservative dentistry to with minimum effect for the teeth tissue. METHODS: We have used 11 extracted or exfoliated primary anterior and posterior teeth and six extracted permanent molar teeth. Three different types of composite resin were chosen (microfiller, hybrid, and condensable) in terms of chemical and structural composition. Composite tablets and the teeth were irradiated with a Er:YAG laser at different laser beam energy level per pulse (100, 200, 300, and 400 mJ). Diameter and depth of each resulted microcavity were measured and the material removed volumes were calculated. The resulted values were plotted and fitted to allow a comparative observation of the material removed as a function of energy level per pulse. RESULTS: While the idea of ultra-conservative dentistry seems to apply well for enamel of primary and permanent teeth, at the present stage it does not apply well for primary or permanent dentin. For dentin, the composition and content of water makes the Er:YAG laser ablation equal or superior in rate compared with the three used resins. SIGNIFICANCE: This work presents of a comparative study of Er:YAG laser ablation, allowing to analyze the possible selective ablation between composite resin placed and cured and dental hard tissues, with the goal to propose a new clinical technique: differential ablation for composite resin restorations using Er:YAG laser.

Acrylic Resins↗

[Relationship between fetal lead exposure and birth weight--evaluation using deciduous incisor enamel].

OBJECTIVE: The purpose of this study was to examine the relationship between fetal lead exposure and birth weight, using deciduous incisor enamel as a biomarker and laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) for analysis of lead. METHODS: We asked dental clinics (n=11) and kindergartens (n=11), mainly in the Tokyo metropolitan area and Miyagi Prefecture, and parents to enroll donors of exfoliate deciduous incisors. Donors who consented to this study voluntarily sent deciduous incisors and questionnaires to the authors between March and October, 2003. The Pb/Ca ratios of inner enamel samples were determined by LA-ICP-MS. The relationship between the lead-to-calcium ratio in the enamel and the birth weight was evaluated by stepwise multiple linear regression analysis. RESULTS: One hundred forty-one subjects (male, 72; female, 69) were enrolled in this study. The mean Pb/Ca ratio in the enamel was as low as 0.24 mg-Pb/kg-Ca (SD=0.17). Stepwise multiple linear regression analysis extracted the following maternal variables with a positive coefficient with birth weight: gestational age (p < 0.01), weight gain during pregnancy (p < 0.01), prepregnancy BMI (body mass index, p < 0.01), and parity (p < 0.05). Lead concentration in the enamel was significantly negatively associated with birth weight (p < 0.05). CONCLUSIONS: Our study indicated that lead concentration in the enamel was inversely related to birth weight. This association was found in a population of which the mean blood lead level was estimated to be as low as about 1 microg/dl. We concluded that in utero low lead exposure decreased birth weight, within the normal range of birth weight.

Birth Weight↗