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Physical anthropology and the dental and medical specialties.

The rise of two sub-specialties in Physical Antrhopology traces back to the Anatomy Departments of Schools of Medicine in Germany and France during the nineteenth century. The study of human diversity in bones and bodies was largely by medically-trained anatomists. There developed Medical Antropology and Dental Anthropology, employing osteometry and craniometry on the skeleton, somatometry and cephalometry on the living body. As a result cross-sectional studies gave way to longitudinal studies and X-ray techniques were added to purely mensurational procedures. In Medical Anthropology the specialties most directly concerned are pediatrics, plastic surgery, endocrinology, and orthopaedics. In Dental Anthropology the specialties most directly concerned are pedodontics, orthodontics, oral surgery, and prosthodontics. The contributions of Physical Anthropology to each is discussed.

Anthropology, Physical↗

The free focus concept in dental and maxillofacial radiography. The present status of the miniaturized dental x-ray machines.

"Free focus" radiography has shown promise in the examination of complex anatomy in many parts of the body, where conventional and tomographic exposures provide limited information. The approach was introduced in dentistry three decades ago and applied clinically from the time the miniaturized x-ray machines with rod anodes became available in the early 1960's. Yet it has received little attention in the international literature. Recent generations of the unique machines allow free focus surveys of the dentition in two exposures with a film quality comparable to or better than conventional periapical surveys and with a fraction of the radiation load. There is a need for evaluation of such procedures for use in dental practice. Additional applications of free focus radiography promise unusual flexibility in the use x-ray examinations in endodontics, pedodontics, periodontics, and oral surgery, which may justify further development of the miniaturized equipment for such new approaches. Specific suggestions for technical improvements are discussed.

Dental Equipment↗

II. Stylohyoid chain ossification: a discussion of etiology.

It has been estimated that between 2% and 4% of the general adult population has radiographic evidence of an ossification of the stylohyoid chain. In an effort to prove that this is also the case in children and adolescents, 150 panoramic radiographs were examined at the Department of Pedodontics of St. Justine's Hospital in Montreal, Quebec, Canada. A total of 300 styloid processes and stylohyoid chains were evaluated and measured radiographically. The patients' mean age was 11 years. The mean length of the styloid processes was 10 mm. Forty percent of the population without symptoms studied showed some evidence of stylohyoid ligament ossification. Sixty percent of these were males; 40% were females. It was also found that 65.6% had no history of cervicopharyngeal trauma on review of the medical and dental histories.

Adolescent↗

Reaction of the dental pulp to hydroxyapatite.

The purpose of this study was to evaluate the action of hydroxyapatite (HA) (Osteogen HA Resorb, GBD Marketing Group Inc., Valley Stream, N.Y.) on the dental pulp of rats. Four upper molar pulps in 45 rats were exposed and capped with synthetic HA (Osteogen) with a stereoscopic microscope. Pulps capped with calcium hydroxide (Dycal, L.D. Caulk Co., Milford, Del.) served as controls. The cavities were filled with amalgam, and the molars on each side of the maxilla were protected by the placement of a pedodontic steel crown. Pulp inflammation and dentin repair were compared by histologic observations and computer image analysis after 7, 14, and 28 days. After 7 days a partial acute pulpitis were observed in specimens treated with Osteogen or Dycal. Reparative dentin formation along the pulp walls was also seen. After 14 days the pulpitis was more extensive in the Osteogen-treated teeth than in the control teeth. Dentin formation as measured by morphometric analysis was more pronounced in Osteogen-treated teeth. Neo-odontoblasts were observed after the use of both materials. After 28 days an acute inflammatory reaction was still evident in the Osteogen-treated group. A complete dentinal bridge was observed more frequently with Dycal than with Osteogen. Despite the putative abilities of HA to be osteoconductive, osteogenic, and dentinogenic, the results of this study indicate that it should not be used as a pulp-capping agent because of its tendency to cause scattered dystrophic calcification in the dental pulp, which could interfere with future endodontic treatment.

Animals↗

Distribution of 10 periodontal bacteria in saliva samples from Japanese children and their mothers.

OBJECTIVE: We analyzed the distribution of 10 periodontal bacteria species (Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia, Prevotella nigrescens, Campylobacter rectus, Eikenella corrodens, Actinobacillus actinomycetemcomitans, Capnocytophaga ochracea, Capnocytophaga sputigena, and Treponema denticola) in children, and then compared their distribution in those children and their mothers, with special attention given to three of the species known as the red complex (P. gingivalis, T. forsythensis, and T. denticola) whose presence has been shown to be associated with conditions related to periodontal diseases. METHODS: One hundred thirteen pairs of children and their mothers were randomly selected from patients treated at the Pedodontic Clinic of Osaka University Dental Hospital. Saliva samples were taken at the second visit prior to receiving professional tooth brushing instruction. Genomic DNA was extracted from each saliva sample, followed by a polymerase chain reaction assay with species-specific sets of primers. RESULTS: A. actinomycetemcomitans was the most frequently detected species in the mothers, followed by C. sputigena, P. gingivalis, and T. forsythensis, while C. sputigena had the highest detection rate, followed by A. actinomycetemcomitans and T. denticola in the children. The detection rate of the red complex species in children whose mothers possessed the same species was significantly higher than in those whose mothers did not possess them. CONCLUSIONS: Our results indicate a correlation between the presence of periodontal bacteria in children and their mothers, while the presence of red complex bacteria in children was highly associated with that in their mothers.

Adolescent↗

A clinical and radiologic study of autotransplanted impacted canines.

The aim of the present study was to evaluate the clinical and radiologic results of 20 autotransplantations of impacted canines performed in the Orthodontic and Pedodontic Department of the University of Geneva between 1979 and 1988. The sample, divided into two different age groups (group A: 13-20 years; group B: 20-48 years), demonstrated persistence of pulp vitality in 80% of the cases in group A, whereas routine endodontic treatment was instituted in all cases of group B. Periodontal healing was noted in 90% of the cases in group A, and in 70% of the cases in group B. The present clinical and radiologic data indicate that impacted canines can be transplanted at any age with good prognosis and are an alternative to orthodontic repositioning in selected cases of canine impaction.

Adolescent↗

Prognosis of replanted primary incisors after injuries.

Between 1979 and 1997, 58 avulsed primary teeth were treated at the Pedodontic Clinic of Niigata University Dental Hospital. Among these, we replanted six avulsed incisors of four patients and treated two teeth of two patients replanted at other dental clinics. Referring to the clinical records, oral photographs and radiographs, we examined the injury age, cause of injury, condition of tooth storage, length of time until replantation, and also the prognosis after replantation. Three teeth of two cases remained until eruption of their permanent successors, and one tooth of one case remained under observation without extraction. Although the other four teeth of three cases resulted in extraction, no secondary infection was detected due to replantation. The following reasons were suspected for the poor prognosis of the four teeth. One avulsed tooth was not fixed immediately after replantation. One replanted tooth might not have been compatible with the alveolar socket. In the other two teeth, the periodontal vital tissues might have been removed before replantation. It is generally suggested that replantation of primary teeth is not a good option. However, from the present results, it was considered that replantation can be an effectual method when the condition of the avulsed primary tooth is suitable.

Age Factors↗

Healing of 208 intra-alveolar root fractures in patients aged 7-17 years.

This retrospective study consisted of 208 root-fractured, 168 splinted and 40 not splinted incisors in young individuals (aged 7-17 years) treated in the period 1959-1973 at the Pedodontic Department, Eastman Institute, Stockholm. Clinical and radiographic analyses showed that 69 teeth (33%) had developed hard tissue (fusion) healing of fragments. Interposition of periodontal ligament (PDL) and bone between the fragments was found in 17 teeth (8%). Interposition of PDL alone was found in 74 teeth (36%). Finally, non-healing with pulp necrosis and inflammatory changes between fragments was seen in 48 teeth (23%). Various clinical factors were analyzed for their relationship to the healing outcome with respect to healing/no healing and type of healing (hard tissue versus interposition of bone and/or PDL). Immature root and positive pulp sensitivity at time of injury was found to be significantly related to both pulp healing and hard tissue repair of the fracture. The same applied to concussion or subluxation of the coronal fragment compared to luxation with displacement (extrusive or lateral luxation). This relation was also represented by the variable millimeter diastasis between fragments before and after repositioning. Repositioning appeared to enhance the likelihood of both pulp healing and hard tissue repair. A positive effect of splinting, splinting methods (cap splints or orthodontic bands with an arch wire) or splinting periods could not be demonstrated on either pulp healing or type of healing (hard tissue versus interposition of bone and/or PDL). In conclusion, the findings from this retrospective study have cast doubts on the efficacy of long-term splinting and the types of splint used for root fracture healing. It is suggested that the role of splinting and splinting methods be examined in further studies.

Adolescent↗

Combined apexification and orthodontic intrusion of a traumatically extruded immature permanent incisor.

A patient with a traumatic extrusion of the maxillary right central incisor was referred to the Pedodontic Clinic of Gazi University Faculty of Dentistry after 15 days. Orthodontic repositioning of the tooth was planned in 6 months. At the beginning of orthodontic therapy it was observed that the tooth was necrotic and needed an apexification procedure. The apexification procedure and orthodontic intrusion were successfully performed at the same time. In addition, a "walking bleach" was performed after the orthodontic and endodontic procedures were completed. At the 3-year recall, the tooth appeared normal in all respects.

Child↗

Mandibular growth and third molar impaction in extraction cases.

The position of mandibular third molars was studied in 60 patients from the pedodontic and orthodontic departments at the Federal University of Rio de Janeiro. All individuals received orthodontic treatment with an edgewise appliance following the extraction of first premolars. Examination of superimposed pretreatment and posttreatment cephalometric radiographs led to the observation that mandibular growth is directly related to the positioning of mandibular third molars. Third molar impactions were more likely to occur in cases with a predominance of vertical growth. The larger ascending ramus, the diminution in total length of the mandible and the larger mesial inclination of the crowns also seem to be indicative of third molar impaction.

Adolescent↗

Caries risk analysis: considering caries as an individual time-dependent process.

AIM: To estimate the probability that a tooth does not develop a cavitated lesion (= end-stage caries) within time periods of interest. Additionally it was of interest to assess the heterogeneity between patients, in relation to the time periods required for their teeth to develop a cavitated lesion. DESIGN: A prospective study using patient data of a clinical pedodontic course. SAMPLE AND METHODS: Forty-one patients who had been followed for at least 3 years were selected. Before initiation of therapy, affiliation to a specific risk group was checked. Nine individuals who had belonged to a high-risk group on test were excluded. Of 1968 teeth, 1378 were eligible for data evaluation. The statistical techniques applied originate from time-to-event analysis methods, including a parametric frailty approach providing estimates of the relative caries risk for each individual to develop a cavitated lesion. RESULTS: In the selected group of patients the probability that a tooth remained free of a cavitated lesion within five years ranged from 0.89 to 0.95 applying a 95% confidence interval. In the present sample the true caries risk of the patients to develop a cavitated lesion varied considerably although such variation was not expected from the individual examinations at baseline. CONCLUSION: The frailty model accounts sufficiently for the heterogeneity of each patient. The applied time-to-event methods facilitated reliable estimation of both the probability that a tooth remains free of a cavitated lesion within a certain time and the relative caries risk of an individual to develop a cavitated lesion.

Child↗

Urinary mercury excretion following amalgam filling in children.

OBJECTIVES: Dental amalgam is the major source of inorganic mercury exposure in the general population. Dental amalgam contains approximately 50% mercury, which is a toxic element. Since children are more at risk for mercury toxicity, we aimed to study prospectively the effects of amalgam filling on urinary mercury excretion in 5- to 7-year-old children. METHODS: Children admitted to the Pedodontics Department with no previous amalgam filling, and in a good state of health with one or more carious posterior teeth, were selected. All fillings were placed in one session for each child using Sina (Iran) amalgam powder and Degussa (Germany) mercury, which were mixed by an automated electric amalgamator (Dentomate 3, Germany). Urinary mercury concentrations were estimated before and 9-12 days after amalgam filling by atomic absorption using the mercuric hydride system. RESULTS: Forty-three children (20 male, 23 female) aged 5.95+/-0.92 years and weighing 19.09+/-3.10 kg were studied. Urinary mercury concentrations before and after amalgam filling were 3.83+/-2.45 and 5.14+/-3.14 microg/L, respectively (p = 0.001). There were no statistically significant correlations between the urinary mercury concentrations and any other variables, including the number and surfaces of filled teeth, weight, age, and sex. CONCLUSION: Although there were highly significant increases in urinary mercury concentrations after amalgam filling, no significant correlation was found between the urinary mercury concentration and the amounts of filled amalgam. Additional investigation is required concerning the effects of mercury release from amalgam.

Child↗

Causes of dental fractures in the early permanent dentition: a retrospective study.

Two hundred eight patients, who applied to the Department of Pedodontics, Dental School, Dicle University between 1995 and 1998, were evaluated in terms of permanent teeth fracture. The aim of this retrospective study was to investigate the probable causes of the trauma, the effects of age and gender on dental trauma, prevalence of fracture types, and distribution of fracture type according to arch. It was observed that the falls or collisions were the main causes. It was also determined that the age group most frequently suffering fractures was ages 9 to 11 years. The majority of the patients were male. The enamel-dentin-pulp-type fracture and those causing the tooth to become nonvital were the most prevalent, and the majority of the fractures were observed in maxillary central teeth.

Accidental Falls↗

Evaluation of students' performance in obtaining local anaesthesia in children.

This study was designed to determine the success of various local anaesthesia techniques as assessed by the presence or absence of pain during restorative procedures performed by senior undergraduate dental students in a pedodontic clinic. Data gathered from the treatment of 151 patients by 43 students recorded the frequency of pain complaints during procedures for which local anaesthesia had been employed. It was found that 73% of the administrations were successful. The proportion of children who complained of pain during the operative procedure was significantly higher in those with a previous history of a painful dental experience.

Adolescent↗

Dental caries experience in children with congenital heart disease: a case-control study.

OBJECTIVES: To compare the dental health of a group of children with complex congenital heart disease with that of age and gender matched healthy controls. DESIGN: Case-control study. SETTING: Faculty of Medicine and Odontology/Pediatric cardiology and Pedodontics, Umeå University, Sweden. SAMPLE AND METHODS: All the cases and their controls lived in the county of Västerbotten in northern Sweden. Each group comprised 41 children with a mean age of 6.5 years. Data were collected from medical and dental records while all bitewing radiographs were read separately by one of the authors. RESULTS: Children with congenital heart disease had significantly more caries in their primary teeth than the control group. The mean dmfs-value was 5.2 +/- 7.0 in the cardiac group compared to 2.2 +/- 3.5 in the control group (P < 0.05). Twenty-six of the children had all four 6-year-molars, and their mean DMFS-values were 0.9 +/- 1.9 in the cardiac group compared to 0.3 +/- 0.6 in the control group (P > 0.05). The children with congenital heart disease had received more caries prevention based on the use of fluorides than the control group. There was a significant correlation between the number of fluoride varnish treatments and the dmfs value of the child (r = 0.411, P < 0.01). Fifty-two per cent of the children in the cardiac group had been prescribed fluoride tablets on one or more occasions compared to 17% in the control group (P < 0.01). Number of months on digoxin medication and the dmfs-value had a significant correlation (r = 0.368, P < 0.05). Ten of the children had been on digoxin medication between 6 and 87 months; this subgroup had a mean dmfs-value of 10.1 +/- 8.5. CONCLUSION: Swedish children with complex congenital heart disease have poorer dental health than healthy age and gender matched controls in spite of intensive preventive efforts. In many cases, intervention had been given when caries were present. A closer cooperation between paediatric cardiology and paediatric dentistry is needed.

Cardiotonic Agents↗

Electron microscope characteristics of dentin repair after hydroxylapatite direct pulp capping in rats.

In order to study the osteogenic action of hydroxylapatite (HA) on the dental pulp, a pulp capping experiment was designed using the rat upper molar. Under general anesthesia, molar teeth in 14 male Sprague-Dawley rats were pulp capped with Osteogen (HA) or with Dycal as a control material. After pulp capping, the maxillary molars cavities were restored with amalgam and a pedodontic steel crown was adjusted and sealed over the molar teeth on either side of the maxilla. After 7 days, the areas of necrosis and acute inflammation were more evident in the pulps treated with Dycal than with Osteogen. Hard tissue formation began to appear around dentinal chips in the pulp and extended from the cavity walls into the pulp regardless of the material that was used. Furthermore, this calcified material was scattered throughout the pulp when Osteogen was used, but was not observed in the Dycal treated pulps. The hard tissue formation was thought to be due to the putative fibroblasts and odontoblasts found in the pulp. After 28 days dense dentinal tissue was observed bridging the exposure site when Dycal was used. The dentinal tissues formed with Osteogen was always of a globular type, and showed an irregular distribution. Since Osteogen tends to cause areas of dystrophic calcification in the pulp, its use is not be recommended for pulp capping purposes in humans, because these areas of calcification would make future endodontic treatment difficult.

Animals↗

A 5-year evaluation of semipermanent composite resin crowns.

The use of composite resin crowns in the restoration of traumatized and hypoplastic permanent incisors has proved to be of great clinical and aesthetic value for the pedodontic practice. Due to the composite resin materials and the acid etch technique, an easy method of making and retaining the restorations is at hand. The present study deals with long-term observations of composite resin crowns in restoring Ellis Class II and Class III coronal fractures of traumatized permanent incisors. In all, 253 composite resin crowns were controlled every year for a minimum of 5 years. In no case was an intermediate resin layer applied on etched enamel before the restoration material was placed. Surface, marginal and "body" discoloration, marginal leakage, marginal caries, abrasion, and fractures were controlled. The study demonstrated that discoloration of the surface of the restorations, and a discoloration of the restorative material not restricted to its surface ("body" discoloration) were the most frequent causes for considering the crowns as semipermanent restorations. The other factors seemed to be of minor clinical significance.

Adolescent↗