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PubMed2003

Traumatic intrusion of maxillary permanent incisors into the nasal cavity associated with a seizure disorder: report of a case.

Childhood traumatic dental injury is typically associated with motor vehicle accidents, sports, or other recreational activities. However, seizure disorders or other compromising medical conditions may precipitate dental trauma. Complete intrusion injuries in the mixed or permanent dentition are relatively rare. This paper describes the case history of an adolescent male who sustained displacement of a lateral incisor into the nasal cavity and complete bony intrusion of the three other permanent maxillary incisors because of a fall following a seizure. Counseling on helmet/face-shield usage for seizure-susceptible patients must be provided and documented, particularly after sustaining traumatic injury.

Accidental Falls↗
PubMed1975

Cytotoxicity of cyclophosphamide in the rat incisor.

Three of the 4 groups of 3 Wistar rats each were given 40 mg, 80 mg and 120 mg cyclophosphamide/kg respectively by single intraperitoneal injections. The fourth group was given 2 ml of normal saline as control. One animal from each group was killed after 1, 4 and 8 days. The incisor teeth of all experimental animals showed evidence of cytotoxic injury, which appeared to be more severe with increasing dosage, to the undifferentiated mesenchymal cells in the proliferating zone of the pulp close to the basal odontogenic epithelium, cessation of root growth and relative acellularity of the basal area of the pulp. Evidence of cytotoxicity to the odontogenic epithelium was seen only in the groups given 80 mg/kg and 120 mg/kg. Resolution of the cytotoxic injury and re-establishment of normal basal odontogenesis were seen in the 40 mg dose group by the eighth day but appeared to be slower with increasing dosage. It would seem that of the rapidly proliferating epithelial and mesenchymal odontogenic cells in the basal area of the rat incisor those in the mesenchyme may be most susceptible to the cytotoxicity of cyclophosphamide. The odontogenic epithelium may be resistant to the cytotoxicity of 40 mg cyclophosphamide/kg. The results may be of significance in the investigation of the mechanism of cytotoxicity of this cancer chemotherapeutic agent.

Ameloblasts↗
PubMed2000

Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy.

OBJECTIVES: To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood. DESIGN: A prevalence study of children aged 8-9 years who had been continuous residents in fluoridated Newcastle or fluoride-deficient Northumberland. METHOD: The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998. OUTCOME MEASURE: Prevalence of dental fluorosis measured by the Thylstrup-Fejerskov index. RESULTS: Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis (> or = 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were--fluoridated area, affluence, and use of adult toothpaste. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of aesthetically important dental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.

Child↗
PubMed2000

Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption.

OBJECTIVE: To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption. SETTING: Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne. DESIGN: Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome. RESULTS: 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p = 0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p = 0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29. CONCLUSION: The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

Adolescent↗
PubMed1990

Single maxillary central incisor in association with mid-line anomalies.

A single maxillary central incisor may occur as an isolated dental finding. However, it has also been reported to occur in association with autosomal dominant holoprosencephaly, in association with growth retardation with or without growth hormone deficiency and occasionally in association with other mid-line developmental defects. Holoprosencephaly and pituitary dysfunction are two specific examples of mid-line defects and this report emphasises that other mid-line defects may be associated with a single maxillary central incisor. We recommend that patients with this dental anomaly should be referred for a detailed medical examination.

Abnormalities, Multiple↗
PubMed1997

The relationship between reported toothpaste usage in infancy and fluorosis of permanent incisors.

OBJECTIVE: To examine a possible relationship between reported toothbrushing habits in infancy and fluorosis of permanent maxillary incisors at age 8-9 years. DESIGN: Comparison of clinical findings with retrospective survey data. SETTING: Five primary schools in the City of Birmingham where the water is fluoridated at 1.0 mg F/l. SUBJECT AND METHODS: Results of clinical examinations were compared with historical data collected via parental questionnaires. Maxillary central incisors of 325 consecutive children were examined for fluorosis clinically and photographically according to the criteria of the Modified Thylstrup and Fejerskov Index. 112 children had fluorosis and 213 did not. Information concerning toothbrushing habits in infancy was obtained via a questionnaire to parents who were also asked to add paste to a brush in a similar way to when the children were small. From a combination of questionnaire replies and paste weights the amount of fluoride that each child may have ingested from toothpaste each day was then estimated. RESULTS: Highly significant associations were found between estimated fluoride ingestion from toothpaste and fluorosis. The mean DMF score of the fluorosis group was half that of the fluorosis-free children. The prevalence of fluorosis among children in ACORN group A-C was significantly greater than in groups D-F. CONCLUSIONS: The results of the study suggest that toothpaste swallowing may be a factor in the production of fluorosis.

Child↗
PubMed2004

Five mandibular incisors: an autosomal recessive trait?

A fifth mandibular incisor is a eumorphic supernumerary tooth and has rarely been described in the medical literature. We report here a large Lebanese consanguineous family where four individuals displayed five incisors in the anterior mandible. Such familial observation has not been previously described. The possibility of an autosomal recessive inheritance for this nonsyndromic trait is discussed.

Adult↗
PubMed2006

Survival of resin-bonded bridgework provided for post-orthodontic hypodontia patients with missing maxillary lateral incisors.

OBJECTIVE: To analyse the clinical performance and factors influencing the survival of resin-bonded bridgework provided for hypodontia patients with missing maxillary lateral incisors, following orthodontic treatment to open, maintain or redistribute the missing tooth space. DESIGN: A retrospective analysis of patients treated at a single centre using case notes with all patients invited for review to corroborate findings. SETTING: Departments of Orthodontics, Child Dental Health and Restorative Dentistry, Newcastle upon Tyne Dental Hospital and School. SUBJECTS AND METHODS: Between 1989-2000, 59 suitable hypodontia patients were identified of whom 45 had complete records. For these patients 73 resin-bonded bridges (RBBs) were provided. Following invitation, 24 patients attended for a review appointment. The survival of the RBBs, grade of operator providing treatment, duration of post-orthodontic retention, the influence of design, presence of pontic contact in static and dynamic excursions, and the effect of habits were assessed. Life table, Kaplan-Meier and Cox regression analysis were carried out for the 73 RBBs with complete records. A separate analysis of the RBBs provided for patients who attended for the invited review did not show a higher failure rate than those patients who did not attend. Therefore both sets of data were combined. RESULTS: Of the 73 RBBs provided, 30 had debonded on at least one occasion (41.1%), six of these debonds were due to trauma (20%). The mean survival time of all the restorations was 59.3 months, with a median survival time of 59 months. Senior members of staff (Consultant, Senior Lecturer or Specialist Trainee) provided most restorations (n = 39) and achieved the highest mean survival of 72.6 months and median survival time of 100+ months. RBBs provided by junior staff and students had significantly lower survival times (p <0.05) compared with senior staff. Risk of failure was 3.9 times greater with junior staff and 2.5 times greater with students (p = 0.01 and p = 0.02, respectively). Analysis of all the other factors investigated showed no statistical difference in survival times or in hazard ratios. Analysis of fixed/fixed versus cantilevered bridges was limited by the number of fixed/fixed bridges (n = 11), and only two cantilevered bridges with multiple abutments were provided; both failed within one month. CONCLUSION: RBBs provided for post-orthodontic hypodontia patients with missing maxillary lateral incisors can for many patients be an acceptable and definitive restoration. Experienced staff achieved the best results, but why this should be was not explained by the individual factors analysed in this study.

Adolescent↗
PubMed1980

The influence of fluoride administration on the structure of proteoglycans in the developing rat incisor.

1. 35S-labelled chondroitin 4-sulphate proteoglycan was isolated from the mineralized elements of the developing incisor teeth of Harvard rats receiving intraperitoneal administration of Na235SO4. 2. The chondroitin 4-sulphate proteoglycan underwent a decrease in molecular size in fluorotic teeth as judged by gel filtration on Sepharose 2B. 3. When examined by anion-exchange chromatography on DEAE cellulose-52, the proteoglycan from fluorotic teeth resolved into four peaks in comparison with the material from non-fluorotic teeth, which exhibited only a single major peak. 4. Both the single peak from non-fluoridated teeth and the four peaks from the fluorotic teeth were further resolved on cellulose acetate electrophoresis. 5. Isolated chondroitin 4-sulphate chains obtained from fluorotic teeth also were of smaller molecular size as judged by gel filtration on Sephadex G-150. 6. Some possible influences of fluoride on the metabolism of these connective-tissue components in the developing rat incisor are discussed.

Amino Acids↗
PubMed1983

The biosynthesis of dentine gamma-carboxyglutamic acid-containing proteins by rat incisor odontoblasts in organ culture.

Rat odontoblasts were shown to synthesize and secrete gamma-carboxyglutamic acid(Gla)-containing proteins into dentine after organ culture in the presence of radiolabelled amino acid precursors. Purified dentine Gla-containing protein from rat incisors was used as antigen to prepare rabbit antisera as a probe of dentine Gla-containing-protein biosynthesis in organ cultures of dentine (rat incisor) and bone (rat calvaria). Use of the antiserum also pointed out the cross-reactivity of a high-M, glycoprotein present within the dentine matrix. The present results are significant in identifying dentine gla-containing protein as endogenous to mineralizing dentine and may relate to the commonality between calcifying connective tissues in general.

1-Carboxyglutamic Acid↗
PubMed1980

Floating norms as guidance for the position of the lower incisors.

1. The incisor position should be evaluated in relation to the sagittal and vertical configurations of the face, as well as to the shape of the bony chin. 2. A floating norm for the positioning of the lower incisors is established based upon the guiding variables ANB, ML-NL and the N angle with the introduction of a multiple regression equation. The anticipated values for the guiding variables at the end of the treatment are used in the calculation.

Adult↗
PubMed1986

Cephalometric evaluation of incisor position.

An evaluation of seventeen measurements of incisor angulation and position for their applicability in describing the incisor relationship to maxilla and mandible. Most are better descriptors of other relationships that could confound interpretation of relationships to the supporting bones.

Adolescent↗
PubMed1995

Incisor stability in patients with anterior rotational mandibular growth.

The aim of this study was to investigate stability and patterns of relapse tendency in 42 children in whom mandibular incisors had been proclined as part of orthodontic treatment. All patients were selected on the basis of their predicted anterior rotational mandibular growth pattern. Results were based on study casts and standardized cephalometric profile radiographs, registered before and after active treatment as well as after a postretention period. Results demonstrate the clinical acceptability of the treatment principle employed in that the majority of the treatment changes were maintained well after the cessation of retention. There was, however, a general tendency to slight crowding in the mandibular incisor region in connection with bite deepening and reduction in intercanine distance. The reliability of prediction of mandibular rotation using the morphological criteria method is discussed.

Adolescent↗
PubMed2001

Moving an ankylosed central incisor using orthodontics, surgery and distraction osteogenesis.

When a dentist replants an avulsed tooth, the repair process sometimes results in the cementum of the root and the alveolar bone fusing together, with the replanted tooth becoming ankylosed. When this occurs, the usual process of tooth movement with bone deposition and bone resorption at the periodontium cannot function. If dental ankylosis occurs in the maxillary incisor of a growing child, the ankylosed tooth also cannot move vertically with the subsequent vertical growth of the alveolar process. This results in the ankylosed tooth leaving the plane of occlusion and often becoming esthetically objectionable. This report describes a 12-year-old female with a central incisor that was replanted 5 years earlier, became ankylosed, and left the occlusal plane following subsequent normal vertical growth of the alveolar process. When growth was judged near completion, the tooth was moved back to the occlusal plane using a combination of orthodontics, surgical block osteotomy, and distraction osteogenesis to reposition the tooth at the proper vertical position in the arch. This approach had the advantage of bringing both the incisal edge and the gingival margin of the clinical crown to the proper height in the arch relative to their antimeres. Previous treatment procedures for ankylosed teeth have often involved the extraction of the affected tooth. When this is done, a vertical defect in the alveolar process results that often requires additional bone surgery to reconstruct the vertical height of the alveolar process. If the tooth is then replaced, the replacement tooth must reach from the final occlusal plane to the deficient ridge. This results in an excessively long clinical crown with a gingival height that does not match the adjacent teeth.

Alveolar Process↗
PubMed2003

Incisor crowding in untreated persons 15-50 years of age: United States, 1988-1994.

The purpose of this study was to (1) describe the prevalence of mandibular incisor irregularity (II) among untreated adults in the United States and (2) evaluate the factors explaining individual differences in II. Data were derived for a random sample of 9044 individuals (49% male and 51% female; 35% Mexican American, 34% black, and 31% white) between 15 and 50 years of age collected as part of the Third National Health and Nutrition Examination Survey. Although the differences were small (0.5 mm), males had significantly greater II than did females; blacks showed less II than did whites (0.9 mm) and Mexican Americans (1.1 mm). Family income was negatively related with II. Incisor irregularity increased in a curvilinear fashion with age, with the greatest increases occurring during early adulthood. Although the number of premolars and molars (first and second) were positively related with II, the presence of third molars had a negative effect on II. Multivariate Poisson regression analyses showed that the ethnicity, the number of first and second molars, sex, and age combined to explain differences in II. Odds ratios were relatively low, indicating that these factors explained relatively small amounts of between-subject variation. We conclude that (1) approximately 50% of individuals in the United States who were 15-50 years of age have little or no II, 23% have moderate II, and 17% have severe irregularity, (2) erupted third molars are not associated with increased crowding, (3) crowding increases most during early adulthood, and (4) although individual differences in crowding are multifactorial, the primary determinants remain unidentified.

Adolescent↗