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[Fluorine as a factor in premature aging].

The use of fluorine compounds in various areas of medicine, particularly in dentistry, as well as in agriculture and industry became very popular in the second half of the 20th century. Fluorine owed this widespread acceptance to observations that its compounds stimulate ossification processes and reduce the prevalence of caries. Unfortunately, growing expectations overshadowed the truth regarding interactions of fluoride on the molecular level. The fact was often ignored that fluoride is toxic, even though laboratory data stood for a careful approach to the benefits of usage. Excessive exposure to fluoride may lead to acute poisoning, hyperemia, cerebral edema, and degeneration of the liver and kidneys. Acute intoxication through the airways produces coughing, choking, and chills, followed by fever and pulmonary edema. Concentrated solutions of fluorine compounds produce difficult to heal necrotic lesions. In spite of these dramatic symptoms, acute intoxications are relatively rare; the more common finding is chronic intoxication attributable to the universal presence of fluorine compounds in the environment. The first noticeable signs of excessive exposure to fluoride in contaminated water, air, and food products include discolorations of the enamel. Dental fluorosis during tooth growth and loss of dentition in adulthood are two consequences of chronic intoxication with fluorine compounds. Abnormalities in mineralization processes affect by and large the osteoarticular system and are associated with changes in the density and structure of the bone presenting as irregular mineralization of the osteoid. Fluorine compounds also act on the organic part of supporting tissues, including collagen and other proteins, and on cells of the connective tissue. These interactions reduce the content of collagen proteins, modify the structure and regularity of collagen fibers, and induce mineralization of collagen. Interactions with cells produce transient activation of osteoblasts, stimulate fibroblasts to produce collagenase, and trigger toxic reactions in osteocytes and chondrocytes of trabecular bone. Growing deformations of the skeleton reduce mobility and result in permanent crippling of the patient. Fluoride increases the mass of non-collagen proteins such as proteoglycans and glucosaminoglycans, accelerating skin aging even though protein biosynthesis is generally suppressed. The final outcome includes progressive vascular lesions and disorders of energy metabolism in muscles. In conclusions, the use of fluoride, particularly by dentists and pediatricians, must be controlled and adapted to individual needs. It is worth remembering that fluoride: is the cause of disability due to bone deformations and abnormalities in the musculoskeletal system; reduces the incidence of caries but do not protect against tooth loss; exerts an adverse effect of metabolic processes in the skin; accelerates calcification of vessels and thus reduces their elasticity; inhibits bioenergetic reactions, in particular oxidative phosphorylation, reducing physical activity of muscles. These findings suggest that fluorine may be yet another factor in accelerated aging and revive the dispute started more than two and half thousand years ago whether aging is a physiologic or pathologic process. The understanding of factors modifying the process of aging is the basis for preventive measures aimed at extending life and maintaining full psychosocial activity.

Aging↗

Radiographic manifestations of an unusual combination Types I and Type II dentin dysplasia.

Dentin dyslasia is a rare autosomal dominant hereditary variant of dentinogenesis imperfecta. The primary defect is mesodermal and involves the dentin. Two types (Type I and Type II) of dentin dysplasia have been described previously. The current case presents radiographic findings which include characteristics common to both types. It is proposed that either a third type (Type III) be recognized or the variability of the developmental defect precludes definitive subclassification.

Adult↗

[Histological examinations of persisting milk teeth (author's transl)].

In twelve patients aged 13 to 24, histological examinations of twenty persistent milk teeth (with persistency having been due to aplasia of permanent teeth) showed that root resorptions are possible in such cases too. Cellular resorption results in the root being decomposed lacunally or linerly, respectively. The formation of osteodentin, which is a result of the phase of apposition and which is taking place in the pulp and along the surface of resorption, respectively, is considered a characteristic concomitant phenomenon. However, this tissue does not cause "true ankylosis". Accordingly, use of the term "ankylosis" to describe such cases is questionable. The author, on the strength of the results obtained in these studies, believes that root resorption of persistent milk teeth is a pathological process in the case of congenital absence of permanent teeth.

Adolescent↗

Apexogenesis of a symptomatic mandibular first permanent molar with calcium hydroxide pulpotomy.

Vital pulp therapy of immature, symptomatic permanent posterior teeth presents a challenge in pediatric endodontics. A case report is presented in which cervical pulpotomy with calcium hydroxide was performed on a cariously exposed mandibular first permanent molar. The patient was seen every 3 months for a total of 18 months for a clinical and radiographic follow up. During the follow-up period, root development, as evidenced by root lengthening, was observed. Apical closure was evident at the end of 19 months. As the root canals showed a tendency toward calcification, root canal treatment was carried out, followed by restoration of the tooth with a stainless-steel crown. The success of this single-visit apexogenesis procedure supports the contention that young pulp possesses remarkable reparative capacity, as well as resistance to bacterial infection due to greater vascularity, and that apexogenesis with calcium hydroxide apical closure pulpotomy can be attempted for continued root development of symptomatic, vital, permanent teeth.

Calcium Hydroxide↗

The clinical significance and management of calcific pulp obliteration.

In this paper, the biological events that give rise to the radiographic appearance called calcific pulp obliteration will be described, as will the anatomical and histological changes that attend its presence. There will also be a review of the studies that explore the relative incidence of this pulp change subsequent to trauma, and the incidence of attending periapical disease that should indicate to the clinician that some form of treatment is required. Finally, the endodontic management of these teeth will be described with emphasis on the types of adjustments that can be made to minimize the chance for a procedural accident.

Dental Pulp Calcification↗