Professional Documents
Culture Documents
Kotlow LA. Breastfeeding: a cause for dental caries in children. J Dent Child.1977; 44:192 Breastfeeding and the risk of early childhood caries. White V. Evid Based Dent. 2008;9(3):86-8. Association between infant breastfeeding and early childhood caries in the United States. Iida H, Auinger P, Billings RJ, Weitzman M. Pediatrics. 2007 Oct;120(4):e944-52 Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent. 1999;21:86
Conclusions
1. Breast milk has a pH of 7.2 2. Proven health benefits of breastfeeding 3. Lack of consistent evidence 4. Promote breastfeeding 5. Emphasize OH and reduce CHO consumption
Ankyloglossia
6 week old healthy infant is referred to you for problems with sucking. Pediatrician is concerned and noted a short tongue. Your examination reveals ankyloglossia. What do you tell the parent and pediatrician? Is there any evidence to support treatment? Evidence based decision: There are no controlled prospective trials for surgical interventions in infants with ankyloglossia, therefore there no conclusive suggestions regarding the method of intervention. Also controversial is which type of tongue-tie needs to be surgically repaired and which can be left to observe How severe is the condition? Is the infant having problems latching on to the mothers breast? Is the infant gaining weight?
1. Cochrane Oral Health Groupnothing 2. ADA EBD: nothing 3. PubMed: Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Geddes DT, et al Pediatrics. 2008 Jul;122(1):e188- 94. 4.NGCH1. Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. Academy of Breastfeeding Medicine Professional Association. 2004.
With rare exception, the studies we rely on are academic thesis projects Almost all use the same inclusion criteria which really dont reflect clinical reality Few follow their teeth through exfoliation and eruption of the succedaneous teeth Results are often clouded by purist views of radiologic success
5
Extent of Carious Lesions Tooth Coloration Location of Tooth Clinical, Radiographic and Bleeding
Looked at 53 carious primary incisor pulps without x-ray or clinical pathosis, but deemed unrestorable Removed caries after these teeth extracted as one would do if they were to be saved Had carious exposures on 24 but not on 29 of these Of 29 unexposed, only 6 were histologically healthy pulps None of the 24 exposed pulps were histologically normal; two-thirds had coronal inflammation
10
Sonis et al. Longitudinal study of discolored primary teeth and effect on succedaneous teeth. J Pedo 1987;11:247 Followed 37 darkened incisors until lost and eruption of successor No clinical or x-ray pathosis on 72 percent Only 11 teeth with pathosis Only one successor had enamel problems; and successors tended to erupt early
11
Fei et al Casas et al
83
03
182
24
96
61
Fuks et al
97
55
6-35
92.7
74.5
Smith et al
00
242
4-57
99
n/a
12
13
Ballesio et al Eur J Pediatr Dent (2002) 133-140. Chemical and pharmacological shaping of necrotic primary teeth. Found 92% success rate
Necrotic primary molars with fistulas First visit: canals filled with powdered antibiotic mixed with anesthetic solution Second visit: canals were filled with IRM
14
15
Looked at 187 primary posterior teeth treated with indirect pulp therapy Deep dentinal caries, but no symptoms or x-ray signs of pulpal pathosis CaOH placed with crown, amalgam or composite A 95% success with a 96% 1-year success Crowns had best success
16
17
Why Do a 5-Minute Full Strength Histobiological effectiveness of a reduced FC Pulpotomy? concentration of Buckleys formocresol. Verco PJ.
Ped Dent 1985;7:130 Looked at S. faecalis, S. salivarius, Staph aureus Found formocresol concentrations of 0.05 to 0.33% to be bacteriocidal Comparison of antimicrobial and cytotoxic effects of glutaraldehyde and formocresol . Hill SD et al. O,O,O 1991;71:89 Mean microbicidal concentration of formocresol was 0.23% and cytotoxic concentration (fixation) was 0.0075% The minimum concentration of formocresol to kill 9 organisms was 0.75% for 2 minutes
18
Confused? Me Too!
Literature on FC, FS, MTA, laser, NaOCl, CH is often conflicting or does not track long enough to show a measurable difference to merit switching materials If what you use works, keep using it!
19
Carious primary tooth with deep caries but no exposure, do an indirect pulp cap Carious primary tooth with stoppable pulpal hemorrhage and no other clinical or radiographic signs, do a pulpotomy Carious primary tooth with pulpal pathosis but good root structure (ie, no resorption) do a pulpectomy
20
21
Restorative Care
22
Braff 1975
150
131(87)
76
19(25)
2.5 yr
Dawson 1981
Messer 1988 Roberts 1990 Einwag 1996
102
1177 706 66
72(71)
255(22) 82(12) 38(58)
64
331 673 66
8(13)
40(12) 13(2) 4(6)
2 or more yr
5 yr 10 yr 8 yr
23
Pre-crimped, precontoured crowns or do it yourself? Trimming crowns? One brand versus another? Polishing before cementation? Type of cement used? High occlusion?
24
SSC Types
3M (Ion) pre-crimped pre-contoured pre-trimmed pre-ferred!
2nd molar
1st molar
25