Inflammatory response in periodontal tissue in children with Down syndrome

Periodontal diseases are inflammatory diseases affecting the supporting tissues of the teeth. Subjects with Down syndrome have a higher prevalence of periodontal disease compared to healthy controls. Periodontal disease in Down syndrome is considered to be multifactorial, although the aetiology is uncertain. The aim of this thesis was to study the inflammatory response in periodontal tissue in terms of cytokines, prostaglandins, matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in children with Down syndrome as well as in healthy controls. In study I, 18 subjects with Down syndrome and 14 controls were clinically and radiographically examined and matched for age and degree of gingival inflammation expressed as percentage of bleeding on probing (BOP%). In all subjects, gingival crevicular fluid (GCF) was collected from six sites with paper strips, and levels of prostaglandin E2 (PGE2), leukotriene B4 (LTB4), and MMP-9 were analysed using RIA and ELISA kits. BOP% and volume of GCF (μL) were similar in both groups while Down syndrome patients had significantly higher (p<0.05) mean levels of PGE2, LTB4, and MMP-9 in GCF than controls. In study II, PD and BOP% were clinically assessed in subjects with Down syndrome (n=24) and controls (n=29) (both groups, mean age 16.4 yr). The controls were matched for age and BOP% to subjects with Down syndrome. GCF was collected and Bio-Plex cytokine multiplex assays were used to determine levels of interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), and interleukin (IL)-1β, IL-4, -6, -10, -12, and -17. GCF volume (μL) was significantly higher in subjects with Down syndrome (p<0.001) than controls. Mean levels of IL-1β, IL-4, IL-6, IL-10, IL-12, IFN-γ, and TNF-α in GCF were significantly (p<0.005) increased in subjects with Down syndrome compared with controls. The correlation between IFN-γ and IL-4 in GCF in subjects with Down syndrome differed significantly from controls (p<0.01). In study III, 21 adolescents with Down syndrome exhibiting gingivitis (DS-G), 12 subjects with Down syndrome exhibiting periodontitis (DS-P), 26 controls with gingivitis (HC-G), and 8 controls with periodontitis (HC-P) were clinically and radiographically examined. All patients were between ages 11 and 20 yr. GCF was collected from each subject and the amounts of MMP-2, -3, -8, -9 and -13 and of TIMP-1, -2 and -3 were determined with R&D multianalyte kits. The amounts of MMP-2, -3, -8, and -9 and of TIMP-2 in GCF were significantly higher (p<0.005) in the DS-G than the HC-G group. The correlation coefficient between MMP-8 and TIMP-2 also differed significantly (p<0.01) between the DS-G and HC-G groups. In contrast, the correlation coefficients between the MMPs and TIMPs did not differ significantly between the DS-P and the HC-P groups. The DS-P group, however, exhibited significantly (p<0.005) lower amounts of TIMP-2 in GCF compared to the HC-P group. In study IV, children with Down syndrome (n=10) and controls (n=10) were clinically and radiographically examined during dental treatment under general anaesthesia. Peripheral blood and GCF were gathered from each patient and levels of MMP-2, -3, -8 and -9, of TIMP-1, -2 and -3 in serum, and of GCF were determined. Peripheral blood leukocytes were isolated, and the relative amounts (%) of the various cells were determined with flow cytometry. Peripheral blood cells were stimulated with lipopolysaccharide (LPS) from Porphyromonas gingivalis (Pg) and MMP and TIMP levels were measured. Levels of MMP-3 and -8 and TIMP-1 in serum were significantly enhanced (p’s<0.05) in subjects with Down syndrome compared to controls. When peripheral blood leukocytes were cultured in the presence or absence of Porphyromonas gingivalis lipopolysaccharide, MMP- 8 levels were significantly (p < 0.05) higher in the Down syndrome group compared to controls. Children with Down syndrome exhibited significant positive correlations of CD8+ T cells with MMP-8 (r=0.630; p=0.050) and MMP-9 (r=0.648; p<0.05) and of CD56+ NK cells with MMP-3 (r=0.828; p<0.005) compared to controls. Conclusions Subjects with Down syndrome had increased levels of the arachidonic acid metabolites PGE2 and LTB4, the cytokines IL-1β, IL-4, IL-6, IL-10, IL-12, IFN-γ and TNF-α, and of MMP-2, -3, -8 and -9 and TIMP-2 in GCF compared to controls. In addition, the balance between pro- and anti-inflammatory cytokines and between MMPs and TIMPs was altered in subjects with Down syndrome but not in controls. Furthermore, in contrast with controls, no significant differences in MMP and TIMP levels in GCF were observed between Down syndrome patients with gingivitis and periodontitis. This finding might indicate that the inflammatory response in Down syndrome is already upregulated during early stages of periodontal disease. We also demonstrate an association between MMPs and lymphocyte subpopulations (CD8+ T-cells and CD56+ NK-cells), which may facilitate the migration of immune cells into the periodontal tissue. This assumption is well compatible with the higher levels of MMPs in GCF found in Down syndrome subjects. These findings, may contribute to the increased periodontal inflammation demonstrated in this current cohort of Down syndrome subjects

Abnormalities in Tooth Formation after Early Bisphosphonate Treatment in Children with Osteogenesis Imperfecta

Treatment with intravenous bisphosphonate (BP) in children and adolescents with osteogenesis imperfecta (OI) started in Sweden in 1991. No human studies on the role of BP therapy in development of disturbances in tooth mineralization or tooth morphology have been published. The study cohort comprised 219 individuals who were divided into four groups: group 1, BP treatment onset before 2 years of age (n = 22); group 2, BP treatment onset between 2 and 6 years of age (n = 20); group 3, BP treatment onset between 6 and 10 years of age (n = 13); and a control group of patients with OI who had not received BP therapy (n = 164). The chi-square test was used in between-group comparisons of the prevalence of tooth agenesis. The prevalence of tooth agenesis was significantly higher in children who began BP treatment before the age of 2 years (group 1; 59%,) compared to the controls (10%; p < 0.001) and to children who had begun BP therapy between ages 2 and 6 years (group 2; 10%; p = 0.009) or between ages 6 and 10 years (group 3; 8%; p = 0.003). Different types of disturbances in the enamel formation were seen in 52 premolars, where 51 were seen in those who began BP treatment before the age of 2 years. To conclude, starting BP treatment before the age of 2 years increases the risk of abnormalities in tooth formation manifesting as morphological aberrations, tooth agenesis, and enamel defects.Peer reviewe

Cone beam computed tomography indications for interdisciplinary therapy planning of impacted canines

Objective: To investigate how cone beam computed tomography (CBCT) affects the therapeutic planning of impacted maxillary canines. Study Design: A total of 132 impacted canines from 89 pediatric patients were collected from 3 specialist clinics in Stockholm, Sweden. An interdisciplinary therapy planning team consisting of 5 dental specialists evaluated each case and chose their preferred treatment alternative, initially without and later with CBCT images, to decide whether CBCT was justified for therapy planning. Predefined variables measurable using only 2-dimensional (2D) assessments were analyzed using stepwise logistic regression analyses. Results: The CBCT was considered indicated in 47% of the cases. Additional information from CBCT led to a treatment decision change in 9.8%. Significant 2D predictors for CBCT justification were horizontal canine angulation compared with vertical angulation (odds ratio [OR] = 10.9), extraction strategy involvement (OR = 6.7), and buccally positioned canines compared with palatal (OR = 5.3), central (OR = 25.0), and distal or uncertain positions (OR = 7.7). Conclusions: The benefit-risk assessment of CBCT for impacted canines may be reinforced by performing and applying justification decisions for CBCT acquisition at the therapeutic thinking level. If preliminary treatment planning motivates further in-depth investigation of either root status or tooth location, a CBCT is indicated.publishedVersio

Salivary biomarkers in the context of gingival inflammation in children with cystic fibrosis

Abstract Background Cystic fibrosis (CF) is a life-threatening chronic inflammatory disease in children due to respiratory complications. Saliva could serve as reservoir of bacterial colonization and potentially reflect systemic inflammation. This study investigated whether salivary triggering receptor expressed on myeloid cells 1 (TREM-1), peptidoglycan recognition protein 1 (PGLYRP1), interleukin (IL)-1? and calprotectin are associated with CF or reflect concomitant gingival inflammation. Methods Ten CF (age:3-12yrs) and ten systemically healthy age-and-gender-matched children (C) were enrolled in the study. Individuals with CF underwent routine laboratory determinations. Probing pocket depth (PPD), gingival index (GI), plaque index (PI) and bleeding on probing (BOP) were recorded on fully erupted teeth and saliva samples collected. Salivary TREM-1, PGLYRP1, IL-1? and calprotectin were analysed by ELISA. Results Children with CF had significantly higher BOP scores (P = 0.001) and calprotectin levels (P = 0.017) compared to the C group. TREM-1, PGLYRP1 and IL-1? could not distinguish between CF and SH but showed positive correlation with GI, PI and BOP in both groups. Calprotectin levels positively correlated with procalcitonin (P = 0.014), thrombocyte counts (P = 0.001), mean platelet volume (P = 0.030) and with PGLYRP1 (P = 0.019) and IL-1? (P = 0.013) in CF children. Receiver operating characteristic curve analysis for calprotectin (CFvsC) showed an area under the curve of 0.79 (95% CI 0.58-0.99, P = 0.034). Conclusions CF children presented with higher gingival inflammation scores and salivary calprotectin levels, that correlated with systemic inflammatory markers. Salivary calprotectin levels were not associated with periodontal parameters. Hence, preliminary data demonstrate that salivary calprotectin might have a chairside diagnostic potential for CF in children. This article is protected by copyright. All rights reservedPeer reviewe

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the Primary Dentition

Traumatic injuries to the primary dentition present special problems that often require far different management when compared to that used for the permanent dentition. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The primary goal of these Guidelines is to provide clinicians with an approach for the immediate or urgent care of primary teeth injuries based on the best evidence provided by the literature and expert opinions. The IADT cannot, and does not, guarantee favorable outcomes from strict adherence to the Guidelines, However, the IADT believes their application can maximize the probability of favorable outcomes

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth

Avulsion of permanent teeth is one of the most serious dental injuries. Prompt and correct emergency management is essential for attaining the best outcome after this injury. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. It represents the current best evidence and practice based on that literature search and expert opinions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on consensus opinions or majority decisions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. The purpose of these Guidelines is to provide clinicians with the most widely accepted and scientifically plausible approaches for the immediate or urgent care of avulsed permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes

Dental management of long-term childhood cancer survivors: a systematic review.

PURPOSE Critically review and summarise existing knowledge on prevalence of oral, dental, and craniofacial side-effects of antineoplastic treatment in childhood cancer survivors (CCS). METHODS A literature search was conducted for studies reporting on children aged 4-19 years treated for any type of malignancy up to the age of 15 years and for whom, at the time of the examination, more than 8 months have elapsed since the end of treatment. Data regarding dental late effects on teeth and craniofacial complex were collected and mean prevalence of each defect was reported. RESULTS From the 800 articles identified, 17 studies fulfilled inclusion criteria and were included. A total of 983 CCS were examined, with the total number of healthy controls being 1266 children. Haematological malignancy was the most prevalent diagnosis with the age at diagnosis ranging between 0-15 years. Multiple antineoplastic protocols were implemented with the elapsed time being 8 months up to 17 years. One-third of CCS experienced at least one late effect, with corresponding value for the control group being below 25%. Among the defects identified clinically, microdontia, hypodontia and enamel developmental defects were recorded in 1/4 of CCS. Impaired root growth and agenesis were the two defects mostly recorded radiographically. The effect on dental maturity and on salivary glands was unclear. CONCLUSION CCS are at risk of developing dental late effects because of their disease and its treatment and therefore, routine periodic examinations are essential to record their development and provide comprehensive oral healthcare