Sequential supernumerary teeth development in a non-syndromic patient; report of a rare case.

Isolated impacted supernumerary teeth are quite rare, but they can be seen associated with several syndromes such as cleidocranial dysostosis or Gardner's syndrome. This article aims to discuss a case of sequential formation of supernumerary teeth with no other associated disease or syndrome. A 17-year-old Iranian male with 8 impacted supernumerary teeth was referred to the department of pediatric dental clinic at Shahid Beheshti Medical University in Tehran with a history of several impacted unerupted teeth. Repeated and periodical clinical and radiographic examinations revealed newly formed teeth buds in unusual dental ages. All extra teeth were associated with generalized enamel hypoplasia to some degree on their relative permanent adjacent teeth. The patient did not have any record of a systemic disease or any syndromic condition to relate his dental problem to. This rare condition involved repeated and continued formation of extra teeth out of the normal numbers and dental age evident in serial radiographs

Effect of an Informative Leaflet on Knowledge Level of Mothers Regarding Traumatic Dental Injuries

Objectives: The present study aimed to assess the level of knowledge regarding traumatic dental injuries (TDIs) among mothers and evaluate the efficacy of a simple educational leaflet, as an informative tool, to raise their awareness in this respect. Methods: A total of 150 mothers with their children receiving dental care were included in this study and assigned to two groups of intervention and control. Before the intervention, a questionnaire was distributed among all the recruited mothers (time 0). After its completion, an informative leaflet with basic first aid information regarding what to do in case of TDIs was given to the mothers in the intervention group and their knowledge level was examined immediately after reading the leaflet (time 1). The knowledge of both groups was evaluated again after 3 months (time 2). The data were analyzed by SPSS version 21. Results: The mean knowledge score was 6.53 out of 10 at baseline. A significant increase in knowledge score was noted in the intervention group (9.20) at time 1 (P<0.001). The knowledge score improved in both the intervention (8.57) and control groups (7.61) after 3 months (P< 0.001). The intervention group had significantly higher score than the control group at time 2 (P< 0.001).  Conclusion: The informative leaflet enhanced the knowledge level of mothers regarding TDIs. Use of leaflets is suggested as an effective tool to inform mothers about the management of TDIs

Oral Melatonin Versus Midazolam as Premedication for Intravenous Sedation in Pediatric Dental Patients

Objectives: This study aimed to evaluate the effect of oral melatonin and oral midazolam as premedication for intravenous (IV) sedation of pediatric dental patients. Materials and Methods: This crossover, double-blind randomized clinical trial was conducted on 23 uncooperative 2-6-year-olds with definitely negative behaviors according to the Frankl's scale. Each child served as their own control. The children were randomly divided into two groups: group I received 0.5mg/kg of oral melatonin one hour before IV sedation, while group II received 0.5mg/kg of oral midazolam 30 minutes before IV sedation on their first visit. Every child received the other premedication on their second visit. The degree of sedation was judged according to the Houpt scale. Physiologic parameters including blood pressure (PB), heart rate (HR), and blood oxygen saturation (SpO2) and side effects including dizziness, nausea, vomiting, and sleepiness were assessed. The parents' and the operator's satisfaction rates were scored. Data were analyzed using paired t-test and Wilcoxon signed-rank test. Results: There were significant differences in sedation scores between the two sessions (P0.05). Nausea and vomiting were more common during the first two hours in the midazolam group (P=0.002). Tremors were more common in the melatonin group (P=0.013). Dizziness was more evident when melatonin was used (P<0.001). The clinician and the parents were more satisfied with the results of midazolam intake (P<0.05). Conclusions: Premedication with oral midazolam in pediatric patients is superior to that with melatonin with a higher parents' and operator's satisfaction.  

Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial

Background: This study compared the safety and efficacy of nitrous oxide (N2O)/midazolam and N2O/promethazine for dental treatment of uncooperative children. Materials and Methods: In this randomized, cross-over, clinical trial investigation Eighteen healthy uncooperative children with a pair of similar teeth requiring the same treatment were included.Combination of N2O/midazolam was given in one visit, where N2O/promethazine was administrated in the other appointment for each patient in a cross-over manner. Oxygen saturation and heart rate as well as behavior parameters according to Houpt behavior scales were recorded. Postoperatively, patients' anxiety and parents' satisfaction were assessed by visual analog score and a questionnaire, respectively. Data were analyzed using Wilcoxon' s signed rank test and Paired t-tests with a P value set at 0.05. Results: Physiologic parameters were within normal limit in both groups. Children in midazolam group were significantly deeper sedated compared to other groups. In the first phase, children sedated with midazolam behaved superiorly in comparison to promethazine, while there was no difference at the final phase of the treatment between the two groups. Conclusion: Both of the drug combinations resulted in acceptable, efficient, and safe sedation outcomes

Remineralization of Artificial Caries in Primary Teeth by Grape Seed Extract: An In Vitro Study

Background and aims. Promoting remineralization is the ultimate goal of clinical prevention of caries lesion. The present in vitro study aimed to investigate the effect of grape seed extract (GSE) on artificial enamel caries in primary human teeth. Materials and methods. Seventeen human sound primary incisors were sectioned mesiodistally. The tooth slices were placed in a demineralizing solution for 96 hours at 37ºC and 50% relative humidity to create lesions. The demineralized fragments of each tooth were randomly divided into two case (immersed in GSE solution in phosphate buffer for 8 days) and control (immersed in distilled water) groups. The samples were subsequently evaluated using a scanning electron microscope and a micro-hardness tester. Data were analyzed using independent t-test. Results. The mean ± SD micro-hardness values for the case and control groups were 358.6±83.42 and 296.51± 69.41, respectively. Grape seed extract significantly increased the micro-hardness of the lesions (P=0.03). The morphology of GSE treated enamel was clearly different from that in the control group, and there were deposits of scaffolding insoluble complexes on the enamel surface. Conclusion. GSE enhanced the remineralization process of artificial enamel lesions of primary teeth, and thus, might be considered an effective natural agent in non-invasive dentistry

Sedative Effect of Oral Midazolam/Hydroxyzine versus Chloral Hydrate/Hydroxyzine on 2-6 Year-Old Uncooperative Dental Patients: A Randomized Clinical Trial.

Different drugs are used for conscious sedation in pediatric dentistry either single or in combination. This study assessed the comparative effect of midazolam/hydroxyzine and chloral hydrate/hydroxyzine on 2-6 year-old uncooperative children needing dental treatment.A double blind cross-over randomized clinical trial was designed and 16 children aged 2-6 years with ASA1 status who were judged with negative to definitely negative behavior (according to Frankl) were chosen. Cases were divided randomly into two groups. The first group received midazolam/hydroxyzine (MH) at the first visit while the second group received chloral hydrate/hydroxyzine (CHH) as the first medication. Both groups received the other regimen at the second visit. Midazolam 0.5mg/kg and chloral hydrate 50mg/kg with 1mg/kg hydroxyzine were administered. Cases were subsequently assessed for sedation and then dental treatment was performed. Blood oxygen saturation (SpO2) and pulse rate (PR) were measured before and after drug administration, as well as during and after dental treatment. The Houpt scale was also used for the level of sedation before, during and after treatment. Data were analyzed using Wilcox-on signed rank test and the paired t-test.Sedative success rate was 64.3% in cases of MH and 33.3% in CHH. The difference between groups was significant (P=0.046). The success rate was significantly different between groups at different measurement stages as well (

The Effect of An Angiogenic Cytokine on Orthodontically Induced Inflammatory Root Resorption

Objective Orthodontically induced inflammatory root resorption (OIIRR) is an undesirable sequel of tooth movement after sterile necrosis that takes place in periodontal ligament due to blockage of blood vessels following exertion of orthodontic force. This study sought to assess the effect of an angiogenic cytokine on OIIRR in rat model. Materials and Methods In this experimental animal study, 50 rats were randomly divided into 5 groups of 10 each: E10, E100 and E1000 receiving an injection of 10, 100 and 1000 ng of basic fibroblast growth factor (bFGF), respectively, positive control group (CP) receiving an orthodontic appliance and injection of phosphate buffered saline (PBS) and the negative control group (CN) receiving only the anesthetic agent. A nickel titanium coil spring was placed between the first molar and the incisor on the right side of maxilla. Twenty-one days later, the rats were sacrificed. Histopathological sections were made to assess the number and area of resorption lacunae, number of blood vessels, osteoclasts and Howship’s lacunae. Data were statistically analyzed using ANOVA and Tukey’s honest significant difference (HSD) test. Results Number of resorption lacunae and area of resorption lacunae in E1000 (0.97 ± 0.80 and 1. 27 ± 0.01×10-3, respectively) were significantly lower than in CP (4.17 ± 0.90 and 2.77 ± 0.01×10-3, respectively, P=0.000). Number of blood vessels, osteoclasts and Howship’s lacunae were significantly higher in E1000 compared to CP (P<0.05). Conclusion Tooth movement as the outcome of bone remodeling is concomitant with the formation of sterile necrosis in the periodontal ligament following blocked blood supply. Thus, bFGF can significantly decrease the risk of root resorption by providing more oxygen and angiogenesis

Comparison of pulse oximeter, cold test, and electric pulp test for assessment of pulp vitality in permanent immature teeth

Introduction: Pulp sensitivity tests are commonly used for assessment of pulp vitality. However, indirect assessment of pulp vitality by evaluation of nerve response and subjective nature are the main limitations of these tests. Pulse oximetry is used for assessment of blood oxygen saturation in medicine, and its efficacy for assessment of pulp vitality needs to be evaluated. Aim: This study aimed to assess and compare the efficacy of pulse oximeter with a modified probe, cold test, and electric pulp test for evaluation of pulp vitality in permanent immature teeth. Materials and methods: This cross-sectional study was conducted on 240 permanent maxillary incisors in four groups based on the type of tooth (central and lateral incisors) and degree of root development (complete or incomplete). Also 40 endodontically treated central and lateral incisors teeth in two groups were evaluated as negative controls. Pulp vitality was assessed by an expert clinician using pulse oximeter, cold test, and electric pulp test. Based on the true and false positive and negative responses, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood, diagnostic accuracy, and diagnostic odds ratio were calculated. Results: The pulse oximeter showed diagnostic accuracy of 98.7% in the permanent central incisors with complete and incomplete roots and 100% in the permanent lateral incisors with complete and incomplete roots. The diagnostic accuracy of the electric pulp test was 76.2% and 92.5% in the incomplete and complete central incisors, respectively, and 76.2% and 83.7% in the incomplete and complete lateral incisors, respectively. The cold test had a diagnostic accuracy of 85% and 92.5% in the incomplete and complete central incisors, respectively, and 91.2% and 88.7% in the incomplete and complete lateral incisors, respectively. Conclusions: The findings of this study showed that pulse oximetry has a higher specificity and better accuracy than the cold test and the electric pulp test in assessing the pulp vitality in the diagnosis of vital teeth and should be introduced as a suitable method for this purpose and preferred to the cold and electric pulp tests for more evaluation to diagnose pulp vitality