Polycystic ovarian disease: a new look at an old subject

We report a 2-day-old neonate with incontinentia pigmenti combined with destructive encephalopathy. Generalized seizures developed soon after birth; characteristic papulovesicles and hyperpigmented linear streaks appeared several days later. The brain CT scan showed multiple low density areas with cortical atrophy and ventricular enlargement. Histopathological examination favored the diagnosis of incontinentia pigmenti. Although a series of microbiological examinations failed to identify any infectious agent, the patient was still treated vigorously with anticonvulsants, systemic antibiotics, and acyclovir from the beginning of hospitalization. However, the seizures persisted, and the patient died 26 days after birth. Our report suggests that incontinentia pigmenti with encephalopathy may have a fatal prognosis.     

Pioneering Alberta cardiac surgeons walked into uncharted territory 40 years ago

PURPOSE: To report corneal abnormalities associated with incontinentia pigmenti. CASE REPORTS: Two girls, aged 2 1/2 and 5 years, with incontinentia pigmenti from one family underwent a complete ophthalmic examination. RESULTS: We found vortex (whorl-like) epithelial keratitis characterized by epithelial microcysts that stained with fluorescein and midstromal radial mild haziness in daughters of a family with incontinentia pigmenti. CONCLUSION: Incontinentia pigmenti should be included in the differential diagnosis of children with keratitis, particularly if there is evidence of characteristic dermatologic or other systemic manifestations.     

Distal digital keratoacanthoma: a report of 12 cases and a review of the literature

Twelve cases of distal digital keratoacanthoma (DKA) affecting the subungual area or the proximal nail fold are reported. The distal phalanx of the toe was affected in three cases. Spontaneous resolution occurred in one; one other recurred after surgery. We also discuss the link between DKA and incontinentia pigmenti subungual tumours; these entities are indistinguishable.     

Linear and whorled nevoid hypermelanosis: report of two cases]

CASE REPORTS: Two cases of linear and whorled nevoid hypermelanosis are reported. Cutaneous lesions (hyperpigmented macules along Blaschko's lines) appeared gradually after birth. Neurologic anomalies were detected in both cases (symptomatic in one, only cerebral MRI anomalies in the other). CONCLUSION: This sporadic condition, probably caused by somatic mosaicism, must be differentiated from incontinentia pigmenti, Mac Cune-Albright disease and chimerism. Its situation among the Blaschko linear pigmentary anomalies (hypomelanosis of Ito) is discussed.     

Contribution of curietherapy in the treatment of ENT tumors

The purpose of this study was to compare dental status and resource requirements in immigrants to Norway, three to 18 years of age, with Norwegians of the same age group. Data on dmft and DMFT, fillings placed and time spent for dental care were registered in the records of 9000 such children in the period 1992-93. Eleven per cent of the children were immigrant children. Immigrant children three to six years of age had fewer sound teeth and more decayed, missing and filled teeth than Norwegian children and the pre-school immigrant children had higher treatment needs. However, the time spent on a pre-school child with an immigrant background was shorter than the time spent on a Norwegian child with the same number of decayed teeth. The differences between immigrants and Norwegians disappeared with higher age. Immigrant children older than six years had dental health and resource requirements similar to those of Norwegian adolescents.     

The aesthetic composite bridge

New developments are constantly introduced in the search for the optimal treatment modality to restore a single anterior tooth. The patient attention has shifted to aesthetics of the restoration, biocompatibility of the dental materials utilized, conservative preparation of the teeth to be restored, and the retention of intact adjacent dentition. The learning objective of this article is to review the methods currently utilized and to present a recently introduced treatment modality--the two-component bridge, which combines the strength and resiliency of composite resin with the aesthetic advantages of porcelain. The technology of the material is reviewed, the predominantly lingual tooth preparation procedures are outlined, and the bridge try-in is described. The advantages of the two-component bridge are presented along with the contraindications and suggestions of careful case selection. Three cases with congenitally missing maxillary lateral incisors in youthful patients are presented to supplement the theoretical outline and to describe and illustrate the clinical procedure.     

Correlation of optotypes with the Landolt ring--a fresh look at the comparability of optotypes

During seemingly routine check-ups, the dental practitioner must be ever aware of "quiescent" abnormalities or irregularities. Knowledge of special problems occurring within a certain patient population is of great value to the practitioner when evaluating the individual patient. Numerous studies have been conducted evaluating the pediatric Caucasian population; however, no comparable studies for the Black pediatric population have been done. This study sought to establish prevalence rates for the Black pediatric population with regards to the following anomalies: congenitally missing teeth, supernumerary teeth, dens in dente, odontomas, dentinogenesis imperfecta, gemination, fusion and concrescence. The radiographs (panographs mandatory), history forms and treatment progress records of 2,267 children (1,136 males and 1,131 females) were analyzed. Radiographs of poor quality were eliminated and attempts were made to include only children of Black American heritage. Prevalence rates established for a predominantly Black pediatric population were: 4.4%, congenitally missing teeth; 1.49%, supernumerary teeth; 0.26%, dentinogenesis imperfecta (Brandywine type); 0.44%, odontomas; 0.22%, gemination; and 0.12%, fusion. Evidence of dens in dente was found in only one erupted supernumerary maxillary paralateral, and the detection of only one case of concrescence occurred; both have prevalence rates of 0.04%. No other study has produced such a high rate of dentinogenesis imperfecta (.26%), except that conducted within the tri-racial group itself. In addition, if assumptions are to be made from this investigation for the general population, supernumeraries and odontomas may be present significantly more often in the Black than Caucasian pediatric population.     

Prosthodontic considerations for the older patient

The elderly have both the greatest level of need for prosthodontic services of any age group, and the greatest degree of complicating dental, medical, and behavioral factors. Issues arise in daily practice of whether or not to replace a missing tooth or teeth for a patient of advanced age and a wide variety of challenges-dental/oral and others-face the dentist who is considering replacing some or all of an older person's teeth. This article focuses on clinical approaches and techniques that have proven particularly important and useful for providing prosthodontic care to the older adult.     

How to appoint a senior house officer

A considerable body of evidence exists to suggest that genes play a dominant role in the etiology of the dental anomalies reviewed. It has been postulated that some kind of genetically controlled interrelationship may exist for some of these coincidental dental anomalies, as evidenced by their frequency of association. It has also been speculated that a "common genetic defect" may give rise to different phenotypic manifestations, including missing, malformed, and even ectopic and malpositioned teeth. The maxillary teeth that develop in the critical marginal areas of the dental lamina, namely the lateral incisors, canines and second premolars, seem most susceptible. Such dental anomalies may be symptoms of an inheritable developmental disturbance of tooth structures. Knowing that these dental anomalies can be inherited, a familial history and early clinical or radiographic detection of one anomaly, could alert parents and clinicians to the high likelihood of detection of other defects in the same individual and similar defects in other family members. Early diagnosis is important so that interceptive pediatric and orthodontic opportunities in relation to missing, malformed and ectopically erupting teeth are not overlooked. Further family studies are necessary to reveal the mode of inheritance of some of these dental anomalies and twin studies comparing monozygous and dizygous twins would enable an estimation of the extent of their inheritance.     

Teeth or implants: a 1990s dilemma

Using endosseous implants to replace missing teeth is a highly predictable process when the precepts defined by Br?nemark are followed. The question of whether or not to extract periodontally compromised teeth, however, remains controversial. This article presents a case report illustrating some of the concerns involved when treating a patient with a combination of natural teeth and implants, and proposes several compelling questions regarding the treatment decisions made in this case.     

Incontinentia pigmenti: clinical and neuroradiologic features

Developmental brain malformations and destructive processes of unknown etiology were described in incontinentia pigmenti (IP). Two patients, a male and a female, with characteristic skin lesions and central nervous system (CNS) involvement are reported. Neuroradiological examinations revealed hypoplasia of corpus callosum, neuronal heterotopias, and periventricular white matter damage. No specific infectious, inflammatory, or metabolic abnormalities were identified. These neuroradiographic findings may suggest that an ischemic pathogenetic mechanism occurred prenatally. We speculate that the brain damage in IP may occur during CNS development and in successive stages. Magnetic resonance imaging appears more useful to detect white matter lesions and brain malformations in patients with IP.     

X-linked genodermatoses

Chromosome X is one of the best genetically defined. Many disease loci are assigned to this chromosome, due to the peculiar mode of inheritance of X-linked disorders. Chromosome X undergoes X-inactivation in females. Recombination with chromosome Y occurs at pseudoautosomal regions. Some features of X-linked genodermatoses are a consequence of these phenomenons: variable expression, topography following Blaschko's lines. This can be seen in incontinentia pigmenti, focal dermal hypoplasia or hypohidrotic ectodermal dysplasia. Deletions at the pseudoautosomal region may cause contiguous gene syndromes. Hence ichthyosis with steroid-sulfatase deficiency may occur in association with various disorders. Transmitting females should be recognized by clinical examination or molecular studies, as this represents the main point in genetic counselling.     

Absorption and elimination kinetics of zidovudine in the cerebrospinal fluid in HIV-1-infected patients

The first two surveys of the dental health of young Finnish men were conducted in 1919 and 1965. The objective of four subsequent surveys (1976, 1981, 1986, and 1991) was to collect both interview and clinical examination data for the monitoring of changes in the oral health status of the recruits. A significant reduction in self-reported toothache, gingival bleeding, and number of decayed teeth was observed from 1976 to 1991. At examination, the numbers of decayed teeth, teeth indicated for extraction, teeth in need of fillings, and missing teeth decreased substantially, as did the teeth with visible plaque, subgingival calculus, and teeth with 4-mm or deeper periodontal pockets. This comprehensive series of successive cross-sectional oral health surveys clearly shows that since 1976 a significant decrease in oral disease and treatment needs has taken place among the Finnish population of young men.     

The use of cantilever bridges

Replacement of missing teeth with fixed bridgework often involves producing full crown retainers on teeth on both sides of an edentulous space. Unfortunately, this approach can result in the destruction of much healthy tooth tissue, and the clinician must balance the benefits of replacing missing teeth with the amount of tooth preparation required. Current thinking in restorative dentistry places the preservation of tooth tissue at a premium, and most practitioners are happy to use techniques that embrace this philosophy. Because of this, cantilever bridges have an increasing role in dental practice, where the replacement for a missing tooth or teeth has one or more abutments on only one side of the edentulous space, being unsupported at the other. Cantilever bridges fall into several types, depending on the number of abutments and types of retainers. This article describes the various cantilever bridge designs, considers the biomechanics of these restorations, and provides guidelines for their clinical use.     

Trend of aging on the number of teeth investigated through a survey of dental health representation in a simple equation by using a kinetic method and its application

A survey of dental health was conducted on 6,933 residents (aged 61.8 +/- 11.1) in 4 villages Nara Prefectural Uchiyoshino Health Center administers. Examinees were divided into 7 ages groups. The mean value of present teeth at each age group was calculated. Age dependency of number of teeth was investigated with a kinetic model based on the following premise. 1. Changes between age groups can be treated as a time series occurrence. 2. Number of missing teeth can be estimated as 29 - that of present teeth. Results show that the rate of decrease of the number of present teeth is of a first order in itself and the number of missing teeth. It can be mathematically expressed as follows: -dX/dt = k.X.(29 - X).......eq. (1). in which X = number of present teeth, 29 - x = number of missing teeth k = rate constant, t = time. From this simple relationship the following are suggested 1. Tooth loss is caused by the interaction of present teeth and sites where teeth are lost. 2. Integration of eq. (1) yields ln?(29 - X)/X? = 29.k.t + a.......eq. (2). in which 0 < X < 29, t = time from the youngest age group (20-29), a = constant. It appears that, from eq. (2), the dental health of a community is determined by two coefficients, 29.k and a. 3. Helping a person realize his present and future dental state and to motivate action for prevention of tooth loss by showing him his rate of decrease, "tooth age" and the predicted number of teeth a certain years later calculated from eq. (1) and eq. (2), can be of great value. 4. Eq. (2) is transformed to X = 29/?exp(29.k.t + a) + 1?, which represents the reverse S-shaped curve of the age dependency of the number of teeth. 5. Applying this method to cohort analysis will enable forecast of the trend of the number of teeth.     

CPITN, DMFT, and treatment requirements in a Nicaraguan population

WHO basic methods were used to assess CPITN, DMFT, and treatment requirements in a population of 178 persons aged 12-64 yr living in urban and rural areas of Nicaragua. Two groups were examined: individuals presenting for dental treatment at health clinics (30%) and subjects chosen randomly at other locations (70%). Mean ages of both groups were similar although females were found in higher percentages among those presenting for dental care. With the exception of one young individual, all subjects had calculus in at least one sextant. About 26% of the subjects who presented for treatment had a > or = 6 millimeter pocket compared to about 14% of the remainder of subjects. The mean DMFT for health clinic subjects was 16.1 compared to 10.3 for subjects from other locations. Subjects presenting for treatment had twice as many missing teeth and a mean of 0.5 filled teeth compared to 2.4 filled teeth for other subjects. Subjects at the clinics were in greater need of restorative care and extractions, while subjects from other locations were found to have more teeth that did not require any treatment. Health clinic subjects reported more visits to the dentist in the last year than other subjects. Only 80% of those presenting for treatment owned a toothbrush compared to 97% of those examined in other locations, and the latter group reported brushing their teeth more frequently. Attrition was a commonly encountered tooth disorder with 53% of all subjects exhibiting this condition.     

Lipid peroxidation in patients with ischemic heart disease, hyperlipidemia and/or hypertension while polyunsaturated omega-3 fatty acids of plant and animal origin were in their diet

Missing anterior teeth are being replaced by implant-supported restorations quite frequently in modern dentistry. Providing the patient with a temporary prosthesis prior to or following implant fixture placement must satisfy established esthetic and functional criteria. When orthodontic treatment is included as part of the overall treatment effort, additional considerations include the retention and stabilization of newly established tooth positions. This article describes the fabrication, use and advantages of a provisional anterior prosthesis that replaces missing teeth prior to or following implant placement.     

Hypomelanosis of Ito

The main peculiarities of the hypomelanosis of Ito (HI) or incontinentia pigmenti achromians are shown. The most frequent and severe complications of this multisystemic neurocutaneous disease are reviewed. The most severe complications concern to the central nervous system (CNS), mental retardation and epilepsy--both present in more than 50% of cases--being the two most severe and frequent disorders. About 10% of patients with HI show infantile spasms during the first year of life and another 10% have autistic behavior. Moreover, other complications can be observed in some patients. These complications consist of ocular, musculoskeletal and oral alterations, hypotonia, macrocephalia, microcephalia, congenital cardiac malformations, urological and genital malformations and other rarer disorders. Chromosomal anomalies, especially translocations or mosaicisms type are found in about 50% of cases. The study, however, can show the chromosomal abnormalities in the karyotype performed in fibroblasts of the hypopigmented skin while it may be normal in the blood and in skin unaffected.     

Morquio's syndrome. A case report and review of clinical findings

Morquio's syndrome is a genetic disorder caused by the lack of the enzyme responsible for the breakdown of the mucopolysaccharide keratin sulfate. The resulting buildup of keratin sulfate causes a specific pattern of abnormalities, including short stature, spinal deformity, cardiac abnormalities, corneal opacities, deafness and dental abnormalities. The specific dental findings in the patient described here are as follows: the posterior teeth were tapered and had pointed. cusps; the maxillary anterior teeth were spaced and flared, and on radiographs, the enamel was less than 25 percent of normal thickness but of normal radiodensity. Despite these findings, the patient exhibited a low rate of caries. This paper is a review of medical and dental findings in the Morquio's patient and how this may affect dental management.     

Removable partial prostheses for the elderly

Elderly partially edentulous patients can have teeth replaced with removable or fixed prostheses supported by mucosa, teeth, or implants. Age per se does not influence which option is best. Instead, the relative health of the patient, dental tissues, and the patient's finances determine treatment. A three-level index of these factors, the PTF index, is proposed to assist in the decision-making for treatment. Removable partial prostheses (RPPs) can be indicated for all patients because RPPs offer esthetic, versatile, noninvasive, and reversible features. They are particularly indicated when remaining teeth are questionable. If teeth are lost, they can be more easily added to existing RPPs compared with fixed prostheses. Six changes to ideal designs are illustrated in this article for prostheses with a compromised dentition, to make continued prosthetic service simpler.