International Poster Journal of Dentistry and Oral Medicine, 03/2017

Background: Early childhood caries (ECC) is a public health problem. Studies have reported propinquity between ECC and maternal knowledge, attitudes, practices, age, education, and smoking habits. Objective: To assess the evidences of association between maternal factors and early childhood caries. Method: This comprehensive literature search was conducted for the period 2006 to 2016. Databases included Pubmed, Google Scholar, and cross references. Two authors independently selected the studies and extracted the data. Mesh terms "caregivers", "mother", "caries", and "knowledge" were used. 506 articles were selected after removing the duplicates and those that did not match the search criteria. Methodological quality assessment was done using a tool based on Strobe and NIH checklists for observational studies. Results: 10 papers were finally included. The mothers' caries status, knowledge, socioeconomic status and smoking habits significantly affect the caries status of children, whereas the effects of education status and breast feeding were inconclusive. The studies were heterogenous. There was a lack of studies on children aged 30 months. Conclusion: This systematic review of observational studies indicates Level IV evidence for an association between maternal factors and early childhood caries. Dental public health significance: Oral health promotion of mothers can significantly reduce ECC. Keywords: caregivers, mother, caries, knowledge

Head and neck tumours are among the top ten of all tumour entities. They make up a total of 30%, with 90% of these being squamous cell carcinomas. Upper jaw carcinoma is one of the rare sites in the mouth and is below 35%. The occurrence in childhood is extremely rare. Only a few publications are available. With 1800 childhood malignancies per year, the probability of occurrence is less than 0.2%. Boys are 20% more affected than girls. The prognosis quoad vitam of childhood-treated cancer cases under the age of 15 years at initial diagnosis is 81% over the next 15 years. The exclusion of typical childhood risk factors such as EBV-associated carcinoma or genetic disposition suggests a sporadic occurrence. We present a 13-year-old patient with an exophytic upper jaw carcinoma. Initially, neoplasia was histologically noted as a pseudoepithelial hyperplasia (PEH). After referring the sample to the Center for Dermatopathology and the Children's Cancer Registry, the diagnosis of carcinoma was revealed. Staging was performed, EBV and HPV were excluded as well as tumour predisposition syndrome. Complete tumour resection was performed, followed by reconstruction with Bichat's fat graft, palatal rotation-flap, and a Rehrmann-flap. No further therapy was performed. The young patient currently remains free of cancer after 3 years and is regularly seen at paediatric hematology and oncology departments and the oral and maxillofacial surgery. Quarterly clinical and MRI controls are performed. Bony reconstruction with free autologous iliace crest graft was performed at age 16, followed by implantation. Keywords: Oral cancer, child

Aim: The incidence of traumatic dental injuries (TDIs) is higher in evenings and on weekends. They require early and appropriate management to minimise complications and to save the affected tooth. Consequently, many patients present in dental emergency services, which operate outside regular consulting hours. The aim of this study was to analyse the TDI cases in a dental emergency service unit of a university hospital over 4 years. Methodology: All patients with TDIs between 2010 and 2013 were determined from the hospital database and subjected to further analysis. Demographic data, classification of trauma (according to the WHO), teeth involved, and cause of trauma were evaluated. Results: Of 16 301 patients who received treatment in the dental emergency service over a period of 4 years, 1305 (8.0%) came due to TDIs. Average age was 14.4 years (range: 0.6- 88.1). More than half of the trauma patients (54.2%) were under the age of ten and about two-thirds (74.5%) under twenty. Males experienced trauma more often than females (range 1.5 : 1). Nearly half of cases (48.2%) occurred on weekends. The most common diagnosis was subluxation (27.8%), followed by uncomplicated enamel-dentin fracture (25.9%), and lateral luxation (21.7%). 355 patients (27.2%) had an additional soft tissue injury. In 48.6% of cases only one tooth was involved, in 33.5% two. The permanent dentition was injured in 56.6% of cases, the primary dentition in 41.1%. The maxillary central incisors were affected in 79.2% of cases. The most common causes of TDIs were falls (54.6%) and sport accidents (13.4%). Conclusions: The prevalence of TDIs in the dental emergency unit was high. Due to the complexity of management, possible complications, and lifelong consequences, the dentist on duty as well as the one providing further treatment have to be aware of the endodontic and surgical measures. A regular update of the dentists' knowledge about traumatology is required and more attention should be given to the prevention of trauma. Keywords: TDI, dental trauma, traumatic dental injuries, emergency

Introduction: Furcation lesions are a common symptom of moderate or severe periodontitis. Making an accurate diagnosis and conducting the proper treatment is a challenge in dentistry. Aim: Analyse the competence of the Bulgarian dentists concerning the diagnosis and treatment of furcation lesions. Material and methods An anonymous survey among 150 dentists about the knowledge and the use of furcation lesion diagnostic methods and therapeutic approaches was conducted. Results: For Class I furcation lesions, only 32.9 % of the dentists would employ odontoplasty. For Class II furcation lesions - only 9.4 % would use regenerative therapy. For Class III furcation lesions - only 1/3 of the respondents would perform resective periodontal surgery, odontoplasty, or extraction. Conclusion: Additional training to establish the exact diagnostic and treatment of furcation lesions is necessary. This will result in better treatment of the periodontitis. Keywords: furction lesions, odontoplasty, regenerative therapy, diagnosis/furcation lesions

Aim: The aim of this study is to investigate the impact of various amelogenin preparations on the attachment and proliferation of periodontal ligament cells (PDL-cells) on periodontally infected root surfaces. Material & Methods: Root surfaces of periodontally infected, extracted human teeth were treated with scaling and root planing (SRP) and subsequently coated with three different amelogenin preparations, the clinically well-established Emdogain, a recombinant human wildtype-amelogenin (rH174), and a modified recombinant human wildtype-amelogenin (RGD-amelogenin). For modification, the tripeptide Arg-Gly-Asp (RGD) loop from fibronectin was inserted into the rH174 nucleotide sequence at the C-terminal ending using polymerase chain reaction (Imhof et al., 2015). PDL-cell attachment was measured after 30 minutes. PDL-cell proliferation on coated periodontally infected root surfaces which were treated with SRP was analysed after 72 h and compared with healthy root surfaces (positive control), periodontally infected, untreated root surfaces (negative control) or root surfaces that were exclusively treated with SRP. Cell morphology and distribution was documented using a scanning electron microscope. Results: The attachment analysis revealed a significant increase in PDL-cell attachment after coating with Emdogain compared to coating with wildtype-amelogenin (p0.05). RGD-amelogenin caused an even higher increase compared to Emdogain (p0.05). SRP and wildtype-amelogenin caused a significant increase in proliferation compared to the negative control (p0.05). Emdogain and RGD-amelogenin led to an even higher increase in proliferation compared to SRP and wildtype-amelogenin. None of the groups was able to reach the level of proliferation of the positive control (p0.05). Conclusion: The applied, simulated clinical conditions result in outcomes for Emdogain that are in accordance with those of recent clinical trials. This supports the chosen methods. For the first time, the positive effect of RGD-amelogenin on PDL-cell adhesion and on PDL-cell proliferation compared with Emdogain were shown. Obviously, the higher number of cells after 72 hours on root surfaces coated with RGD-amelogenin is caused by the optimised initial cell adhesion. Emdogain, however, possibly contains more components, besides amelogenins, which stimulate cell proliferation. The combination of RGD-amelogenin and Emdogain could be an option for optimising periodontal regeneration. This must be confirmed clinically. Keywords: PDL-cell, attachment, proliferation, periodontal regeneration, Emdogain, amelogenin, fibronectin, RGD

Introduction: Dental caries are a major public health problem. Various attempts have been made to deal with the problem. One of them is reducing sugar consumption, but it is not so effective. Tobacco-use control programs, however, have shown that substitution therapy-replacing a harmful habit with a positive, more culturally acceptable practice-can be effective. Xylitol has attracted much attention as an alternative sweetener. The effect of xylitol on caries development relates to its non-cariogenicity and to the beneficial effect of substituting sucrose with xylitol in chewing gums. Objective: Investigate the effectiveness of xylitol chewing gum in the prevention of dental caries. Methods: A systematic literature survey was carried in electronic data bases like Pubmed, Google Scholar, and the Cochrane Library with MeSH terms "xylitol chewing gum", "dental caries" in the English language. The authors extracted data on study characteristics, dental caries increment, and the main findings. Results: 199 potentially relevant studies were identified. The 10 articles selected for this review showed that the use of xylitol chewing gum is associated with prevented fractions ranging from 33.33 percent to 63.03 percent. Conclusions: The evidence suggests that xylitol chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings. Keywords: xylitol, chewing gums, dental caries

Introduction: Congenital nasal pyriform aperture stenosis and solitary median maxillary central incisor are uncommon anomalies and are associated with further malformations. Solitary median maxillary central incisor itself initially has no impact on a child's health, but congenital nasal pyriform aperture stenosis is a potentially life-threatening condition. Case presentation: A Caucasian baby boy showed severe dyspnea and was intubated orotracheally. Multiple anomalies were detected, including urogenital and craniofacial malformations. Computed tomography scans revealed congenital nasal pyriform aperture stenosis with a diameter of 4.9mm and a solitary median maxillary central incisor. A 3.0mm tube was inserted in his left nasal cavity, and the baby was able to breathe sufficiently and spontaneously. The nasal tube was removed after seven days, and the baby was discharged under application of decongestant drops. After seven months, the baby was readmitted with respiratory distress, and surgery was carried out using an intraoral sublabial approach. The stenotic area of the pyriform aperture was widened, and 3.0mm tubes were inserted in both nasal cavities for 10 days. Over a period of six month, no further respiratory distress has occurred. Conclusion: The decision to perform surgery was delayed since the baby's nasal breathing was adequate as a result of the insertion of a nasal tube. Since treatment depends on the severity of symptoms, it is appropriate in some cases to take a conservative approach at first and to keep surgery as a last resort. Once a conservative approach has been selected for congenital nasal pyriform aperture stenosis, awareness of the life-threatening nature of the condition should be kept in mind, and a surgical approach must still be taken into account. Keywords: Congenital nasal pyriform aperture stenosis, solitary median maxillary central incisor, malformations, associated anomalies

Introduction: Despite the growing strength of social networks, television advertising is still the most influential medium in people's purchasing decisions, particularly children. Aim: To assess the influence of television advertisements on the purchasing behaviour of foods detrimental to oral health and their impact on caries prevalence among school children and to analyse the extent and nature of food advertising in a sample of kids' television programmes focusing on the foods detrimental to oral health. Methodology: A non-randomised, uncontrolled questionnaire-based study was conducted among 480 children aged 6-14 years attending the schools of Bangalore city, followed by an oral examination. Based on the response, kids' channels were analysed for the nature and extent of food advertisements that are detrimental to oral health. Oral health education was given to all the children about the ill-effects of foods that were advertised on television. A post intervention questionnaire was administered after one month to evaluate the effect of intervention. Results: Among 480 children, 14.1% reported that they purchase food products once in a month, 57.2 % once in a week, 26% every day and only 0.02% have never purchased any, and there was a significant association (p0.001) between the purchasing patterns and caries prevalence. Among 1354 advertisements that were recorded, 57.8% (782) were food-based products, and those detrimental to oral health account for 75.97% (594). After oral health education, there was a significant change (P0.05) in the purchasing patterns of food-based products. Conclusion: Television advertisements may strongly influence children's food preferences and eating habits, resulting in a higher caries prevalence. Keywords: Television advertisements, caries prevalence, purchasing behavior, children, health education

Background: Oral squamous cell carcinoma is the sixth most common cancer worldwide and is one of the leading causes of death, especially in developing countries like India. Cancer is a hyperproliferative disorder that is usually managed with the help of chemotherapeutic agents that are toxic not only to tumour cells, but also to normal cell in many ways. In addition, these agents are very expensive and thus not affordable for most. Moreover, these agents cannot be used for the prevention of cancer. In contrast, the traditional herbal medicines used from ancient days in India are generally known to be free of the deleterious effects and are inexpensive but effective. Wheatgrass is the young grass of the wheat plant "Tritcum aestivum Linn." from the family Poeaecae (Graminae). It contains a plethora of vitamins, mineral, amino acids, and vital enzymes like dismutase superoxide and cytochrome oxydase. These enzymes play an important role in the anticancer approach of this herbal product. It is also called "green blood' because of its high chlorophyll content, which accounts for 70% of its chemical composition. Chlorophyll bears a structural similarity with hemoglobin and thus results in a high oxygen supply to all the body tissues. Aim of the study: To analyse the effect of wheat grass extract on an oral squamous cell carcinoma (OSCC) cell line. Materials and methods: KB (Mouth Epidermal Carcinoma Cells) was used for the present study. Aqueous extract of wheat grass was prepared in the institution. The effect of aqueous extract was studied on an OSCC cell line (KB cell line). Conclusion: Inhibition of cancer cell proliferation by aqueous extract of wheatgrass, which is abundantly grown in India. Keywords: Wheatgrass (Triticum aestivum), Oral squamous cell carcinoma cell line, Oral squamous cell carcinoma

Introduction: Rhabdomyosarcoma (RMS) develops as a malignant soft tissue tumour from the cells of the cross-striated muscle. For the under 15-year-olds, the annual incidence is estimated at 1: 224,000. The median age at diagnosis is 5 years. Rhabdomyosarcoma can occur anywhere in the body, even in areas where there is no cross-strained muscle. The head and neck area is affected in 40% of cases, with the orbitae and the paranasal sinus being the most common areas. Cause and origin are still largely unknown. The sequence and the execution of the individual types of therapy depend on the tumour- and patient-induced risk factors. Case report: In a 17-year-old female patient at the age of 3 years, a rhabdomyosarcoma in the right pterygopalatine fossa was diagnosed with intracranial spreading tendency, which was successfully treated by excision with subsequent radiotherapy and polychemotherapy. As a result, there was complete anesthesia in the supply area of the right trigeminal nerve and visual loss of the right eye. The growth of the skull developed on the irradiated side less than on the unaffected side; the maxilla and mandibula are micrognathic. From the point of view of the positional relationship of both jaws, an Angle Class III was found. The patient also complained about the intraoral situation, which had existed for years, since all teeth had a degree of relaxation of II-III, resulting in severe ingestion. In addition, there was pain in the area of the temporomandibular joints and the masticatory muscles. Radiographically, the panoramic view showed multiple ageneses of the permanent teeth and rudimentary apices. The capites mandibulae and coronoid processes appeared degenerated and flattened. In addition to producing an acceptable functionality, the patient also wishes to improve the aesthetic appearance. Method: After orthodontic and oral-maxillofacial surgery, a reconstruction osteotomy in combination with implant-mediated rehabilitation was considered not indicated because of the unpredictable healing tendency. Thereupon, a bite elevation was initiated in the patient with removable bite splints, in order to potentially achieve intercuspidation and to evaluate the resilience of the temporomandibular joints, the muscles, and the teeth. After 6 months of easy wearing time, a removable interim denture based on a deep drawing splint was inserted into the upper and lower jaw. The teeth still present were used to guide the patient during incorporation and to achieve a slight friction. After 3 months of wearing this in combination with logopedic support, the patient reported a significant improvement, especially in the social environment due to improved aesthetics. However, step-by-step corrections in the areas of ingestion and language have been announced for the coming months. As a definitive supply variant, we are striving for a supply by means of galvanic telescopes. Summary: Since rhabdomyosarcomas are located in sensitive body regions (e.g. head and neck area), the treatment is sophisticated and multidisciplinary. The aim of the therapy is the oral rehabilitation of the young patient in the sense of personalized medicine. Keywords: embryonic rhabdomyosarcoma, oral rehabilitation