Williams syndrome is a rare congenital disorder with various physical abnormalities and characterized by facial, oral, and dental features. Individuals with Williams syndrome typically have eating disorders in the early childhood, which lead to prolonged night feeding. Prolonged night feeding is a risk factor for rampant dental caries. Williams syndrome is caused by the microdeletion of chromosome 7, resulting in elastin deficiency. Elastin is integral to cardiovascular health. Many patients with Williams syndrome have complex cardiovascular abnormalities that must be considered a part of dental management. Complications related to cardiovascular diseases may induce adverse effects such as dangerously elevated blood pressure. This may occur in patients during stressful dental treatment. In addition, characteristics of auditory hyperalgesia and anxiety disorders among patients with William syndrome, complicate receiving routine dental management. Therefore, dental treatment under sedation or general anesthesia may be preferable for patients with Williams syndrome; in particular, patients who are very uncooperative and/or needs extensive dental treatment. A thorough evaluation of each patient's physical condition is required before making decisions regarding dental treatment. Careful monitoring and preparation for emergencies are very important during and shortly after dental treatment under general anesthesia or sedation. Monitoring is critical until vital signs have stabilized and return to normal. A 28-month-old man diagnosed as having Williams syndrome, visited the Dental Hospital of OO University for the management of rampant dental caries. We reported on the management of this patient who had peripheral pulmonic stenosis, and received dental treatment under general anesthesia. We also reviewed the characteristics of Williams syndrome and discussed considerations for dental treatment under general anesthesia.
Anesthesia, General ; Anxiety Disorders ; Blood Pressure ; Cardiovascular Abnormalities ; Cardiovascular Diseases ; Child, Preschool ; Chromosomes, Human, Pair 7 ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Dental Caries ; Eating ; Elastin ; Emergencies ; Humans ; Hyperalgesia ; Pulmonary Valve Stenosis ; Risk Factors ; Vital Signs ; Williams Syndrome

The aim of this review is to introduce about the issue of benzocaine and methemoglobinemia. Through blocking the pain during dental treatment, fear and anxiety of patients will be reduced. Thus, anesthetic agent containing benzocaine is commonly used while controlling the pain of patients during treatment. However, on May 28, 2018, the Ministry of Food and Drug Safety reported a medication safety report about restricting the use of benzocaine-containing agents in infants under 24 months and children. Also, they recommended a cautious use to adolescents and adults to prevent methemoglobinemia (MHb). This report was published due to an advice from Food and Drug Administration (FDA) on May 23, 2018. When using agents containing benzocaine, dentists must consider the probability of MHb and prepare for early diagnosis and appropriate action. Since 1930s, methylene blue is known to cure MHb patients. Therefore, the proper use of methylene blue for emergencies and diagnosis methods for early diagnosis of MHb should be familiar to dentists planning for the use of topical anesthetic agents. Dentists should be trained for emergency situation of MHb caused by the use of benzocaine.
Adolescent ; Adult ; Anesthetics ; Anxiety ; Benzocaine ; Child ; Dentists ; Diagnosis ; Early Diagnosis ; Emergencies ; Humans ; Infant ; Methemoglobinemia ; Methylene Blue ; United States Food and Drug Administration

A salivary testing instrument has an advantage that the method is simple and can be performed in a short time. However, it is necessary to verify the factors that affect the reliability of the result, because the device is easy to use and even saliva collection is simple. The aim of this study was to compare the difference of the test results according to the measurement time in order to analyze the time factor of the external variable among the factors that may affect the measurement results of the salivary testing instrument. The relationship between the measured values of the salivary testing instrument to identify the internal variables was analyzed. Saliva was collected from 20 randomly selected patients regardless of age, sex, or diseases. The mean age was 46.6 years, 10 males and 10 females. The saliva collected was directly measured with the salivary testing instrument as group I. The saliva samples were placed in air in a paper cup for 10 minutes, and then measured as group III. Then group I was remeasured after 30 minutes and assigned as group II. Group III was remeasured after 30 minutes and called as group IV. As a result, all of the cariogenic bacteria, acidity, buffer capacity, blood, leukocyte, protein and ammonia, except buffer capacity, showed statistically significant changes in group II and IV. This means that the reliability of the test results is poor if the measurement time is not observed. Cariogenic bacteria were correlated with leukocyte and protein, buffer capacity was related to acidity, protein, and protein was related to buffer capacity and leukocyte. In conclusion, the result according to the measurement time as the external variable was different, which means that time must be strictly monitored when testing saliva. It is also necessary to take into account the relevance of the correlations between the internal variables and the clinical data.
Ammonia ; Bacteria ; Female ; Humans ; Leukocytes ; Male ; Methods ; Saliva ; Time Factors

The aim of this study is to compare the properties of odontoblast gene of early passage cells and late passage cells derived from impacted maxillary supernumerary teeth.
Impacted supernumerary teeth with maxilla were extracted from 12 patients (8 males, 4 females) between 6 - 9 years old without medical history. Real-time polymerase chain reaction (PCR) was conducted to compare characterization of odontoblast cell in the 3rd and 10th passage, and between with bone inducing additive group and without additive group. Genes for odontoblasts characteristics are osteonectin (ONT), alkaline phosphatase (ALP), osteocalcin (OCN), dentin matrix protein 1 (DMP-1) and dentin sialophosphoprotein (DSPP).
The level of gene expression was in a decreasing order of ONT, ALP, OCN, DMP-1 and DSPP in the 3rd passage, and in decreasing order of ONT, DMP-1, OCN, ALP, and DSPP in the 10th passage in the undifferentiation and differentiation group. The order of ONT, DMP-1, and OCN did not changed. ALP and DMP-1 were switched in order.
ALP and DMP-1 may be used as important markers for differentiating between the 3rd passage and 10th passage cells.
Considering that supernumerary tooth was extracted young age and the time required to cultured 10th passage was short, supernumerary tooth can be considered a useful donor site of dental pulp stem cells.

The purpose of this study was to compare the effect of sodium fluoride(NaF) varnish and potassium iodide(KI) on remineralization efficacy of silver diamine fluoride(SDF) by measuring microhardness and evaluating surface morphology by scanning electron microscope(SEM).
Artificial caries lesions were induced on extracted primary molars and vickers microhardness was measured. Specimens were randomly separated into 4 groups for treatment. The specimens in group I were treated with SDF, group II with NaF varnish after SDF, group III with KI after SDF and group IV with distilled water. After 8 days of pH cycling, vickers microhardness was measured and difference before and after treatment was calculated. For SEM, 2 samples were evaluated respectively after enamel polishing, lesion formation and after pH cycling.
Group III showed highest increase in microhardness. Group I showed higher increase in microhardness than Group II but without statistical difference. Group IV showed lowest increase in microhardness value among 4 groups.
On SEM image, group I, II and III showed smoother and less irregular surface compared to group IV. Amorphous crystal pellicles were observed in group III.
In conclusion, SDF, SDF and NaF, SDF and KI groups showed smoother surface and increase in microhardness suggesting the possibility that remineralization effect might take place in oral conditions. In addition, in limited conditions of this study, applying NaF varnish after SDF did not increase the remineralization efficacy of SDF while KI significantly increased the remineralization efficacy of SDF. However, additional study considering various conditions that might affect demineralization and remineralization in clinical situations need to be conducted.

The purpose of this study was to compare the effect of the hemostatic agent containing aluminum chloride with hemostatic agent containing ferric sulfate on the shear bond strength of resin-modified glass ionomer cement(RMGIC) to dentin in primary tooth.
Twenty extracted non-carious human primary teeth were collected in this study. The specimens were cut to expose dentin and polished. The specimens were randomly seperated into 3 groups for treatment; group I: polyacrylic acid(PAA), RMGIC; group II: aluminum chloride, PAA, RMGIC; group III: ferric sulfate, PAA, RMGIC
Ten specimens from each group were subjected to shear bond strength test.
The mean shear bond strength of each group was as follows: 10.07 ± 1.83 MPa in Group I, 7.62 ± 0.78 MPA in group II, 5.23 ± 0.78 MPa in group III. There were significant differences among all groups(p < 0.001).
In conclusion, both aluminum chloride hemostatic agent and ferric sulfate hemostatic agent decreased the shear bond strength of RMGIC to dentin. And ferric sulfate hemostatic agent decreased the shear bond strength of RMGIC more than the aluminium chloride hemostatic agent.

The purpose of this study was to evaluate the effect of a hemostatic agent containing aluminum chloride on the shear bond strength of resin-modified glass ionomer cement (RMGIC) to the dentin of primary teeth.
Thirty-six extracted non-carious human primary teeth were collected in this study. Dentin surfaces were cut and polished. The specimens were randomly divided into 4 groups; group I: RMGIC without conditioning; group II: polyacrylic acid (PAA), RMGIC; group III: aluminum chloride, RMGIC; group IV: aluminum chloride, PAA, RMGIC.
All teeth were thermocycled between 5.0℃ and 55.0℃ for 5000 cycles. Fifteen specimens from each group were subjected to shear bond strength test and 3 specimens from each group were inspected using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy.
The mean shear bond strength of each group was as follows: 4.04 ± 0.88 MPa in group I, 8.29 ± 1.40 MPa in group II, 1.39 ± 0.47 MPa in group III, 6.24 ± 2.76 MPa in group IV. There were significant differences among all groups (p < 0.001). SEM image of the dentinal tubules were partially exposed in group III and group IV. Fully exposed dentinal tubules were found in group II.
In conclusion, aluminum chloride decreased the shear bond strength of RMGIC to dentin, regardless of PAA conditioning.

Objectives: The purpose of this study was to investigate the prevalence of permanent first molar taurodontism and identify the correlation between primary molars and permanent first molar taurodontism. Methods: Among the 10,113 children who underwent panoramic radiography at a dental hospital from January 2010 to December 2019, 685 children (404 boys, 281 girls) were included in this study. Results: Six children (0.8%) and 98 children (14.1%) showed taurodontism of the primary molars and permanent first molar, respectively. All of the children with taurodontism in the primary molars had at least one taurodontism in the permanent first molars. Conclusions Early diagnosis of taurodontism in primary molars might allow dentists to make treatment plans in accordance with tooth development.

The aim of this study was to evaluate the antibacterial effect on Enterococcus Faecalis and physical properties of chitosan added calcium hydroxide canal filling material.
Low, medium, high molecular weights of chitosan powder were mixed with calcium hydroxide canal filling material. Also, for each molecular weight group, 1.0, 2.0, 5.0 wt% of chitosan powder were added. An overnight culture of E. faecalis was adjusted to 1 × 106 CFU/ml. For test of antibacterial effect, three different molecular weights of 2.0 wt% chitosan and three different concentrations of high molecular weight chitosan were mixed with calcium hydroxide canal filling material. The absorbance of plates was analyzed using spectrophotometer at 570 nm with a reference wavelength of 600 nm. Physical properties such as flow, film thickness and radiopacity were examined according to ISO 6876 : 2012.
All molecular weight type of chitosan containing material showed inhibitory effect against E. faecalis growth compared to non-chitosan added calcium hydroxide canal filling material group (p < 0.05). High molecular weight chitosan containing material showed the most antibacterial effect. Also, the antibacterial effect decreased as the incorporated amount of chitosan decreased (p < 0.05). Every molecular weight group of material containing chitosan had a tendency for reduced flow and radiopacity, increased film thickness according to amount of chitosan. Low molecular weight of 1.0 wt% chitosan addition did not show any significant difference of physical properties compared to conventional calcium hydroxide canal filling material.
In conclusion, for reinforcement of antibacterial effect against E. faecalis and for favorable physical properties, 2.0 wt% of chitosan adding is recommended. Considering its antibacterial effect of chitosan, further studies are required for clinical application of chitosan in endodontics and pediatric dentistry.

The current study aimed to compare the pH, solubility value, and ion release capability of premixed mineral trioxide aggregates (MTAs) versus conventional pulp capping materials before and after setting. The following materials were used: resin-modified calcium silicate cement (TheraCal LC®, TLC), resin-modified calcium hydroxide cement (Ultra-BlendTM plus, UBP), and 2 kinds of premixed MTA (Endocem MTA® premixed regular 〔EMPR〕 and Well-RootTM PT 〔WRP〕). The specimens of each material were prepared before and after setting and were immersed in distilled water. The materials’ pH and solubility value were assessed. Next, three kinds of ion (calcium, sulfide, and strontium) released by pulp capping materials were evaluated via inductively coupled plasma atomic emission spectrometry. In the after-setting group, the pH of TLC and UBP decreased. However, the pH of the premixed MTAs increased with time. TLC released a higher concentration of strontium ion compared with the other materials. Meanwhile, EMPR released a significantly high concentration of sulfide ion (p < 0.05). In the after-setting group, the 2 kinds of premixed MTAs released a significantly higher concentration of calcium ion compared with the other materials (p < 0.05). In the after-setting group, EMPR had a significantly low solubility value (p < 0.05). The Kruskal-Wallis test, followed by the Mann-Whitney U test with Bonferroni correction, was used in statistical analysis. In conclusion, resin-modified calcium silicate cement, modified calcium hydroxide cement, and the 2 kinds of premixed MTAs had an alkaline pH and low solubility value and they released various concentrations of ions after setting.