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Dental Management in a Patient with Glanzmann’s Thrombasthenia : A Case Report

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):352-358. doi:10.5933/JKAPD.2020.47.3.352

Glanzmann’s thrombasthenia (GT) is a rare, autosomal recessive inherited congenital disorder, characterized by impaired blood coagulation due to platelet dysfunction. It was first reported by the pediatrician Glanzmann in 1918. GT affects both males and females, and it is more common in regions of the Middle East, India, and France, where intermarriage is common. It has an incidence of about 1 in 1,000,000 people. In South Korea, according to the Division of Rare Diseases, Korea Centers for Disease Control and Prevention, around 200 cases have been reported in 2018. Clinical symptoms include petechia, ecchymosis, epistaxis, and gingival bleeding. The spontaneous loss of deciduous teeth can result in excessive bleeding with that blood transfusion should be considered. Preventing hemorrhages and hemostasis are most important factors in dental treatment. Local bleeding can be controlled by compression, but platelet transfusion can be required by prolonged bleeding. Pediatric dentists can minimize the gingival bleeding by control of the oral hygiene to prevent gingivitis and dental caries. The importance of oral hygiene and periodic recall check-up should be emphasized. During dental treatment, the examination and the treatment plan of patient should be modified to prevention of hemorrhages carefully. A 6-year-old girl with GT was referred for the treatment of dental caries, and resin restoration was performed under nitrous oxide inhalation sedation. After treatment, compression was required for the bleeding control.

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Enamel Renal Syndrome: A Case Report of Amelogenesis Imperfecta Associated with Nephrocalcinosis

Sooji CHOI ; Young Bae SOHN ; Suk JI ; Seungil SONG ; Jeongwon SHIN ; Seunghye KIM

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):344-351. doi:10.5933/JKAPD.2020.47.3.344

Amelogenesis imperfecta (AI) occurs either in isolation or in association with other dental abnormalities and systemic disorder. A rare syndrome associating AI with nephrocalcinosis was named as Enamel Renal Syndrome (ERS; OMIM #204690). This syndrome is characterized by severe enamel hypoplasia, failed tooth eruption, intra pulpal calcifications, enlarged gingiva, and nephrocalcinosis. Nephrocalcinosis is a condition where calcium salts are deposited in renal tissue, and this may lead to critical kidney complications. This rare syndrome shows pathognomonic oral characteristics that are easily detectable at an early age, which proceeds the onset of renal involvement. Pediatric dentists are the first oral health practitioners whom ERS patients will meet at early age. The role of pediatric dentists is critically important for early diagnosis and referral of patients to both nephrologists for renal assessment and geneticists for identification of causative mutation and diagnosis. Early detection of renal involvement may provide chances to prevent further undesired renal complications.

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Generalized Pulp Stones of Primary Dentition in a Patient with Molar-Incisor Malformation : A Case Report

Dongyun LEE ; Jisun SHIN

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):337-343. doi:10.5933/JKAPD.2020.47.3.337

Molar-incisor malformation (MIM) is a new type of root anomaly reported recently. The characteristics of MIM are dysplastic root formations, constriction of pulp chambers and presence of calcified matrices at the level of cementoenamel junction in permanent first molars and primary second molars. In some cases, permanent maxillary incisors are also affected. The permanent first molars of the patient in this case report were affected with MIM. Generalized pulp stones were observed in overall primary dentition. Micro-computed tomography (micro-CT) imaging and scanning electron microscope-energy dispersive X-ray spectrometer analysis were performed on the extracted mandibular first molar and maxillary primary second molar of the patient. Micro-CT images revealed the discontinuity of enamel directly connected to an accessory canal of the root.

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Characteristics and Risk Factors of High Caries Risk Group in 12-year-old Children Using Data from the 2015 Children’s Oral Health Survey

Kayoung KIM ; Ah-Hyeon KIM ; So-Youn AN

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):327-336. doi:10.5933/JKAPD.2020.47.3.327

The purpose of this study was to examine the characteristics of the high caries risk group of 12-year-old children in Korea. Oral health status and interview data were collected from 23,089 children aged 12 years who participated in the 2015 Korean Children’s Oral Health Survey. Subjects were classified into high-risk and low-risk groups according to the Significant caries (SiC) index, and the influence of each variable was analyzed. As a result of the study, the SiC index of the high-risk group was 5.08, which was about 9.6 times higher than the lowrisk group. The risk factors associated with the high-risk group were in the order of the number of sealant teeth, dental treatment demand for the past year, perceived oral health status, gender, region, frequency of snack intake per day, and use of oral hygiene aids. In order to improve the oral health of children, appropriate preventive treatment and oral health education should be carried out with reference to the items indicated as risk factors in the high-risk group of dental caries.

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Comparison of Microhardness and Compressive Strength of Alkasiteand Conventional Restorative Materials

Kunho LEE ; Jongsoo KIM ; Jisun SHIN ; Miran HAN

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):320-326. doi:10.5933/JKAPD.2020.47.3.320

The aim of this study was to compare compressive strength and microhardness of recently introduced alkasite restorative materials with glass ionomer cement and flowable composite resin. For each material, 20 samples were prepared respectively for compressive strength and Vickers microhardness test. The compressive strength was measured with universal testing machine at crosshead speed of 1 mm/min. And microhardness was measured using Vickers Micro hardness testing machine under 500 g load and 10 seconds dwelling time at 1 hour, 1 day, 7 days, 14 days, 21 days and 35 days. The compressive strength was highest in composite resin, followed by alkasite, and glass ionomer cement. In microhardness test, composite resin, which had no change throughout experimental periods, showed highest microhardness in 1 hour, 1 day, and 7 days measurement. The glass ionomer cement showed increase in microhardness for 7 days and no difference was found with composite resin after 14 days measurement. For alkasite, maximum microhardness was measured on 14 days, but showed gradual decrease.

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Evaluation of Characteristics of the Dental Maturity in Girls with Precocious Puberty

Chi Hoon KIM ; Chung-Min KANG ; Ik-Hwan KIM ; Je Seon SONG ; Seong Oh KIM

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):312-319. doi:10.5933/JKAPD.2020.47.3.312

Precocious puberty (PP) is defined as the early development of secondary sexual characteristics (before the ages of 8 years in girls and 9 years in boys). The aim of this study is to identify characteristics of the dental maturity in girls with PP that discriminate them from normal healthy girls. This study included 99 girls aged 6 - 8 years with PP and 99 girls without past medical history of same chronological age (control group). The study was performed on 198 panoramic radiographs (99 PP girls, 99 control group girls). Demirjian method was used to evaluate the panoramic radiographs and determine dental maturity. Difference in dental maturity score and tooth formation stages between the two groups were analyzed. The PP group showed significant higher maturity score than control group. Among mandibular teeth, mandibular 2nd premolar and 2nd molar were significantly more mature in the PP group than control group. Logistic regression analysis showed that mandibular 2nd molar was only significant predictor for PP girls.

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Awareness of Caregivers, Emergency Medical Technicians, and Emergency Medical Doctors about the Storage Media for Avulsed Teeth

Gyulim KIM ; Seunghye KIM ; Yonjoo MAH

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):303-311. doi:10.5933/JKAPD.2020.47.3.303

The aim of this study was to assess the awareness of caregivers, emergency medical technicians, and emergency medical doctors by investigating the storage media for avulsed teeth at the trauma site. This study was performed by reviewing medical records of 183 patients with the age under 17 years old, who visited Ajou University Hospital for dental trauma. Based on their medical records, storage media for avulsed permanent teeth were investigated by classifying them as dry, milk, saline, saliva and tap water. The storage media chosen by caregivers at the trauma site were classified as cases by parents and school nurse teachers. Storage media chosen by emergency medical technicians and emergency medical doctors were also investigated using the same classification criteria. The results show that both parents and school nurse teachers used milk the most as a storage medium for avulsed teeth. Dry storage was the second most chosen medium by parents, and saline by nurse teacher. As a storage media emergency medical technicians used saline the most, while emergency medical doctors used only saline when they failed to replant avulsed teeth. There is a need to improve the knowledge of caregivers, emergency medical technicians, and emergency medical doctors regarding the storage media for avulsed teeth.

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Evaluation of Virtual Reality Simulation of Dental Caries through Student Questionnaire

Byunggee KIM ; Jeeheon RYU ; Jaehwan KIM ; Seonmi KIM ; Namki CHOI

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):293-302. doi:10.5933/JKAPD.2020.47.3.293

The purpose of this study was to evaluate the applicability of virtual reality simulation after experience of dental caries diagnosis for dental students before exposing to clinical pediatric practice. A pediatric patient model of a five-year-old child with primary dentition was developed and a caries model that is amenable to VR(virtual reality) diagnosis was organized and set-up. The dental student’s were allowed to use the simulated model for fifteen minutes and their experiences were evaluated using a self-reported questionnaire to evaluate presence and usability of this application. Overall, virtual presence and appearance area of the simulation were highly scored. The result indicates that the VR model has no significant difference from the actual clinical caries regardless of grade of students, gender and VR experience. If the prototype is continuously advanced, its applicability in dental education will increase.

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Status and Survey of Pulp Treatment by Korean Pediatric Dentists

Jee Soo BAE ; Ik-Hwan KIM ; Hyung-Jun CHOI ; Je Seon SONG

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):277-292. doi:10.5933/JKAPD.2020.47.3.277

The pulp treatment of primary and immature teeth in the children and adolescents is affected by the environment of the patients, clinical careers and dentists performing the techniques, as well as clinical modalities and pulpal diagnosis. The purpose of this study was to investigate the current status of pulp treatment performed in real clinical practice, as well as the reasons behind the choice of treatment methods. The study was conducted on a total of 153 members of the Korean Academy of Pediatric Dentistry, and statistical data from the Health Insurance Review and Assessment Service (HIRA) from 2010 to 2018 were analyzed ogether. Both the survey results and the statistics from the HIRA showed that 1-visit pulpectomies of primary teeth were most common, and the frequency of the use of the Ni-Ti file was increased in children with primary or mixed-dentition. In the treatment of immature permanent teeth, regenerative endodontic treatment by individual dentists was found to be less frequent than in university hospitals.

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Effect of Silver Diamine Fluoride and Sodium Fluoride Varnish on Remineralization in Artificially Induced Enamel Caries: An in vitro Study

Soyoung KIM ; Sangho LEE ; Nanyoung LEE ; Myeongkwan JIH

Journal of Korean Academy of Pediatric Dentistry.2020;47(3):266-276. doi:10.5933/JKAPD.2020.47.3.266

The purpose of this study was to compare the remineralization effect of 38% silver diamine fluoride (SDF) and 5% sodium fluoride (NaF) varnish on artificially induced enamel caries.The present study standardized the physiochemical characteristics of the tooth structure using bovine teeth, realized the wash-off action of agents using a saliva, reproduced an environment similar to mouth through pH-cycling, and comparatively assessed the remineralization effect of 38% SDF and 5% NaF varnish in a non-destructive method using micro-CT. And the remineralized enamel surface structure was analyzed by scanning electron microscopy (SEM) and energy dispersive X-Ray spectroscopy (EDS). In both SDF and NaF varnish, mineral density (△Hounsfield unit value) and the volume of enamel restored to normal mineral density through remineralization gradually increased with time. And the SDF showed a much higher level of increase in mineral density at all depths and remineralized volume than NaF varnish. According to SEM analysis, the surface roughness decreased in the order of artificial saliva, NaF varnish and SDF. In addition, EDS analysis showed that silver ion was precipitated on the enamel surface in SDF group. In conclusion, SDF had a greater remineralization effect than NaF varnish on demineralized enamel.

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