A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay

Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.

Timings of Permanent Tooth Emergence in Children of Rural Vanuatu, Melanesia

Introduction Global patterning and timing of permanent tooth emergence is influenced by ethnicity, with no known timings reported for ethnic Melanesian children living in the tropical archipelago of Vanuatu. Aim To determine timings of permanent tooth emergence and sequencing for children who reside in rural Vanuatu. Methods Children aged 4-17 years (n=1026), part of a larger oral health cross-sectional study, were examined recording all permanent teeth present, across four spatially separated islands. Binary logistic modelling established children’s median age of emergence of each permanent tooth for each study area. Results The median emergence of first permanent molars for girls is 4.9-years and 5.3 -years for boys. In all locations, children had all permanent teeth emerge by age 11 years (excluding 3rd molars). Clinically important differences exist for permanent tooth emergence by study area. Discussion Permanent teeth emerge earlier for Ni-Vanuatu children compared to both Melanesian children of Papua New Guinea as well as other ethnicities across Oceanic countries. These results can be used as a set standard for Vanuatu. Early tooth emergence suggests oral health education programmes should target pregnant women with clinical preventive strategies commencing for their children before 5-years of age.

Molar space closure: To do or not to do?

Missing or compromised permanent molars can complicate orthodontic treatment planning and mechanics. Molar extraction should be considered in appropriate situations, but clinicians must decide between closing and regaining the edentulous space. Several factors should be taken into consideration to achieve appropriate molar space management, such as the need for space, asymmetry, periodontal status, sinus pneumatization, and the terminal molar position. Herein, three sample cases are reported to demonstrate the treatment options for molar space closure and maintenance with these factors taken into consideration during treatment planning. The understanding of mechanics played a crucial role in anchorage preparation and side effect prevention. If the third molar substitution was managed in advance and adequate space between the ramus and third molar was obtained via second molar protraction, the tooth spontaneously erupted in a favorable position without requiring further treatment. This case series can aid clinicians in molar space management. Regardless of whether the space is to be closed or regained, the treatment plan should conform to the patient’s expectations and improve occlusion with minimal side effects and treatment duration.

Bilateral Symmetry of Number and Size of Dental Caries Lesions among Children

Aim. To determine the bilateral occurrence of caries lesions in 5–12-year-old children, and to assess whether one bitewing photograph can predict caries size and occurrence in the homologous tooth on the other side of the mouth. Study design. The study was carried out on 222 medical files of children 5–12 years old who were first examined in the university dental clinic. The presence and size of the caries lesions in the first and second primary molars and first permanent molars were recorded. Results. No correlation was found when comparing the caries lesion distribution of each tooth’s proximal surface. Seventy-one of the X-rays demonstrated a single caries lesion in a first or second primary molar or in a first permanent molar on one side of the mouth, of which 21.3% demonstrated a single caries lesion in the collateral side, 43.6% demonstrated 2 or more lesions, and 35.21% did not have any caries lesion on the collateral side of the mouth. Conclusion. One bitewing cannot determine the presence and size of a caries lesion on the same site of the homologous tooth.