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Junko Kindaichi, Junji Sugawara, Naoki Kosuge, Toshihiko Sakamoto, Tom ...
1981 Volume 19 Issue 3 Pages
431-440
Published: December 25, 1981
Released on J-STAGE: January 18, 2013
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In this article, a case of mandibular deformation incidental to a congenital branchial cyste under the tongue region is discussed. The surgical removal of the cyste was performed soon after birth. However, little improvement of the mandibular deformation was observed until the age of 3. when the patient visited the Orthodontic Clinic Tohoku University Dental Hospital.
The tongue was large and usually could be seen through the lips, and saliva flowed out continuously. The mouth slit was large, and when the patient was forced to close his mouth, many wrinkles appeared at the corner of the mouth. The patient suffered severe dental caries over the entire deciduous dentition except for the mandibular incisors partly because of poor oral hygiene. A severe open-bite with the contacting area only at both side deciduous second molar regions were noted. A remarkable labial inclination of the deciduous incisors and the buds of permanent incisors of the mandible were found from the Roentgenocephalogram.
Normal size and position of maxilla were observed. The mandible had a large mandibular body length, an opening tendency of mandibular plane angle and a prominent curvature of the body downward and forward.
Based on the Egyedi-Obwegeser method, tongue-ectomy was conducted. The chin cup appliance was also utilized.
Even after only seven months of treatment, remarkable improvements in facial appearance and a drastic reduction of the mandibualr deformation were already observed.
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Yoshitaka Hayashi, Okio Kimura, Hiroshi Ono
1981 Volume 19 Issue 3 Pages
441-447
Published: December 25, 1981
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For the esthetic restoration of the deciduous anterior teeth, we made a new thin wall type of preformed polycarbonate crown (Pedocrown-Nisshin Co. ), which requires less preparation of the teeth than the previously used polycarbonate crowns.
For cementing to the teeth, we used adhesive composite resins (Clearfil F and Clearfil SC-Kurarey). Also for adhering these composite resins to the polycarbonate, we used a self curing methyl methacrylate monomer.
With this method, we made clinical observations of 62 cases from 23 children of ages 2 to 6 years, with observation periods of 3 to 18 months.
The result was that a more esthetic restoration with a simple procedure in one appointment could be made. However there were rather many cases in which the crowns had peeled off or were lost.
Crowns were lost between the prepared teeth and the composite resins in 12cases. In these cases, the composite resins were still attached to the polycarbonate crowns. These occurred mostly in shorter period of less than 6 months, and in cases of the vital teeth with poorer from of the prepared teeth (greater loss of the tooth materials by decay). The adhesion of Clearfil to the vital dentin seems poor.
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Shohei Higashi, Tetsuo Kawahara, Takeyuki Nakagawa, Fumikazu Nakajima, ...
1981 Volume 19 Issue 3 Pages
448-460
Published: December 25, 1981
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Dental calculi attached to human deciduous teeth were investigated by means of decalcified sections, microradiography, scanning electron microscopy, X-ray microanalysis and microhardness tests.
In decalcified sections or microradiograms, calculi were observed on the surfaces of the enamel, cementum and/or the resorption site of dentin. The typical configurations of the structural elements were glubular, lamellar and woven-lamellar and were similar to those of the calculi attached to permannt teeth.
The outer, inner and fractured surfaces of the calculi were observed by means of scanning electron microscopy. On the surfaces, there were calcified bacilli, calcified molds of bacilli and plate like crystals. Hexahedrally based crystals in various sizes were seen on the inner surfaces of the calculi.
X-ray microanalysis revealed that there was a large amount of Ca and P on the surfaces of calculi at various places. At the same sites, small amounts of Zn, S and Cl were frequently detected. The hexahedrally-based crystals contained much Ca, P and a little Mg.
The microhardnss value of the calculus attached to the cervical enamel indicated 144-198 V. H. N.. The V. H. N. are nearly equal to those of calculi on permanent teeth.
Dental calculi were observed in children above 6 years of age. Their surface views showed mainly milky white or greenish white coloring.
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Mitsunobu Maeda, Seizo Tanase, Hiroshi Horiguchi, Yoshinobu Ochiai
1981 Volume 19 Issue 3 Pages
461-468
Published: December 25, 1981
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In 1940 Ellis and van Creveld first described a type of chondrodysplasia accompanied by ectodermal dysplasia, polydactyly and congenital morbus cordis, which is now generally accepted as the Ellis-van Creveld syndrome.
The patient, a female of 6 years, diagnosed as having the Ellis-van Creveld syndrome at the Department of Cardiovascular Surgery Toyama Red-cross Hospital were referred to the Pedodontic Clinic, Gifu College of Dentistry. Her family histry did not reveal any ectodermal and bone defects and her parents were not consanguinious and were apparently normal.
The patient had a supernumeraly digit on the ulnar side of both hands and these were amputated when she was 1 month old, and after she was operated for congenital heart disease when she was 5 years old.
Dental examination showed that bilateral primary lateral incisors of both jaws were congenitally missing. The crown of all deciduous central incisors were of a cylindric form, and the upper and lower lips were closely connected to the gingiva with numerous small frenula.
Radiographic examination of the jaws showed the congenital missing of upper lateral incisors, lower central and lateral incisors, and malformed upper central incisors.
The analysis of cephalometric radiograph revealed a relatively flattened gonial angle.
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Hiroko Sugawara
1981 Volume 19 Issue 3 Pages
469-477
Published: December 25, 1981
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We examined the teeth of small children attending day-care centers and kindergartens in Sendai. At the same time we investigated the relationship between parents and children, and also the parents' expectations for their children and the personal traits of mothers. According to the research on the relationship between the information we obtained from the investigation mentioned above and dental caries, we came to the following conclusions.
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Zenzo Miwa
1981 Volume 19 Issue 3 Pages
478-488
Published: December 25, 1981
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Correlations of the sensation with the cortical EEG response and the inhibition of the masseteric EMG were studied by applying electrical pulses to the tooth pulp of an upper central incisor in 15 children in good health of 7.7 years of age on the average, who had no caries in the upper central incisor and were co-operative in the experiment. The following results were obtained; 1. Pre-pain sensation was elicited when the tooth pulp was stimulated by monophasic electrical pulses at the intensity lower than that required for evoking pain sensation. The threshold intensity for pre-pain is usually constant in each subject when tested with pulses of 1 or 10 msec in duration delivered at 1 Hz.2. The threshold intensity for pre-pain sensation was approximately the same as that for the initial negative component (N1) of the evoked EEG.3. The threshold intensity for pre-pain sensation was approximately the same as that for the early phase of inhibition of the masseteric EMG. It was concluded that the responses in the cortical EEG and the inhibition of the masseteric EMG evoked by electrical tooth pulp stimulation can be objective indices of the sensation elicited by tooth pulp stimulation in children.
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Part 4. An Examination of Rheological Assessment based on the Viscosity of Saliva
Koji Yagishita, Shinya Yanagisawa, Genshiro Okada, Morito Akasaka, Hid ...
1981 Volume 19 Issue 3 Pages
489-496
Published: December 25, 1981
Released on J-STAGE: January 18, 2013
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The present study was carried out by focusing attention on the viscosity of human saliva, one of its physical characterisics, in an effort to predict possible caries susceptibility and its activities as well. Previous studies dealing with salivary viscosity were chiefly limited to those which employed the capillary viscometer but for the present purpose it was thought to he more effective to use a cone and plate viscometer for the measurement of the rheological character of saliva, which is a non-Newtonian fluid.
Although there are occasionally found studies using a cone and plate viscometer, they deal either with some kind of sliding test or with a comparison by mean of graphs and, for this reason, they are rather complicated and are far from being practical.
In the present study, therefore, attempts were made to introduce the Casson yield value as well as T. I., which are widely used in the industrial field, so that the characteristics of salivary viscosity might be better understood and assessed.
To determine wheter these two methods would prove to be effective indices for better designation of salivary viscosity, data of the seeming viscosity (C. P. ) in 4 sliding tests were comparatively analyzed and were studied in terms of 4 aspects such as the differences by days, difference between the sexs and individual differences.
As for subjects, use was made of healthy adults,10 males and 10 females each, who were subjected to 6 measurements over a period of 3 days between 10 and 11in the morning and 2 and 3 in the afternoon.
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Pt. 1. Influence of Different Biscuits on their Masticatory Muscle Activities
Teiji Shibasaki, Hiroshi Sakairi, Osamu Takahashi, Kazuaki Ikari, Mori ...
1981 Volume 19 Issue 3 Pages
497-506
Published: December 25, 1981
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The present study was carried out to determine what kind of influence would be exerted on the masticatory muscle activities of infants by the difference of hardnesses of different brands of biscuits, which are one of the commonest foods given to them.
The study subjects were 6 infants presumably in normal occlusion in Hellman's Dental Age IIA. As for chewing material, biscuits containing the same gredients were selectively used. There were three kinds, soft-45 g/mm (mean), medium-82 g/mm (mean) and hard-132 g/mm (mean) biscuits.
The electromyographs were taken of bilateral right and left anterior temporal muscle (TA) and masseter muscle (M) from the beginning of free chewing of these biscuits to the completion of swallowing.
The resultant mesurement data were comparatively analyzed in terms of the amount of muscle activities (integrated values), masticatory rhythm, number of masticatory strokes and length of masticatory time for the purpose of bringing out differences due to these three kinds of biscuits.
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1. Effect of Ag(NH3)2F on both intact and artificially produced 'white spot' enamel.
Nobuo Tsutsumi
1981 Volume 19 Issue 3 Pages
507-522
Published: December 25, 1981
Released on J-STAGE: January 18, 2013
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The purpose of this study was to investigate the effect of Ag (NH
3)
2F on enamel surfaces. Both intact and artificially produced 'white spot' enamel slabs were treated with 38% Ag(NH
3)
2F solution. The uptake of F
- and Ag
+ ions was measured by etching these treated enamel slabs with HCl0
4. By the same method, the retention of F
- and Ag
+ ions was evaluated after immersing them in synthetic saliva. In addition, the enamel solubility of these samples was compared by measuring Ca
2+ ions in acid solution. Finally, the remineralization was studied by means of microradiography, electron microprobe analysis and x-ray diffraction analysis. The following results were obtained:
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2. Effect of Ag(NH3)2F on Streptococcus mutans on interproximal plaque
Nobuo Tsutsumi
1981 Volume 19 Issue 3 Pages
523-536
Published: December 25, 1981
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The purpose of this study was to investigate the effect of Ag(NH
3)
2F on cariogenic Streptococcusmutans. In the first experiment, Ag(NH
3)
2F solution was applied on artificially produced 'white spot' of enamel samples. Adherence and growth of S. mutans strain Kl-R (serotype g) on these sample surfaces were observed by means of scanning electron microscopy. SnF2 and NaF solutions were also emp loyed to compare them with Ag(NH
3)
2F. In the second experiment, the effects of Ag(NH
3)
2F on the microflora in the plaque of interproximal surfaces of both permanent and primary molars were studied. Plaque samples were obtained before and after application of Ag(NH
3)
2F from interproximal surfaces and changes of the proportion of S. mutans were evaluated. The following results were obtained: 1) Adherence and growth of S. mutans cells on the enamel surfaces were markedly inhibited by Ag(NH
3)
2F treatment as compared with SnF2 or NaF.2) Immediately after the application of Ag(NH
3)
2F, microorganisms including S. mutans in the interproximal plaque were found to be almost completely eliminated.3) A significant reduction of the proportion of S. mutans by a single application of Ag(NH
3)
2F was observed after 7 days and this effect seemed to continue for over 4 weeks. These results suggested that Ag(NH
3)
2F reveals a marked antibacterial capability against interproximal microorganisms, especially S. mutans and should be effective for control of dental caries development.
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3. Clinical trial of Ag(NH3)2F on interproximal caries in human primary molars.
Nobuo Tsutsumi
1981 Volume 19 Issue 3 Pages
537-545
Published: December 25, 1981
Released on J-STAGE: January 18, 2013
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A clinical trial was designed to evaluate the effect of multiple applications of Ag-(NH3)2F on the incidence and progress of interproximal dental caries in primary molars. Fifty eight children were selected after clinical and radiographic examinations. Each child had at least one contralateral pair of intact interproximal surfaces or a pair of interproximal surfaces with enamel caries. Randomly selected test sides were treated with 38% Ag(NH
3)
2F for 3 minutes by using unwaxed dental floss. Control sides were flossed with plain unwaxed dental floss. These treatments were done at intervals of 3 months. Caries incidence and progress were followed clinically and radiographically by bitewings every 6 months for a total of 18 months. The following results were obtained:
1) The incidence of new interproximal caries was significantly reduced during treatment as compared with the control.
2) The progress of enamel caries on interproximal surfaces was significantly reduced during treatment as compared with the control. In summary, these results suggested that multiple topical application of Ag(NH
3)
2F on interproximal tooth surfaces in primary molars should be effective for the control of interproximal caries development.
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Noboru Yamashita, Yoshiharu Mukai, Yasuo Suzuki, Ryuji Sasa, Tetsuo Ko ...
1981 Volume 19 Issue 3 Pages
546-558
Published: December 25, 1981
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Though dental clinicians frequently encounter injuries to young permanent teeth, it seems that the formation of a root in the dental socket where a young tooth fell off in trauma has not been reported.
Case 1: The formation of a root on the site of an upper right central incisor displaced in trauma was observed radiographically and histologically. The root buried under the gingiva was a bowling-pin like structure and not only had normal dentin and cementum but also cylindrical denticles, accessory canal like canalicles and cementoid tissue. It was considered that the upper portion of this root was abnormally formed under the influence of the injury and the occulusal function by a partial denture while the lower portion was originally formed by Hertwig's epitherial sheath.
Case 2: In reimplantation of an upper left incisor, the formation of a root like structure was observed over a period of time in radiography between the maxillary bone and the root apex of the reimplanted tooth. This structure was considered to arise as well as the lower portion of Case 1, i. e. a root apex.
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Part II. Dental-plaque Distribution of 1 Year and 6 Months Old Children
Atsuko Yamashita, Yuko Usuda, Kazuko Narushima, Akira Okabe, Mayumi Ho ...
1981 Volume 19 Issue 3 Pages
559-569
Published: December 25, 1981
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The subjects were 449 children at 1 year and 6 months old, visiting the Health Center in Ohta Ward in Tokyo, and we examined their oral conditions and daily habits, especially dietary habits.
In this report, we investigated the dental-plaque distribution of the children of this age.
Dental-plaque was disclosed by Red-Cote and stained areas were recorded on a chart in which each labial or buccal surface of a nearly fully erupted deciduous tooth was divided into 9 areas. By using this chart, scores of each deciduous tooth surface and that of each child were calculated.
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The Relationship with Visual and Radiographic Examination, and the Electrical Resistance on the Extracted Teeth
Shuji Ogita, Norihiro Yamada, Kuniyuki Gotoh, Kazuo Kurosu
1981 Volume 19 Issue 3 Pages
570-577
Published: December 25, 1981
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This study was to investigate the evaluation of carious invasion on the proximal and occlusal surfaces of upper and lower primary molars. The materials consisted of 77 teeth which had been extracted from children between the age of 6-14.
After radiographs of the materials had been taken and the electrical resistance had been measured, the relationsips between the visual and radiographic examination, and between the visual examination and the electrical resistance were examined.
The results were asfollows: 1) There was a significant correlation between the visual and the radiographic examination. (r=0.7915)
2) There was a significant correlation between the visual examination and the degree of carious invasion evaluated by radiographic examinaation. (r=0.7054)
3) Based on the examination of the relationship between the visual examination and tnd the electrical resistance, the significant correlation concering both occlusal surface and smooth surface were discovered. (occlusal surface: r=-0.5559, smooth surface: r=-0.73707)
4) Based on investigation of the carious extension on the proximal surface of primary molars by radiographic examination, there was found a significant correlation between the radiographic examination and the stage of carious extension. (r=0.7922)
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Motoharu Mohri, Toshihiko Naruse, Ikuko Nakano, Kenji Simizu, Minoru N ...
1981 Volume 19 Issue 3 Pages
578-585
Published: December 25, 1981
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Two children with pycnodysostosis, a 10 year-old girl and a 9 year-old boy, received dental care and the following findings were noticed.
1) General findings
The patients were products of a first cousin marriage and the elder patient had several histories of bone fracture. Thier height was markedly reduced. The head was dolicocephalic in form and the face was small with swollen eyelids, Pallotlike nose and reduced chin. The fingers were short with a drumstick appearance and the nails were hypoplastic.
Labolatory findings of blood and urine were within normal limits.
2) X-ray findings
X-ray films showed increased radiopacity of all bones, and cranail anomalies such as open frontaneles and cranial sutures, total aplasia of frontal sinus, obuse mandibular angle and deep mandibular notches. The bone age of the hands was normal, but the terminal phalanges were hypoplastic.
Cephalometric analysis revealed severe underdevelopment of the cranio-facial bones, especially with respect to the anterior maxillary higtht and the whole mandibular measurement.
3) Oral findings
The median raphe of the palate was grooved and the vestibular oris was shaow. The dental arches were very small and the teeth were crowded. Other lalnomalies included persistence of deciduous teeth, and congenital missing teeth, pegshaped teeth and delayed or ectopic eruption of permanent teeth.
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part I. Oral function and feeding situation of handicapped children, with particular reference to the cerebral palsied
Yoshiharu Mukai, Mitsuko Inoue, Yasuo Suzuki, Ryuji Sasa, Yoshihiro Ka ...
1981 Volume 19 Issue 3 Pages
586-597
Published: December 25, 1981
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To understand the relationships among many aspect of oral disorders in handicapped children, we have been involved in investigating the oral conditions of the cerebral palsied and mentally retarded children in three institutions in Japan. As the first part of the study, we evaluated degree of oral myofunctional disorders and feeding situations of the children, to clarify the relationship between the oral functional disorders and feeding habits, gross motor development, developmental age and types of food.
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Hideki Chiba, Kazuko Igari, Kikuo Kamiyama
1981 Volume 19 Issue 3 Pages
598-606
Published: December 25, 1981
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The purpose of this paper is to report on the results of a long term clinical and radiographical observation of the condition of deciduous teeth after root canal filling with VITAPEX, on the resorption of the roots and of the filling materials, and on the eruption of the successors to the treated teeth.
The subjects of this study were 126 children (67 boys and 59 girls),183 teeth (54 pulpectomized teeth and 129 infected root canal treated teeth), with 434 root canals. These teeth were filled with the iodoform-calcium hydroxide root canal filling material “VITAPEX”, and evaluated clinically and radiographically at periods ranging from 2 months to 49 months.
The results were as follows;
1. Clinical and radiographical resuults showed that out of 49 cases (pulpectomy),1 case (2.0%) was a failure and out of 114 cases (infected root canal treatment),15 cases (13.2%) were failures.
2. Based on radiographic observation, a tendency toward, under fillings in the mesial root canal of lower primary molars was seen.
3. Excessive root canal filling materials were absorbed within two or three months.
4. VITAPEX was absorbed smoothly with the proportionate resorption of the root in all cases.
5. There were 16 cases of permanent teeth eruption during the clinical and radiographical observation. In 8 cases the corresponding teeth on the opposite side had not been treated by removal therapy of pulp. In 4 out of these 8 cases, the successors erupted faster than the controls on the opposite side. In 3 cases the successors erupted slowly, and in 1 case the successor and control erupted at about same time.
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Kyoko Hasegawa, Mieko Tomizawa, Carolina M. Nishimura M., Koichi Nagam ...
1981 Volume 19 Issue 3 Pages
607-612
Published: December 25, 1981
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Poland's Syndrome was first reported in 1841 by Poland, this is a congenital anomaly and its etiology remains obscure.
This syndrome is characterized by, absence of pectoralis major or more frequently, of the sternal portion of this muscle with syndactyly on the same side.
Although there are many reports concerning this syndrome in thee orthopedic surgery area, only few oral manifestations, have been recorded. This report is a clinical observation on a case of Poland's Syndrome. A boy aged 3, was examined from the dental point of view.
The findings were as follows:
1. Cephalograme study showed that bone development was normal.
2. Severe dental caries were found in the deciduous dentition.
3. a) Fuse d teeth were observed in BA AB 21
b) An impacted supernumerary tooth was found in the left upper central incisor region.
4. No abnormalities were observed in the width, length, and form of the dental arch, and in the occlusion.
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Kyouichi Kitamura, Norio Masuda, Hideaki Imanishi, Nobuyuki Ochiai
1981 Volume 19 Issue 3 Pages
613-618
Published: December 25, 1981
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The use of the arsenic paste on the primary teeth has been considered to be dangerous because this paste induces severe pathological changes when it is applied without correct knowledge of the effect of this material. Even today, this paste is still used for the mortal extripation of the pulp of primary teeth. In this report, we describe the case of the serious damege of a succedaneous permanent tooth which was found to be affected by the use of arsenic paste on a primary molar.
A 4.5 year girl visited the Pedodontic Clinic of Osaka University Dental School Hospital complaining early exfoliation of E and alveolar bone loss.
Oral examination revealed marked atrophy of the gum andO the presence of the partially erupted brown colored 5. Radiography showed a wide radiolucent area around the E lesion, and the hypominearalized rootless 5 which was located in the gum without alveolar bone.
By means of X-ray fluorescence analysis, arsenic (As
+++) was found in the piece of alveolar bone slab (sequester) which had been removed after the loss of E.
Based on the above observation, it was diagnosed that the use of arsenic paste on E induced the formation of sequester and dameged 5.
Today, approximately 2 years after the first visit, no change can be seen on the crown of 5, and radiography shows the growth of the root. However, the implanted condition of 5 is not completed.
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Part 1: Report of actual condition of our clinic
Michiyo Morikawa, Junko Okamoto, Mihoko Shirakawa, Hideaki Amano, Kazu ...
1981 Volume 19 Issue 3 Pages
619-626
Published: December 25, 1981
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The subjects were 280 handicapped children (176 boys and 104 girls), who were reffered to our clinic (Pedodontic Clinic of Hiroshima Universtity Dental Hospital)for dental care and treatment from 1976 to 1980.
Their ages ranged from 3 to 12 years, and 5 year old children were the largest number (70 children) and followed by the 6 year,4 year,3 year old children.
The subjects were classified into 6 groups according to their disorder: the CP Group, the Down Group, the Epilepsy Group, the Autism Group, the MR Only Group and the Other Group. The Autism Group contained the largest number (82 children), and was followed by the CP, MR, Epilepsy, Down and the other Group. Only in the Autism Group was a significant difference found in sex distribution (68 boys and 14 girls).
The caries condition and the dental treatment of the caries were investigated.
The findings were as follows.
The df tooth rate of the primary teeth was 56.8% on the average and it showed a gradual increase as the age increased. However no significant difference was found among the 6 diagnosis groups.
About 80% of the caries teeth were treated, with metal crown and amalgam being commonly used for restoration.
The rate of endodontic treatment in the treated teeth was 9.8%, and vital amputation was most common (66.5%).
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Mihoko Shirakawa, Sayuri Minematsu, Yuko Sakai, Yuzo Onishi, Nobuo Nag ...
1981 Volume 19 Issue 3 Pages
627-634
Published: December 25, 1981
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A 5 year 11 month old boy who was diagnosed as an anhidrotic ectodermal dysplasia associated with total anodontia was reffered again to our clinic with the request to re-make a full denture. Consequently, detail examination and questioning were conducted and the results added to the previously obtained data.
Then following findings were obtained
1) The patient had the 3 symptoms consisting of sparse hair, no teeth (total anodontia)and no sweat glands together with such characteristic features as sparse eyebrows, wide forehead, protrusive mental region, saddle nose and warped lips.
2) In the development of jaw and face, it was revealed that the mandible grew normally but the maxilla grew recessively. The length and width of alveolar ridge increased in length for 3 years.
3) The cousin on his mother's side had similar symptoms such as sparse hair, small number of teeth (partial anodontia) and no sweat glands, and baced on the questioning, his mother's brother was suspected of having the same symptoms. However, no such similar signs were seen in his mother, his mother's sister and her daughter.
From these results, it was logically thoght that this case was caused by X-linked recessive inheritance.
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Masayuki Sano, Eijin Irie, Nobuhiko Osaka, Tadao Yoshida, Sachiko Toki ...
1981 Volume 19 Issue 3 Pages
635-645
Published: December 25, 1981
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We diagnosied a case of Goltz Syndrome in a 14 year old boy. Goltz Syndrome is a very rare disease which has the unique and characteristic clinical symptoms consisting of linear areas of dermal hypoplasia, abnormal skin pigmentation, and fawncolored nodules of adipose tissue in association with other congenital anomalies. There have been no more than 4 cases in Japan, and no report of oral involvement in this disease.
The oral findings in this case were as follows:
1) Hypoplasia of maxilla and mandible were observed.
2) Marked hypoplasia of the enamel of nearly all permanent teeth, and tendency toward small tooth size were also observed.
3) Absence or prolongation of permanent teeth eruption was observed.
4) Verrucous papillomatous lesions were present around the lips and oi the palate.
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