The aim of this study was to investigate changes in tooth positions in the maxilla before and after treatment for anterior crossbite in patients with primary dentition using three-dimensional (3D) analysis in order to evaluate the effectiveness of use of a functional orthodontic appliance (FOA-M). Twenty pairs of cast models obtained before and after treatments were analyzed. Dentition models were superimposed digitally using a reference plane and 14 reference points were dimensionally measured. Differences of each of the 3 coordinates x, y, and z in dentition in measurements taken before and after treatment were determined. The following results were obtained.

1)In the anterior-posterior direction (y-coordinate), we found a significant movement of anterior teeth, in which the primary central incisor showed the greatest amount of forward motion (p ＜0.000). In the vertical direction (z-coordinate), primary anterior teeth changed to an upper direction, while the primary canine did not show change and the primary molar showed a significant change to extrusion (p＜0.000).

2)The amount of 3D tooth movement was the greatest at the Am-point of the frontal teeth (average 1.4 mm), while movement of the molar Do- and Eo- points was smaller (average 0.7 mm).

3)There was a significant change of direction in the θz angle, as θz of the Am-point showed －0.6 rad, indicating a change to the upper direction, that of the Co-point showed a value that was nearly 0 rad, indicating nearly no change for the primary canines, and that of the Eo-point showed a change of ＋0.6 rad, indicating that the second primary molar showed a change to extrusion (p ＜0.000).

4)There was a negative correlation between the amount of 3D movement of the Eo-point, and θxand the occlusal plain angle (p＜0.05).

In conclusion, when patients with an anterior crossbite in primary dentition were treated by FOAM, their crossbite improved by movement of the maxillary primary anterior teeth in an upper and anterior direction, while also spreading laterally and enlarging the primary canine to the outside. As a result, the molars changed to extrusion while spreading in a lateral manner.

Cleft lip and palate (CLP) is the most common cleft malformation occurring in the maxillofacial region, and morphologic changes following treatment have been reported. However, few studies have shown how these changes affect oral function. We investigated changes in the physiologic characteristics of sucking function along with perioral muscle activity in infants with CLP. Ten infants with unilateral CLP underwent a cheiloplasty procedure at the center of the cleft lip and palate at F Health University Hospital. Measurements were obtained preoperatively and postoperatively, and again at 3 months after the cheiloplasty. Electromyogram (EMG) findings from the bilateral temporal (L-R, TM), masseter (L-R, MM), orbicularis oris (OM), and suprahyoid (SM) of the healthy side were recorded. EMG findings obtained from 8 healthy 3-month-old infants were used as a control. The peak amplitude of the OM was significantly increased postoperatively and 3 months later in the CLP group, while the SM was significantly weaker as compared to that in the healthy group. A comparison of the peak time ratio of the SM revealed activation during the first half of the sucking cycle in CLP infants, while that occurred in the latter half of the sucking cycle in the healthy controls. Furthermore, the coordination curve of the SM in CLP infants was obscured as compared with that in the healthy group. Our results indicated that sucking coordination pattern is affected in infants with CLP. In conclusion, as compared to healthy infants, increased OM activity and a weak SM following cheiloplasty, as well as the peak time ratio of SM activation during the first half of the sucking cycle was seen in infants with CLP, resulting in sucking pattern difference as a result of the condition.

To provide safe and comfortable pediatric dental treatment, it is important to understand emotional changes of child patients undergoing such treatment. Appropriate behavioral control of child patients based on such an understanding can help them avoid a negative image regarding dental treatment and acquire desirable oral health behavior habits, such as regular visits to a dentist. In order to develop an objective real-time monitoring system of the emotional state of child patients, we investigated changes of physiological factors in response to internal stress induced by dental treatment in the present study. For physiological factors, we analyzed autonomic nervous responses from heart rate variation and the electroencephalogram (EEG) frequency power spectrum throughout treatment procedures conducted for composite resin restoration. Eleven child patients aged 6-9 years old who came to our pediatric clinic voluntarily participated in this study after parental informed consent was obtained. Sympathetic nervous activity in the children was significantly elevated during infiltration anesthesia and placement of a rubber dam, as compared with the resting level before treatment, indicating a stronger sense of stress during those procedures. Furthermore, a significant reduction in parasympathetic nervous activity, another indicator of stress, occurred during oral examinations, surface anesthesia, infiltration anesthesia, placement of a rubber dam, and cavity preparation. Frequency analysis of the EEG recordings demonstrated that a component of the αwave was prominent, though the αwave ratio showed no significant change at any time during treatment. On the other hand, the ratio of θwaves tended to decrease during treatment that included cutting with a contra-angle, while that of βwaves tended to increase during surface and infiltration anesthesia. Results obtained from both autonomic nervous analysis and spectral analysis of EEG demonstrated similar changes of emotion during several of the treatment procedures, indicating that the present method may be useful for real-time assessments of internal stress and emotional change in children during dental treatment. Collectively, our results suggest that real-time monitoring of internal emotion in children undergoing dental procedures provides useful information for behavioral control by pediatric dentists, thus contributing to the oral health of children.

The purpose of this study was to evaluate psychological anxiety in child patients during dental treatment using non-invasive physiological indicators and a behavior scale. The subjects were 18 healthychildrenaged6to10yearsold.Theirbehavior during dental treatment was rated using the Frankl behavior scale. In addition, we recorded electrocardiogram findings obtained during tooth extraction procedures, which were divided into the following sessions ;relaxation, advance notice of dental treatment, external anesthesia, infiltration anesthesia, tooth extraction, and astriction. We also evaluated the autonomic nervous system (ANS) in the subjects by analyzing power spectral results at high frequency (HF, ＞0.15 Hz) low frequency (LF, 0.05−0.15 Hz), and the ratio of HF and LF (LF/HF), as well as the coefficient of variation of R-R intervals (CVRR) and heart rate (HR). Simultaneously, skin potential level (SPL), a component of electrodermal activity (EDA), was recorded to assess emotional changes in the subjects during dental treatment. For the analysis, we examined the relationships among these physiological indicators (SPL, HF, LF, LF/HF, CVRR, HR) during dental treatment. According to the SPL response during advance notice of dental treatment, the subjects were classified into those with [EC(＋) group] and without [EC(－) group] emotional changes. In the EC(＋) group, ANS activity was significantly higher during the advance notice of dental treatment, infiltration anesthesia, and tooth extraction sessions as compared with relaxation. A significant positive relationship was noted between SPL response and CVRR, and SPL response and LF/HF during advance notice of dental treatment and infiltration anesthesia. Our findings suggest that evaluation of ANS function by use of HR, especially with assessments of CVRR and LF/HF, is quite useful for assessing internal emotional changes of child patients undergoing dental treatment, even when no signs of fear or anxiety are evident.

The purpose of this study was to investigate the attitudes of parents in regard to suckling termination in their children. Three hundred forty-eight parents whose children received a health examination at the age of 1 year 6 months at a public health center agreed to participate in a survey related to the process of suckling termination and their attitudes in regarding this issue. In addition to answering the questionnaire, caries prevalence in their children was also investigated. The following results were obtained.

1)One hundred fourteen (32.8%) of the children continued to suckle at the age of 1 and a half years.

2)Of the 114 who continued a suckling habit, that for breast-feeding was the most common reason given (83). The majority (n＝79) of those children suckled before going to sleep at night as well as during the night, and their parents did not attempt to stop that behavior. The most common reason given for allowing continued suckling was because of child preference.

3)Of the 234 children who had terminated suckling, the majority (n＝137) had spontaneously stopped the habit. The most common reason given for achievement of suckling termination was because the child was easily able to eat age-appropriate foods (n＝109).

4)Caries prevalence in children who had terminated suckling was 6.8% (16/234), while that of children who continued suckling was 21.9% (25/114), which was a statistically significant difference.

Our results suggest that suckling can be smoothly terminated with development of feeding function. In addition, the risk of dental caries is increased in children who have not terminated the habit by the age of 1 year 6 months.

It is common to encounter child patients who have visited a dental clinic for a traumatic dental injury. Treatment options vary widely because of young age, and the need to consider future growth and development. This study sought to establish preventive measures for potential dental trauma cases and improve the clinical acumen among oral healthcare professionals. We analyzed pediatric patients who visited our department for traumatic dental injuries during the 3-year period between April 2012 and March 2015. The following results were obtained.

1.A traumatic dental injury occurred in 381 deciduous teeth of 242 subjects and 178 permanent teeth of 104 subjects, with a slightly higher proportion of boys in both groups.

2.Age at the time of injury ranged from 0 to 17 years, with more incidents occurring from 1-3 years of age in the deciduous tooth group and 7-9 years of age in the permanent tooth group.

3.Most (69.0%) of the affected subjects visited a dental clinic 1 or more days after the day of injury (31.0%). In addition, at least 50% of our patients came to our department after having visiting a local medical or dental clinic first.

4.The most frequent cause of injury in both deciduous and permanent teeth was a fall, while there was a higher incidence of collision in the latter group.

5.The predominant site of injury was the maxillary central incisors in both the deciduous (63.5%) and permanent (75.2%) tooth groups

6.In the deciduous tooth group, 68.5% of the patients had luxation, which most frequently involved displacement/mobility (42.6%). On the other hand, tooth fracture (48.0%) was the most common injury in the permanent tooth group, with involvement seen in the crown most often (43.4%) and in the root least often (4.6%).

Insufficient information is available regarding the response of children to environmental changes. To analyze such responses in regard to oral disease in children, transmission of accurate information is critical. We previously reported first-visit patient statistics acquired at our pediatric dental clinic over three different 5-year periods (1992-1996, 1997-2001, and 2002-2006). In the present study, we analyzed first-visit patients who came to us during the 5-year period from 2007 to 2011 and obtained the following results.

1.The annual mean number of first-visit patients was 629, which was an increase as compared with that reported in our previous 3 surveys (first, n＝324 ;second, n＝462 ;third, n＝569).

2.The most common age at the initial visit was 3 years (12.2%). Children aged less than 6 years comprised approximately 55% of all patients.

3.Most patients travelled a distance of 5 km (30.5%) to the hospital. Those who traveled at least 15 km accounted for 26.0%.

4.Dental caries and pain were the most common complaints at the time of the initial visit (approximately 40%), which demonstrated a slight decrease as compared with our previous survey (ap proximately 50%).

5.The number of patients with df was higher than that reported in the results of a national dental disease survey.

6.Referred patients comprised 34.2% of the total, which was a slight increase from the number of patients reported in our previous survey (33.4%).

7.Those with physical or intellectual disabilities accounted for 2.0% of all new patients.

Dental treatment under general anesthesia is often selected for disabled patients with special needs or non-cooperative patients at the pediatric dentistry clinic of our university hospital. We examined the current situation of dental treatment under general anesthesia by investigating patients who visited our clinic between January 2009 and December 2015.

1.Number of cases and age distribution. Dental treatment under general anesthesia was performed 87 times for 82 patients (53 males, 29 females).

2.Type of patients. Similar to previous reports, 51% of the patients were disabled, most of whom had been diagnosed with mental retardation.

3.Kinds and numbers of treatments. The average numbers of treated teeth per case were 10.5 for deciduous and 7.6 for permanent teeth. Composite resin filling was the most frequently performed treatment, the same tendency as noted in past reports.

4.Treatment time duration. The average treatment time was 2 hours 13 minutes, shorter than past reports.

5.Area of residence. We have found that cooperation between local dental practitioners and our university clinic is important, especially because of the large size of our prefecture.

The prevalence of supernumerary teeth in Japanese patients has been estimated to range from 1- 5%. Most cases show occurrence in the maxillary front tooth area, while that in the maxillary premolar area is relatively rare. Recently, we experienced a case of bilateral supernumerary teeth in the maxillary premolar area of an 11-year-8-month-old boy. The patient initially visited a general practitioner with delay of eruption of the maxillary first premolars and was referred to our university clinic for further examinations of impacted bilateral supernumerary teeth found in panorama X-ray images. There were no subjective symptoms, while cone-beam computed tomography (CBCT) findings confirmed the presence of supernumerary teeth bilaterally, close to the maxillary first premolar. Extraction of the supernumerary teeth was conducted after concluding that early treatment was necessary in order to prevent adverse effects related to permanent tooth alignment. As for the maxillary right first premolar in this case, the shape resembled that of the supernumerary tooth and the size was also similar, thus it was vital to determine which tooth should be extracted. That decision was made after considering the advantages of tooth alignment after extraction and reviewing the root curve shape in images obtained by CBCT. Although the erupted maxillary right first premolar was slightly dislocated in the buccal direction, tooth alignment is presently acceptable and we will continue observations, taking note of occlusion.

Occurrence of a paramolar cusp is relatively uncommon, though is more frequently seen in the second and third permanent molars, while it is relatively rare in the first permanent molars. Affected patients are usually presented with one unilateral cusp in permanent dentition. A 10-year-old girl visited our clinic for examination of dental caries. The maxillary first permanent molars showed delayed eruption, while paramolar cusps were observed on the buccal surface of the bilateral erupted first permanent molars. Fenestration was performed to accelerate eruption of the maxillary left first molar. Notably, two markedly well-developed independent cusps were seen on the buccal surface on the left side. Therefore, it is assumed that this is a relatively rare case. An abnormal tooth crown shape, as well as complicated root and root canal morphologies in cases with a paramolar cusp may pose problems for endodontic management and periodontal therapy. Therefore, strict oral hygiene is imperative for preventing recurrence of dental caries and maintaining periodontal health in affected patients.

We experienced a case of dentigerous cyst that appeared in the anterior tooth region of the maxillary region during the period of mixed dentition, in which the tooth germs of 3 permanent teeth were impacted by the cyst. Marsupialization was selected for treatment in order to preserve the impacted upper left central incisor, lateral incisor, and canine. A reduction in cyst cavity size was observed at 1 month following surgery and continued, after which the upper left central and lateral incisors erupted at 7 months after the procedure. However, traction was needed because the site of eruption was very low. We used a sectional bracket appliance, trans-palatal arch, and 0.014-inch Ni-Ti archwire for traction. After 1 year 5 months of active treatment, the maxillary left canine erupted naturally over the lateral incisor and a chain-type elastic was used to guide the incisor toward the inside of the dental arch. Following 2 years 10 months of active treatment, crowding and rotation of the maxillary anterior teeth showed improvements, and the appliance was removed. X-ray findings after completing active treatment revealed a favorable outcome, with normal tooth root formation of the maxillary left central incisor, lateral incisor, and canine. When multiple teeth are impacted by a dentigerous cyst, it is important to performance guidance at an early stage, taking into account the effects on growth and development.

Hunter syndrome (mucopolysaccharidosis type II), an X-linked recessive inherited congenital heredity disease, is quite rate. The syndrome develops due to a deficiency of glycosaminoglycan degrading enzymes, which causes multi-organ disease from accumulation of metabolites in tissues throughout the whole body. We report here treatment of an 8-year-8-month-old boy with Hunter syndrome for dental caries. Blood oxygen saturation in the patient was remarkably decreased during dental treatment performed using regular behavior management, with that intraoperative hypoventilation condition determined to be caused by general anesthesia. Thus, we performed the necessary dental treatment using a minimally invasive method while monitoring changes in oxygen saturation. Our experience with this case highlighted the importance of recognizing disease symptoms for best treatment planning.

A 15-month-old girl was referred to our hospital from a general dentist for treatment of gingival overgrowth, which was on the buccal side between the mandibular right primary central and lateral incisors, and approximately the size of a grain of rice. Our clinical diagnosis was fibrous epulis and resection was performed using a standard procedure under local anesthesia. A 7 months after the first surgery, another fibrous mass was observed on the lingual side of the same mandibular right primary central incisor, which continued to increase in size in subsequent examinations. Twenty months following the first surgery, this mass was removed using the same procedure. Pathological diagnosis for both masses was epulis fibrosa and no recurrence was observed after the second surgery. We report here a rare case of epulides presenting on different planes and at different times on the same deciduous tooth.

Here, we present two cases of eruption guidance for an impacted lower first molar caused by an odontogenic tumor in mandible.

Case 1. An 8-year-1-month-old boy came to us with impaction of the lower right first molar. In panoramic radiograph and cone beam chromatography findings, the impacted tooth showed an irregular translucent area around the crown. Histopathological diagnosis of the tumor was ameloblastic fibroma. Eighteen months after performing surgery, the first molar erupted with eruption guidance treatment including traction

Case 2. A 6-year-10-month-old boy had impaction of the bilateral lower first molars. In panoramic radiograph and cone beam chromatography findings, both impacted first molars showed an irregular translucent area around the crown. In addition, resorption of the distal root of the primary second molars was also observed. Histopathological diagnosis of the tumor was odontogenic fibroma. Twelve months after fenestration surgery, the first molars spontaneously erupted.

No symptoms of recurrence have occurred in either of these cases.