Annals Vol 23 (2016)

Table 2. Main results from 7 randomized controlled trials for the prevention of childhood caries in the primary dentition through probiotic supplements Figure 1. Lactobacillus reuteri “swimming” in PBS buffer. This probiotic strain is commonly used in clinical trials and has shown to compete with oral pathogens and to reduce plaque and gingivitis. (With permission from Biogaia AB, Sweden) RACDS ANNALS 2016 99

CARIES EXPERIENCE IN VICTORIAN CHILDREN WITH OROFACIAL CLEFTS Dr Jyotsna Raj, BDS, FRACDS, DCD (Paediatric Dentistry) Dr Jyotsna Raj is a Specialist Paediatric Dentist affiliated with a private specialist dental practice in Melbourne, Australia. INTRODUCTION Objective: To evaluate the caries experience of children born with a cleft of the lip and/or palate in Victoria, Australia. Design: Retrospective chart review. Setting: The Royal Children’s Hospital (RCH), Melbourne. Sample: The sample consisted of 701 children from birth to 18 years of age with syndromic and non-syndromic forms of cleft lip, cleft lip and palate and cleft palate only. METHODS Data were extracted from Titanium software routinely used in RCH and public dental clinics. Information collected included gender, age, region of residence, socio-economic status and caries experience (dmft+DMFT). Children were sub-divided by caries experience as low (dmft+DMFT=0), moderate (dmft+DMFT=1-3) or high (dmft+DMFT=4+) and analysed by cleft type and age. RESULTS Just under half (47.2%) of all children had dmft+DMFT=0, this proportion declining significantly with age from 84.8% of the 0-5 year olds to 38.6% of 6-12 year olds and 31.7% of the 13-18 year olds. The difference in caries experience between the age groups was statistically significant (p<0.001). Nearly one third (31%) of the 6-12 year olds and 25.3% of the 13+ year olds had a high caries index with mean dmft+DMFT of 6.69±2.46 and 6.94±3.65 respectively. There was no statistically significant difference in caries experience between cleft types. CONCLUSION Whilst nearly half of all children with CL/P had dmft+DMFT=0, a significant proportion had high caries experience. Identifying high caries- risk children at a young age is important in optimizing care outcomes. ACKNOWLEDGEMENTS I would like to thank my supervisors Associate Professor Nicky Kilpatrick, Professor David Manton and Associate Professor Kerrod Hallet. I am grateful for their assistance and input in completing this research project. Email address for correspondance: [email protected] 100 RACDS ANNALS 2016

IN VIVO CONFOCAL MICROSCOPY FOR THE ORAL MUCOSA Dr Nigel G. Maher, B.Med, B.D.Sc(Hons), B.Sc, FRACDS (GDP) A/Prof Pascale Guitera, MD, PhD, FACD Dr Nigel Maher is a Master of Philosophy research degree student at the University of Sydney, evaluating difficult to diagnose melanomas with the latest non-invasive imaging technologies. Associate Professor Pascale Guitera is the principal supervisor of this research degree. ABSTRACT Confocal microscopy (CM) is a non-invasive imaging technology that allows cellular and subcellular visualization of the epidermis and superficial connective tissues to depths between 200 to 300 μm. The basic concept of CM involves directing light onto a specific three- 1,2 dimensional spot in the tissue, referred to as a ‘voxel’, and capturing the reflected light on a detector as it passes through an aperture whereby out-of-focus reflected light is spatially filtered out. The detector converts the reflected light to a pixel, and as the incoming light is 1,2 scanned along a two-dimensional (x-y) plane, a two-dimensional en face image (i.e. parallel to the tissue surface) can be constructed from 1,2 the reflected light returning from each voxel. A ‘stack’ of two-dimensional images can be created by changing the z-plane of incoming light focus (i.e. creating a collection of en face images at different tissue depths). Contrast in the images is created by the differences 1,2 in the refractive indices of different tissues/molecules. When the reflected light relies on endogenous reflectance, this is referred to as reflectance CM (RCM). For example, melanin has a higher refractive index compared to the surrounding epidermis, and appears white on RCM images. When an exogenous fluorophore is used, this is referred to as fluorescence CM (FCM). 1 2 CM has been useful in dermatology and ophthalmology, and is now starting to be evaluated for oral mucosal conditions. RCM holds significant potential for diagnosing and treating oral mucosal diseases and lesions, as the normal lining mucosa in the oral cavity lacks 2 a stratum corneum. This enables RCM for beautiful clarity of images, due to the lack of interference caused by strongly back-scattered light that occurs from thickly keratinized tissues. 2 A recent comprehensive review of the literature has revealed that in vivo CM has been evaluated on the oral mucosa for: neoplasia and dysplasia; inflamed mucosa; taste impairment; autoimmune conditions; pigmented oral pathology/melanoma; delayed type 2 hypersensitivity; cheilitis glandularis; and characterization of normal oral mucosa. Nonetheless, the evidence for using in vivo CM for the evaluation and treatment of oral mucosal lesions and conditions remains weak, as there have been very few studies published, and these have mainly been case series. 2 Our initial research (unpublished observations) has shown the potential value of RCM in the diagnosis and management of pigmented- appearing oral mucosa, in the anterior region of the oral cavity. In this regard, RCM may reveal features concerning for melanoma or in situ melanoma, that may prompt biopsy over monitoring or vice versa. One of the current main limitations for RCM use on the oral mucosa is the probe size from available commercial devices, which limits access to certain oral cavity subsites, especially the more posterior regions in the oral cavity. Hopefully in the future, with improvements in RCM probe design for the oral cavity, along with improved clinician training and awareness of CM, good quality studies can be conducted to rigorously evaluate the benefits of in vivo CM for patients with oral mucosal conditions and lesions. These benefits may include, but are not limited to, facilitating biopsy site selection in field cancerization, mapping of surgical margins prior to resective oncology surgery, and assistance in non-invasive monitoring of lesions. ACKNOWLEDGEMENTS I am extremely grateful for my Master of Philosophy degree principal supervisor, Associate Professor Pascale Guitera, who has been a patient, kind and generous educator. I also acknowledge Professor Richard Scolyer, as my auxiliary supervisor, for his assistance with the histological correlations to confocal microscopy and overall project help. I would also like to thank Ms Michelle Avramidis, who provided excellent patient photography, and Dr Milind Rajadhyaksha for his advice and education regarding confocal microscopy principles and development. Finally, I would also like to thank the University of Sydney, which provided an Australian Post-graduate Award to assist my research studies. REFERENCES 1. Calzavara-Pinton P, Longo C, Venturini M, et al. Reflectance confocal microscopy for in vivo skin imaging. Photochem Photobiol 2008;84:1421-30. 2. Maher N, Collgros H, Uribe P, et al. In vivo confocal microscopy for the oral cavity: Current state of the field and future potential. Oral Oncol 2016;54:28-35. Email address for correspondence: [email protected] RACDS ANNALS 2016 101

DENTAL AND CERVICAL VERTEBRAE MATURATION OF ISOLATED UNILATERAL CLEFT LIP AND PALATE IN AUSTRALIAN CHILDREN: A CONTROLLED, LONGITUDINAL STUDY Sarah R Ting, BDS, DClinDent, FRACDS Wendy Nicholls, BSc, BA, MHA John C Winters, BDSc, MDSc W. Kim Seow, BDS, MDSc, PhD, DDSc, FRACDS Sarah Ting and W. Kim Seow are affiliated with the Centre for Paediatric Dentistry, University of Queensland, Australia. Wendy Nicholls and John Winters are affiliated with the Dental Department of Princess Margaret Hospital for Children in Perth, Western Australia. ABSTRACT The optimal time to begin orthodontic treatment is during the pubertal growth spurt which coincides with the peak of orofacial growth. Dental and skeletal age are reliable indicators of pubertal growth spurt, as the sequence of tooth formation and bone ossification tends to occur in a predictable sequence. 1 2 However, in the presence of an oral facial cleft, the sequence of tooth formation is often delayed. Reports concerning the pattern of dental maturity as the cleft child matures and gender difference in dental development appear inconsistent. Skeletal maturation studies suggest that cleft children are at higher risk of delayed growth period and retarded pubertal growth peak. 3 However, there are reports that there is no notable difference in skeletal maturity among cleft children. 4 The inconsistencies reported in dental and skeletal maturation studies of cleft children may be due to differences in the design of the studies. The majority of studies on cleft children are cross- sectional and there are very few longitudinal studies. Furthermore, the 5,6 study cohorts which are often mixed cleft groups that may include patients with syndromes and associated medical conditions that are associated with altered dental and skeletal maturation. Thus, many previous studies on growth and development of cleft children contain 7 potential confounders. Therefore, the aim of this study was to investigate the dental and skeletal development of isolated unilateral cleft lip and palate (UCLP) children in an Australian population. A retrospective, longitudinal study was conducted based on a cohort of 85 UCLP children (52 boys and 33 girls) treated at the Cleft and Craniofacial Department of Princess Margaret Hospital for Children, Western Australia. The inclusion criteria for the study were children with unilateral cleft lip and palate who had radiographic records taken at a minimum of two time points. This generated a total of 205 orthopantomograms (OPG) and 175 lateral cephalograms (LC). The non-cleft healthy controls consisted of 306 age and gender-matched children from the University of Queensland School of Dentistry Orthodontic Department archives and private orthodontic practices in Brisbane. Dental age was determined from the OPG using the method of Demirjian et al. This method involves assigning a maturity score to 8 seven mandibular teeth on the left side (excluding the third molar). The sums of these scores were converted to a dental age based on a maturity scale. Skeletal maturity was assessed from the morphology of the cervical vertebrae (C2, C3, and C4) seen on the LC as described by Baccetti and co-workers. 9 The data was analysed using paired t-tests and Chi-square tests to determine if there were any significant differences between UCLP and control children, with a significance level set at p<0.05. There was no significant difference in dental and skeletal maturity between cleft girls and controls (p>0.1), indicating that cleft girls were consistently in parity with the control girls. In the case of boys, no difference in dental age was seen, except at 9 years of age. Cleft boys in the 9-year-old group were significantly delayed compared to the control boys with a mean delay of 0.5 ± 1.2 years (p<0.05). This delay was not found to be statistically significant in the older age groups (p>0.1), suggesting that catch-up growth occurs. UCLP boys showed a significant delay of skeletal growth at 12 years of age (p<0.05) in comparison to the controls. By 15 years of age, any difference between UCLP boys and controls ceased to be significant (p>0.1). To date, this study is the first to report on dental and skeletal maturation of isolated unilateral cleft lip and palate in an Australian population. UCLP boys showed significant dental and skeletal delay but eventually caught up to their non-cleft counterparts. There was no significant difference in skeletal and dental maturity between UCLP and control girls. ACKNOWLEDGEMENTS The authors would like to acknowledge the use of patient data from Princess Margaret Hospital for Children, Western Australia. 102 RACDS ANNALS 2016

REFERENCES 1. Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995;107(1):58-66. 2. Ranta R. Comparison of tooth formation in noncleft and cleft-affected children with and without hypodontia. ASDC J Dent Child 1982;49(3):197-9. 3. Jensen BL, Dahl E, Kreiborg S. Longitudinal study of body height, radius length and skeletal maturity in Danish boys with cleft lip and palate. Scand J Dent Res 1983;91(6):473. 4. Prahl-Andersen B. Biological age in children with clefts. Stomatol DDR 1979;29(11):8122. 5. Poyry M, Nystrom M, Ranta R. Tooth development in children with cleft lip and palate: a longitudinal study from birth to adolescence. Eur J Orthod 1989;11(2):125-30. 6. Huyskens RW, Katsaros C, Van’t Hof MA, Kuijpers-Jagtman AM. Dental age in children with a complete unilateral cleft lip and palate. Cleft Palate Craniofac J 2006;43(5):612-5. 7. Ranta R. Comparison of tooth formation in noncleft and cleft-affected children with and without hypodontia. ASDC J Dent Child 1982;49(3):197-9. 8. Demirjian A, Goldstein H, Tanner JM. A new system of dental age assessment. Hum Biol 1973;45(2):211-27. 9. Baccetti T, Franchi L, McNamara JJ. The Cervical Vertebral Maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedic. Semin Orthod 2005(11):119-29. Email address for correspondence: [email protected] RACDS ANNALS 2016 103

PAPERS AND ABSTRACTS SPONSORS CONTRIBUTORS’ INDEX Contributor Page The Convocation Committee for the 23 Convocation extends its rd appreciation to the following sponsors for their commitment and Brunton, Paul 53 support. Cheung, Gary 43 Guitera, Pascale 101 Bronze & Lecturer Award Sponsor Lee, Philip 67 Maher, Niger 101 Moloney, Luke 49 Naughton, Matthew 54 Newnham, Melinda 60 Ngo, Luan 63 Bronze Sponsor Nicholls, Wendy 102 O’Brian, Kevin 31, 78, 94 Paxton, Susan 75 Raj, Jyotsna 100 Robinson, Andrew 32 Schifter, Mark 70 Seow, Kim 102 The Organising Committee thanks the following Industry Exhibitors for their contribution to the Convocation Soma, Artika 49 Sonis, Andrew 80 Ansell Invitro technologies Ting, Graeme 34 Dental Protection NSK Ting, Sarah 102 Dental Integrated dynamics Sirona Twetman, Svante 26, 40, 96 Geistlich Biomaterials Troll Dental Vasudavan, Sivabalan 80, 85 Henry Schein Halas Software of Excellence Watzl, Roland 59 Winters, John 102 Wong, Timothy 74 Wylie, Simon 57 104 RACDS ANNALS 2016



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