ABSTRACTS Abstracts on this page have been chosen and edited by Dr Trevor Watts

FACIAL TRAUMA DENTAL PATHOLOGY Aetiology and incidence of facial fractures Type and incidence of cracks in posterior sustained during sports: a prospective study teeth of 140 patients Ratcliff S, Becker IM et al. J Prosthet Dent 2001; 86: 168-172 Maladière E, Bado F et al. Int J Oral Maxillofac Surg 2001; 30: 291-295 Four types of crack were observed and were associated with restorations and excursive interferences. Facial fractures were caused by different types of impact and many could have been prevented. There is little understanding of the significance of cracks in teeth, despite aids to finding them (such as loupes). Cracks in posterior Over 2 years, 140 patients (13% of all patients with facial fracture; teeth may be placed in 4 groups: type 1, defined as without stain most resulted from assaults) with 154 sports-induced facial fractures in symptomless, unrestored teeth; type 2, as type 1 but with Class I were seen at a Paris hospital. Mean age was 29 yrs and 7/8 were male. or II restorations; type 3, as type 2 but with stain; type 4, with pain Most fractures involved mandible (53), zygoma (36), nose (24) or on releasing bite pressure, sweet substance contact and/or temper- zygomatic arch (10). Most patients were injured in soccer (35), rugby ature change (cracked tooth syndrome). (21), mountainbiking (14), skating (12), riding (11) or skiing (10). In 51 new patients in a USA practice, 763 teeth without full The authors discuss the relationship of impact type with differ- coverage restorations were found to have crack status of: 64% ent sports. In contact sports, most fractures (70/73) were caused none, 1% type 1, 17% type 2, 17% type 3 and 2% type 4. Most by a blow from another player, where protective equipment may significant individual predictors of cracks were: Class I or II prevent the injury; in vehicular sports, falls caused most fractures restorations of all materials (odds ratio 29), amalgam restoration (51/59). The authors recommend the use of protective headgear (11), endodontic treatment (9). and mouthguards where appropriate, but consider some injuries Excursive interference alone had an odds ratio of 2.3 for cracks, were not preventable. but the presence of a restoration, or a restoration with parafunc- tion, increased this to 6 or to 5.8. The authors recommend occlusal equilibration to minimize crack propagation. ORAL MEDICINE

Oral leukoplakia: open trial of topical CARIOLOGY therapy with calcipotriol compared with Maternal risk indicators for childhood tretinoin caries in an inner city population Femiano F, Gombos F et al. Int J Oral Maxillofac Surg 2001; 30: 402-406 Smith RE, Badner VM et al. Community Dent Oral Epidemiol 2002; 30: 176-181 Both drugs reduced lesions, but tretinoin may have potential A high maternal mutans streptococci count (MSC) was the for more adverse reactions. strongest predictor of caries in the child. Dysplasia may occur in up to 16% of leukoplakia, and because of Over a 3 month period at a New York clinic serving lower socioe- the potential for malignancy, there is interest in both surgical and conomic status families, 29 mothers of children with active or medical methods of treatment. Tretinoin, a vitamin A analogue, restored caries and 31 mothers of caries-free children were inter- has been studied in this regard for over 30 yrs, but has numerous viewed and examined. All children were aged 3-5 yrs. Four other side-effects. Its therapeutic effect was compared in this study with mothers refused to participate. The maternal groups did not differ that of the vitamin D analogue, calcipotriol. in ethnic status, country of origin, family income, education, age, Forty patients with leukoplakia of mild or moderate epithelial children’s ages or dental visit frequency. dysplasia were matched in equal groups for gender, site and histo- The caries group mothers, in comparison with the caries-free ry of alcohol and tobacco use. One group used each drug, apply- group, did not differ in mean DS, MT or DMFS, but had significant ing it to the lesion 2x daily for at least 15 min over a 5 week adjusted odds ratios of 11.3 for high MSC (>50 cfu in dorsum of period, with 4 months’ follow-up. tongue saliva), 4.2 for high sugar consumption frequency (>5 At 5 weeks, 16 patients in each group showed complete clinical intakes /day), and 4.0 for active decay. The authors consider these resolution of lesions. At 4 months, this persisted in 16 tretinoin maternal factors may help identify children at risk of caries. and 14 calcipotriol patients. The authors recommend larger, blinded studies to compare both drugs fully.

BRITISH DENTAL JOURNAL VOLUME 193 NO. 6 SEPTEMBER 28 2002 327