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Most popular medical Questions
What is positional plagiocephaly?Since the implementation of the "back-to-sleep" program by the American Academy of Pediatrics in 1992 to reduce the risk of sudden infant death syndrome, about 1 in 60 infants has developed occipital flattening (posterior plagiocephaly) due to transient calvarial deformation from prolonged supine sleeping positions. Simple positional modifications (alternating left and right occipital sleep positions) usually suffice for correction, particularly if intervention is begun at an early age.
What evaluations should be done in a child with microcephaly?
The extent of evaluation depends on various factors: prenatal versus postnatal acquisition, presence of minor or major anomalies, developmental problems, and neurologic abnormalities. The diagnosis can be as straightforward as a simple familial variant (autosomal dominant) in a child with normal intelligence, or it can range to a variety of conditions associated with abnormal brain growth (e.g., intrauterine infections, heritable syndromes, chromosomal abnormalities). Evaluation may include the following:
Parental head-size measurements
Ophthalmologic evaluation (abnormal optic nerve or retinal findings may be in found in various syndromes)
Karyotype
Neuroimaging (cranial magnetic resonance imaging
Metabolic screening
Cultures/serology if suspected intrauterine infection
What are the three main general causes of macrocephaly?
Increased intracranial pressure: Caused by dilated ventricles (e.g., progressive hydrocephalus of various causes), subdural fluid collections, intracranial tumors, or benign increased intracranial pressure (i.e., pseudotumor cerebri) from various causes
Thickened skull: Caused by cranioskeletal dysplasias (e.g., osteopetrosis) and various anemias
Megalencephaly (enlarged brain): May be familial or syndromic (e.g., Sotos syndrome) or caused by storage diseases, leukodystrophies, or neurocutaneous disorders (e.g., neurofibromatosis)
When do primary and secondary teeth erupt?
Mandibular teeth usually erupt first. The central incisors appear by the age of 5-7 months, with approximately 1 new tooth per month thereafter until 23-30 months, at which time the second molars (and thus all 20 primary or deciduous teeth) are in place. Of the 32 secondary teeth, the central incisors erupt first between 5 and 7 years, and the third molars are in place by 17-22 years.
What is the significance of natal teeth?
Occasionally, teeth are present at birth (natal teeth) or erupt within 30 days after birth (neonatal teeth). When x-rays are taken, 95% of natal teeth are primary incisors, and 5% are supernumerary teeth or extra teeth. Very sharp teeth that can cause tongue lacerations and very loose teeth that can be aspirated should be removed. Females are affected more commonly than males, and the prevalence is 1:2,000-3,500. Most cases are familial and without consequence, but natal teeth can be associated with genetic syndromes, including the Ellis-van Creveld and Hallermann-Streiff syndromes.
How common is the congenital absence of teeth?
The congenital absence of primary teeth is very rare, but up to 25% of individuals may have an absence of one or more third molars, and up to 5% may have an absence of another secondary or permanent tooth (most commonly the maxillary lateral incisors and mandibular second premolar).
What are mesiodentes?
These are peg-shaped supernumerary teeth that occur in up to 5% of individuals, and they are most commonly situated in the maxillary midline. They should be considered for removal because they interfere with the eruption of permanent incisors.
Which teeth constitute the 32 permanent teeth?
The upper and lower central incisors, lateral incisors, cuspids, first bicuspids, second bicuspids, first molars, second molars, and third molars.
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