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During the mixed dentition stage, adolescents experience rapid dental and skeletal development. Unfortunately, many of them do not visit the orthodontist early enough and miss out on the opportunity to take advantage of preventive and interceptive orthodontic treatment. This article describes the management of regaining leeway space and correcting anterior crossbite using a modified maxillary molar distalizing appliance.

The aim of this study was to determine the presence of Streptococcus mutans or Streptococcus sobrinus in Cariostat-inoculated plaque samples obtained from Japanese mother-child pairs through a conventional PCR technique and to establish the presence of these bacteria and caries risk. Oral examination and caries risk assessment using the Cariostat ® were carried out on 168 children, aged 6-31 months, and their mothers. The presence of S. mutans and S. sobrinus in Cariostat-inoculated plaque samples was checked through PCR and tested for relevance with caries risk. A significant correlation (PϽ0.001) was found between caries risk of mothers and presence of S. mutans or S. sobrinus in plaque samples from their children in the 19-31-month-old age range. However, no significant relationship found between the presence of either strain in the plaque of younger children (6-18 months) and caries risk of mothers. Likewise, high caries risk was seen in 49.1% of the 19-31-month-old children of highrisk mothers (PϽ0.001) and 27% of the 6-18-month-old children of high-risk mothers (PϽ0.05). The effectiveness of the Cariostat method for prediction of caries risk can be improved by detecting the presence of S. mutans and S. sobrinus in plaque samples obtained from mothers and their children through conventional PCR techniques. Streptococcus mutans and Streptococcus sobrinus are the two strains most commonly isolated from carious teeth. Transmission of S. mutans is believed to primarily occur vertically along the mother-child infection route, and a discrete window of infectivity has been found to occur around the age of 2 years 2,3) or earlier 4-7). In recent studies however, the presence of S. mutans has been found in pre-dentate infants 8-10). In a study by Tanner 11) , the presence of S. mutans was detected in 70% of samples scraped from the tongues of 57 children aged 6-18 months living in Saipan. It is believed that initial acquisition of S. mutans at an early age is associated with caries development at a later age 12-14). Thus, it is important to establish caries risk assessment early in life. The Cariostat 15) method is a colorimetric caries risk

It can be difficult to formulate a definitive diagnosis and treatment plan for patients with hypodontia while dental development is still in progress. Proper radiographs should be used periodically to check for the possibility of delayed tooth development to reduce the potential of misdiagnosis and improper treatment. This article presents a case with orthodontic treatment of hypodontia and delayed development of a maxillary second premolar.

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