Children's electronic screen time exposure and its relationship to dental anxiety and behavior.

Objectives: The purpose of this study was to assess the association between electronic screen time and dental anxiety and behaviour among children aged six to twelve years during dental examination, prophylaxis, and topical fluoride application. Material and methods: This was a cross-sectional study which included 402 paediatric dental patients aged six to twelve years who came to King Abdulaziz University Dental Hospital in Jeddah, Saudi Arabia. The data was collected from September 2020 to December 2021. Self-constructed questionnaire was used to collect data from the patient and his/her guardian. It was comprised of eight demographic questions as well as 13 multiple-choice questions regarding the patients' screen time. Child dental anxiety was assessed by using Abeer Children Dental Anxiety Scale (ACDAS). Assessment of child's behaviour was done by using Frankl Behavioural Rating Scale. Results: This study had a response rate of 100%. Out of the 402 participants, 248 (61.7%) were found to have anxiety while 154 (38.3%) were not. Of all participants 274 (68.2%) were cooperative and 128 (31.8%) were not. A Significant relationship between anxiety and behavioural problems during a dental visit and the participant's total exposure hours to electronic devices was found (p < 0.001). Children exposed to electronics at the age of two years or before displayed more anxiety and uncooperative behaviour (p < 0.001). Conclusions: early exposure to electronic screens, especially for entertainment purposes and longer exposure can be associated with increased dental anxiety and uncooperative behaviour in children age 6-12 years. Recommendations: Parents should be educated about the risks of permitting their children to use electronic devices and encouraged to replace such devices with activities that incorporate physical activity.

Access to dental care for children with special health care needs: a cross-sectional community survey within Jeddah, Saudi Arabia.

The aim of this study was to investigate the level of dental care access among children with special health care needs (CSHCN) in Jeddah, Saudi Arabia and the barriers hindering this access. Data of this cross-sectional study were obtained from self-administered surveys distributed through seven CSHCN centers. Children with autistic spectrum disorder (ASD), Down syndrome, cerebral palsy, and developmental delay were included. Univariate and bivariate analyses were conducted to describe the data. A total of 602 study participants were included in the analyses. Only 24.9% of the participated caregivers routinely visited the dentist for their CSHCN. Half of CSHCN caregivers found difficulties obtaining dental treatment. This trend was significantly greater in 12-18 years old children (p = 0.013) and in families commuting for more than one hour to dental clinics (p = 0.045). The most common reported barrier was fear of the dentist (61.6%) followed by child uncooperativeness (37.8%) and treatment costs (27.8%). CSHCN lack sufficient dental care for a variety of reasons, primarily fear of dentists, child uncooperativeness, and treatment costs. Dentists require more training and education to facilitate better access to dental care for CSHCN.

Clinical and Radiographic Success of 2% Chlorhexidine Gluconate with Mineral Trioxide Aggregate in Indirect Pulp Treatment of Primary Molars.

Purpose: To compare the clinical and radiographic success rates of indirect pulp treatment (IPT) in primary molars using mineral trioxide aggregate (MTA) with and without two percent chlorhexidine gluconate (CHX).
Methods: A blinded, randomized, controlled clinical trial was performed in a split-mouth desi gn. Eighty primary molars in 40 subjects from four to eight years of age were randomly allocated so that each subject had one tooth treated with MTA and CHX and the other tooth treated with MTA alone. Study teeth had deep caries without signs and symptoms of pulpal inflammation or necrosis. All teeth were restored with stainless steel crowns. Follow-up was done at 12 months to evaluate the teeth clinically and radiographically.
Results: At the follow-up, one tooth from each group had failed. Upon the clinical and radiographic evaluations, the overall success rate for both groups was 97 percent. No statistically significant difference was found in the success rate between the two groups.
Conclusions: IPT in primary molars using MTA with or without CHX demonstrated satisfactory clinical and radiographic outcomes in a period of 12 months.

Genotoxicity and cytotoxicity of cone beam computed tomography in children.

BACKGROUND: Dental radiographs are essential tools for diagnosis. However, there are significant concerns about the dangerous effect of radiation especially on children. The aim of this study was to evaluate genotoxicity and cytotoxicity in the exfoliated cells of buccal mucosa of children subjected to Cone Beam Computed Tomography (CBCT). METHODS: The study included 18 healthy children aged (9-12 years) who were exposed to CBCT. All CBCT scans were performed with the i-CAT CBCT. Exfoliated buccal cells were scraped from the left and right cheek immediately before the exposure, after 10 ± 2 days, and after 1 month. Cells were stained using Feulgen/fast green stain and examined under light microscopy. Genotoxicity (Micronuclei) and cytotoxicity (condensed chromatin, karyorrhexis, pyknosis, and karyolysis) were scored. Statistical analysis was performed using the McNemar test, Wilcoxon Signed-Rank test, and Mann-Whitney U test at a significance level of p < 0.05. RESULTS: There were statistically significant differences in the mean percentages of micronuclei, condensed chromatin, karyorrhexis, pyknosis, and karyolysis before and 10 ± 2 days after the CBCT scan (p < 0.05). There were no statistically significant differences in the frequency of micronuclei, condensed chromatin, karyorrhexis, or pyknosis before and 1 month after the exposure (p > 0.05) except for karyolysis (p < 0.05). CONCLUSIONS: CBCT may induce genotoxicity and cytotoxicity in buccal mucosa cells of children. Therefore, CBCT should not be prescribed unless necessary as it cannot be considered a risk-free procedure.

Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review.

AIM: To provide an overview of the techniques of indirect pulp treatment (IPT) and the new materials used. BACKGROUND: Indirect Pulp Treatment (IPT) is a conservative treatment approach that can be used in primary molars. Pulpotomy has been adopted as the treatment of choice for deep caries in primary molars. IPT showed higher success rates in recent researches. MATERIALS AND METHODS: Electronic search of English scientific papers was accomplished using PubMed, ScienceDirect, and Scopus. Papers published from 1995 to 2019 were included. Search terms used were recent advances, indirect pulp treatment, mineral trioxide aggregate (MTA), biodentine, TheraCal-LC, chlorhexidine gluconate (CHX), resin-modified glass ionomer (RMGI), and calcium hydroxide. REVIEW RESULTS: Seventy two papers were obtained from the electronic search and references of selected studies. Thirty five papers explained recent advances in IPT materials for primary molars. MTA produces more dentinal bridging with superior quality than calcium hydroxide. Similarly, Biodentine can form reparative dentin in a very short period. TheraCal-LC has increased stability and durability with strong physical properties and low solubility. Furthermore, CHX is a chemical disinfectant which can aid in increasing the success rate of IPT when conjugated with other materials. It produced highly successful IPT when combined with RMGI or calcium hydroxide. CONCLUSION: IPT is the preferred treatment approach for preservation of primary dentition. CHX is an emerging material that can provide promising results in IPT when combined with other materials. CLINICAL SIGNIFICANCE: Up to date, no material had replaced the popular use of calcium hydroxide in IPT. The use of CHX with RMGI can increase the success rate while preserving the advantages of the latter as it is considered the liner of choice for primary teeth, making IPT a suitable substitute for pulpotomy in primary molars. HOW TO CITE THIS ARTICLE: Saber AM, El Meligy OA, Alaki SM. Recent Advances in Indirect Pulp Treatment Materials for Primary Teeth: A Literature Review. Int J Clin Pediatr Dent 2021;14(6):795-801.

Comparing zirconia to anterior strip crowns in primary anterior teeth in children: a randomized clinical trial.

BACKGROUND: Providing restorations to anterior teeth in children is a challenging task due to the need for high esthetics, strength, and durability. This study was done to compare prefabricated primary zirconia with resin composite strip crowns on primary maxillary central and lateral incisors with regards to gingival health, plaque accumulation, recurrent caries, restoration failure, and opposing teeth wear over a period of 3, 6 and 12 months. METHODS: Children attending the King Abdulaziz University, Faculty of Dentistry (KAUFD) clinics who needed restorations were screened for inclusion criteria. A total of 120 teeth were treated; 60 with zirconia and 60 with strip crowns. Randomization was done by simple random allocation using SPSS software version 20.0 (Armonk, NY; IBM Corp.). A simple descriptive statistic was used for analysis by Wilcoxon Signed-Rank test and Chi-square test. Level of significance was set at (α = 0.05) and level of confidence at (95%). The presented research was registered retrospectively at ClinicalTrials.gov in 6th of August 2017, under registration number NCT03184012. RESULTS: Zirconia crowns showed significantly less gingival bleeding at the 3- and 6-months follow up periods (p < 0.006, p < 0.001; respectively), less plaque accumulation at all follow up visits (p < 0.001), no restoration failure (p < 0.001), but more wear to opposing teeth (p < 0.02). No significant difference was found between the two crowns with regards to recurrent caries (p < 0.135). CONCLUSION: Based on our data we conclude that overtime teeth covered with zirconia crowns show better gingival health and less bleeding, plaque accumulation as well as less loss of material. On the other hand, zirconia can cause more loss of opposing tooth structure.

Molecular Screening of VAX1 Gene Polymorphisms Uncovered the Genetic Heterogeneity of Nonsyndromic Orofacial Cleft Among Saudi Arabian Patients.

OBJECTIVE: Nonsyndromic orofacial cleft (NSOFC) including cleft lip with or without cleft palate (CL±P) and cleft palate (CP) are multifactorial developmental disorders with both genetic and environmental etiological factors. In this study we investigated the association between CL±P and CP, and two polymorphisms previously determined using genome-wide association studies, as well as the association between consanguinity and CL±P and CP. METHODS: DNA was extracted from saliva specimens from 171 triads consisting of affected individuals and their parents, as well as 189 control triads (matched for age, gender, and location) that were recruited from 11 referral hospitals in Saudi Arabia. Two polymorphisms, rs4752028 and rs7078160, located in the VAX1 gene were genotyped using real-time polymerase chain reaction. A transmission disequilibrium test was carried out using the Family-Based Association Test and PLINK (genetic tool-set) to measure the parent-of-origin effect. RESULTS: Significant differences were found between affected individuals and the control group. In the case of the rs4752028 risk allele in cleft, the phenotypes were: CL±P (fathers: odds ratio [OR] 2.16 [95% CI 1.38-3.4]; mothers: OR 2.39 [95% CI 1.53-3.71]; and infants: OR 2.77 [95% CI 1.77-4.34]) and CP (fathers: OR 2.24 [95% CI 1.15-4.36] and infants: OR 2.43 [95% CI 1.25-4.7]). For CL±P and the rs7078160 risk allele, the phenotypes were: (fathers: OR 1.7 [95% CI 1.05-2.86]; mothers: OR 2.43 [95% CI 1.49-3.97]; and infants: OR 2.34 [95% CI 1.44-3.81]). In terms of consanguinity, we found significant association between consanguinity and the rs4752028 polymorphism minor allele among CL±P compared with controls (p = 0.001). CONCLUSION: This is the first study to find a relationship between these two loci on 10q25 (rs4752028 and rs7078160) and NSOFC in a population with high levels of consanguinity.

Comparing Dental Stress in New Child Patients and Returning Patients Using Salivary Cortisol, Immunoglobulin-A and Alpha- Amylase.

OBJECTIVES: this study was aimed at comparing dental stress in children having their first dental visit to those returning for dental treatment using salivary biomarkers of stress including salivary cortisol (s-cortisol), Immunoglobulin-A (s-IgA) and alpha-amylase (s-α-amylase). Additionally, the study was aimed at monitoring the change in stress in new patients as they progressed from the waiting to the clinical areas. STUDY DESIGN: salivary samples were collected from 40 children who had not been to a dentist before and similar samples were collected from 40 children who were returning for completion of dental treatment. Salivary cortisol, s-IgA and s-α-amylase concentrations were obtained by Enzyme-linked Immunosorbent Assay (ELISA). RESULTS: salivary cortisol levels were higher for new patients at the waiting area compared to that at the dental chair (p=0.05). Salivary alpha-amylase significantly increased in new patients while being seated in the dental chair. Returning patients had higher s-α-amylase (p=0.001) and s-IgA (p=0.016) compared to new patients. Returning patients had the lowest level of s-cortisol when providers were faculty pediatric dentists than with students and interns (p=0.035). CONCLUSIONS: children coming in for their first dental visit may experience dental stress at the waiting area before being seated for dental examination. Returning children may experience higher levels of stress compared to new child patients possibly due to previous dental exposure.

The effect of personality traits on undergraduate dental students' performance in multiple mini interviews.

BACKGROUND: Multiple mini interviews (MMI) is a structured student selection method where applicants rotate around a series of stations that do not require previously learned knowledge. The Big Five Inventory (BFI) is a tool often used to measure personality traits commonly used in applicant selection. OBJECTIVE: The aim of the current study was to assess the effect of personality traits using the BFI on undergraduate dental students' performance in MMI. METHODS: This research was conducted at The Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia. All undergraduates applying to the dental program at King Abdulaziz University, Faculty of Dentistry (KAUFD) in two academic years [(2014-2015) and (2015-2016)] undertook the MMI held at KAUFD and completed the BFI inventory with a total number of 350 students. The MMI consisted of five stations while the BFI contained forty-four items. Data were analysed by SPSS version 20, using independent-samples t-test, Mann-Whitney U test, Spearman's rho correlation coefficient and Chi-square test. RESULTS: female students scored higher than their male counterparts but scores were only significant in the empathy station (p<0.001) in the first year, and in both empathetic skills and team work abilities (p<0.05) in the second. BFI results indicate that male students scored higher on agreeableness (p<0.003) and lower on neuroticism (p<0.001) in the first year while female students scored higher on agreeableness and conscientiousness (p<0.001) in the second year. Students of private schools had higher total MMI scores compared to those of public schools (p<0.05). CONCLUSION: MMI combined with the Big Five Inventory can be a useful tool in the admission process.

Prevalence of obesity in elementary school children and its association with dental caries.

OBJECTIVES: To investigate the prevalence of obesity among elementary school children and to examine the association between obesity and caries activity in the mixed dentition stage. Methods: This cross-sectional study was conducted in King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between September 2014 and June 2015 using a multi-stage stratified sample of 915 elementary school children (482 boys, 433 girls) in Jeddah, Saudi Arabia. Anthropometric measurements, consisting of height, weight, body mass index (BMI), and waist circumference (WC), were obtained. Children were classified as underweight/healthy, overweight, or obese and as non-obese or obese according to their BMI and WC, respectively. Each child's caries experience was assessed using the decay score in the primary and permanent teeth. Results: Based on BMI, 18% of children were obese, 18% were overweight, and 64% were underweight/normal. Based on WC, 16% of children were obese, and 84% were non-obese. Girls had a significantly higher prevalence of obesity based on WC measurements (p less than 0.001), but not BMI. Children enrolled in private schools had a significantly higher prevalence of obesity (p less than 0.05) than those in public schools. For primary and permanent teeth combined, children with higher BMI and WC had a lower prevalence of caries (p less than 0.05). Conclusion: The prevalence of obesity was high among male and female elementary school children. Overall caries activity was inversely proportional to BMI and WC.

Can Multiple Mini-Interviews Predict Academic Performance of Dental Students? A Two-Year Follow-Up.

Prior research has shown that students' previous grade point average (GPA) is the best predictor for future academic success. However, it can only partly predict the variability in dental school performance. The aim of this study was to assess the predictive value of multiple mini-interviews (MMI) as an admission criterion by comparing them with the academic performance of dental students over a two-year period. All incoming undergraduate dental students at the King Abdulaziz University Faculty of Dentistry (KAUFD) during academic year 2013-14 were invited to participate in MMI. Students rotated through six objective structured clinical exam (OSCE)-like stations for 30 minutes total and were interviewed by two trained faculty interviewers at each station. The stations were focused on noncognitive skills thought to be essential to academic performance at KAUFD. The academic performance of these students was then followed for two years and linked to their MMI scores. A total of 146 students (71 males and 75 females) participated in an interview (response rate=92.9%). Most students scored in the acceptable range at each MMI station. Students' total MMI score, ambitions, and motives were significant predictors of GPA during the two years of follow-up (p<0.038 and p<0.001, respectively). In this study, MMI was found to be able to predict future academic performance of undergraduate dental students.

Oral Health Quality of Life in Children with Cerebral Palsy: Parental Perceptions.

OBJECTIVE: To assess the parents' perception of the oral health-related quality of life (OHRQOL) in children with Cerebral Palsy (CP) and compare it with normally developing children. STUDY DESIGN: 63 children with CP were recruited from 8 disability centers, and 99 healthy controls were recruited from 5 elementary schools. The ages of the children in both groups were from 6-12 years. The Franciscan Hospital for Children Oral Health-Related Quality of Life (FHC-OHRQOL) was used to measure the OHRQOL and an oral examination was conducted in the schools/centers of the children to assess the teeth, gingival health, and oral hygiene. RESULTS: The FHC-OHRQOL showed a significant difference in 3 out of 4 sections indicating lower OHRQOL in the CP group. The examination showed no significant difference in the dental and gingival health and in the level of oral hygiene. CONCLUSION: The OHRQOL of children with CP is significantly lower than that of normally developing children although the oral health status of children with CP is not significantly different from that of normally developing children.

Gathering validity evidence in the use of multiple mini-interviews as an admission tool for dental students: Preliminary evidence from Saudi Arabia.

AIMS: This study examined the validity evidence of noncognitive skills of incoming students in the Faculty of Dentistry at King Abdulaziz University using multiple mini-interviews (MMI). Validity evidence in response process, internal structure and relationship to other variables was investigated. METHODS: A total of 146 students were interviewed by faculty members over a two-day period. The interviews took the form of an MMI, which consisted of six objective structure clinical examination (OSCE) stations with two faculty interviewers per station. Each student rotated through the six stations and were asked 4-5 structured questions per station. Each student was rated on a three-point rating scale. RESULTS: The majority of dental students were rated to be acceptable. The inter-rater reliability was 0.91 which was significantly high (range: 0.87-0.94). The total MMI score for all stations was 73.47 (SD = 8.49) with female students scoring significantly higher than males did (p < 0.001). Generalizability study results indicated good reliability (Φ-coefficient = 0.73; G-coefficient = 0.75). Moderate association was found between total MMI score and foundation year GPA (r = 0.30, p ≤ 0.001). CONCLUSIONS: Preliminary validity evidence supports the use of MMI scores as an admission tool for dental students, with respect to its response process, internal structure and relationship to other variables.

Molar incisor hypomineralization, prevalence, and etiology.

Aim. To evaluate the prevalence and possible etiological factors associated with molar incisor hypomineralization (MIH) among a group of children in Jeddah, Saudi Arabia. Methods. A group of 8-12-year-old children were recruited (n = 267) from the Pediatric Dental Clinics at the Faculty of Dentistry, King Abdulaziz University. Children had at least one first permanent molar (FPM), erupted or partially erupted. Demographic information, children's medical history, and pregnancy-related data were obtained. The crowns of the FPM and permanent incisors were examined for demarcated opacities, posteruptive breakdown (PEB), atypical restorations, and extracted FPMs. Children were considered to have MIH if one or more FPM with or without involvement of incisors met the diagnostic criteria. Results. MIH showed a prevalence of 8.6%. Demarcated opacities were the most common form. Maxillary central incisors were more affected than mandibular (P = 0.01). The condition was more prevalent in children with history of illnesses during the first four years of life including tonsillitis (P = 0.001), adenoiditis (P = 0.001), asthma (P = 0.001), fever (P = 0.014), and antibiotics intake (P = 0.001). Conclusions. The prevalence of MIH is significantly associated with childhood illnesses during the first four years of life including asthma, adenoid infections, tonsillitis, fever, and antibiotics intake.

Can Socioeconomic status indicators predict caries risk in schoolchildren in Saudi Arabia? a cross-sectional study.

PURPOSE: To determine the prevalence and identify significant socioeconomic predictors of dental caries among children aged 9 and 14 in Jeddah, Saudi Arabia. MATERIALS AND METHODS: A random sample of 24 elementary and middle schools in Jeddah was selected. All 3rd and 8th graders were screened (N = 1655) for caries. A parent questionnaire was administered to collect information on selected socioeconomic indicators. Untreated caries was the outcome of interest. Categorical variables were reported as frequencies and percentages; crude and adjusted odds ratios of caries association with SES were produced with 95% confidence intervals and P-values. RESULTS: A total of 1655 students were examined. The overall caries experience was 83.13%. Untreated caries prevalence in primary and permanent teeth of all students was 63.01% and 56.7%, respectively. In primary teeth, mother's education, family income and having medical insurance were significant unadjusted predictors of caries. Family income was the only adjusted predictor of caries in primary teeth. In permanent teeth, most SES indicators were significant in the univariate analysis. However, mother's education was the only adjusted variable associated with caries. CONCLUSIONS: The prevalence of caries is rising and aggregate measures of SES did not distinguish between children with or without caries, particularly among younger children. The most powerful individual SES predictors of caries were family monthly income and parents' education. Until a more valid aggregate measure of SES is available, community wide approaches to caries prevention and risk reduction for all young children should be utilised to reduce SES-related caries risk.

The effects of asthma and asthma medication on dental caries and salivary characteristics in children.

PURPOSE: To investigate the prevalence and severity of dental caries in children with a history of asthma in addition to their salivary characteristics, flow rate and buffering capacity, as well as the salivary level of Mutans streptococci (MS) and lactobacilli present. MATERIALS AND METHODS: The study sample was composed of 30 cases and 30 controls with an age range from 5 to 13 years. The cases involved children with a past history of asthma, while the controls were medically fit children. The study was conducted from 2010 to 2011 and patients were randomly selected through the electronic filing system at King Abdul-Aziz University Hospital (R4 system), Jeddah, Saudi Arabia. Interviews and questionnaires were completed by the parents of the children involved and dental examinations were performed. Stimulated salivary samples were collected to determine the salivary flow rate, buffering capacity and salivary levels of MS and lactobacilli. RESULTS: No significant differences were found in the DMFT, dmft scores or community periodontal index (CPI) scores between the cases and controls. However, there was a positive correlation between DMFT and dmft scores (r = 0.83, P < 0.0001) in both the cases and controls. In asthmatic patients who took their medication 3 times a day or more, the level of MS and lactobacilli was significantly higher (P = 0.014 and P = 0.008, respectively) compared with other asthmatic patients. Patients with severe asthma had significantly lower salivary flow rate levels than other asthmatic patients (P = 0.040), while patients taking a combination therapy of anti-asthmatic drugs with corticosteroids had higher levels of lactobacilli compared with patients using other medications (P = 0.02). CONCLUSIONS: The frequency of taking asthma medication, the severity of asthma and the use of combination therapy can significantly alter the salivary characteristics in asthmatic children.

Dental pain in children with intellectual disabilities: caregivers' perspective.

Purpose. Description of pain is generally difficult in children, and more so in those with intellectual disabilities (ID). Aim. This study is aimed at evaluating dental pain from caregivers' perspective in children with ID. Methods. The study sampled 86 children (33 with ID, 53 normally developing) ages ranges from birth to 16 years old among those visiting the School of Dentistry, King Abdulaziz University, Saudi Arabia. Caregivers were asked about their awareness of dental pain in their wards using the Dental Discomfort Questionnaire (DDQ+). The children were examined for dental caries and periodontal status. Results. The mean DDQ+ in children with ID (4.55 ± 3.46) was not significantly different from that in healthy children (4.19 ± 3.26, P = 0.7). Children with ID had more salivation (P = 0.01) and were putting their hands inside their mouths more often (P = 0.003). Conclusions. Caregivers can recognize dental pain-related behaviors in children with ID such as excessive salivation and putting hands inside the mouth more often.

Caries experience in asthmatic children: a review of literature.

AIM: This review explores the discriminating factors involved for increased caries experience in asthmatic children. BACKGROUND: Dental caries is the single most common chronic disease of childhood. Children with chronic medical conditions are considered high caries risk. Asthma is one of the most common chronic medical conditions in childhood. MATERIAL: 27 studies examined the asthma-caries causative relationship. Most of them were cross sectional studies; only 5 longitudinal studies were reported. In the literature, there is a lack of consensus regarding the relationship between dental caries and asthma in a child population. CONCLUSION: Despite the fact that some relatively recent studies have provided little evidence for an asthma-caries causative relationship, the majority and the most recent reports have concluded that the individualistic nature of asthmatic condition, through either its disease status or its pharmacotherapy (diferent combinations of medicaments), or attempts to alleviate the condition's physiologic sequelea, carries several factors for an increased caries risk.

Can parents assess dental pain in children with cognitive impairment?

It is often said that the "gold standard" for pain assessment in both children and adults is verbal report. This means that the individual is best at describing his or her pain experience. This however does not take into account individuals who lack the ability to communicate their feelings including those with cognitive immaturity such as infants and very young children, people with cognitive impairment and adults with dementia. This is even complicated by the fact that children who experience the most pain are those who are least able to verbally describe it; those with greater physical and cognitive disability. This paper reviews past and current beliefs on the experience and expression of pain in children with cognitive impairment and how parents can be used as useful tools in diagnosing their pain.

Genetic and dental study of patients with celiac disease.

OBJECTIVES: The aim of this work was to study the pattern of inheritance of celiac disease in a group of Saudi patients and to compare oral mucosal and dental clinical findings in these patients to those of healthy controls. STUDY DESIGN: Fifty patients suffering from celiac disease were screened for dental evaluation. They were subjected to clinical genetic examination, pedigree construction, oral mucosal and dental clinical evaluation. RESULTS: An autosomal recessive mode of inheritance was evident in some of the studied cases, while others showed sporadic occurrence. Oral mucosal and dental clinical examinations revealed recurrent oral ulcerations, enamel hypoplasia in most of the celiac disease patients. CONCLUSIONS: Pedigree analysis of families is important to identify the mode of inheritance. Oral mucosal and dental clinical examinations are important in diagnosing and monitoring cases of celiac disease.