Silver Diamine Fluoride as a Medicament for the Indirect Pulp Therapy in Primary Teeth: A Review of the Literature.

Silver diamine fluoride (SDF) has been demonstrated to be effective in arresting caries lesions and, recently, clinical trials have assessed the effectiveness of SDF as a medicament for indirect pulp therapy (IPT) in primary teeth. This review aims to summarize the literature related to the use of SDF and find out if SDF can be used as an effective material for IPT. A literature search was undertaken on electronic databases including PubMed, MEDLINE, ScienceDirect, and Google Scholar, which elicited 50 studies employing different materials in the IPT of primary molars; however, of them, only four clinical trials used SDF as indirect pulp capping (IPC) material. SDF has the potential to be a useful material for IPT in primary teeth. It is a handy choice for pediatric dentists due to its minimum invasiveness, ease of application, and ability to stop the progression of caries. However, more studies are needed to determine whether SDF can be used routinely for IPT and whether it can even replace the currently available materials, as well as to fully realize its potential and establish criteria for its ideal application in IPT procedures.

Barriers to Using Advanced and Pharmacological Behavior Management Techniques: A Survey of Pediatric Dentists in Jeddah, Saudi Arabia.

Aim: In this study, we assessed the use of advanced pharmacological behavior management techniques (BMTs) among pediatric dentists in Saudi Arabia and the barriers to their clinical application. Materials and Methods: This cross-sectional study used a self-administered electronic survey that targeted members of the Saudi Society of Pediatric Dentistry. The questionnaire included questions on five techniques of advanced and pharmacological behavior management recommended by the American Academy of Pediatric Dentistry. Descriptive statistics, frequency, Chi-square test, and Fisher's exact test were used to present the outcomes and independent variables. Results: A total of 57 pediatric dentists completed the survey. Nitrous oxide (N2O) sedation, general anesthesia (GA), and protective stabilization were used regularly by pediatric dentists in 70.2%, 68.4%, and 56.1% of the participants, respectively. A few participants reported using oral (14.0%) or intravenous (IV) sedation (10.5%) regularly. The most common barriers to using these techniques were either dentists' discomfort or the non-availability of the equipment/drugs. Conclusions: The most common method used by pediatric dentists was N2O inhalation sedation, followed by GA and protective stabilization. The participants' use of pharmacological BMTs, including IV and oral sedation, was relatively low.

Effectiveness of silver diamine fluoride in indirect pulp capping in primary molars: A systematic review and meta-analysis.

Introduction: Recently, clinical trials have assessed the effectiveness of Silver Diamine Fluoride (SDF) as an indirect pulp capping material (IPC) in primary teeth. This systematic review aimed to assess the evidence presented in these trials. Data sources: A comprehensive search identified relevant studies through five electronic databases (PubMed, Scopus, ClinicalTrials.gov, ScienceDirect, and Cochrane). Search strategies were designed using the PICO model to identify all studies that investigated SDF as an IPC compared to calcium hydroxide (CaOH) or mineral trioxide aggregate (MTA). Quality assessment and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to assess the level of evidence. Study selection: Four clinical trials were found to be suitable for inclusion in the qualitative synthesis and three studies were included in the quantitative analysis. Three studies compared SDF with CaOH and only one study compared SDF, CaOH, and MTA. Only one randomized controlled trial (RCT) had a low risk of bias, and the non-RCT study had a moderate risk of bias. The level of evidence based on the GRADE was low. Three out of four studies showed higher clinical and radiographic outcomes with SDF than with CaOH. One non-RCT study showed that SDF resulted in the least reparative dentin at the 6-months follow-up. The meta-analysis showed a non-significant difference between the SDF and CaOH groups (P = 0.36). Conclusion: There is little evidence showing a higher clinical and radiographic outcome of SDF compared to CaOH as an IPC material in primary molars. Clinical significance: This systematic review updates pediatric dentists regarding the effectiveness of using SDF as indirect pulp caping in primary teeth.

Behavioral and Dental Management of a Pediatric Patient Diagnosed with Autoimmune Encephalitis: A Case Report.

Background: This is a case report presenting the behavioral and dental management of a 9-year-old child recently diagnosed with autoimmune encephalitis, seizure disorder, and psychosis and treated with anticonvulsant and antidepressant medications. In this case, seizure semiology was presented as eye blinking during the attack, and the child was usually not conscious. It is absorbed by itself and associated with a post-sleeping attack that lasts for minutes. Case description: Parents presented to the pediatric dental clinic with a chief complaint of decayed teeth that needs to be restored. The child has mixed dentition and is diagnosed with anterior crossbite and single posterior crossbite. The child was cleared by the pediatric neurologist and psychiatrist and had no contraindications to dental treatment under local anesthesia. The child's treatment was completed on the dental chair without any seizure attacks, and the patient's chief complaint was resolved. Conclusion: Pediatric dentists should be educated about dental precautions and consider drug interactions when treating children with autoimmune encephalitis. Various types of non-pharmacological behavior guidance techniques and pharmacological methods of behavior management techniques can aid in the behavioral management of children with psychosis. How to cite this article: Alowi WA, Baghlaf K. Behavioral and Dental Management of a Pediatric Patient Diagnosed with Autoimmune Encephalitis: A Case Report. Int J Clin Pediatr Dent 2023;16(2):416-419.

Environmental tobacco smoke exposure and non-syndromic orofacial cleft: Systematic review and meta-analysis.

INTRODUCTION: Environmental tobacco smoke (ETS) is associated with several congenital anomalies, including non-syndromic orofacial clefts (NSOFCs). This systematic review aimed to update the literature on the association between ETS and NSOFCs. METHODS: Four databases were searched up to March 2022, and studies that evaluated the association between ETS and NSOFCs were selected. Two authors selected the studies, extracted the data, and evaluated the risk of bias. Comparing the association of maternal exposure to ETS and active parental smoking with NSOFCs allowed for the creation of pooled effect estimates for the included studies. RESULTS: Twenty-six studies were deemed eligible for this review, of which 14 were reported in a previous systematic review. Twenty five were case-control studies, and one was a cohort study. In total, these studies included 2142 NSOFC cases compared to 118129 controls. All meta-analyses showed an association between ETS and the risk of having a child with NSOFC, based on the cleft phenotype, risk of bias, and year of publication, with a pooled increased odds ratio of 1.80 (95% CI: 1.51-2.15). These studies had a marked heterogeneity, which decreased upon subgrouping based on the recent year of publication and the risk of bias. CONCLUSIONS: ETS exposure was associated with more than a 1.5-fold increase in the risk of having a child with NSOFC, showing a higher odds ratio than paternal and maternal active smoking. TRIAL REGISTRATION: The study is registered on the International Prospective Register of Systematic Reviews database # CRD42021272909.

Necessity and relevance of qualitative research in pediatric dentistry. A literature review.

Objectives: This review aims to understand the essence and relevance of qualitative research in pediatric dentistry and summarizes the most important information needed for a pediatric dentist before conducting a qualitative study. Methods: An electronic search was conducted on studies published from December 2019 until December 2021 using PubMed, Scopus, and King Abdulaziz University Digital library. Several keywords were used to identify the studies for this review. Results: Thirty-three studies involving qualitative methods in pediatric dentistry have been conducted on parents and dentists. Qualitative studies in pediatric dentistry are used to explore the perceptions of mothers and their children and to understand their behavior in different areas related to pediatric dentistry. Barriers to conducting qualitative studies with children include credibility, the influence of others on children's opinions, and differences that influence children's behavior while conducting the study. Conclusion: Qualitative methods in pediatric dentistry have been conducted on parents and dentists; however, little is known about the credibility and trustworthiness of conducting qualitative research with children. Future studies are needed to investigate effective interview techniques with children and more research should be conducted to evaluate the credibility and trustfulness of using children as a source to collect data in qualitative research.

Developmental Disturbance in Premolars After Intraligamental Anesthesia Using Computer-Controlled Local Anesthesia Delivery System: An-Eight-Years Follow-Up Study in Children.

Aim This study aimed to evaluate the prevalence of developmental disturbances in permanent second premolars in which their tooth buds were exposed to mandibular intraligamental anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLAD). Materials and methods This was a longitudinal follow-up study conducted in a previous randomized clinical trial (RCT). In the previous RCT, a total of 91 children were included (61 control and 30 cases). A structured form was created that contained details about the date of birth, age, and sex at which the participants received local anesthesia and the type of local anesthesia administered (ILA using CCLADS, traditional inferior alveolar nerve block [IANB], and IANB using CCLADS). A history of post-treatment abscess, retreatment, and post-treatment extraction was documented in both groups. Descriptive statistics, including frequency and percentage, and additionally, the chi-square test and Fisher's exact test were used to compare ILA and IANB. Results Forty of the 91 children attended follow-up visits. Only two children had developmental defects: one child who received traditional IANB had a demarcated white opacity (this patient had a history of dental abscess), and another who received ILA using CCLADS showed hypoplasia on his permanent premolar. No significant association was found between the type of anesthesia and the presence of developmental defects. Conclusion The slow administration of ILA delivered by CCLADS in the primary teeth does not increase the chances of developmental disturbances or damage to the corresponding permanent tooth bud.

The Impact of the COVID-19 Lockdown on Sugar-Sweetened Beverage Consumption in Children in Saudi Arabia: A Mixed-Methods Study.

(1) Background: In 2020, there seems to have been a global shift in lifestyle and eating habits with the emergence of the coronavirus disease 2019 (COVID-19) and the ensuing lockdowns implemented by national governments. This study assessed the impact of the COVID-19 lockdown on SSBs consumption among healthy 6-11 years old children in Saudi Arabia; (2) Methods: This is a mixed-methods study, incorporating a quantitative component, which was a validated Arabic online questionnaire completed by parents, and a qualitative component, involving structured interviews with 10 selected parents using a criterion sampling method; (3) Results: There was a small decrease in consumption reported during lockdown across all SSBs types (soft drinks, n = 58 (13.9%); juices: n = 115 (27.6%); flavored milk: n = 93 (22.3%)). The results showed that with every increase in the dental pain scale there was a positive odd (AOR:0.64; p = 0.001) of decreased consumption of SSBs. Several themes related to increase and decrease SSBs consumption emerged; (4) Conclusions: There was a small decrease in SSBs consumption during lockdown reported by parents. Several themes emerged that can be used to strategize against problematic eating behavior, enabling such provisions as family dietary interventions, which target both parents and children.

Impact of COVID-19 Pandemic on Dental Treatment in Children: A Retrospective Cross-Sectional Analysis in Jeddah City.

Background/Purpose: The novel coronavirus disease (COVID-19) outbreak has affected individuals worldwide. Considering the nature of dental treatments and direct exposure to saliva, blood, aerosols, or droplets from infected individuals, dentists are at significant risk of COVID-19 infection. Therefore, to decrease aerosol-generating procedures, minimally invasive dentistry (MID) is recommended during this pandemic. The goal of this research was to compare the flow of patients during a pandemic at a single university hospital in Jeddah City, Saudi Arabia, and to retrospectively assess the impact of the COVID-19 pandemic on pediatric dental treatments including MID. Materials and Methods: This study was a retrospective cross-sectional analysis of pediatric patient records, dental procedures performed, and minimally invasive techniques using the database of the King Abdul-Aziz University Dental Hospital (R4) system during the period of COVID 19 pandemic compared to the same period in the previous year. Results: During the COVID-19 pandemic, pediatric dental patient flow included only 699 patients compared to 1151 patients during the same period in the previous year. The most common pediatric dental procedures performed during the pandemic period were simple restorative treatments, including fissure sealants, followed by dental extractions, and fluoride varnish applications. During the pandemic period, more minimally invasive treatments were performed, including the Hall technique, silver diamine fluoride, resin infiltration, and atraumatic restorative techniques. Conclusion: Based on this data, the COVID-19 pandemic had an impact on dental patient flow and the type of dental procedures performed on children. Minimally invasive treatments that minimize air generation are recommended; however, to establish the long-term effectiveness of minimally invasive treatments in pediatric dentistry, more follow-up studies with bigger sample sizes are required. More recommendations regarding conservative pediatric dental management after the COVID-19 era are suggested.

Clinical and radiographic evaluation of triple antibiotic paste pulp therapy compared to Vitapex pulpectomy in non-vital primary molars.

OBJECTIVES: This study compared and evaluated the clinical and radiographic efficacy of non-instrumentation triple antibiotic paste pulp therapy and Vitapex pulpectomy in non-vital primary molars. MATERIAL AND METHODS: Healthy, 5-9 years old children with at least one non-vital primary molar were included in the study. Molars were divided into two groups based on the subject's cooperation level. In the first group, molars received triple antibiotic paste, and a second group received Vitapex pulpectomy followed by a stainless-steel crown. Triple antibiotic paste was freshly prepared and proportioned in equal parts by volume (metronidazole, minocycline, and ciprofloxacin = 1:1:1) before the scheduled treatment. A clinical and radiographic examination was performed by two trained and calibrated pediatric dentists at the pre-operative baseline and the 6- and 12-month follow-up visits. RESULTS: A total of 28 molars received triple antibiotic paste pulp therapy and 20 received Vitapex pulpectomy. At the 6-month follow-up, the success rate among the molars in the triple antibiotic paste group was clinically (92.85%) and radiographically (85.71%) higher compared to the Vitapex group (91.67%, 62.50% respectively) with p = 0.89 and 0.55 respectively. At the 12-month follow-up, the molars in the triple antibiotic paste group showed lower clinical (95.45%) but higher radiographic success rate (72.73%) compared to the Vitapex group (100% and 62.50%) with (p = 0.85 and 0.47) respectively. None of the differences were statistically significant. CONCLUSIONS: Both triple antibiotic paste and Vitapex can be clinically and radiographically effective in treating non-vital primary molars.

Gingival Recession after Surgical Endodontic Treatment and Quality of Life: A Systematic Review and Meta-analysis.

PURPOSE: This systematic review addressed flap designs in endodontic surgery which can have an impact on the Oral Health Related Quality of Life (OHRQoL). MATERIALS AND METHODS: Four electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) to identify all studies up to November 2019 that investigated the effect of flap designs on gingival recession and quality of life among healthy adults. RESULTS: The initial search identified 2701 references. Ten studies were included in this systematic review; two were randomised clinical trials and eight were non-randomised clinical trials. Studies showed that sulcular incision increases the risk of gingival recession and decreases OHRQoL. Two studies were included in the meta-analysis in relation to gingival recession. The pooled results demonstrated that submarginal incision showed a decreased weighted mean difference in gingival recession by 0.31 mm (95% CI: 0.12 - 0.51) (p = 0.002) compared to sulcular incision. CONCLUSION: Sulcular incision flap unfavourably affect the level of gingiva and OHRQoL. All nonrandomised studies had a statistically significant bias and the sample sizes in all studies were relatively small. More gingival recession and lower OHRQoL were associated with sulcular incision. Additional investigations are warranted to provide more evidence.

Knowledge, perception, and confidence of hospital pharmacists toward pharmacogenetics in Jeddah, Kingdom of Saudi Arabia.

BACKGROUND: Integrating pharmacogenetics (PGx) testing into clinical practice leads to personalized medicine, which improves treatments' efficacy and safety. Successful implementation of such a service requires sufficient knowledge, perception, and self-confidence among healthcare providers, especially pharmacists. OBJECTIVES: To evaluate governmental hospital pharmacists' knowledge, perception, and self-confidence toward PGx testing in Jeddah, Kingdom of Saudi Arabia. METHOD: This cross-sectional study was conducted using previously validated questionnaire. Pharmacists working in five randomly selected general governmental hospitals in Jeddah between August and October 2019 were interviewed. Comparative and descriptive analyses were used to analyze the data, and the significance level was at P-value < 0.05. RESULTS: A total of 119 pharmacists with a mean (±SD) age of 31.2 (±5.05) years were included with a response rate of 79.3%. The average total mean (±SD) score for PGx knowledge-based questions was low (2.4 ± 1.09 out of 5). Most of the participants, with a total mean score of (10.1 ± 1.6 out of 12), revealed a positive perception toward PGx testing and its implications. A moderate self-confidence score for utilizing PGx testing (4.3 ± 2.3 out of 8) was observed among the participants. Pharmacists who had completed postgraduate studies had a statistically higher mean knowledge score (P = 0.006) compared with pharmacists with undergraduate degrees. CONCLUSION: Governmental hospital pharmacists have limited knowledge and understanding about PGx testing; however, the majority expressed a high level of awareness and agreed that PGx testing is a valuable tool for enhancing drug efficacy and safety. The study also highlighted the importance of improving pharmacists' knowledge about PGx testing, which will help them in implementing such a valuable service into their clinical practice in Saudi hospitals.

Dental Students' Perceptions before and after Attending a Centre for Children with Special Needs: A Qualitative Study on Situated Learning.

Objectives: To develop an in-depth understanding of the perceptions and experiences of senior dental students before and after fieldwork visits to a centre for children with special needs. Methods: A qualitative study utilised open-ended questions and involved 39 fifth-year dental students. A thematic analysis of the collected responses was undertaken, and a hierarchy of themes and subthemes were developed. Results: Analysis of the pre-visit responses revealed three main themes and a number of subthemes: 'negative expectations', 'positive expectations', and 'pain expectations'. Similarly, four main themes with a number of subthemes emerged from the post-visit responses: 'positive perceptions', 'negative perceptions', 'oral problems observed', and 'recommendations'. Conclusions: Within the study limits, different perspectives were extracted. Prior to the fieldwork visit, students expressed their lack of self-confidence and inadequate preparation. Following the situated learning visit experience, students' perceptions of managing special needs children was positively influenced. Students were happy to be exposed to such an experience, but hoped for better organisation and specialised supervision in the future.

Relationships between children's sugar consumption at home and their food choices and consumption at school lunch.

OBJECTIVE: To investigate the relationships between children's food and drink choices at school lunch for children who consume high and low sugar intakes at home. DESIGN: Children's food and drink consumption at home was assessed using diet diaries over three consecutive days. Children were classified as 'high' or 'low' sugar consumers at home using the WHO recommendation that free sugars should be less than 10 % of their daily total energy intake. A purposive sample of children was then selected and observed during school lunch, recording food selections, food left on plates and content of packed lunches. SETTING: Six primary schools in Newham and Kent, England. PARTICIPANTS: Parents and children aged 6-7 years. RESULTS: Seventy-one parents completed diet diaries. From the seventy-one, thirty-nine children were observed during school lunch. Twenty children were high sugar consumers, nineteen children were low sugar consumers; thirty-one children had a school meal. Eleven of the fifteen children (73 %) who had school meals and who were high sugar consumers selected a high-sugar dessert rather than fruit. Only five of the sixteen (31 %) children who had school meals and were low sugar consumers at home chose a high-sugar dessert. Most of the children who had packed lunches had sweet items, despite school policies. CONCLUSIONS: Children who consumed high sugar intake at home tended to select foods high in sugar for school meals or had packed lunches containing high-sugar foods. The implications for public health programmes include healthy eating workshops and implementing school food policies.

Computerized intraligamental anesthesia in children: A review of clinical considerations.

Pain control by means of local anesthesia is an intrinsic part of clinical practice in dentistry. Several studies evaluated intraligamental anesthesia using a computer-controlled anesthetic device in children. There is a need to provide a clinical guide for the use of computerized intraligamental anesthesia in children. Intraligamental anesthesia using a computer-controlled anesthetic device was found to cause significantly lower pain perception scores and lower pain-related behavior than traditional techniques. This device proven to be effective in restorative and pulp treatment in children; however, its effectiveness in primary teeth extraction is controversial. It is important to withdraw recommendations necessity of future studies concerning the side effects of computerized intraligamental anesthesia in children. The present study aims to review different clinical aspects of computerized intraligamental anesthesia in children along with the side-effects, type of local anesthesia and postoperative pain of this technique. This study provides dentists with a clinical guide for the use of computerized intraligamental anesthesia.

The effectiveness of computerized anesthesia in primary mandibular molar pulpotomy: A randomized controlled trial.

OBJECTIVE: The technique of local anesthetic administration is an important consideration in the behavior guidance of a pediatric patient. The study hypothesized that there is no difference in the pain effectiveness in the experimental subjects with the use of single tooth anesthesia and the controls with the use of conventional technique (traditional inferior alveolar nerve block [IANB]).The purpose of this study was to compare the anesthesia effectiveness of traditional IANB; IANB using a computer-controlled local anesthetic delivery system (CCLAD); and intraligamental anesthesia (ILA) using CCLAD in pulpotomy of the primary mandibular second molars. METHOD AND MATERIALS: Ninety-one healthy 5- to 9-year-old children underwent pulpotomy of the mandibular second molars. They were randomly assigned into Group A (traditional IANB), Group B (IANB using CCLAD), or Group C (ILA injection using CCLAD). The effectiveness of anesthesia was measured during different steps of pulpotomy using the sounds, eyes, and motor (SEM) scale. The postoperative complications were recorded after 24 hours. RESULTS: For all five pulpotomy steps, the anesthesia effectiveness was similar among the three anesthesia techniques. Anesthesia effectiveness was not significantly different (based on SEM scores) between the three groups during clamp application, drilling of the tooth, entering the pulp, pulp extirpation, and removal of the clamp (P = .635, P = .996, P = .630, P = .945, and P = .101, respectively). There was no significant difference in postoperative complications between the three groups. CONCLUSION: The IANB anesthesia using CCLAD and periodontal ligament anesthesia using CCLAD were as effective as traditional IANB in anesthetizing the primary mandibular molars during pulpotomy.

The pain-related behavior and pain perception associated with computerized anesthesia in pulpotomies of mandibular primary molars: A randomized controlled trial.

OBJECTIVE: The purpose of the study was to compare the pain-related behavior and the pain perception associated with three anesthetic techniques in pulpotomies of primary mandibular second molars: traditional inferior alveolar nerve block (IANB), IANB with computer-controlled local anesthetic delivery (CCLAD), and intraligamental anesthesia with CCLAD. METHOD AND MATERIALS: The sample comprised 91 randomly selected healthy children aged 5 to 9 years, who were scheduled for pulpotomy in the mandibular second molar. Patients were divided into three groups according to the type of anesthesia received. Group A received traditional IANB, group B received IANB with CCLAD, and group C received intraligamental anesthesia with CCLAD. Pain-related behavior and pain perception levels were assessed using the established behavior code and the Wong-Baker FACES Pain Rating Scale respectively. RESULTS: The mean of pain-related behavior was significantly lower (P < .001) in the intraligamental anesthesia with CCLAD group than in the other two groups. The pain perception scores were significantly higher in the traditional IANB group than in the IANB with CCLAD group, and the intraligamental anesthesia with CCLAD group (P = .044 and P < .001 respectively). The mean ± SD of the pain perception of IANB was 1.39 ± 0.200, IANB with CCLAD was 0.87 ± 0.133 and ILA with CCLAD was 0.13 ± 0.063. CONCLUSION: Intraligamental anaesthesia with CCLAD was clearly associated with less pain than the IANB with or without CCLAD.

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.