Children's Perceptions of Dental Experiences and Ways to Improve Them.

This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.

Effects of curing modes on depth of cure and microtensile bond strength of bulk fill composites to dentin.

Objectives To compare the microtensile bond strength (µTBS) and depth of cure (DOC) of bulk-fill composites cured by monowave (MW) and polywave (PW) LED units using different curing times. Methodology Three composites were tested: Tetric EvoCeram Bulk Fill (TBF), Filtek Bulk Fill (FBF), and Tetric EvoCeram (T; control). Flat dentin surfaces treated with adhesive (AdheSE Universal®, Ivoclar Vivadent) were bonded with 4 mm cylindrical samples of each bulk-fill composite material (n=6) and cured with monowave (Satelec) or polywave (Bluephase Style) curing units for 10 or 20 seconds. After 24 hours, teeth were sectioned into individual 0.9 mm2 beams and tested for µTBS. Failure modes were analysed. Moreover, the DOC scrape test (IOS 4090) was completed (n=5) following the same curing protocols. Two-way ANOVA (a=0.05) was performed, isolating light-curing units. Results For samples cured with the MW light-curing unit, no significant effects were observed in the µTBS results between any of the resin composite brands and the curing times. Conversely, when resins were cured with a PW light unit, a significant effect was observed for TBF resin. In general, bulk-fill composites presented greater DOC and longer curing time resulted in higher DOC for all composites. Conclusion The µTBS of the composites to dentin was not affected by the curing mode of the resins, except for TBF cured with PW light unit. Bulk-fill composites exhibit greater DOC than conventional resin-based composites.

Effects of curing modes on depth of cure and microtensile bond strength of bulk fill composites to dentin

Abstract Objectives To compare the microtensile bond strength (µTBS) and depth of cure (DOC) of bulk-fill composites cured by monowave (MW) and polywave (PW) LED units using different curing times. Methodology Three composites were tested: Tetric EvoCeram Bulk Fill (TBF), Filtek Bulk Fill (FBF), and Tetric EvoCeram (T; control). Flat dentin surfaces treated with adhesive (AdheSE Universal®, Ivoclar Vivadent) were bonded with 4 mm cylindrical samples of each bulk-fill composite material (n=6) and cured with monowave (Satelec) or polywave (Bluephase Style) curing units for 10 or 20 seconds. After 24 hours, teeth were sectioned into individual 0.9 mm2 beams and tested for µTBS. Failure modes were analysed. Moreover, the DOC scrape test (IOS 4090) was completed (n=5) following the same curing protocols. Two-way ANOVA (a=0.05) was performed, isolating light-curing units. Results For samples cured with the MW light-curing unit, no significant effects were observed in the µTBS results between any of the resin composite brands and the curing times. Conversely, when resins were cured with a PW light unit, a significant effect was observed for TBF resin. In general, bulk-fill composites presented greater DOC and longer curing time resulted in higher DOC for all composites. Conclusion The µTBS of the composites to dentin was not affected by the curing mode of the resins, except for TBF cured with PW light unit. Bulk-fill composites exhibit greater DOC than conventional resin-based composites.

Congenital Insensitivity to Pain with Anhidrosis: A Case with Self-Inflicted Oral Ulcerations.

Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV, is a rare autosomal recessive condition. CIPA is caused by mutations in the NTRK1 gene, leading to the inability to feel pain and decreased or absent sweating (anhidrosis). The signs and symptoms of CIPA may not be easily diagnosed at birth, but repeated severe injuries or unintentional self-injurious behavior during infancy may prompt further investigation leading to a CIPA diagnosis. We present the case of an 18-month old child who was diagnosed with CIPA, after repeated visits to a hopsital's emergency department for serious tongue and finger biting, which prompted further investigation.

A Rare Case of Gingival Cyst in a Child.

Gingival cysts, which are more frequently reported as gingival cysts of adults (GCA), are soft tissue cystic lesions of odontogenic origin that are infrequently seen, especially in children. These lesions usually appear as localized firm elevations on the facial gingiva in the anterior segment of the mandible. The purpose of this paper is to present a rare case of a gingival cyst discovered on the palatal aspect of the posterior maxilla in a four-year-old child. The lesion was treated with excisional biopsy.

Access to Dental Services for Children with Special Health Care Needs: A Pilot Study at the Dental Department of BC Children's Hospital.

OBJECTIVES: This pilot study at the dentistry department of BC Children's Hospital (DD-BCCH) in Vancouver, British Columbia, Canada, aimed to explore issues of access to dental services for children with special health care needs (CSHCN). METHODS: Caregivers of CSHCN, who were patients of record at DD-BCCH, were recruited to participate in this study. We collected sociodemographic characteristics, insurance coverage and medical diagnosis, and information on caregivers' perceptions of enabling factors and barriers to dental services using a pretested survey instrument with 33 closed and open-ended questions. We also obtained referral source, insurance coverage and medical diagnosis from the child's dental record. We analyzed quantitative data descriptively and qualitative comments from caregivers thematically. RESULTS: Common medical diagnoses among this sample of CSHCN (n = 50) were: genetic disorder/syndrome, developmental delay, sensory impairments and autism. Half of the children were referred by a medical professional; most (90%) had had a dental appointment within the last year that included preventive treatment. Although most caregivers reported some available dental benefits, affordability of dental services was a concern. Lack of dentist's training or comfort treating CSHCN, because of the complexity of the child's medical condition or behavioural challenges was also a reported barrier. CONCLUSIONS: The complexity of the child's medical status, the limited ability of dentists to provide care and financial obstacles were commonly reported barriers to care. Current efforts may best be focused on encouraging the province's health professionals, including dentists, to facilitate early referral to tertiary-level care for CSHCN whom they consider medically or behaviourally complex beyond their skill or comfort level.

Weather Regulates Location, Timing, and Intensity of Dengue Virus Transmission between Humans and Mosquitoes.

BACKGROUND: Dengue is one of the most aggressively expanding mosquito-transmitted viruses. The human burden approaches 400 million infections annually. Complex transmission dynamics pose challenges for predicting location, timing, and magnitude of risk; thus, models are needed to guide prevention strategies and policy development locally and globally. Weather regulates transmission-potential via its effects on vector dynamics. An important gap in understanding risk and roadblock in model development is an empirical perspective clarifying how weather impacts transmission in diverse ecological settings. We sought to determine if location, timing, and potential-intensity of transmission are systematically defined by weather. METHODOLOGY/PRINCIPAL FINDINGS: We developed a high-resolution empirical profile of the local weather-disease connection across Peru, a country with considerable ecological diversity. Applying 2-dimensional weather-space that pairs temperature versus humidity, we mapped local transmission-potential in weather-space by week during 1994-2012. A binary classification-tree was developed to test whether weather data could classify 1828 Peruvian districts as positive/negative for transmission and into ranks of transmission-potential with respect to observed disease. We show that transmission-potential is regulated by temperature-humidity coupling, enabling epidemics in a limited area of weather-space. Duration within a specific temperature range defines transmission-potential that is amplified exponentially in higher humidity. Dengue-positive districts were identified by mean temperature >22°C for 7+ weeks and minimum temperature >14°C for 33+ weeks annually with 95% sensitivity and specificity. In elevated-risk locations, seasonal peak-incidence occurred when mean temperature was 26-29°C, coincident with humidity at its local maximum; highest incidence when humidity >80%. We profile transmission-potential in weather-space for temperature-humidity ranging 0-38°C and 5-100% at 1°C x 2% resolution. CONCLUSIONS/SIGNIFICANCE: Local duration in limited areas of temperature-humidity weather-space identifies potential locations, timing, and magnitude of transmission. The weather-space profile of transmission-potential provides needed data that define a systematic and highly-sensitive weather-disease connection, demonstrating separate but coupled roles of temperature and humidity. New insights regarding natural regulation of human-mosquito transmission across diverse ecological settings advance our understanding of risk locally and globally for dengue and other mosquito-borne diseases and support advances in public health policy/operations, providing an evidence-base for modeling, predicting risk, and surveillance-prevention planning.

Melanotic neuroectodermal tumour of infancy: a case report.

Melanotic neuroectodermal tumour of infancy is a rare benign pigmented tumour that typically appears in the first year of life. We report an atypical presentation of this tumour, associated with an erupted primary tooth in a 7-month-old boy. We discuss the clinical, radiographic and histologic features of this rare tumour, as well as its surgical management and the follow-up treatment plan.

A unique case of craniopagus twins: considerations and challenges for dental rehabilitation.

The purpose of this case report was to describe oral findings and outline challenges and considerations for general anesthetic (GA) and dental management of 4-year-old female craniopagus (cranially conjoined) twins, at high risk for medical comorbidity, who presented for treatment of severe early childhood caries. This hospital-based procedure required good interdisciplinary communication, cooperation, and presurgical planning to address unique challenges and ensure positive postoperative outcomes. Two separate anesthesia teams delivered GA simultaneously to each twin. To minimize anesthetic exposure, two pediatric dental teams completed dental care concurrently. Extensive plaque accumulation and unusual "mirror-image" caries distribution were attributed to frequency and postural pooling during feeding. The rehabilitation objective was to provide definitive dental management, minimizing future need for dental retreatment under GA. Two-month follow-up revealed intact dental restorations, good oral hygiene, and weight gain. For these unique twins however, the challenge of long-term oral health maintenance remains.

The complex relationship between weather and dengue virus transmission in Thailand.

Using a novel analytical approach, weather dynamics and seasonal dengue virus transmission cycles were profiled for each Thailand province, 1983-2001, using monthly assessments of cases, temperature, humidity, and rainfall. We observed systematic differences in the structure of seasonal transmission cycles of different magnitude, the role of weather in regulating seasonal cycles, necessary versus optimal transmission "weather-space," basis of large epidemics, and predictive indicators that estimate risk. Larger epidemics begin earlier, develop faster, and are predicted at Onset change-point when case counts are low. Temperature defines a viable range for transmission; humidity amplifies the potential within that range. This duality is central to transmission. Eighty percent of 1.2 million severe dengue cases occurred when mean temperature was 27-29.5°C and mean humidity was > 75%. Interventions are most effective when applied early. Most cases occur near Peak, yet small reductions at Onset can substantially reduce epidemic magnitude. Monitoring the Quiet-Phase is fundamental in effectively targeting interventions pre-emptively.

Development of ankylosis in permanent incisors following delayed replantation and severe intrusion.

Ankylosis is a predictable outcome for replanted incisors and for most severely intruded incisors. There is no treatment to arrest or reverse this periodontal ligament complication. Ankylosis of the incisors of preadolescents alters local alveolar growth and eventually produces tooth loss subsequent to resorption. Currently, clinical methods used to diagnose ankylosis in the early postinjury period include subjective assessments of percussion sound and mobility and quantitative devices such as the Periotest. This paper describes the progression of ankylosis in two preadolescent patients that sustained severe trauma to their maxillary central incisors. A number of clinical assessments for diagnosis of ankylosis were compared for their usefulness, reliability and suitability.

Ankylosis of traumatized permanent incisors: pathogenesis and current approaches to diagnosis and management.

Ankylosis is a known complication of replanted or severely intruded permanent incisors and can be diagnosed by the characteristic sound emitted when the tooth is tapped. The ankylosed incisor demonstrates a lack of physiologic mobility and, later, radiographic evidence of replacement resorption. If the patient is pre-adolescent or adolescent at the time of trauma, infraocclusion relative to adjacent teeth will become apparent during jaw growth. Despite considerable knowledge about the pathogenesis of ankylosis garnered from animal studies and observation of human replanted teeth, there is no known treatment to arrest this condition. Management techniques and rehabilitation options for addressing ankylosis and its consequences are supported by little evidence, do not appear to be widely adopted and do not offer any proven long-term benefit. Avulsion and severe intrusion of permanent incisors are rare injuries. Should the decision be made to intervene by replantation or reduction of the intrusion, the clinician must be prepared to diagnose ankylosis, identify its negative consequences and develop treatment plans accordingly.

Diagnosis of ankylosis in permanent incisors by expert ratings, Periotest and digital sound wave analysis.

The objectives of this investigation were to: (i) assess the reliability of expert raters to detect ankylosis from recordings of percussion sounds, (ii) measure differences in Periotest values (PTV) between ankylosed and non-ankylosed incisors and (iii) identify characteristic differences in recorded percussion sounds from ankylosed and non-ankylosed incisors using digital sound wave analysis. A convenience sample of healthy children (age range 7-18 years) was invited to participate. Ankylosis group children had one or more documented ankylosed maxillary incisors. Control group children had intact, non-ankylosed incisors. Digital recordings of percussion sounds and PTV were acquired for each incisor of interest. Four experienced pediatric dentists rated the randomized percussion sound pairs for the presence of ankylosis. Percussion sounds were also subjected to digital sound wave analysis. Overall agreement for the expert raters was substantial (kappa = 0.7). Intra-rater agreement was substantial to almost perfect (kappa = 0.6-0.9). Diagnosis of ankylosis demonstrated sensitivity of 76-92% and specificity of 74-100%. PTV from ankylosed incisors were statistically lower than PTV from non-ankylosed incisors. Ankylosed incisor digital sound wave signals exhibited significantly more energy in high-frequency bands than non-ankylosed incisors. This investigation demonstrated that: (i) experienced pediatric dentists reliably detected ankylosis by percussion sound alone; (ii) PTV for ankylosed incisors were statistically lower than PTV from non-ankylosed incisors; and (iii) ankylosed incisors exhibited a higher proportion of their signal energy in high-frequency bands.