Silver Diamine Fluoride and Fluoride Varnish May Halt Interproximal Caries Progression in the Primary Dentition.

Objective: The study described the incidence of interproximal caries arrest following SDF and fluoride varnish application in the primary dentition. Study design: A retrospective analysis of dental records including radiographs was conducted for interproximal dental caries in pediatric patients treated with SDF applied with woven floss. Bitewing radiographs and ICCMS™ radiographic scoring criteria were used to assess caries depth in primary teeth at baseline and then at 12-month follow-up examination. Results: This study included 185 interproximal carious lesions in 131 patients treated with SDF. Mean baseline ICCMS™ score for all lesions was 1.50, with an average dmft of 2.9. The majority of carious lesions (n=155, 84.0%) showed radiographic evidence of non-progression at 12-month follow-up. There was no statistically significant difference in caries arrest among primary canines, primary first molars, and primary second molars (P=0.61). Furthermore, there was no statistically significant difference in caries arrest in patients with commercial insurance, Medicaid, or no insurance (P=0.27). Conclusions: SDF application with woven floss was associated with interproximal caries arrest in the primary dentition at 12-month follow-up in this sample of low caries risk children. Tooth type and insurance type were not associated with caries arrest.

Improving children's oral health: an interdisciplinary research framework.

Despite the concerted efforts of research and professional and advocacy stakeholders, recent evidence suggests that improvements in the oral health of young children in the United States has not followed the prevailing trend of oral health improvement in other age groups. In fact, oral health disparities in the youngest children may be widening, yet efforts to translate advances in science and technology into meaningful improvements in populations' health have had limited success. Nevertheless, the great strides in genomics, biological, behavioral, social, and health services research in the past decade have strengthened the evidence base available to support initiatives and translational efforts. Concerted actions to accelerate this translation and implementation process are warranted; at the same time, policies that can help tackle the upstream determinants of oral health disparities are imperative. This article summarizes the proceedings from the symposium on the interdisciplinary continuum of pediatric oral health that was held during the 43rd annual meeting of the American Association for Dental Research, Charlotte, North Carolina, USA. This report showcases the latest contributions across the interdisciplinary continuum of pediatric oral health research and provides insights into future research priorities and necessary intersectoral synergies. Issues are discussed as related to the overwhelming dominance of social determinants on oral disease and the difficulty of translating science into action.

Pediatric oral health-related quality of life improvement after treatment of early childhood caries: a prospective multisite study.

PURPOSE: This study's purpose was to compare changes in parent-reported pediatric oral health-related quality of life between children with early childhood caries (ECC) and children who were caries-free; the ECC children received surgical dental intervention between baseline and follow-up. METHODS: A newly developed self-report instrument, the POQL, was administered to 501 parents of 2- to 8-year-old children (caries-free=315; ECC=186) in hospital dental clinics in Columbus, Ohio, and Washington, D.C. RESULTS: At baseline, ECC children were more likely to have fair or poor oral health and were rated as having more pain and trouble with physical, mental, and social functioning due to their teeth or mouth vs caries-free children (P<.001). At 6 and 12 months following dental treatment for ECC, there were significant improvements in parental ratings of their children's oral health status and a significant reduction in problems reported with physical, mental, and social functioning (all P<.001). CONCLUSIONS: Compared with caries-free children, early childhood caries children were more likely to have worse questionnaire response scores and to experience greater negative impacts on physical, mental, and social functioning. Dental interventions in ECC children had a significant positive impact on parental ratings of their overall oral health and physical, mental, and social functioning.

Maternal oral health.

Maternity changes a woman's body and can have an effect on fetal oral health. Prenatal counseling can improve oral health of both mother and child. Maternal diet, self-care, and lifestyle can lead to permanent changes in the offspring's oral health. Transmission of maternal oral microflora and use of fluorides are important in a baby's oral health early in life.

Compomers as Class II restorations in primary molars.

A variety of alternatives to amalgam are now available for use in class II restorations in primary teeth, including glass ionomer, composites, and intermediate materials such as compomer and resin modified glass ionomers (RMGI). The purpose of the present study was to evaluate the clinical performance of two compomers, Hytac and Dyract, and to compare these results to those reported for other intracoronal restorative materials. Evaluation after 24 months shows Hytac and Dyract to have performed well and comparably as class II restorations in primary teeth. The low failure rate, even in a population with a high caries increment, suggests that compomers are a suitable alternative to amalgam or other, tooth-colored materials when used as class II restorations in primary teeth.

Social factors associated with pediatric emergency department visits for caries-related dental pain.

PURPOSE: This study was performed to describe and relate sociodemographic factors and management of visits to a pediatric hospital emergency department for caries-related dental pain. METHODS: Retrospective chart review of cases with a verifiable chief complaint of caries-related dental pain in 1998, was conducted using established protocol and trained reviewers. RESULTS: Three hundred of 984 hospital ED dental emergencies met the study's selection criteria and 109 children were six years old or younger. Almost two-thirds (66%) came from single parent families. Fifty-eight percent were self-pay or covered by government programs and the rest had some insurance. African-American children were 45% of cases. Over 80% were from within Franklin County, OH. Only 4 children (1%) had been seen for the same tooth previously. Lower primary molars were most often affected. Race, insurance, parental marital status were not significantly related to follow-up attendance at the facility (P > 0.05). Those living outside Franklin County and under 5 years of age were more likely to attend follow-up appointments (P < 0.05). When compared to the catchment population of Franklin County, this ED sample had six times as many uninsured children, two and a half times more African-Americans, and came from single parent families four and a half times more often. CONCLUSIONS: Children seen in the ED were predominantly poor, from single-parent families, and disproportionately minority, and were different from the catchment area population. These social risk factors were not related to attendance at follow-up.

Relationships between oral and systemic health.

Oral and systemic health cannot be separated. This article addresses some established and emerging relationships that highlight the association between systemic and oral health. The physician's role requires an understanding of the effects of disease and its treatment on oral health. Also, physicians should be able to identify abnormality in the oral cavity that might be attributable to disease or be a compromising factor in the health, growth and development, or functioning of children and make a referral. Cooperation between dentist and physician can mean good overall health for children, including oral health.

A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care.

PURPOSE: The purpose of this retrospective study was twofold: a) to examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on patient age, dental needs, and pre-operative clinical impression; and b) to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children. METHOD: Records of more than 600 patients sedated at Columbus Children's Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens: a) chloral hydrate and hydroxyzine (CH-H), b) chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or c) midazolam (M). A minimum of 300 patients (100/drug regimen) were randomly selected. The standard sedation sheet used in all sedations at the clinic included, among other factors, pre-operative assessments of patient behavior, interaction, and cooperation. Physiological and behavioral variables during the intraoperative sedation periods were also available. These periods included initial baseline vitals, vitals following drug administration, topical and local drug administration, rubber, dam placement, and a minimum of the first 15 minutes of restorative procedures. The three drug regimens were compared for these variables. Data were entered into SPSS for data analysis using one-way ANOVA, Chi-square, regression analysis, and descriptive statistics. RESULTS: The results indicated significant mean differences in patient age, weight, and duration by drug regimen (F = 20.3, P < 0.001; 16.2, P < 0.001; and 48.7, P < 0.001, respectively). ANOVA indicated a significant difference among drug regimens for percent of quiet, sleeping, and struggling behaviors. Quiet behavior accounted for 26%, 41%, and 67% of all behaviors for CH-H, CH-D-H, and M, respectively. Sleep accounted for 50%, 43%, 0.4% and struggling 11%, 8%, and 19% for CH-H, CH-D-H, and M, respectively. Pre-operative behaviors were also significantly different and patient cooperation was the only variable found minimally predictable of intra-operative behaviors (R = 0.32, P < 0.001). Significant differences among drug regimens were found for heart rate (HR) and mean arterial blood pressure (MAP) during certain procedures (e.g., CH-H produced lower MAP compared to the other drug regimens); however, all physiological variables were within normal limits for the children. CONCLUSION: Significant differences were found for behavioral and physiological variables among the drug regimens (e.g., CH-D-H produced significantly more quiet and sleeping behaviors than M). Prospective studies are needed to confirm these findings.

Opinions of practitioners and program directors concerning accreditation standards for postdoctoral pediatric dentistry training programs.

PURPOSE: This study was performed to assess opinions of program directors and practitioners about the importance and necessary numbers of experiences required by current accreditation standards for training of pediatric dentists. METHODS: A 32-item questionnaire was sent to all program directors of ADA-accredited postdoctoral pediatric dentistry training programs and to a random sample of 10% of the fellow/active membership of the American Academy of Pediatric Dentistry. RESULTS: An overall response rate of 56% was obtained from the single mailing. Practitioners and program directors differed significantly (P < or = 0.05) only in their opinions about the number of submucosal and intravenous sedation cases required for proficiency of eight experiences surveyed. The two groups differed significantly in 3 of 12 areas in terms of importance attributed for practice of contemporary pediatric dentistry: initiating and completing a research paper, biostatistics/epidemiology, and practice management. Program directors had little difficulty obtaining required experiences, and program dependence on Medicaid did not negatively affect quality of education. CONCLUSION: Practitioners and program directors agreed on the importance of most experiences and activities required by current accreditation standards.

The effect of orally administered midazolam on children of three age groups during restorative dental care.

PURPOSE: The effects of orally administered midazolam on three groups of preschool children who differed by age only and required dental treatment were studied. Sixty-one children age 24-58 months participated in this institutionally-approved study. METHODS: Selection criteria for the children included: demonstrated disruptive behaviors; healthy (ASA I); required at least one restorative appointment involving a posterior quadrant; no known drug allergies; were between two and five years of age; and had no prior experience with sedative trials. The children were divided into three groups according to age: Group I (24-35 months), Group II (36-47 months), and Group III (47-59 months). Each child received midazolam 0.5 mg/kg orally 15 minutes before treatment. Behavior was evaluated using the Ohio State Behavior Rating Scale (OS). Physiological parameters including heart rate, oxygen saturation, systolic and diastolic blood pressure were also evaluated. Data were analyzed using chi-square, cross tabulation, descriptive statistics, ANOVA, t-tests, and regression and correlation analysis. RESULTS: Results indicated no statistically significant difference in behavior across all age groups as evaluated by the OS. CONCLUSION: No significant differences of clinical significance were noted.

Presenting characteristics and treatment outcomes for tongue lacerations in children.

PURPOSE: Tongue lacerations in children require treatment decisions by clinicians, but there is conflicting literature on the topic of suturing. METHODS: In this prospective study, 28 patients (mean age 3.0 +/- 2.3 yr) with traumatic tongue lacerations were triaged according to an existing protocol to determine if the laceration would be sutured. At least 2 weeks post-trauma, 22 patients were evaluated by examination or report for quality of result and post-trauma complications. The most common location was anterior dorsum. A fall at home was the most common situation. Mean delay from injury to treatment was 4.5 +/- 9.0 h. No statistically significant difference was found for quality of result or post-trauma morbidity between those lacerations sutured and those not. No significant relationship was found between quality of result and size of laceration or bleeding at the time of presentation. Time delay did not significantly affect the quality of result. CONCLUSION: Results suggest that suturing does not improve outcome or post-trauma course for tongue lacerations in young children.

The effects of nitrous oxide on pediatric dental patients sedated with chloral hydrate and hydroxyzine.

PURPOSE: The purpose of this prospective, double-blind, crossover study was to evaluate the effect of 50% nitrous oxide (N2O) compared to oxygen (O2) alone on behavioral and physiologic parameters when a standard regimen of chloral hydrate (CH) (50 mg/kg) and hydroxyzine (2 mg/kg) was administered to young children for dental procedures. METHODS: Twenty children (mean age 42 +/- 7.3 months) were sedated, each for two appointments. At one appointment they received 100% O2 and at the other 50% N2O, the order randomized across patients. Physiologic parameters measured were heart and respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and expired carbon dioxide. Behavior was rated using the Ohio State University Behavior Rating Scale. Physiologic and behavioral parameters were measured at eight defined procedural events. RESULTS: Results indicated differences as a function of inhalation agent were seen for crying, quiet, and struggling, but not for any physiologic parameters. Significant differences across procedures were found for systolic and diastolic blood pressure and for all behaviors (crying, movement, quiet, and struggling). CONCLUSIONS: Compared to O2, N2O significantly modifies some behaviors but not physiologic parameters in sedated children. However, certain dental procedures did significantly modify some physiologic parameters and all behaviors.

Effect of dental treatment on the lung function of children with asthma.

In this preliminary study, the authors evaluated whether dental treatment can trigger a reaction in the hyperactive airways of children with asthma, thereby affecting lung function. They also examined the variables, if any, that predict a change in lung function in relation to dental treatment. They tested the lung function of 57 6- to 18-year-old subjects with histories of active asthma, using spirometry before, immediately after and 30 minutes after routine dental treatment. Results revealed a statistically significant decrease (P < .05) in lung function and a clinically significant decrease in lung function in approximately 15 percent of the subjects.

Nontraumatic dental emergencies in a pediatric emergency department.

The objectives of this study were to describe nontraumatic dental emergencies among children treated in a pediatric emergency department. The children studied received emergency treatment for a nontraumatic dental problem from December 1992 through November 1993. Among the 1,459 children treated for dental emergencies, 949 had a nontraumatic emergency (65%) and were enrolled in this study. Patients ranged in age from 1 month to 19 years, with a mean age of 6.9 years. Fifty-two percent of patients were male. The teeth were involved in 99% of cases. An abscess was present in 33% of patients; and among these patients, 26% also had a fistula. Pericoronitis was seen in 4% of patients, primary viral stomatitis in 1%, and an eruption hematoma in 0.5%. Caries is the etiology of the problem prompting the emergency department visit in 73% of patients, and baby bottle caries accounted for 18% of all cases of caries. Other etiologies included the late effects of trauma (8%), iatrogenic (7%), idiopathic (3%), and periodontal processes (2%). Tooth extraction was performed in 45% of patients. Findings of this large consecutive series provide a better understanding of this type of visit to the pediatric emergency department.