A survey of pediatric oncology nurses' oral health knowledge, attitudes, practices, and perceived barriers in a Singapore Tertiary Children's Hospital.

AIM: To explore oral health-related knowledge, abilities, attitudes, practices, and barriers of pediatric oncology nurses at an Asian children's hospital. METHODS: A cross-sectional study was conducted via a self-administered anonymized questionnaire. Data was analyzed to summarize knowledge, confidence, and practice behaviors. RESULTS: All sixty-three pediatric oncology nurses responded. Fifteen participants had >80% of the knowledge questions correct. Majority (97.3%) agreed on their roles in helping patients maintain their oral health. However, 75.8% of participants felt need for training in giving oral health advice. Notably, 74.6% checked patients' mouths at least once daily but only 57.1% felt adequately trained. Though a high proportion (>90%) of nurses felt confident to assist with oral care, only 65% would assist patients to do so; "Uncooperative patient" was the major barrier reported. DISCUSSION: Nurses have high general awareness of importance of oral health, but had incomplete knowledge. Compared to previous studies, most (90.5%) did not find performing oral care unpleasant but other barriers might have hindered actual oral care practice. CONCLUSION: Nurses were motivated to assist in oral care of children with cancer but sometimes felt ill-equipped. Updated national and institution guidelines, didactic and hands-on training, and implementation of practical support could be considered.

Parental acceptance of silver diammine fluoride in children with autism spectrum disorder.

BACKGROUND: Parents of children with autism spectrum disorder (ASD) may have concerns with fluoride/silver content in silver diammine fluoride (SDF). AIM: To compare parental acceptance of SDF and dental fear between children with and without ASD. DESIGN: Three hundred parents were enrolled. Demographics, dental history, and dental fear were recorded. Subjects viewed an educational video and completed survey about SDF acceptance including the following: (a) overall acceptance, (b) aesthetic concerns by tooth location, (c) fluoride/silver concerns, and (d) its use as a general anaesthesia (GA) alternative. Descriptive, bivariate, and multivariate analyses were used. RESULTS: Significantly, more children with ASD had dental fear (ASD: 56% vs neurotypical: 26%). No differences in acceptance existed between the two groups overall or with respect to aesthetics, fluoride/silver content, or as an alternative to GA. Overall acceptance is >60%. Regardless of group, parents of older children were less likely to accept SDF as an alternative to GA (OR = 0.67 [95% CI: 0.50-0.90]). CONCLUSION: Parents of children with ASD had similar acceptance of SDF use compared to parents of neurotypical children. Children with ASD had higher levels of dental fear. Parents of younger children are more likely to accept SDF as an alternative to GA in both groups.

Safety and effectiveness of intramuscular ketamine sedation in the management of children with oro-dental trauma in a paediatric emergency department.

BACKGROUND/AIMS: Ketamine sedation has not been reported to be widely used as a pharmacological behavioural management strategy to facilitate the treatment of acute paediatric oro-dental trauma. The aim of this study was to investigate the safety and effectiveness of intramuscular ketamine sedation for managing paediatric oro-dental trauma in a paediatric Emergency Department (ED). METHODS: The database of all paediatric procedural sedations performed in the hospital ED from 01 January 2014 to 31 December 2016 was reviewed to identify cases where intramuscular ketamine sedation was administered for dentists' treatment of oro-dental trauma. Patient demographics and epidemiological data, the type and number of sedation-related adverse events, and interventions performed were extracted from the database. Clinical notes were reviewed to verify the dental diagnoses and dental treatment performed. Adverse events were further risk stratified using the World SIVA adverse event reporting tool. RESULTS: In the study period, 167 intramuscular ketamine sedations were administered by ED doctors for dental treatment of oro-dental trauma. The patients' median age was 3.6 years (range 1.1 to 12 years). All dental procedures were successfully completed. Nineteen adverse events were reported (11.4%, n = 19) with the most common being emesis (9.0%) followed by transient desaturation (1.8%) and hypersalivation (0.6%). The lowest oxygen saturation level was 90%. None of the patients aspirated, and none required assisted ventilation or chest compression. The most common dental diagnosis was primary tooth luxation (49.1%). The most common dental treatment was primary teeth extraction (70.7%). When adverse events were stratified using the World SIVA tool, there were only 17 (10.2%) minor risk outcomes. CONCLUSIONS: The data support the safety and effectiveness of intramuscular ketamine sedation administered by trained ED doctors to facilitate the management of paediatric oro-dental trauma emergencies.

Nitrous oxide inhalation sedation in dentistry: An overview of its applications and safety profile.

Nitrous oxide in oxygen (N2O/O2) inhalation sedation is used less commonly by Singapore dentists than their counterparts in the United Kingdom and the United States. Using this technique, trained dentists often perform the dual roles of a sedationist and an operating dentist. This paper describes the mechanism of action of N2O and highlights the modern gas delivery system commonly used in dentistry. The built-in safety features of this unique system helps to ensure that patient-specific therapeutic dosages are effectively and safely administered by dentists. Existing evidence for adverse events and the safety profile of the N2O/O2 inhalation sedation is discussed. Finally, recommendations of equipment, training and techniques for safe N2O/O2 inhalation sedation are provided.

Pediatricians' Self-Efficacy Affects Frequency of Giving Oral Health Advice, Conducting Oral Examination, and Prescribing Referrals.

Purpose: To assess the role of pediatricians' self-efficacy on frequency of enquiring about dental visits, conducting oral examinations, and prescription of referrals to dentists.
Methods: Pediatricians and pediatric medicine residents in public hospitals in Singapore completed a self-administered written questionnaire between April and October 2015. Participants' demographics, training, knowledge of oral health, perceived importance of oral health, and confidence in health-promoting behaviors were assessed. Self-efficacy related to oral health, including frequency of enquiring about dental visits, conducting oral examinations, and prescribing dental referrals, was measured. Generalized linear models were used for bivariate and multivariable analyses.
Results: A total of 122 responses were analyzed out of 227 that were sent out (response rate: 53.7 percent). Confidence in oral health knowledge was related to the frequency of enquiring about dental visits (relative risk [RR] = 0.74; 95 percent confidence interval [95% CI] = 0.55 to 1.00; P =0.047). Confidence in identification of caries was related to frequency of examination for oral diseases (RR=0.62; 95% CI=0.49 to 0.79; P <0.001). Confidence in giving oral health advice was related to referral of children with special needs (B=0.30; 95% CI=0.07 to 0.53; P =0.01) and those without (B=0.42; 95% CI=0.23 to 0.61; P <0.001).
Conclusion: Pediatricians' self-efficacy was strongly associated with the frequency with which they advised, examined, and referred children for oral-health-related reasons. (J Dent Child 2019;86(3):131-8).

A novel Ser40Trp variant in IFITM5 in a family with osteogenesis imperfecta and review of the literature.

Osteogenesis imperfecta, is a genetically and clinically heterogeneous connective tissue disorder that disrupts bone architecture, making it fragile and more prone to fractures. While more than 85% of cases are due to variants in COL1A1 and COL1A2, variants in noncollagen genes have been identified in the remaining cases. The recurring heterozygous variant in IFITM5 (c.-14C>T) leads to osteogenesis imperfecta type V, a second missense variant in IFITM5 (c.119C>T, p.Ser40Leu) leads to phenotype resembling osteogenesis imperfecta type VI. In this report, we describe the first patient with Ser40Trp variant in IFITM5, who presented with multiple fractures in the prenatal period. She remained fracture free after birth (except for trauma-related fractures during puberty) with normal bone mineral densitometry. Her mother, who did not have a history of fracture, was noted to have somatogonadal mosaicism for this variant and became pregnant with a second child with multiple prenatal fractures, found to have the same variant. To our knowledge, this is the first case of somatogonadal mosaicism in IFITM5. In addition, we have summarized the literature on patients presenting with variant in codon 40 (serine) of IFTIM5 protein.

The effect of resin infiltration and oxidative pre-treatment on microshear bond strength of resin composite to hypomineralised enamel.

BACKGROUND: Reduced bond strengths of resin composites to hypomineralised enamel increase restorative failure. AIM: To investigate if the adhesion of resin composite to hypomineralised enamel can be improved by pre-treatments: resin infiltration, oxidative pre-treatment followed by a resin infiltration, or oxidative pre-treatment. DESIGN: Twenty-one enamel specimens in each of five Groups: 1) Normal enamel; 2) Hypomineralised enamel; 3) Hypomineralised enamel pre-treated with a resin infiltrant, (Icon(®)); 4) Hypomineralised enamel pre-treated with 5.25% sodium hypochlorite then treatment with resin infiltrant; 5) Hypomineralised enamel pre-treated with 5.25% sodium hypochlorite. A resin composite rod was bonded to each specimen using Clearfil™ SE bond as the adhesive (hereafter termed 'routine bonding'), then subjected to microshear bond strength (MSBS) testing. RESULTS: Overall, the mean MSBS between the five groups differed significantly (P = 0.001). Pre-treatment of hypomineralised enamel with 5.25% sodium hypochlorite with or without subsequent resin infiltration in Groups 4 and 5 prior to routine bonding resulted in increased mean MSBS compared to Groups 2 and 3, with mean MSBS values not differing significantly when compared to routine bonding to normal enamel. CONCLUSION: Increased bond strength of resin composite to hypomineralised enamel was obtained by pre-treatment of hypomineralised enamel specimens with 5.25% sodium hypochlorite with or without subsequent resin infiltration.