Bifid Mandibular Canals: A Pediatric Case Series with Clinical Implications.

Aim: The aim of this case series is to provide a detailed account of pediatric cases with bifid mandibular canal (BMC) along with clinical implications. Background: The prevalence of BMC on panoramic radiographs has been reported to be 0.03-1.90% in adults. Only one study reported prevalence of BMC in children based on cone-beam computed tomography (CBCT) images. As CBCT images are not routinely prescribed in children, it is important to understand if panoramic radiographs provide a valuable tool to diagnose BMC in children. Case description: This case series provides a review of three cases of nonsyndromic, bilateral BMC, and associated radiculomegaly affecting mandibular permanent first molars in children during the mixed dentition stage. An overview of clinical implications of BMC in children is also discussed to help clinicians provide appropriate dental care and anticipatory guidance. Conclusion: Bifid mandibular canal (BMC) has never been reported in children during mixed dentition stage based on panoramic radiographs. This is the first case series reporting BMC and associated dental anomalies in children. Clinical significance: This case series will help clinicians in diagnosing BMC during mixed dentition stage and understand its clinical implications. Additionally, this case series will help define future cross-sectional studies evaluating BMC and associated dental anomalies in children. How to cite this article: Puranik CP, Chandki R, Mladenovic R, et al. Bifid Mandibular Canals: A Pediatric Case Series with Clinical Implications. Int J Clin Pediatr Dent 2023;16(3):547-549.

Recognizing the Relationship Between Disorders in the Oral Cavity and Systemic Disease.

Oral health is integral to general health. The oral cavity may harbor manifestations of systemic disease and can be the harbinger of early onset. Primary care providers (PCPs) can therefore use the oral cavity to support working diagnoses. Conversely, systemic diseases and treatments can affect oral health and require interactions between PCPs and dental providers. Acute oral manifestations of systemic disease may involve teeth and/or gums. This article reviews oral and systemic disease connections for some diseases, identifies issues that benefit patients through medical-dental collaboration, and highlights some nondental oral injuries that might confront PCPs or emergency medical providers.

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics.

PURPOSE: Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia). We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. METHODS: We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C) or separate (group S). Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. RESULTS: Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7) or separately (n=27). No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: -58, +10 minutes; P=0.115) and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: -16, +48 minutes; P=0.307). The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394) did not differ between the groups. No postoperative complications were noted in either group. CONCLUSION: These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or significant changes in postoperative outcomes.

Dental Caries Experience in Texan Children with Cleft Lip and Palate.

PURPOSE: The purpose of this study was to assess the caries experience in the primary dentition of children born with cleft lip and palate (CLP). METHODS: A retrospective chart review was conducted on subjects between two and six years old recruited from a university-based pediatric dentistry residency clinic. The number of dental visits and professional fluoride applications, the plaque index and treatment modality, and the presence/location of caries, white spot lesions, and enamel hypoplastic lesions were compared between CLP patients and healthy age- and gender-matched controls. Descriptive statistics, Student's t test, Mann-Whitney U test, and regression analysis were completed. RESULTS: A total of 183 charts were reviewed. Compared to healthy children, CLP children had increases in number of dental visits (P<0.001), decayed-missing-filled surfaces (dmfs; P<0.001), decayed-missing-filled teeth (dmft; P<0.001), enamel hypoplastic lesions (P=0.003), treatment completed under general anesthesia (P<0.001), plaque score (P<0.001), and caries increment between baseline and most recent oral examination (P=0.003). Regression analysis revealed a positive association between age and dmft scores within the CLP group (P=0.018). The caries experience of unilateral and bilateral CLP cases was the same (P>0.05). CONCLUSIONS: Children with cleft lip and palate are at a greater risk of enamel hypoplasia and dental caries. No significant caries experience difference was found between unilateral or bilateral CLP cases.

Utilization of Chinese Herbal Medicine for Selected Oral Conditions in Two Pediatric Populations.

PURPOSE: To characterize traditional Chinese medicine (TCM) use, emphasizing herbal remedies, for oral conditions among two Chinese pediatric populations in the United States. METHODS: 318 unique ethnic Chinese parental units in Houston and Boston with children younger than 12 years old were interviewed for themselves and their children. Questionnaire included age, gender, duration in the United States, frequency of TCM use, and the five selected oral conditions for which TCM agents might be used. RESULTS: Parents (45.6 percent) and children (19.1 percent) used TCM for oral conditions, most commonly for aphthous ulcers (64.2 percent). Most commonly used TCM agents included watermelon frost (37.4 percent), niuhuang jiedu pian (15.5 percent), and honey/propolis (9.9 percent). Chi-square tests with logistic regression (P<0.05) showed duration of U.S. residency significantly affected (P=0.002), parental TCM usage, age group (P=0.003), and birth location (P=0.02) related to child use. Parental TCM use increased child likelihood of use (P<0.0001). CONCLUSIONS: In this study, traditional Chinese medicine was widely used for oral conditions by Chinese immigrants. Factors such as duration of U.S. residency, age, birth location, and parental use affect utilization of TCM in this population. Future studies are needed to explore the therapeutic properties of the various components of TCM.

Postdischarge events occurring after pediatric sedation for dentistry.

PURPOSE: To investigate postdischarge events occurring in children during the 24 hours following sedation for dentistry. METHODS: A convenience sample of 50 children undergoing sedation with combinations of midazolam, hydroxyzine, and meperidine were included. Parents received a standardized timesheet to record child's behavior, alertness, activity level, motor imbalance, emesis, and soft tissue trauma every two hours from discharge until bedtime. A questionnaire asked about transportation, supervision, and return to normal activity. Families were telephoned after 24 hours to collect the information. RESULTS: Sixty-six percent of children slept in the car; of these, 30 percent were supervised by only the driver, and 12 percent were difficult to awaken. Agitation was observed in 22 percent, restlessness in 10 percent, withdrawn behavior in 16 percent, and soft tissue trauma in 18 percent. Motor imbalance was significantly associated with midazolam (P=.002), as was restlessness (P=.004). Eighty-two percent slept between discharge and bedtime, with 16 percent sleeping for greater than four hours. Return to normal activity was greater than four hours in 36 percent, and was inversely correlated with age (P=.02). CONCLUSIONS: Postdischarge sleepiness, drug-specific motor imbalance, sleep during transit, and recovery times greater than four hours were common and warrant vigilant adult supervision.

Role of fluoridated dentifrices in root caries formation in vitro.

PURPOSE: To evaluate in vitro root caries formation in human permanent teeth and to determine the effects of commercially available dentifrices containing different amounts of fluoride, while employing a well-tested artificial caries system using an acidified gel. METHODS: Root surfaces from caries-free human permanent teeth (n = 10) underwent debridement and fluoride-free prophylaxis. The tooth roots were sectioned into six portions, and acid-resistant varnish was placed with two sound root surface windows exposed on each tooth portion. Each portion from a single tooth was assigned to a treatment group: (1) No treatment control; (2) Denticious 5000 dentifrice (5,000 ppm F + xylitol); (3) PreviDent 5000 (5,000 ppm F); (4) AIM dentifrice (1,500 ppm F); (5) Listerine dentifrice (1,300 ppm F); and (6) Crest Regular Paste (1,500 ppm F). Tooth portions were treated with fresh dentifrice twice daily for 180 seconds, followed by fresh synthetic saliva rinsing over a 7-day period. Controls were exposed twice daily to fresh synthetic saliva rinsing over a 7-day period. In vitro root caries were created using an acidified gel (pH 4.25, 21 days). Longitudinal sections (three sections/tooth portion, 30 sections/group; 60 lesions/group) were evaluated for mean lesion depths (water imbibition, polarized light). Statistical analyses were performed using ANOVA and Duncan's Multiple Range test. RESULTS: Mean lesion depths were 389 +/- 43 microm for No treatment - control, 223 +/- 33 microm for Denticious 5000 dentifrice, 242 +/- 42 microm for Prevident 5000, 337 +/- 29 microm for AIM dentifrice, 297 +/- 37 microm for Listerine dentifrice, and 282 +/- 34 microm for Crest Regular Paste dentifrice. All treatment groups had mean depths significantly less than the No treatment - control group (P < 0.05). Denticious 5000 and PreviDent 5000 had significantly reduced mean depth compared with the other dentifrice treatment groups (P < 0.05).

Living in limbo: Ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to reemerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

Fluoride dentifrice containing xylitol: in vitro root caries formation.

PURPOSE: To evaluate the effects of experimental xylitol dentifrices with and without fluoride on in vitro root caries formation. METHODS: Root surfaces from caries-free human permanent teeth (n = 10) underwent debridement and a fluoride-free prophylaxis. The tooth roots were sectioned into quarters, and acid-resistant varnish was placed with two sound root surface windows exposed on each tooth quarter. Each quarter from a single tooth was assigned to a treatment group: (1) No treatment control; (2) Aquafresh Advanced (0.15% F = 1,150 ppm F); (3) Experimental xylitol dentifrice without fluoride (0.45% xylitol); and (4) Diamynt fluoride dentifrice with xylitol (0.83% sodium monofluorophosphate = 1,100 ppm F and 0.20% xylitol). Tooth root quarters were treated with fresh dentifrice twice daily (3 minutes) followed by fresh synthetic saliva rinsing over a 7-day period. Controls were exposed twice daily to fresh synthetic saliva rinsing daily over a 7-day period. In vitro root caries were created using an acidified gel (pH 4.25, 21 days). Longitudinal sections (three sections/tooth quarter, 60/group) were evaluated for mean lesion depths (water inhibition, polarized light, ANOVA, DMR). RESULTS: Mean lesion depths were 359 +/- 37 microm for the control Group; 280 +/- 28 microm for Aquafresh Advanced; 342 +/- 41 microm for the experimental xylitol dentifrice without fluoride; and 261 +/- 34 microm for Diamynt. Aquafresh Advanced and Diamynt had mean lesion depths significantly less than those for the no treatment control and the experimental xylitol without fluoride dentifrice (P< 0.05). There were minimal non-significant differences in mean lesion depths between Aquafresh Advanced and Diamynt (P > 0.05).

Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas.

BACKGROUND: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions. TYPES OF STUDIES REVIEWED: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected 5 systematic reviews and 4 clinical studies to use as a basis for developing recommendations. RESULTS: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care. CLINICAL IMPLICATIONS: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.

The journey beyond silos. Teaching and learning interprofessional ethics at UTHealth.

Interprofessional education and ethics education are two educational programs that blend together well, and, moreover, they are a natural fit for teaching in an academic health science center. The purpose of this paper is to describe our recent journey of developing and implementing an interprofessional ethics curriculum across the six schools of UTHealth. We provide an overview of the goals of the Campus-wide Ethics Program, which is housed in the McGovern Center for Humanities and Ethics, and we highlight certain innovative developments that are the result of the collaborative work of faculty and administrators from all six schools of UTHealth. In addition, a brief synopsis of the specific didactic and clinical courses in which ethics is a significant component is outlined for both the dental and the dental hygiene curricula. Lastly, we describe some of the recent scholarly activities that are a product of this new program. We are excited about our evolving efforts and the potential benefits of weaving interprofessional ethics within our school and across our campus. This article tells the story of our journey beyond "the silos" that are common among academic health science centers.

Living in limbo: ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to re-emerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

Fluoride-releasing orthodontic adhesives and topical fluoride effect on enamel caries formation: an in vitro study.

PURPOSE: To examine in vitro orthodontic bonding sealants combined with daily fluoride (NaF) rinse on caries-like lesion depths. METHODS: Permanent molar teeth (n = 40) were randomly divided into four treatment groups: 1: Pro-Seal, 2: Light Bond, 3: Pro-Seal with NaF rinsing, and 4: Light Bond with NaF rinsing. Orthodontic sealant material was placed on buccal surfaces of each group and surrounded by acid-resistant varnish on the buccal and a control window on the lingual. Each group underwent synthetic saliva rinsing and lesion initiation. Groups 3 and 4 were subjected to 0.05% NaF for 1 minute per day. Artificial caries were created in vitro. The specimens in each treatment group were sectioned and mean lesion depth was assessed with polarized light microscopy (water imbibition). Lesion depth was compared among the treament groups using ANOVA and Duncan's Multiple Range Test. RESULTS: The ProSeal and Light Bond treatment groups exhibited significant reductions in mean lesion depths as compared to the controls (P < 0.05). ProSeal with NaF rinsing and Light Bond with NaF rinsing treatment groups exhibited significant reductions in mean lesion depth when compared to Pro Seal and Light Bond treatment without fluoride rinsing and controls (P < 0.05). The enamel-resin interfaces of all treatment groups were intact and exhibited no caries-like lesion formation.

Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas.

BACKGROUND: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions. TYPES OF STUDIES REVIEWED: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected five systematic reviews and four clinical studies to use as a basis for developing recommendations. RESULTS: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care. CLINICAL IMPLICATIONS: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.