Impacts of oligodontia on oral health-related quality of life reported by affected children and their parents.

BACKGROUND: Oligodontia (agenesis of six or more permanent teeth) affects functional, emotional, and social aspects of an individual's life. Few published studies have evaluated oral health-related quality of life (OHRQoL) in children with oligodontia and very limited have compared the child and parental perceptions. METHODS: Thirty-five 8- to 18-year-old patients with oligodontia (10 M, 25 F; mean age: 12.4 ± 2.9 years; mean number of permanent teeth missing due to agenesis: 8.9 ± 3.2) recruited from The Hospital for Sick Children, Toronto, and Holland Bloorview Kids Rehabilitation Hospital, Toronto, and their parents completed the short format of Child Perception Questionnaire (CPQ11-14) and the Parent Child Perception Questionnaire, respectively. RESULTS: Children reported significantly worse overall CPQ score than their parents. Correlations between children's and parents' overall CPQ score, oral symptoms and functional limitations, and social well-being were not statistically significant. However, as children's emotional well-being score increased, parents' score also increased. There was no association between child CPQ score and age, gender, number, and location of permanent tooth agenesis in this sample. There was a significant correlation between overall CPQ score and Site-Specific Tooth Absences. CONCLUSION: Children's overall CPQ score and domain scores were significantly worse than their parents indicating that children with oligodontia had poorer OHRQoL compared to what was perceived by their parents.

Oral Health of Children with Congenital Heart Disease at a Pediatric Health Science Centre.

PURPOSE: This study aimed to examine the oral health status of seniors residing in Providence Health Care (PHC) long-term care facilities in 2002 and 2012. METHODS: Staff dentists with the University of British Columbia Geriatric Dentistry Program made a complete oral health assessment of 799 elderly residents of 7 long-term care PHC facilities in 2002 and 381 residents in the 5 remaining PHC facilities in 2012. The 2012 data were divided into those for 275 residents who had received treatment in previous years and 106 new residents. All consenting residents were examined by dentists using the clinical oral disorder in elders (CODE) index detailing their medical and oral health status and medications. On completion of the oral health assessment, the dentist documented the need for specific dental treatment and reassessment. RESULTS: Comparing the cohorts from 2002 and 2012, the mean age of the residents who had CODE assessments increased from 85 years to 86 years, the proportion of men increased from 31% to 35%, the mean number of medical conditions per resident remained unchanged (2.6 to 2.5), but the mean number of prescribed medications has increased from 4.0 to 4.6. The percentage of residents with natural teeth increased from 56% to 76%. The proportion of edentulous residents recommended for denture-related treatment decreased from 21% to 10%. The 106 new residents in 2012 had higher treatment needs than the 275 original residents, but fewer required extractions than in 2002. Although the mean number of teeth per resident examined increased from 14.6 to 17.4 over the study period, the need for restorations remained at 20%, and the need for extraction of teeth decreased from 22% to 6%. The proportion of residents with healthy periodontium increased from 14% to 21%, but the need for dental hygiene services increased from 43% to 80%. CONCLUSIONS: The profile of long-term care residents who consented to an oral health assessment changed over the first decade of the new millennium, with an increase in mean age and number of prescribed medications, number of retained natural teeth and the need for dental hygiene services, but a decrease in the need for extractions.

Comparison of Ferric Sulfate Combined Mineral Trioxide Aggregate Pulpotomy and Zinc Oxide Eugenol Pulpectomy of Primary Maxillary Incisors: An 18-month Randomized, Controlled Trial.

PURPOSE: The purpose of this study was to compare outcomes and survival of ferric sulfate with mineral trioxide aggregate (FS+MTA) pulpotomy and root canal therapy (RCT) in carious vital primary maxillary incisors. METHODS: In this parallel group noninferiority trial, asymptomatic carious vital primary incisors with pulp exposure in healthy 18- to 46-month-olds were allocated randomly to receive FS+MTA pulpotomy or RCT between September 2010 and September 2012. Each incisor was classified into one of the following radiographic outcomes: N (incisor without pathologic change); Po (pathologic change present, follow-up recommended); Px (pathologic change present, extract.) Clinical findings and incisor survival were secondary outcomes. RESULTS: Seventy subjects were enrolled with a total of 172 incisors. Twelve- and 18-month radiographic outcomes demonstrated no statistical difference between FS+MTA pulpotomy and RCT incisors for Px outcomes (P=0.38; odds ratio equals 0.60; 95 percent confidence interval equals 0.19 to 1.89; chi-square test). There was no statistical differences in clinical outcomes for FS+MTA pulpotomy and RCT at 12 and 18 months (P=0.51; Fisher's exact test) or survival for FS+MTA pulpotomy and RCT incisors (P=0.11; log-rank test). CONCLUSIONS: Ferric Sulfate with Mineral Trioxide Aggregate (FS+MTA) is an alternative to RCT for vital primary incisors.

Oral health assessment practices and perceptions of North American paediatric cardiologists.

OBJECTIVE: Children with cardiac defects should have good oral health, particularly prior to cardiac surgery to minimize risks of infective endocarditis. The aim of the study was to examine the oral health assessment practices of North American cardiologists. METHODS: Online surveys were e-mailed to 1409 cardiologists. Cardiologists without paediatric patients or practicing in centres without cardiac surgical care were excluded. Surveys addressed oral health assessment practices for paediatric cardiac patients, and perceptions of the impact of oral health on cardiac care. RESULTS: The centre response rate was 69%, individual response rate 20%. Most cardiologists (96%) reported oral health was assessed as part of cardiac care. The most common time for assessment was prior to cardiac surgery (44%), with a quarter assessing by age 1 (28%). While most oral assessments involved a dentist (59%), 17% of cardiologists performed the oral assessment without the aid of a dentist. Four-fifths of cardiologists (83%) reported cancellation of cardiac surgery due to oral disease. Cardiologists who deferred assessment until prior to surgery had the highest experience of cancellation (96%). Assessments were delayed despite the common belief (89%) that children on pre-surgical high-calorie diets are at increased risk of oral disease. CONCLUSION: Assessments of oral health status were often deferred until immediately prior to cardiac surgery despite the cardiologist's perception that children with cardiac defects were at increased risk of oral disease and prior experience of surgical cancellation due to oral disease. Paediatricians may need to facilitate early oral assessment for these children.

Perspectives toward oral mucositis prevention from parents and health care professionals in pediatric cancer.

PURPOSE: The objectives of this study were: (1) to describe parents and health care professionals (HCPs) perceived importance of oral mucositis prevention in children with cancer; (2) To describe utilities and willingness-to-pay (WTP) to prevent mucositis. METHODS: Respondents included parents of children receiving intensive chemotherapy for leukemia/lymphoma or undergoing stem cell transplantation and HCPs caring for children with cancer. Importance of mild and severe oral mucositis was estimated using a visual analogue scale (VAS). Mucositis-associated utilities were elicited using the time trade-off technique (TTO). WTP to avoid mucositis was obtained using contingent valuation. These techniques quantify how much time or money the participant is willing to relinquish in order to prevent mucositis. RESULTS: Eighty-two parents and 60 HCPs were included. Parents and HCPs believed mild mucositis to be of similar importance (median VAS 2.5 versus 3.6; P = 0.357) while parents considered severe mucositis less important than HCPs (median VAS 8.3 versus 9.0; P < 0.0001). No differences in parent versus HCP responses were seen with TTO (mild or severe mucositis) and most parents were not willing to trade any survival time to prevent severe mucositis. Parents were willing to pay significantly more than HCPs to prevent mild mucositis (average median WTP $1,371 CAN vs. $684 CAN, P = 0.031). No differences were seen in WTP to prevent severe mucositis. CONCLUSIONS: Parents and HCP believe severe mucositis to be important, although it is more important to HCPs. Parents would not be willing to reduce life expectancy to eliminate mucositis.

Reliability and construct validity of the oral mucositis daily questionnaire in children with cancer.

BACKGROUND: The objective of this study was to examine the test-retest reliability and construct validity of parent-reported Oral Mucositis Daily Questionnaire (OMDQ) in children receiving intensive chemotherapy. METHODS: Parents of children with cancer receiving intensive chemotherapy for leukaemia/lymphoma or undergoing stem cell transplantation (SCT) were asked to complete OMDQ daily for 21 d after chemotherapy. Other measures of mucositis obtained concurrently with OMDQ included the World Health Organization (WHO) Mucositis Scale, pain Visual Analogue Scale (VAS) and the Functional Assessment of Cancer Therapy Esophageal Cancer Sub-scale (FACT-ECS). RESULTS: Parents of 59 children (median age = 5.62) provided complete OMDQ data for inclusion in analysis. The majority of children (73%) received SCT. Test-retest reliability of OMDQ exceeded the expected moderate reliability threshold established a priori and in particular, was good to excellent when mucositis was expected. In general, items of OMDQ that relate to pain, swallowing, drinking, eating and talking demonstrated moderate correlations with WHO, VAS and FACT-ECS indices with correlation coefficients ≥ 0.5. CONCLUSIONS: Parent-report of a modified version of OMDQ is reliable and the questions relating to mouth and throat pain, as well as effect on function display construct validity for this population of children receiving intensive chemotherapy.

Mineral trioxide aggregate produces superior outcomes in vital primary molar pulpotomy.

PURPOSE: The purpose of this study was to investigate the outcomes of vital primary molar pulpotomy when there is no direct contact between eugenol and the vital pulp. Four pulpotomy techniques were compared: (1) ferric sulfate (FS) pulpotomy; (2) eugenol-free FS pulpotomy; (3) mineral trioxide aggregate (MTA) pulpotomy; and (4) FS/MTA pulpotomy. METHODS: The pulpotomy technique assigned to each molar was determined by random selection. Two blinded, disinterested raters classified each molar into 1 of 3 radiographic outcomes: (1) N=normal molar without pathologic change; (2) Po=pathologic change present, follow-up recommended; (3) Px=pathologic change present, extract. RESULTS: A total of 92 patients with 227 pulpotomy-treated molars returned for at least 1 recall examination. Median follow-up for molars was 24 months (range=12-38 months). MTA molars demonstrated significantly fewer Px radiographic outcomes than FS molars (P=.002, chi-square test). Eugenol-free FS molars demonstrated significantly more Px radiographic outcomes than MTA (P<.001, chi-square test) or FS/MTA (P=.002, chi-square test) molars. Significantly lower survival was demonstrated for eugenol-free FS molars compared to MTA molars (P=.02, log-rank test) over 6 to 38 months. CONCLUSIONS: Outcomes for mineral trioxide aggregate pulpotomy were superior to ferric sulfate and eugenol-free ferric sulfate pulpotomy after a median follow-up of 2 years.

Refinement of the Children's International Mucositis Evaluation Scale (ChIMES): child and parent perspectives on understandability, content validity and acceptability.

PURPOSE: A new paediatric mucositis assessment instrument, the Children's International Mucositis Evaluation Scale (ChIMES), has required several phases of development. A draft of ChIMES was developed that required further refinement. This paper describes two iterations of refinements of ChIMES using child and parent reporting of understandability, content validity and overall acceptability. METHODS: Parents, children and teenagers were asked to rate their opinion of understandability and overall acceptability of ChIMES on a five-point ordinal scale. Content validity was assessed by whether participants considered the instrument "good", "okay" or "bad". Descriptive analysis of the results was conducted. RESULTS: One hundred and twenty-two participants evaluated two iterations. On the initial evaluation, ChIMES was considered easy to understand, acceptable and have content validity. However, minor amendments were required and a further iteration of testing was necessary to achieve a satisfactory instrument. A final version of ChIMES was developed. CONCLUSION: Modification of each draft of ChIMES was performed until comments were minimal and the scores from participants were consistently high. A final instrument appeared to contain the correct content and was easy to understand by parents, older children and teenagers.

Understandability, content validity, and overall acceptability of the Children's International Mucositis Evaluation Scale (ChIMES): child and parent reporting.

Mucositis assessment in children has primarily relied on assessment tools that have been developed for an adult population. A mucositis assessment scale for use in children has previously been developed from expert opinion, namely Children's International Mucositis Evaluation Scale (ChIMES). After the development of ChIMES, we aimed to evaluate the user perspective of the scale by testing the understandability, content validity, and overall acceptability of ChIMES working with parents, children, and teenagers as content experts. Overall acceptability of the scale was satisfactory; however, comments provided by the participants questioned several aspects of the initial version of ChIMES. After discussion of the results, a refined version of ChIMES was produced that accounts for the views of the target population.

Designing an oral mucositis assessment instrument for use in children: generating items using a nominal group technique.

GOALS OF WORK: There was a need to develop a mucositis instrument that would be specific for use with children. This paper describes the step of generating items in the process of developing a new instrument for the assessment of oral mucositis in children. MATERIALS AND METHODS: Nine health care professionals with expertise in pediatric cancer, mucositis assessment, and oral assessment in children were invited to participate in a nominal group technique to generate items that should be included in an instrument. RESULTS: Thirty items were generated initially. Voting processes established that six of these items were thought to be necessary for inclusion: (1) presence of ulcers, (2) pain assessment, (3) amount of pain medication received, (4) effect on eating, (5) drooling-pooling of saliva, and (6) effect on drinking. Using these six items, an initial draft of an instrument was developed that could be used to assess oral mucositis in children, namely, the Children's International Mucositis Evaluation Scale. CONCLUSION: The six items generated by this process provided the basis for a simple, feasible, and reliable instrument. With increased clinical research investigating interventions to reduce and prevent oral mucositis, such an instrument will be critical to the effective conduct of this research in children. Further testing of this instrument is necessary.

Challenges of mucositis assessment in children: expert opinion.

Mucositis is a challenging treatment-related complication in children receiving therapy for cancer. The conduct of clinical trials that investigate mucositis prevention and treatment requires adequate evaluation of the oral cavity. However, few instruments to measure mucositis in children have been appropriately developed or evaluated. A focus group of nine health care professionals with expertise in mucositis assessment, oral assessment in children and paediatric cancer aimed to determine the challenges and possible solutions to mucositis assessment in children. The results led to the identification of several areas of concern that included: (1) challenges in oral assessment in children related to age and cooperation, (2) the need for proxy responses while recognizing the challenges of reporting pain and function attributed to oral mucositis, (3) the need for an instrument that is simple, quick to complete, and easy to use in almost all children and (4) educational considerations. The results provide a basis from which guidelines for the oral assessment of mucositis in children can begin. This information could be used to aid in the development of a new scale for the assessment of oral mucositis in children.

Establishing literature-based items for an oral mucositis assessment tool in children.

Although there are numerous instruments for oral mucositis (OM) assessment in adults, there is a lack of validated instruments for use in children. The objectives of this systematic review were to describe literature-based items that should be considered for a pediatric mucositis scale and other issues that should be considered when assessing mucositis in children. Literature search of PubMed and bibliography searches identified articles relevant to the assessment of mucositis and mucositis assessment studies in children. The elements established from the literature were grouped under objective, subjective, and functional items. Other issues that require consideration include the conditions for the assessment of the oral cavity and the etiology of OM. The resultant list included 23 items that have been used in mucositis assessment scales. This list of items may be used as an initial step in developing a new pediatric OM scale that particularly focuses on the unique issues in children.

Determining the understandability and acceptability of an oral mucositis daily questionnaire.

Oral mucositis research in children receiving anticancer therapy has been impeded by the lack of an acceptable, appropriate assessment scale. Some scales attempt to measure subjective symptoms associated with mucositis such as pain and difficulty swallowing. These types of patient-reported outcomes are gaining prominence in clinical trials because they capture the perspective of the patients in whom the intervention is designed to benefit. In mucositis research, very few patient-reported outcome measures have been developed. The aim of this study was to determine whether an adaptation of the adult-validated Oral Mucositis Daily Questionnaire is understandable and acceptable for use in the pediatric oncology/hematology population. Twelve subjects were asked to rate their opinion of understandability and acceptability of the adapted Oral Mucositis Daily Questionnaire. As a result of their comments, minor changes were made. Evaluation of the psychometric properties of this instrument can now be performed.

Effectiveness of 2 scavenger mask systems for reducing exposure to nitrous oxide in a hospital-based pediatric dental clinic: a pilot study.

Chronic exposure to elevated ambient air levels of nitrous oxide during nitrous oxide/ oxygen (N2O/2) sedation can result in deleterious side effects to dentists and auxiliary staff. A sampling survey was done in the outpatient dental clinic at the Hospital for Sick Children to determine whether airborne nitrous oxide (N2O) gas concentrations were within established regulatory limits. The effectiveness of 2 scavenger mask systems, the Matrix Medical single-mask system and the Porter/Brown double-mask system, for reducing airborne contamination in a clinical environment during the treatment of pediatric dental patients was compared in a pilot study. The results indicated that the double-mask system more effectively minimized N2O exposure during N2O/O2 sedation of outpatients for a variety of clinical pediatric dental procedures.

Measurement of oral mucositis in children: a review of the literature.

GOALS OF WORK: The assessment of oral mucositis is important. There is a paucity of validated oral mucositis assessment instruments for use in children. This paper reviews the available mucositis measurement tools and their applicability to a paediatric population. MATERIALS AND METHODS: Literature search of PUBMED and bibliography searches identified articles relevant to mucositis measurement tools and the measurement of mucositis in paediatrics. RESULTS: The relevant issues in the literature could be grouped into three categories: (1) development and evaluation of oral assessment tools, (2) oral assessment in the paediatric population, and (3) challenges to the assessment of oral mucositis in children. There were numerous validated mucositis assessment scales for use in adults. Only three of these scales have received limited evaluation for use in the paediatric population. The unique challenges presented by the paediatric population are excluded from much of the discussion in the literature. CONCLUSION: The paper demonstrates the need to consider the issues specific to children. It must be determined whether previously developed tools are ideally suited for children enrolled on mucositis clinical trials.

Validation of the oral mucositis assessment scale in pediatric cancer.

BACKGROUND: Our objective was to examine the construct validity of the Oral Mucositis Assessment Scale (OMAS) in children receiving doxorubicin chemotherapy. METHODS: Children between 6 and 18 years of age with cancer receiving doxorubicin-containing chemotherapy were included. OMAS was measured on days 7, 10, 14, and 17 after chemotherapy. Other measures of mucositis obtained concurrent with OMAS were the World Health Organization (WHO) mucositis scale and pain visual analogue scale (VAS). We also recorded analgesia administration. RESULTS: Sixteen children were studied for 45 post-chemotherapy cycles and 156 OMAS assessments were performed. OMAS was moderately correlated with WHO scores (r = 0.56; P = 0.0006) whereas correlation with the pain VAS was fair (r = 0.37; P = 0.002). OMAS also had fair correlation with the number of doses of topical analgesia (r = 0.43; P = 0.001) and with the cumulative dose of opioid analgesia (r = 0.38; P = 0.003). CONCLUSIONS: The OMAS is valid for use in mucositis clinical trials for children at least 6 years of age.

Malnourishment in a population of young children with severe early childhood caries.

PURPOSE: The purpose of this study was to describe the nutritional status of children with severe early childhood caries (S-ECC) using several clinical measurements. METHODS: Children aged 2 to 6 years with S-ECC were measured for height, weight, triceps skinfolds (TSF), and measurement of upper mid-arm circumference (MAC). Blood samples assessed: (1) hemoglobin; (2) mean corpuscular volume (MCV); (3) serum ferritin; and (4) serum albumin. Weight-for-height was converted into ideal body weight (IBW) percentiles. Body mass index (BMI) was calculated as kg/m2. TSF and MAC were converted into measurement of arm muscle circumference (MAMC). All measurements were compared with population reference values. RESULTS: Using weight for height centiles, 17% were diagnosed as being malnourished and 66% as within normal limits. Using BMI centiles, only 4% were identified as being malnourished and 75% as being normal. Conversely, the body fat of 24% was assessed as low (<10th percentile). Serum albumin was low for 16%. The majority had evidence of inadequate iron intake with low serum ferritin (80%), iron depletion (24%), iron deficiency (6%), or iron deficiency anemia (11%). CONCLUSIONS: All tests detected levels of malnutrition, with blood tests finding the most severe cases. The results suggest that severe Early Childhood Caries may be a risk marker for iron deficiency anemia. Since iron deficiency has permanent effects on growth and development, pediatric dentists should recommend assessment of iron levels in S-ECC patients regardless of their anthropometric appearance.

Long-term outcomes of primary molar ferric sulfate pulpotomy and root canal therapy.

PURPOSE: The purpose of this study was to compare long-term outcomes of ferric sulfate pulpotomy (FS) and primary tooth root canal therapy (RCT) in vital pulps of deciduous molars exposed to caries lesions. METHODS: A total of 291 molars were treated in 130 children. One hundred and eighty-two molars received FS and 109 received RCT by random selection. RESULTS: At 3-year re-assessment, 29 molars (15 FS, 14 RCT) were available for clinical and radiographic examination. Two independent pediatric dentists evaluated periapical radiographs of the treated molars. Molars were classified 1 of 4 outcomes: (1) N = normal treated molar; (2) H = nonpathologic radiographic change present; (3) P(o) = pathologic change present, follow-up in 6 months; (4) P(x) = pathologic change present extract immediately. Survival analysis was applied. A good level of agreement between raters was found for molars with outcome P(x) (K = 0.79). No difference in radiographic outcomes was demonstrated 3 years after treatment (chi2 = 1.4). Survival analysis demonstrated a 3-year survival probability of 0.62 for FS-treated molars and 0.92 for RCT molars. Survival of RCT molars was significantly greater than for FS molars (Wilcoxon: P = .01; log-rank: P = .02). CONCLUSIONS: RCT-treated molars demonstrated significantly greater survival than FS-treated molars 3 years after treatment.

Outcomes of vital primary incisor ferric sulfate pulpotomy and root canal therapy.

PURPOSE: To compare ferric sulfate (FS) pulpotomy and primary tooth root canal therapy (RCT) in cariously exposed vital pulps of primary incisors. METHODS: A total of 133 incisors in 50 children were randomly selected to be treated by FS pulpotomy (64) or RCT (69). RESULTS: Two years after treatment, 77 incisors (41 FS pulpotomy, 36 RCT) were available for clinical and radiographic examination. There was no clinical evidence of pathosis in 78% of FS pulpotomy-treated and 100% of RCT-treated incisors. Two independent pediatric dentists evaluated periapical radiographs of the treated incisors. Incisors were classified into 1 of 4 treatment outcomes: N, normal treated incisor; H, nonpathologic radiographic change present; PO, pathologic change present, but not requiring immediate extraction; PX, pathologic change present, extract immediately. Survival analysis was applied. A moderate level of agreement between raters was found for incisors with outcome PX (K = 0.54). Intra-rater reliability was substantial for incisors with outcome PX (K = 0.61). No difference was demonstrated in the proportion of FS pulpotomy- and RCT-treated incisors rated PX at the 2-year recall (x2 = 0.6). RCT incisors demonstrated a significantly higher survival rate than FS pulpotomy incisors at 2 years (p = 0.04). CONCLUSIONS: Treatment outcomes for RCT incisors were not significantly different from FS pulpotomy-treated incisors at 2 years; however, at 2 years the survival rate of RCT incisors was statistically greater than that of FS pulpotomy-treated incisors.