An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol.

BACKGROUND: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. METHODS: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. CONCLUSION: This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Light Chain Myeloma Precipitating Cryoglobulinemic Vasculitis.

Multiple Myeloma (MM) is characterized by monoclonal immunoglobulin production leading to widespread skeletal destruction and renal dysfunction. Light chain multiple myeloma (LCMM) affects 15% of individuals with MM and has an overall poor prognosis. Cutaneous manifestations are uncommon and it is rarely complicated by Type I Cryoglobulinemia (CG). Here we present an atypical case of κ-predominant LCMM complicated by Type I CG in an 80-year-old man who presented with a progressive non-blanching necrotic rash and ulcers involving his face, distal extremities, and oropharynx of two months duration prior to his admission at our facility. On admission to our facility, workup showed an overabundance of κ-light chains, elevated free κ/λ ratio, cryoglobulins, and an acute kidney injury. Marrow biopsy demonstrated 60% plasma cells with κ-light chain predominance. Cutaneous manifestations such as acral cyanosis and distal gangrene in LCMM indicate late stages of the disease, and such findings should raise suspicion for additional comorbid pathologies, including cryoglobulinemia, which could help direct earlier initiation of treatment.

Using the Timmer Scale to Standardize Pediatric Dentistry Residents' Scientific Appraisal Skills.

Introduction: There is no consensus on the best methodology to apply evidence-based practice principles to develop a systematic approach to improve critical appraisal or research design evaluation skills in advanced education journal clubs. Methods: We implemented a tool-based approach for our pediatric dentistry residents' journal club centered on the use of a study quality assessment tool, the Timmer scale. The tool consisted of 19 standard questions that evaluated the research methodology, data collection, statistical analysis, and reporting of the findings of each article. Learners first underwent a 4-hour training session on study quality assessment. They were then assigned to read articles from monthly issues of core journals and appraised the quality of each article using the Timmer scale and submitted their scores in advance of the group session. Then, during a 1-hour journal club, the group came to a consensus on the Timmer scale score, and group and individual scores were compared to the course director's scores as prompts for feedback and further discussion. Results: Over 3 years, 24 pediatric dentistry residents participated in the course. A noticeable improvement in the pediatric dentistry residents' performance was noticed, with the discrepancy between their scores and group scores improving over time. Discussion: Using a quality assessment tool in journal clubs appeared to improve the residents' ability to critically assess articles in a systematic way. Additionally, the tool was useful for assessing residents' performance over time.

Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US.

Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. Design, Setting, and Participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. Main Outcomes and Measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. Conclusions and Relevance: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.

Relationship Between Body Mass Index and Dental Development in a Contemporary Pediatric Population in the United States.

Purpose: To determine if there is a positive correlation between increased body mass index (BMI) and dental development in children.
Methods: The records of 500 six- to 13-year-old children were reviewed, and 250 were included in the study. BMI was calculated for each patient. Panoramic radiographs were evaluated, and dental age was estimated using Cameriere's formula. Delta values (dental age, chronological age) were analyzed using the Kruskal-Wallis test. All tests of hypotheses were two-sided at an alpha level of 0.05.
Results: A statistically significant difference in delta was observed among different BMI categories (P <0.001). Larger deltas were observed for obese patients compared to normal weight patients (P = 0.027) and underweight patients (P = 0.012). Prepubertal patients were observed to have larger deltas than pubertal patients (P < 0.001). Differences between sexes were not significant (P = 0.930).
Conclusion: Obese children were more advanced dentally than normal or under-weight children. Older children were more dentally advanced than their chronological age when compared to younger children. As children grew older, the difference between dental age and chronological age decreased.

Traumatically Intruded Permanent Teeth: Three Case Reports and a Review of Current Recommendations.

Intrusion of permanent teeth is not extensively covered in the literature compared to other injuries. Treatment guidelines have been published and clinical data is accumulating to support the current recommendations, which are illustrated in the three cases here. This review evaluates the current information about management of traumatically intruded permanent teeth. As more data accumulates, uncertainties with respect to both treatment recommendations and long-term outcomes can be expected to be elucidated.

Pre-Eruptive Intracoronal Resorption (PEIR): Literature Review and Case Report.

Pre-eruptive intracoronal resorption (PEIR) are lesions that are often located in the occlusal portion of the crown in unerupted teeth. The etiology and pathology of these lesions remain unclear and most go undetected until later stages of development. Prognosis is dependent on early detection, and conservative treatment is recommended. This report reviews the etiology, prevalence, diagnosis and treatment of PEIR and describes a case of a permanent second molar with PEIR diagnosed in an 11-year-old patient.

Clinical and radiographic success of mineral trioxide aggregate compared with formocresol as a pulpotomy treatment in primary molars: a systematic review and meta-analysis.

BACKGROUND: The authors conducted a systematic review and meta-analysis to compare the long-term clinical and radiographic success of using mineral trioxide aggregate (MTA) and formocresol (FC) as a pulp-dressing material in pulpotomy treatment in primary molars. TYPES OF STUDIES REVIEWED: The authors searched MEDLINE, Thomson Reuters Web of Science and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) published from Jan. 1, 1990, to May 9, 2013. For an RCT to be included, the authors required that the primary molars treated with a pulpotomy procedure must have received stainless steel crowns as a final restoration and that rubber dam isolation was used during treatment; that the pulp must have been vital as determined clinically by means of hemorrhage control with a cotton pellet; and that the RCT must have included a follow-up period of at least two years. For each included RCT, two authors assessed the risk of bias independently. RESULTS: The authors identified 20 trials and included five of them. A total of 377 primary molars were treated. The authors judged that none of the included RCTs had a low risk of bias. They noted no significant differences in clinical success (relative risk [RR] = 1.01; 95 percent confidence interval [CI], 0.98-1.05) and radiographic success (RR = 1.09; 95 percent CI, 0.97-1.21) for primary molars treated with MTA versus those treated with FC. PRACTICAL IMPLICATIONS: On the basis of the limited evidence, pulpotomy procedures performed in primary molars involving the use of MTA or FC showed comparable clinical success rates.

Fluoride concentration in commonly consumed infant juices.

PURPOSE: The purpose of this study was to measure the fluoride concentration in the most commonly consumed, commercially available infant fruit juices and to determine if a significant difference existed among various juice flavors and brands. METHODS: Ninety samples of different flavors from three infant juice manufacturing companies were analyzed using the Taves microdiffusion method. The fluoride content in one serving juice container was calculated and compared to the recommended optimal daily fluoride intake. RESULTS: Fluoride concentrations ranged from 0.11 to 1.81 ppm (mean=0.75+0.45 ppm) for all samples. A statistically significant difference in fluoride concentration among different manufacturers (P<.001) was found. Gerber juices contained higher fluoride amounts (mean=1.1+0.22 ppm) than Beechnut juices (mean=0.43+0.42 ppm) and Earth's Best juices (mean=0.34+0.13 ppm). CONCLUSION: Fluoride was found in all tested infant juice samples, and concentrations varied among manufacturers and flavors assessed. Fluoride in all tested samples was below the recommended optimal daily intake. When taking other fluoride sources into consideration, infants six months old and younger who consume three times the American Academy of Pediatrics' recommended amounts of juice per day may be at risk of developing fluorosis.