Agências de regularização técnica odontológica em relação ao manejo clínico em crianças: uma revisão de literatura / Dental technical regularization agencies in relation to management clinic in children: a review of the literature

O manejo clínico em Odontopediatria é individual, podendo variar nas diversas culturas mundiais. O objetivo desta revisão de literatura é reunir as principais diretrizes de diferentes países ao redor do mundo, incluindo o Brasil, visando identificar como em cada lugar o uso das técnicas de comportamento são aplicadas e sua eficiência. Inicialmente, foram selecionados os principais guias nacionais e internacionais, sendo eles retirados da Associação Internacional de Odontopediatria (IAPD) e Associação Americana de Odontopediatria (AAPD), além de artigos de diferentes países e continentes, como Argentina, Brasil, Europa e Ásia, também foram analisados se o protocolo dos principais guias estão condizentes com os protocolos do Departamento de Clínica Infantil da Faculdade de Odontologia de Ribeirão Preto - USP. Os resultados obtidos nos guias para manejo clínico odontológico brasileiro, americano, internacional e os artigos estudados recomendam inicialmente utilizar técnicas menos invasivas, com o intuito proporcionar um atendimento tranquilo e sem criar traumas para a criança, uma vez que muito do comportamento não cooperativo vem de experiências anteriores traumáticas. Entretanto, técnicas avançadas podem ser utilizadas para casos mais desafiadores. Concluímos com o estudo dos guias e artigos, que o cirurgião dentista possui diversas técnicas a serem aplicadas para que o atendimento infantil seja atraumático e restabelecer saúde ao paciente.

Clinical management in Pediatric Dentistry is individual and varies across different cultures around the world. The objective of this literature review is to bring together the main guidelines from different countries around the world, including Brazil, aiming to identify how the use of behavioral techniques are applied and their efficiency in each place. Initially, the main national and international guides were selected, taken from the International Association of Pediatric Dentistry (IAPD) and the American Association of Pediatric Dentistry (AAPD), as well as articles from different countries and continents, such as Argentina, Brazil, Europe and Asia, as well as It was analyzed whether the protocols of the main guides are consistent with the protocols of the Children's Clinic Department of the Faculty of Dentistry of Ribeirão Preto - USP. The results obtained in the guides for Brazilian, American and international dental clinical management and the articles studied recommend initially using less invasive techniques, with the aim of providing calm care and without creating trauma for the child, since much of the uncooperative behavior comes from previous traumatic experiences. However, advanced techniques can be used for more challenging cases. We conclude from studying the guides and articles that the dental surgeon has several techniques to be applied so that child care is atraumatic and restores health to the patient.

A retrospective study on the outcome of pulpotomy with iRoot BP plus in primary molars and its relationship with hemostasis time.

BACKGROUND: Pulpotomy is a crucial method to preserve primary teeth until natural exfoliation. This study aimed to evaluate the clinical and radiographic outcomes of pulpotomy with iRoot BP Plus in primary molars and to explore the association between hemostasis time and these outcomes. METHODS: Primary molars that underwent iRoot BP Plus pulpotomy and were followed for at least 12 months were selected for this study. Clinical and radiographic data were collected, and the success rate was analyzed in relation to factors such as hemostasis time, tooth type, and arch type. The tests of significance used were the chi-square test, Fisher's exact test, or Kruskal-Wallis test. Statistical significance was set at P < 0.05. RESULTS: A total of 183 teeth in 106 patients were included in the analysis. The follow-up period fell into a range of 1-3 years, with a mean of 1.6 years. The clinical and radiographic success rates were 96.7% and 92.9%, respectively. The earliest time to observe the radiographic failures was half a year after the treatment, and the latest time was two years after the treatment. Among all the teeth, 130 were recorded with hemostasis time before the application of iRoot BP Plus. Compared to teeth with a hemostasis time of 5 min or less, teeth with a hemostasis time exceeding 5 min showed no significant differences in clinical and radiographic success (P = 1.000 and 0.879). Additionally, neither arch nor teeth type showed a relationship with the pulpotomy success rate (P > 0.05). CONCLUSIONS: Pulpotomy using iRoot BP Plus in primary molars achieved favorable results. The hemostasis time may not significantly impact the outcomes of pulpotomy using iRoot BP Plus in primary molars.

Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children.

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

Effectiveness of Different Behavior Management Techniques in Pediatric Dentistry.

Background: Pediatric dentistry necessitates efficient behavior management methods to ensure successful treatment outcomes and positive experiences for young patients. This research aims to evaluate the comparative effectiveness of "Tell-Show-Do (TSD)", positive reinforcement, nitrous oxide sedation, and pharmacological sedation in pediatric dental practice. Methods: A retrospective analysis was conducted on pediatric patients aged 3-12 years who underwent dental treatment at a designated dental center over a 1-year period. Patients were categorized based on the behavior management method utilized: TSD, positive reinforcement, nitrous oxide sedation, or pharmacological sedation. Treatment success rates and patient cooperation levels were evaluated for each method. Results: Positive reinforcement and TSD demonstrated the highest treatment success rates (85% and 80%, respectively) and patient cooperation levels (90% and 85%, respectively). Nitrous oxide sedation exhibited moderate effectiveness with a treatment success rate of 70% and a patient cooperation level of 75%. Pharmacological sedation had the lowest treatment success rate (60%) and patient cooperation level (65%). Statistical analysis revealed significant differences in treatment success rates (P < 0.05) and patient cooperation levels (P < 0.05) among the behavior management methods. Conclusion: Positive reinforcement and TSD emerge as highly efficient behavior management methods in pediatric dentistry, promoting high treatment success rates and patient cooperation levels. Nitrous oxide sedation offers a valuable adjunct for managing anxiety and enhancing patient comfort. Pharmacological sedation, while efficient in certain cases, should be used judiciously due to associated risks.

Assessment of Discomfort and Analgesic Usage Following Pediatric Dental Procedures in India: A Cross-Sectional Study.

Introduction: Pain management in pediatric dentistry is crucial for ensuring positive treatment outcomes and reducing patient suffering. This study aimed to evaluate postoperative discomfort and analgesic usage among pediatric dental patients undergoing various procedures in India. Methodology: A cross-sectional study was conducted at a tertiary care dental hospital in India from June 2023 to December 2023. A total of 150 pediatric patients aged 2-18 years who underwent different dental procedures were included. Data on postoperative discomfort and analgesic usage were collected immediately following the procedure and during follow-up phone calls. Results: Significant differences were found in immediate postoperative discomfort following pulpotomy (P = 0.03). Patients receiving primary stainless steel crowns (SSCs) alone or in combination with pulpotomy were significantly more likely to report discomfort (P < 0.001 and P < 0.05, respectively). No significant associations were observed between discomfort and sealants, preventive resin restorations, 1- or 2-surface restorations, or extractions. Over-the-counter analgesic usage was prevalent, particularly following SSC placement. Conclusion: This study highlights the variability in postoperative discomfort among pediatric dental patients undergoing different procedures in India. Tailored pain management strategies based on specific procedures are essential to minimize discomfort and improve patient outcomes in pediatric dentistry.

Pain Perception During Local Anesthesia Administration in Pediatric Dental Patients and The Impact of Pre-Cooling The Injection Site: An in-vivo Study.

Aim: Examining how pre-cooling affects children's experience of pain during local anesthetic administration is the primary goal of this study. Material and Methods: This study was conducted in vivo and involved 60 child patients who required local anesthetic in order to undergo dental procedures. Patients were divided into two groups based on a random chance: Group I was the control group, which did not receive any pre-cooling. Group II was the pre-cooling group, which allowed the injection site to be chilled with an ice pack for one minute prior to the administration of anesthesia. The Wong-Baker FACES Pain Rating Scale was used to evaluate the participants' level of pain perception immediately following the administration of the anesthetic injection. Results: The group that received pre-cooling showed a reduction in pain levels that was statistically significant when compared to the group that received control (P < 0.05). Conclusion: Pediatric dental patients may decrease local anesthesia pain by pre-cooling the injection site. This technique can be simply used in dental practices to improve patient experience, especially for children with dental anxiety or needle phobia.

Application of Artificial Intelligence in Pediatric Dentistry: A Literature Review.

Artificial intelligence (AI) is the development of computer systems that can do tasks that normally require human intelligence. A number of dental specialties, including pediatric dentistry, now use AI and its subsets, machine learning, and deep learning. The evolution of AI in healthcare has been linked to the creation of AI applications meant to support medical professionals in diagnosing patients and choosing the best course of treatment. AI is the capability of robots to learn and use that information to carry out a range of cognitive tasks, including language processing, learning, reasoning, and making decisions-basically imitating human behavior. This review gives an overview of the numerous applications of AI that are beneficial to pediatric dentistry.

Comparing Oral Microbiota Changes after Pulpotomy/Pulpectomy in Pediatric Patients.

Background: Pediatric dental procedures like pulpotomy and pulpectomy are commonly performed to treat pulp-related dental issues in primary teeth. The choice of instrumentation, such as traditional rotary instruments or laser technology, can impact the oral microbiota. This study aims to compare the changes in oral microbiota following pulpotomy/pulpectomy in pediatric patients treated with traditional rotary instruments versus laser technology. Materials and Methods: A total of 60 pediatric patients, aged 4-10 years, requiring pulpotomy or pulpectomy were randomly assigned to two groups: group A (traditional) and group B (laser). In group A, traditional rotary instruments were used for pulp removal, while in group B, a dental laser was utilized. Saliva and plaque samples were collected before the procedure (baseline), immediately after the procedure, and at the one-month follow-up. Microbial deoxyribonucleic acid (DNA) was extracted and analyzed using 16S ribosomal ribonucleic acid (rRNA) sequencing to assess changes in the oral microbiota. Results: At baseline, both groups exhibited similar microbial diversity and composition. However, immediate post-procedure results showed a significant decrease in microbial diversity in both groups, with group B (laser) demonstrating a more pronounced reduction. At the one-month follow-up, group A (traditional) showed a partial recovery of microbial diversity, while group B (laser) continued to exhibit lower microbial diversity compared to baseline. Notably, group B (laser) displayed a shift in microbial composition with a decrease in pathogenic species and an increase in beneficial bacteria compared to group A. Conclusion: This study highlights that both traditional rotary instruments and laser technology have a significant impact on the oral microbiota of pediatric patients following pulpotomy/pulpectomy. While both methods initially reduce microbial diversity, laser treatment appears to have a more sustained effect, favoring the growth of beneficial bacteria over time. Further research is needed to assess the long-term clinical implications of these microbiota changes for the oral health of pediatric patients.

Use of Computer Digital Techniques and Modern Materials in Dental Technology in Restoration: A Caries-Damaged Smile in a Teenage Patient.

Prosthodontic treatment of developmental age patients presents a significant challenge to the dentist. The growth and development of the stomatognathic system must be considered in treatment planning. Temporary prosthetic restorations must be regularly inspected and recemented, and final prosthetic restoration should not be delivered until the growth of the body is complete. In addition, due to the complex nature of morphological and functional disorders during the developmental period, simultaneous prosthetic and orthodontic treatment may be required. The case presented in this article is a 16-year-old boy with severe tooth destruction caused by untreated caries disease and poor oral hygiene. The patient required conservative, endodontic, and surgical treatment to restore the occlusion and aesthetics to allow the proper development of the masticatory organ. This article also presents the treatment case of a young patient with damaged crowns in the upper arch, which were restored with standard root-crown posts and cores and temporary 3D-printed composite crowns.

Do Preventive Programs Reduce the Need for New Sedations for the Treatment of Oral Pathologies in Healthy and Special Health Care Needs Children?

Background: The goal is to analyze the need for reinterventions under deep sedation to treat oral pathologies in a population of children with special health care needs (SHCNs) and healthy children who followed a prevention program and to study the influence of parental motivation and child collaboration on the need for reinterventions under deep sedation. Methods: A retrospective study was carried out in a private clinic in Cartagena (Murcia, Spain), with patients treated under deep sedation from 2006 to 2018, both years included, following the Strobe statement. Results: In this study with 230 children who were treated under deep sedation, 23.92% underwent two or more sedations. The mean time elapsed between the first and the second sedations was 21.64 ± 15.87 months, and the main cause for reinterventions was the occurrence of new pathologies. Significantly more pulp treatments were performed in the first sedation than in the second (p = 0.013) and in the third (p = 0.007). Healthy children required fewer reinterventions under deep sedation than children with special needs (6.42% vs. 39.67%). Similarly, patients who followed the preventive program and required some type of dental treatment were reoperated fewer times than those who did not follow the preventive program (35.8 vs. 50%); than "cooperative" children as opposed to "non-cooperative" (12.12% vs. 60.93%) and than patients with "motivated" parents as opposed to those with "non-motivated" parents (20.83% vs. 46.34%). A total of 50% of the children who participated in the preventive program became "cooperative", and 100% were able to receive some treatment in the dental chair. Conclusions: Prevention programs, including motivational interviewing, are essential to improve children's behavior in the dental chair and reduce the need for reinterventions under general anesthesia or deep sedation. Although patients with special needs do require more sedation during their lifetime due to their inability to cooperate, these programs are necessary for the maintenance of oral health status and for the early diagnosis of caries lesions. Pediatric dentists should implement a quarterly preventive program because it improves patient collaboration. It is essential to achieve the motivation of parents in the oral care of their children.