Effect of rapid maxillary expansion on the apnoea-hypopnoea index during sleep in children. Systematic review.

Background: Rapid maxillary expansion (RME) treatment is prescribed in patients with maxillary compression, achieving increases in transverse palate and nasal cavity dimensions together with an increase in the distance between the pterygoid processes. Sleep apnoea-hypopnoea syndrome (SAHS) in children is often associated with anatomical risk factors and treatment may involve surgery, drugs, dentofacial orthopaedics, myofunctional and positional approaches. Material and Methods: The aim of this systematic review it to obtain scientific evidence of the effect of RME on the apnoea-hypopnoea index (AHI) in growing patients. PubMed, Cochrane Library and EMBASE were the online databases used for the search. The scientific publications selected met the following inclusion criteria: articles published from 2011 to May 2021; growing patients undergoing rapid maxillary expansion surgery; and studies with records of AHI before and after rapid maxillary expansion using polysomnography or respiratory polygraphy. Results: Seven articles that provided the necessary quality of scientific evidence were finally selected. The review followed the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0, and the GRADE approach for rating the certainty of evidence. Data analysis was performed using Numbers 4.3 and ReviewManager (RevMan) 5.4.1 software and GRADEpro and Mendeley online platforms. Conclusions: The results show a reduction in AHI following RME therapy in growing patients. More research is needed with larger sample sizes, more specific inclusion criteria and standardised data sharing. Key words:Rapid maxillary expansion, maxillary distraction, sleep apnoea, children.

Spanish Paediatricians' Knowledge, Attitudes and Practices Regarding Oral Health of Children under 6 Years of Age: A Cross-Sectional Study.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic pathology, and it has a negative impact on the oral and general health of the child patient. AIM: To evaluate the knowledge, attitudes and practices of Spanish paediatricians regarding early childhood caries according to the professional's years of experience. MATERIAL AND METHODS: A cross-sectional questionnaire was conducted by Spanish paediatricians via WhatsApp and e-mails from January to April 2021. Data were analysed using Chi-squared test, Fisher's exact test and Cramer's V test. RESULTS: There were a total of 359 participants. Most respondents were women (81.3%) with up to 10 years of professional experience (31.2%) in primary health care and public health. In most cases, participants had an excellent knowledge of primary dentition (90.8%), but they ignored (56%) when the first visit to the dentist should occur. Regarding the aetiological factors of caries, oral hygiene and prevention, a lower rate of knowledge was observed. The majority of participants (80.8%) were not able to identify white spot lesions and enamel defects (76%). They considered that their knowledge in oral health was deficient, highlighting the need to increase their training. Less experienced paediatricians were found to have higher success rates. CONCLUSIONS: The level of knowledge and attitudes regarding early childhood caries of the evaluated paediatricians should be improved. Paediatricians had difficulties in identifying early caries lesions and enamel defects. Nevertheless, a higher level of knowledge and positive attitudes towards dental caries has been detected among paediatricians with fewer years of professional experience.

Delivery of Health Care by Spanish Dental Hygienists in Private and Public Dental Services during the COVID-19 De-Escalation Phase (June 2020): A Cross-Sectional Study.

BACKGROUND: The first wave of the COVID-19 pandemic in Spain posed a major challenge for Spanish dental professionals. The objective of this work is to describe the dental hygienists' work status and employment patterns during the de-escalation phase in order to analyse the standards of knowledge, compliance with official recommendations, and dental activities both in the public health service and in the private sector. MATERIAL AND METHODS: A cross-sectional questionnaire was answered by Spanish dental hygienists via WhatsApp, Facebook, and Instagram. The questionnaire was piloted before it was distributed and carried out during June 2020. RESULTS: Here, 517 dental hygienists were surveyed, of which 86.2% followed the official recommendations to avoid contagion and 63.8% agreed with the gradual return to work by limiting the use of aerosols. Private dental hygienists identified more with returning to work without restrictions (14.5%) versus those working for the public service (1.2%) (p < 0.005). CONCLUSIONS: Dental hygienists' return to work has involved different strategies, aimed at controlling infection and guaranteeing the safety of patients and the rest of the dental team. The availability of personal protective equipment, the adaptation of clinical infrastructure, and patient care management have differed between professionals working in the private and public sectors.

Oral manifestations of HIV infection in infants: a review article.

The vast majority of children with HIV infection present oral manifestations among the first signs of illness. These lesions are not produced directly by the virus, but are manifestations associated with HIV infection, and are not pathognomic of the infection itself. Some of these oral lesions have a prognostic value with regard to progression of the infection and the appearance of AIDS; independently of other, more commonly used markers. The essential risk factors that influence the development of such oral manifestations are the low number of CD4+ lymphocytes, xerostomia, and the lack of anti-retroviral therapy. Opportunist infections, such as mycoses -- including pseudomembranous oral candidiasis, are found with higher frequency; followed by the herpetic viral infections. The oral lesions that appear in infected children differ in prevalence from those found in seropositive adults, some, such as parotid hypertrophy, present more exclusively in children, others, such as periodontal bacterial infections and Kaposi's Sarcoma, are lesions that predominate in the adult HIV-infected population. Given the current impact of the pandemic caused by HIV, it is the responsibility of dental professionals to prevent, detect, treat and control the oral lesions in those patients infected with HIV. All of which will be reflected in a reduction in transmission, lower mortality and greater long-term survival for infected children.

Manifestaciones orales de la infección por VIH en la infancia: artículo de revisión / Oral manifestations of HIV infection in infants: a review article

La gran mayoría de niños con infección por VIH presentan, dentro de sus primeros signos de enfermedad, manifestaciones orales. Estas lesiones orales no están producidas directamente por dicho virus, son manifestaciones asociadas a la infección por VIH, ya que no son patognomónicas de la infección. Algunas de estas lesiones orales tienen un valor pronóstico de cara a la evolución de la infección y la aparición de SIDA, independientemente de otros marcadores de uso más común. Los factores de riesgo esenciales que predisponen al desarrollo de dichas manifestaciones orales son el bajo número de linfocitos T CD4+, xerostomía y la ausencia de tratamiento antiretroviral. Infecciones oportunistas como las micosis, entre ellas la candidiasis oral pseudomembranosa se hallan con mayor prevalencia; seguidas de las infecciones víricas herpéticas. Las lesiones orales que aparecen en niños infectados se difieren en cuanto a prevalencia a las halladas en el paciente adulto seropositivo, algunas como la hipetrofia parotídea se presentan con mayor exclusividad en niños, otras como las infecciones bacterianas periodontales, el Sarcoma de Kaposi son lesiones que predominan en población adulta infectada por VIH. Dada la trascendencia actual de la pandemia causada por VIH, es responsabilidad de los profesionales odontólogos y estomatólogos el prevenir, diagnosticar precozmente, tratar y controlar las lesiones orales de los pacientes infectados por el VIH. Todo ello refleja una reducción en la transmisión, menor mortalidad y mayor supervivencia a largo plazo de los niños infectados (AU)

The vast majority of children with HIV infection present oral manifestations among the first signs of illness. These lesions are not produced directly by the virus, but are manifestations associated with HIV infection, and are not pathognomic of the infection itself. Some of these oral lesions have a prognostic value with regard to progression of the infection and the appearance of AIDS; independently of other, more commonly used markers. The essential risk factors that influence the development of such oral manifestations are the low number of CD4+ lymphocytes, xerostomia, and the lack of anti-retroviral therapy. Opportunist infections, such as mycoses - including pseudomembranous oral candidiasis, are found with higher frequency; followed by the herpetic viral infections. The oral lesions that appear in infected children differ in prevalence from those found in seropositive adults, some, such as parotid hypertrophy, present more exclusively in children, others, such as periodontal bacterial infections and Kaposi's Sarcoma, are lesions that predominate in the adult HIV-infected population. Given the current impact of the pandemic caused by HIV, it is the responsibility of dental professionals to prevent, detect, treat and control the oral lesions in those patients infected with HIV. All of which will be reflected in a reduction in transmission, lower mortality and greater long-term survival for infected children (AU)