Latent profiles as predictors of response to instruction for students with reading difficulties.

The program code developed by others is appropriately cited in the text and listed in the references section. The raw and processed data on which study conclusions are based are not available. The statistical syntax needed to reproduce analyses in the article is available upon request. The methods section provides references for the materials described therein. We report how we determined our sample size, all data exclusions, all manipulations, and all measures in the study, and we follow APA Style Journal Article Reporting Standards. This study's design, hypotheses, and data analytic plan were not pre-registered. Prior research supports the need for elementary-aged students with reading difficulties (RD) to receive explicit systematic small group evidence-based reading instruction. Yet for many students, simply receiving an evidence-based reading instruction in a small group setting is insufficient to reach the progress milestones needed to meet grade level reading standards. The current study examined whether: (1) elementary school students with RD constitute a homogeneous or heterogeneous groups when considering their basic language and cognitive skills (using a latent profile analysis), and (2) if latent profiles are predictive of response to reading comprehension instruction (using a mixed modeling approach). The sample consisted of 335 students, including students with RD and typical students (n = 57). The results revealed heterogeneity within students with RD - there were two distinct profiles, with one having higher basic language (reading fluency and decoding) and cognitive (verbal domain productivity, cognitive flexibility, working memory) skills and lower attention skills, and the other having stronger attention skills and lower basic language and cognitive skills. The findings also suggested that latent profiles were predictive of response to reading comprehension instruction. Our results provide a convincing argument for leading the field in the direction of developing customized interventions. It is conceivable, but remains to be further examined, that researchers and educators could potentially improve reading outcomes through providing a customized reading intervention to a student based on their cognitive-language profile.

Effectiveness and acceptability of intravenous sedation in child and adolescent dental patients: report of a case series at King's College Hospital, London.

INTRODUCTION: Conscious sedation for young patients continues to be challenging. Few studies have shown positive results using intravenous midazolam when sedating young patients. This case series reports an investigation of conscious sedation using intravenous midazolam for young patients receiving dental treatment. OBJECTIVE: To determine acceptance, safety and efficacy of intravenous midazolam for conscious sedation in children and adolescent patients undergoing dental treatment.Patients and methods Patients from seven to 16 years of age, ASA I, II and III, opted to have extractions, minor oral surgery and/or conservative treatment with IV midazolam and local anaesthesia. A pulse oximeter was used to monitor vital signs and the Houpt scale to assess overall behaviour. RESULTS: A total of 552 patients, 234 boys and 318 girls with mean ages of 13.3 years and 13.5 years respectively, were included. Three hundred and sixty-five patients (66%) claimed to be anxious or very anxious before treatment. The average dose given was 5.7 mg and dosage ranged from 2 to 10 mg. Four hundred and fifty-seven patients (83%) scored 'very good' and 'excellent' for overall behaviour. Side-effects included crying, drowsiness and amnesia. CONCLUSIONS: Intravenous midazolam is accepted by patients and is a safe and effective method of sedation for use in children and adolescents, producing some level of tearfulness.

Dental age assessment: are Demirjian's standards appropriate for southern Chinese children?

Estimation of age is an important requisite in forensic, judicial and criminal proceedings. Dental age can be estimated from a dataset that has been prepared from a similar or a different population group. Demirjian and his co-workers proposed dental maturity scores from a French-Canadian population and this has served as a reference dataset for evaluation of age for various population groups. Considering the high number of illegal immigrants who have entered Hong Kong from neighboring countries, age estimation studies on southern Chinese is warranted. This study aimed to validate the applicability of Demirjian's dataset on a southern Chinese population. A total of 182 dental panoramic tomographs comprising an equal number of boys and girls with an age range from 3 to 16 years were scored. Dental maturity scores were obtained from the Demirjian's dataset and dental age was calculated. The difference in chronological and estimated dental ages was calculated using the paired t-test. There was a mean overestimation of dental age of 0.62 years for boys (p < 0.01) and 0.36 years for girls (p < 0.01). Demirjian's dataset is not suitable for estimating the age of 3-16 years old southern Chinese children.

Oral sedation for dental treatment in young children in a hospital setting.

INTRODUCTION: Conscious sedation for young children is a rapidly developing area of clinical activity. Many studies have shown positive results using oral midazolam on children. These case series investigated oral midazolam conscious sedation as an alternative to general anaesthesia in a clinical service setting. OBJECTIVE: The purpose of this work was to determine the safety and efficacy of oral midazolam for conscious sedation in children undergoing dental treatment. METHODS: Patients were selected by colleagues for treatment under oral sedation. The main general criteria were weight below 36 kilos and ASA I, II, or III. Midazolam 0.5 mg/kg was administered orally. A pulse oximeter was applied to a finger to monitor vital signs and the Houpt scale was used to assess behaviour. RESULTS: A total of 510 children aged between 13 months and 11 years were included. The behaviour of 379 (74%) was excellent or very good. The pulse rate and peripheral oxygenation were within the normal range for all patients. The main adverse effects were diplopia and post-sedation dysphoria. CONCLUSIONS: Oral midazolam is a safe and effective method of sedation although some children were agitated and distressed either during or after treatment. Parents need to be warned about this.

Prevalence, intensity and identity of bacteraemia following conservative dental procedures in children.

INTRODUCTION: The aim of this study was to investigate the prevalence, intensity and microbial identity of bacteraemia following conservative dental procedures. The procedures were placement of rubber dam, use of the fast drill, use of the slow drill and placement of a matrix band and wedge. METHOD: Two hundred and five children and adolescents undergoing general anaesthesia for dental treatment at the Eastman Dental Hospital were recruited. Each subject was randomly allocated to one of the procedure groups. A baseline blood sample was taken before any dental treatment was carried out. A second blood sample was taken 30 s after a single conservative procedure. The blood samples were processed using lysis filtration. All bacterial isolates were identified using comparative 16 S ribosomal RNA gene sequencing. Oral Streptococcus spp. and coagulase-negative Staphylococcus spp. were further identified by comparative sodA gene sequencing. RESULTS: The prevalence of bacteraemia was significantly greater following placement of rubber dam (P = 0.01) and placement of matrix band and wedge, compared with baseline. The intensity of bacteraemia was significantly greater following placement of rubber dam (P = 0.001) and placement of matrix band and wedge (P = 0.0001). The most frequently isolated bacteria were Streptococcus spp. (56%), Actinomyces spp. (15%) and coagulase-negative Staphylococcus spp. (15%). CONCLUSION: Conservative dental procedures are a significant cause of bacteraemia.

Oral health of children with intractable epilepsy attending the UK National Centre for Young People with Epilepsy.

AIM: To investigate the oral health of children with intractable epilepsy attending the UK National Centre for Young People with Epilepsy. STUDY DESIGN AND METHODS: 39 children and adolescents with intractable epilepsy at a residential school, the UK National Centre For Young People With Epilepsy (NCYPE) were age, gender and ethnicity matched with 39 healthy children from local schools in Surrey (England). Dental examinations were completed for indices for both the primary and permanent dentitions comprising decayed, missing and filled teeth and surfaces, plaque index, gingivitis index, developmental enamel defects, and incisor tooth trauma. RESULTS: There was no significant difference in the dmfs, dmft, DMFS or DMFT in the children with epilepsy compared with the controls. There was a significantly greater mean plaque score associated with permanent teeth in the children with epilepsy 68.0 SD+/- 31.5, compared with the control children, 142.9 SD+/- 23.2, p<0.0001. The mean +/- SD gingivitis score was significantly greater in the children with epilepsy 47.9+/-33.8, compared with the control children, 15.85+/-21.8, p<0.001. A significantly greater number of children with epilepsy had experienced anterior tooth trauma, 54% in all, compared with the controls, 12.5% p<0.0001. Although children with epilepsy had greater mean plaque and gingivitis scores, the prevalence of dental caries was low. Children and teenagers with intractable epilepsy were more likely to have sustained dental trauma than controls. CONCLUSIONS: A dental service aimed at early attention to anterior tooth trauma is needed. In addition, there is an ongoing need for improving the oral hygiene of these individuals to prevent the development of periodontal disease in later life.

A survey of attitudes, knowledge and practice of dentists in London towards child protection. Are children receiving dental treatment at the Eastman Dental Hospital likely to be on the child protection register?

OBJECTIVE: To investigate the attitudes, knowledge and practices of general dental practitioners (GDPs), specialists and consultants in paediatric dentistry in London, towards child protection. Additionally, to determine if children attending paediatric dental casualty at the Eastman Dental Hospital (EDH) and those who need treatment of caries under general anaesthesia (GA) are on the child protection register (CPR). DESIGN: The survey was conducted by postal questionnaires with 14 closed questions. A total of 228 dentists were invited to participate in the study. Children who attended EDH and required treatment under GA or at paediatric dental casualty were checked against the CPR. RESULTS: The respond rate was 46% (105/228). Overall 15% (16/105) of dentists had seen at least one patient with suspected child abuse in the last six months, but only 7% (7/105) referred or reported cases to child protection services. Reasons for dentists not referring included: fear of impact on practice (10%; 11/105); fear of violence to child (66%; 69/105); fear of litigation (28%; 29/105); fear of family violence against them (26%; 27/105); fear of consequences to the child (56%; 59/105); lack of knowledge regarding the procedures for referral (68%; 71/105); and lack of certainty about the diagnosis (86%; 90/105). Of the 220 children attending for dental GA and casualty from October 2004 to March 2005, one child was found to be on the CPR. CONCLUSION: More information and training is required to raise awareness of the potential importance of the role of dentists in child protection. Improved communication between dental and medical departments is important for safeguarding children.

Dental age assessment (DAA): a simple method for children and emerging adults.

INTRODUCTION: Methods of dental age assessment (DAA) give a wide margin of error and, because third molars are usually excluded, prevent estimation around the age of 18 years. This study extends the use of defined tooth development stages (TDSs) to include third molars. SUBJECTS AND METHODS: Re-use of dental panoramic tomographs (DPTs) and other X-rays taken for clinical use comprised the sample of 1,547 subjects. The radiographic images were then captured in digital format. The TDSs were assessed and the estimated mean age and its standard error were calculated for each TDS. The mathematical technique of meta-analysis was used to provide an estimate of the mean age, with 99% confidence interval, of a new 'test' subject. To assess the accuracy of the method, each of these mean values was then compared with the gold standard of chronological age. RESULTS: On average, estimated dental age (DA) over-estimated chronological age (CA) by 0.29 years, approximately 3(1/2) months. The maximum likely difference between the estimated DA and CA was 1.65 years. CONCLUSION: Estimation of dental age using well defined TDSs, extended to include third molars and combined with the statistical technique of meta-analysis, provides investigators with a rapid and accurate estimation of age.

Perioperative local anaesthetic in young paediatric patients undergoing extractions under outpatient 'short-case' general anaesthesia. A double-blind randomised controlled trial.

OBJECTIVE: To investigate if postoperative pain/discomfort and anxiety experienced by young children who had extractions under general anaesthesia (GA) were affected by perioperative injection techniques of local anaesthetic (LA). DESIGN: A single-centre, double-blind, randomised controlled trial. SETTING: Conducted in 2002/2003 at the Unit of Paediatric Dentistry, Eastman Dental Hospital, London. METHODS: Children, aged 2-6 years scheduled for extractions under GA, were randomly assigned to receive either no LA (NLA), infiltration injection (IFL) or intraligamental injection (ITR) perioperatively. All children received analgesic suppositories after induction. OUTCOME MEASURES: Anxiety was scored using the Venham Picture Scale. Postoperative pain was scored using the Simplified Toddler-Preschooler Postoperative Pain Scale and supplemented with the Modified Pain/Discomfort Scale. RESULTS: Eighteen children received NLA, 17 received IFL and 19 received ITR. Postoperative pain/discomfort and anxiety scores were not significantly different during the period of recovery. On the first night, the intraligamental group had significantly lower pain scores (p = 0.012). CONCLUSION: Postoperative pain/discomfort and anxiety during the period of recovery experienced by young children who had extractions under GA appear not to be affected by perioperative injection techniques of LA. Upon discharge, intraligamental injection appears beneficial, as it is probably well tolerated by causing less soft tissue numbness initially and thus, reduces perceived pain/discomfort.

Knowledge of dental trauma first aid (DTFA): the example of avulsed incisors in casualty departments and schools in London.

OBJECTIVE: To investigate awareness and practices of dental trauma first aid (DTFA) in hospital emergency settings and in primary and secondary schools in London. DESIGN: A cross-sectional study using self-administered questionnaires and semi-structured interviews. SETTING: Primary and secondary schools and casualty/emergency and walk-in casualty centres in London in 2005. SUBJECTS AND METHODS: A randomly selected sample of 125 schools and a total of 31 walk-in casualty centres, providing services for five randomly selected London boroughs. A person responsible for emergency care of children represented each of these study sites. RESULTS: Response rates of 81.6% and 87% were achieved for schools and casualty/emergency centres respectively. The school respondents who had previously received advice on DTFA were three times more likely to be willing to replant an avulsed tooth compared to those who had not. A third of casualty personnel showed gaps in knowledge in DTFA. Results from schools showed an unwillingness to start emergency action mainly due to perceived inadequacy in knowledge/skills and also for legal reasons. CONCLUSION: There is the need for further studies focused on the barriers resulting in unwillingness to provide DTFA among school personnel and clarification regarding issues of responsibility and acceptable levels of competence of professionals other than dentists.

Guidelines for the prevention of endocarditis: report of the Working Party of the British Society for Antimicrobial Chemotherapy.

These guidelines have been produced following a literature review of the requirement for prophylaxis to prevent bacterial endocarditis following dental and surgical interventions. Recommendations are made based on the quality of available evidence and the consequent risk of morbidity and mortality for "at risk" patients.

Duration, prevalence and intensity of bacteraemia after dental extractions in children.

OBJECTIVE: To investigate the duration, prevalence and intensity of bacteraemia after dental extractions in children by comparing within-patient bacteraemia before and after dental extraction. METHODS: Children were randomly allocated to one of 10 postprocedure time groups from 10 s to 60 min. The differences between intensity and prevalence of the bacteraemia at each time after extractions were used to estimate the duration of the bacteraemia. After attainment of general anaesthesia, pre-extraction and postextraction blood samples were processed by broth culture and lysis filtration to isolate and quantify bacteria present in the patients' blood. RESULTS: 500 subjects between 3 and 16 years old were recruited. The estimated duration of bacteraemia was about 11 min. CONCLUSIONS: The duration of bacteraemia after dental extractions is less than previously thought. This has implications for the interpretation of odontogenic bacteraemia studies.

Epidermolysis bullosa and dental developmental age.

OBJECTIVES: The dental development of permanent mandibular teeth in a small group of children with dystrophic epidermolysis bullosa (DEB) was assessed from radiographs and compared to a healthy, age-and-sex-matched control group. METHODS: This was a retrospective radiographic cross-sectional study. The sample consisted of a group of 44 children aged between 4 and 15 years with DEB and healthy, age-and-sex-matched controls. Two quantitative methods of assessing tooth formation were used: (1) a combination of information about tooth length and apex width; and (2) the use of tooth length to predict age. Panoramic radiographs were digitized in order to determine tooth length and apex width. Dental age was calculated, and the difference with real age was tested with Student's t-test. RESULTS: The dentition of both the DEB and control groups was slightly delayed. Using the first method, the delay was 0.34 +/- 0.87 years for the DEB group and 0.29 +/- 0.97 years for the control group. Using the second method, the delay was 0.49 +/- 1.18 years for the DEB group and 0.23 +/- 0.62 years for the control group. This delay was not statistically significant for either method. CONCLUSIONS: The dental formation of permanent mandibular teeth in the group of children with DEB was not significantly different to that found in the control group.

Penicillins for the prophylaxis of bacterial endocarditis in dentistry.

BACKGROUND: Many dental procedures cause bacteraemia and it is believed that this may lead to bacterial endocarditis (BE) in a few people. Guidelines in many countries recommend that prior to invasive dental procedures antibiotics are administered to people at high risk of endocarditis. However, it is unclear whether the potential risks of this prophylaxis outweigh the potential benefits. OBJECTIVES: To determine whether prophylactic penicillin administration compared to no such administration or placebo before invasive dental procedures in people at increased risk of BE influences mortality, serious illness or endocarditis incidence. SEARCH STRATEGY: The search strategy was developed on MEDLINE and adapted for use on the Cochrane Oral Health, Heart and Infectious Diseases Groups' Trials Registers (to October 2003), as well as the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2002), OLDMEDLINE (1966 to June 2002); EMBASE (1980 to June 2002); SIGLE (to June 2002); and the Meta-register of current controlled trials. SELECTION CRITERIA: Due to the low incidence of BE it was anticipated that few if any trials would be located. For this reason, cohort and case controlled studies were included where suitably matched control or comparison groups had been studied. The intervention was the administration of penicillin compared to no such administration before a dental procedure in people with an increased risk of BE. Cohort studies would need to follow those at increased risk and assess outcomes following any invasive dental procedures, grouping by whether prophylaxis was received. Included case control studies would need to match people who had developed endocarditis (and who were known to be at increased risk before undergoing an invasive dental procedure preceding the onset of endocarditis) with those at similar risk but who had not developed endocarditis. Outcomes of interest were: mortality or serious adverse event requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse events to the antibiotics; and cost implications of the antibiotic provision for the care of those patients who develop endocarditis. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies for inclusion, then assessed quality and extracted data from the included study. MAIN RESULTS: No RCTs, CCTs or cohort studies were included. One case-control study met the inclusion criteria. It collected all the cases of endocarditis in the Netherlands over 2 years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxys). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes. REVIEWERS' CONCLUSIONS: There is no evidence about whether penicillin prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. There is a lack of evidence to support published guidelines in this area. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.

Oral health and caries related microflora in children during the first three months following renal transplantation.

UNLABELLED: There is little information on the oral health of children undergoing renal transplantation during the early transplant period. METHODS: Twenty-four children undergoing renal transplantation aged 4-13.2 years and their matched controls were recruited. The dmfs, dmft, DMFS and DMFT, plaque, gingivitis and gingival enlargement scores were recorded. The oral microflora was sampled and cultured for S. mutans, Lactobacllus species and Candida species. RESULTS: There was a significantly lower mean dmfs (0.3 +/- 0.9; P = 0.03), dmft (0.3 +/- 0.9; P = 0.03), DMFS (2.3 +/- 5.3; P = 0.01) and DMFT (1.5 +/- 2.6; P = 0.02), respectively, in the transplant group. There was a significantly greater mean plaque score (14.7 +/- 11) for the permanent dentition, at baseline only, compared with 90 days post-transplantation (9.4 +/- 10.4; P = 0.02). There was a significantly greater gingival enlargement score (1.8 +/- 1.4; P = 0.04) 90 days post-transplantation compared with baseline. The S. mutans and Lactobacillus counts were significantly lower both at baseline (P = 0.0001 and P = 0.004) and 90 days post-transplantation (P = 0.02; and P = 0.05), respectively, compared with the controls. CONCLUSIONS: The transplant children had less active dental disease than the controls although gingival enlargement needs careful monitoring.

Metastatic infiltration of the dental pulp by medulloblastoma.

Medulloblastoma is an infratentorial primitive neuroectodermal tumour. It is the most commonly occurring brain tumour of childhood, accounting for 15-20% of all paediatric tumours. Extracranial metastasis is rare, but may involve the skeleton. Jaw lesions, however, have never been described. A case is reported of metastases of a medulloblastoma to the jaw including the dental pulp.

Dental disease indices and caries-related microflora in children with glycogen storage disease.

OBJECTIVE: To establish the levels of dental caries, bacterial dental plaque, gingivitis and caries-related microflora in children with glycogen storage disease (GSD). Patients with GSD are treated with regular intakes of glucose polymer and uncooked cornstarch to prevent hypoglycaemia. Dental health data are scarce. STUDY GROUP: The study group comprised 21 children with GSD attending the Great Ormond Street Hospital for Children. OUTCOME MEASURES: These included the number of decayed, missing and filled teeth, and surfaces in both the primary and permanent dentitions, plaque and gingivitis scores. Both plaque and saliva were collected from each child and cultured for Mutans streptococci, Lactobacilli and Candida. RESULTS: The study group included 13 boys and eight girls, aged from 2.7 to 15.5 years. Four of the 21 children had some caries experience. The mean dmft was 0.5 and the mean DMFT, 0.06. Mean plaque and gingivitis scores were 4.8 and 5.9, respectively, for plaque and gingivitis adjacent to the primary teeth, and 11.6 and 12 for those related to permanent teeth. CONCLUSIONS: Only a small proportion of the children had caries experience but most were found to have plaque associated with both primary and permanent teeth. Preventive care should be targeted to improve plaque control thus minimizing the risk of developing periodontal disease as adults.

Dental disease and caries related microflora in children with dystrophic epidermolysis bullosa.

PURPOSE: The purpose of this study was to investigate dental caries, bacterial dental plaque, gingivitis and caries related oral microflora in children with predominantly autosomal recessive Dystrophic Epidermolysis Bullosa (DEB). METHODS: Thirty children with DEB from The Great Ormond Street Hospital for Children and 31 control children matched for age, gender and ethnicity were included in the study. RESULTS: The main findings were: 1. A significantly greater mean dmft in the DEB children (p < 0.05). 2. A significantly greater mean plaque score for the DEB children for both the primary (p < 0.001) and permanent teeth (p < 0.02) compared with the control children. 3. A significantly greater mean gingivitis score for the DEB children for both the primary (p < 0.002) and permanent teeth (p < 0.0001) compared with the control children. 4. A significantly greater salivary total anaerobic count for the control children compared with the DEB children (p < 0.001). CONCLUSIONS: The results reflect the difficulties that children with DEB have with basic oral hygiene procedures combined with slow oral clearance.