Clinical orthodontic management during the COVID-19 pandemic.

OBJECTIVES: To provide a comprehensive summary of the implications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) on orthodontic treatment, contingency management, and provision of emergency orthodontic treatment, using currently available data and literature. MATERIALS AND METHODS: Orthodontically relevant sources of information were searched using electronic databases including PubMed and Google Scholar and current reports from major health bodies such as Centers for Disease Control and Prevention, World Health Organization, National Institutes of Health, and major national orthodontic associations. RESULTS: Where available, peer-reviewed and more recent publications were given priority. Due to the rapidly evolving nature of COVID-19 and limitations in quality of evidence, a narrative synthesis was undertaken. Relevant to orthodontics, human-to human transmission of SARS-CoV-2 occurs predominantly through the respiratory tract via droplets, secretions (cough, sneeze), and or direct contact, where the virus enters the mucous membrane of the mouth, nose, and eyes. The virus can remain stable for days on plastic and stainless steel. Most infected persons experience a mild form of disease, but those with advanced age or underlying comorbidities may suffer severe respiratory and multiorgan complications. CONCLUSIONS: During the spread of the COVID-19 pandemic, elective orthodontic treatment should be suspended and resumed only when permitted by federal, provincial, and local health regulatory authorities. Emergency orthodontic treatment can be provided by following a contingency plan founded on effective communication and triage. Treatment advice should be delivered remotely first when possible, and where necessary, in-person treatment can be performed in a well-prepared operatory following the necessary precautions and infection prevention and control (IPAC) protocol.

Comparison of dental outcomes in patients with nonsyndromic complete unilateral cleft lip and palate who receive secondary alveolar bone grafting before or after emergence of the permanent maxillary canine.

INTRODUCTION: For patients with complete unilateral cleft lip and palate (CUCLP), secondary alveolar bone grafting (SABG) can be performed before or after the emergence of the cleft side permanent canine (pre-CE and post-CE, respectively). The controversy regarding dental outcomes related to the timing of SABG remains unsettled. The objective of this study was to evaluate dental survival and specific dental outcomes of cleft-adjacent teeth in children with CUCLP who received either pre-CE or post-CE SABG. METHODS: The permanent maxillary canines and the central and lateral incisors of 21 pre-CE and 23 post-CE SABG subjects with nonsyndromic CUCLP and all cleft-related surgeries performed by the same surgeon were analyzed retrospectively. Intraoral radiographs and clinical chart notes were collected at age 7 years, at the time of the SABG, and approximately 4 years after the grafting. Dental survival, spontaneous canine eruption, planned prosthetic replacement, root development, and root resorption were analyzed. RESULTS: Dental outcomes on the noncleft side were better than those on the cleft side. On the cleft side, dental survival of the cleft-adjacent teeth was not significantly different between the pre-CE and post-CE SABG groups (P >0.05). Most teeth completed root development after grafting, and the cleft side canine root development in the pre-CE SABG group appeared to accelerate after SABG. Trends showed that the pre-CE SABG group suffered less root resorption (16.28%; post-CE: 22.73%; P >0.05) and received fewer planned prosthetic replacements (14.29%; post-CE: 26.01%; P >0.05) but required a greater number of canine exposures (33.33%; post-CE: 4.55%; P = 0.02). CONCLUSIONS: Pre-CE SABG showed better dental outcomes in patients with CUCLP, with fewer adverse dental outcomes than post-CE SABG.

Infective endocarditis and orthodontic implications in children: A review of the literature.

INTRODUCTION: Owing to access to high-quality medical care, more medically compromised patients are seeking orthodontic therapy, including those at risk of developing infective endocarditis (IE). The current guidelines for orthodontic therapy and IE are few. The objective of this review is to provide an evidence-based update on the relationship between orthodontic procedures and IE in children. METHODS: A comprehensive review of the English language literature available through PubMed, Ovid Medline, and Google Scholar without any limits of years of publication was conducted to analyze the evidence regarding IE and orthodontics. LITERATURE REVIEW: A necessary prerequisite for IE is bacteremia. Although the only orthodontic procedure included in the current American Heart Association guidelines is the placement of bands, placement of separators has also been found to lead to significant bacteremia. Procedures with possible clinical significance include removal of expanders, placement of separators, and placement of bands. Because of the unavailability of high-quality evidence, elective invasive procedures prone to causing bacteremia should be avoided. CONCLUSIONS: Evidence regarding orthodontic treatment and IE is limited because of ethical considerations of conducting trials in patients who are at risk for IE. Clinical interpretation based on a comprehensive review of the available literature is therefore essential. CLINICAL IMPLICATIONS: Before initiating orthodontic therapy in cardiac patients, the patient's IE risk is best determined by referring to the current American Heart Association guidelines and through consultation with the patient's cardiologist. Procedures that can lead to tissue injury or bacteremia should be avoided. Oral hygiene must be reinforced because inflammation influences bacteremia.

Dental injuries in younger emergency department patients.

BACKGROUND: Dental trauma is a relatively common occurrence in childhood, with an impact exceeding that of periodontal diseases. It places a significant burden on the public health system because of its high frequency, impact on quality of life and consumption of resources. OBJECTIVES: To identify changing trends of dental injury in patients between 0-18 years of age in Canada and provide a detailed assessment of dental injury patterns in patients attending a large pediatric tertiary care hospital. METHODS: This retrospective study was carried out in two parts. Firstly, data from patients who presented to the emergency departments of the 15 Canadian hospitals involved in the Injury Reporting and Prevention Program (CHIRPP) from 1st January 1990 to 31st December 2013 was collected. Secondly, at the Hospital for Sick Children, charts of patients identified from the aforementioned database from the years 2008, 2012 and 2015 were accessed for additional clinical data. RESULTS: Based on CHIRPP data there appears to be an increasing incidence in dental injuries presenting to emergency departments nationally. Participation in sports and cycling contributed to the majority of dental injuries. The use of safety equipment such as helmets with a face-grill and mouth-guard was low. CONCLUSIONS: Our study demonstrates a rising incidence of dental injuries in young patients. Most dental injuries occurred during sports and playground related activities. The low rate of use of safety equipment and playground safety measures suggests that Canadian Standards Association standards for playgrounds could be more effective if strengthened by mandatory legislation.