Generalised hypomineralisation of enamel in oculodentodigital dysplasia: comprehensive dental management of a case.

Oculodentodigital dysplasia (ODDD) is a rare congenital disorder characterised by developmental abnormalities of the eye, dentition and digits of the hands and feet, with neurological symptoms reported in 30% of individuals. Dental anomalies associated with ODDD include enamel hypoplasia and subsequent caries, microdontia, missing teeth, amelogenesis imperfecta, pulp stones and delayed tooth development. Here, we describe the comprehensive dental management of a 3-year-old girl who presented with rapid deterioration of the primary dentition due to generalised enamel hypomineralisation. Conservative, comprehensive restorative management was performed under general anaesthesia. Within 6 months, further breakdown of the remaining unrestored enamel was noted. This case documents the challenges of conservative management in dental anomalies that are not well documented due to the extreme rarity of the disorder.

Comparison of Intubated Versus Nonintubated Airway Management in Children Under General Anesthesia Provided by Dentist Anesthesiologists.

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (0.2 percent), two incidents of hypoxia (less than 0.1 percent), and six incidents of difficult airway (0.1 percent). When intubated versus nonintubated GA was compared for respiratory complication incidence, no significant association was found (P=0.81, odds ratio equals 0.93). Conclusion: No significant difference was found between the incidence of respiratory complications with intubated versus nonintubated GA provided by dentist anesthesiologists.

Adverse Events During Dental Care for Children: Implications for Practitioner Health and Wellness.

Adverse events during dental care for children inevitably happen, despite precautionary procedures. Remedial measures have primarily focused upon affected children and their parents/caregivers. The purpose of this paper was to summarize the effects of adverse events upon practitioners involved in the incident who have been termed second victims. Affected practitioners may suffer negative emotions impinging upon their professional performance as well as deleterious personal health consequences, including substance abuse and depression/suicidal ideation. Peer support has been identified as an important mechanism to foster recovery in second victims. Practitioners need supportive efforts following their inadvertent involvement in adverse events to facilitate their recovery and maintenance of personal health and wellness.

Procedural pain in routine dental care for children: a part of the Swedish BITA study.

AIM: To investigate the frequency and reported intensity levels of dental treatment pain and discomfort in children, in conjunction with regular dental visits. METHODS: The study included 2363 children in four different age cohorts. Data was collected from structured interviews by dental personnel regarding pain experiences or discomfort after treatments, including analgesia, extractions, operative treatments and radiographic examinations. RESULTS: One-third of all treatment occasions were experienced as painful and/or causing discomfort. Treatment sessions including analgesia were assessed as painful in 49.7% of occasions, with injection being the most common given reason for pain. Extraction was painful in 62.4% of occasions, with injection as the main reason for pain. Operative treatments were assessed as painful in 38.8% of occasions, with drilling as the most common reason for pain and discomfort. Pain was reported in approximately 19% of all radiographic examinations. CONCLUSIONS: Injection was the major reason for pain during treatment, including injection and extraction, while drilling was the most common cause of pain during restorative treatment. Dentists should try to minimise the experience of pain and discomfort by using all available measures to perform pain-free and effective dental injections.

Postoperative dental morbidity in children following dental treatment under general anesthesia.

BACKGROUND: General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. METHODS: From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. RESULTS: Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. CONCLUSION: Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.

Middle East respiratory syndrome in children. Dental considerations.

As of January 2016, 1,633 laboratory-confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection and 587 MERS-related deaths have been reported by the World Health Organization globally. Middle East Respiratory Syndrome Coronavirus  may occur sporadically in communities or may be transmitted within families or hospitals. The number of confirmed MERS-CoV cases among healthcare workers has been increasing. Middle East Respiratory Syndrome Coronavirus may also spread through aerosols generated during various dental treatments, resulting in transmission between patients and dentists. As MERS-CoV cases have also been reported among children, pediatric dentists are at risk of MERS-CoV infection. This review discusses MERS-CoV infection in children and healthcare workers, especially pediatric dentists, and considerations pertaining to pediatric dentistry. Although no cases of MERS-CoV transmission between a patient and a dentist have yet been reported, the risk of MERS-CoV transmission from an infected patient may be high due to the unique work environment of dentists (aerosol generation).

Orbital, Mediastinal and Cervicofacial Subcutaneous Emphysema after Dental Rehabilitation in a Pediatric Patient.

Subcutaneous emphysema is a rare possible complication of dental procedures. The majority of the dental literature describes cases of localized areas of subcutaneous emphysema following various dental procedures, with a large number of these cases seen following intraoral surgical procedures. Classically, subcutaneous emphysema occurs within minutes to hours after conclusion of dental procedures and is commonly misdiagnosed as either an allergic reaction or acute post-operative swelling. This case report describes a four-year-old male who underwent dental rehabilitation for routine restorative dentistry without extractions under general anesthesia. He subsequently developed extensive subcutaneous emphysema involving the right periorbital region, cervicofacial spaces, and caudal extension to include the superior aspect of the mediastinum. The purpose of this report was to provide a brief review of the prior literature on the subject, report on the case, and review the management for patients with subcutaneous emphysema.

Sinais vitais em crianças e adolescentes submetidos à diferentes tratamentos em Odontopediatria / Vital signs in children and adolescents subjected to different treatments in pediatric dentistry

O objetivo do presente estudo foi monitorar os sinais vitais em crianças e adolescentes submetidos aos diferentes tratamentos na Odontopediatria. Inicialmente foi realizada uma revisão sistemática da literatura para avaliar se procedimentos odontológicos em crianças são capazes de provocar mudanças na pressão sanguínea. Com relação a revisão sistemática, cinco artigos preencheram os critérios de inclusão, na busca eletrônica nas bases Lilacs, PubMed, Web of Science, e Scopus, e concluiu-se que existe evidencia moderada para suportar as mudanças na pressão sanguínea em crianças submetidas a procedimentos odontológicos. Posteriormente, foi elaborado a pesquisa que gerou o segundo artigo da Tese denominado Aferição das alterações nos sinais vitais em crianças frente aos procedimentos em Odontopediatria e o seu perfil social foi dividido em duas fases. A fase I: clínica e a fase II: questionários. A fase I examinou 64 crianças e adolescentes atendidos na clínica de Odontopediatria da Faculdade de Odontologia da Universidade Federal do Rio de Janeiro divididos em 2 grupos: 32 pacientes compareceram para Revisão (Grupo R) com aferição da pressão arterial (PA), frequência cardíaca e saturação periférica de oxigênio antes e depois do procedimento odontológico. O outro Grupo A, também com 32 pacientes foram submetidos a anestesia para o tratamento, sendo aferido a pressão arterial, frequência cardíaca e oximetria, no início do tratamento, após a anestesia e no final do tratamento. Os responsáveis pelos pacientes dos dois grupos receberam o questionário para obter dados da saúde, hábitos alimentares, atividade física e nível socioeconômico. A frequência cardíaca mostrou diferença significativa (p<0,001) entre o início e o final dos tratamentos nos dois grupos. Houve elevação da pressão sistólica e diastólica em 28,8% dos pacientes do grupo R e em 38,4% dos do Grupo A, tendo retornado ao normal em 96,8% dos pacientes. As alterações de elevação da pressão arterial ocorreram na fase inicial dos procedimentos. Podemos supor que o fator ansiedade e medo iniciais contribuem para esta alteração. Na fase II (questionário) a elevada ingestão de biscoitos (79,7%) e de refrigerantes (84,4%) durante a semana pelos participantes do estudo além da prática de atividade física (37,5%) apenas uma vez por semana, foram achados relevantes e preocupantes nesta pesquisa. O presente estudo demonstrou pequenas alterações nos parâmetros cardíacos avaliados nos dois grupos, sendo que o retorno à normalidade após o final dos procedimentos foi verificado. Uma atenção maior aos hábitos alimentares não saudáveis capazes de produzir alterações cardíacas nas crianças e adolescentes em longo prazo e a falta da prática de atividades físicas regulares devem ser mais bem divulgadas e discutidas nas mídias sociais e nos consultórios odontopediátricos. (AU)

The research underscores the fact that little is known about the influence of cardiac alterations on the child's health and its implications on dental treatment. Primary factors such as, Obesity, sodium concentrations in food, inadequate diet and idleness in the present day, are generating a new lifestyle. The objective of the present study was to monitor the vital signs in children and adolescents submitted to different treatments in Pediatric Dentistry. A systematic review of the literature was carried out to evaluate whether dental procedures in children are capable of causing changes in blood pressure. Regarding the systematic review, five articles met the criteria for inclusion in the electronic search in the databases: Lilacs, PubMed, Web of Science, and Scopus, and concluded that there is moderate evidence to support changes in blood pressure in children undergoing dental procedures. Article 2, titled Measurement of changes in the body in children in relation to procedures in Pediatric Dentistry and its social profile was divided into two phases. Phase I: clinical and phase II: questionnaires. Phase I examined 64 children and adolescents attending the Pediatric Dentistry Clinic of the Faculty of Dentistry of the Federal University of Rio de Janeiro. Subjects were divided into two groups: 32 patients attended for Revision (Group R) for gauging blood pressure, heart rate and peripheral saturation of Oxygen before and after the dental procedure. The other group, A, also with 32 patients underwent anesthesia for the treatment, being measured arterial pressure, heart rate and oximetry, at the beginning of treatment, after anesthesia and at the end of the treatment. Patients in both groups received the questionnaire to obtain health data, eating habits, physical activity and socioeconomic status. The heart rate showed a significant difference (p <0.001) between the beginning and the end of treatments in both groups. There was an increase in systolic and diastolic pressure in 28.8% of patients in-group R and in 38.4% of patients in-group A, and returned to normal in 96.8% of patients. Changes in blood pressure occurred in the initial phase of the procedures. We may assume that the initial anxiety and fear factors contribute to this change. In phase II (questionnaire) the high intake of biscuits (79.7%) and soft drinks (84.4%) during the week by study participants beyond practice of physical activity (37.5%) only once a week were found to be relevant and worrying in this study. The present study showed small changes in the cardiac parameters evaluated in both groups, and the return to normal after the end of the procedures was verified. Greater attention to unhealthy eating habits capable of producing cardiac changes in children and adolescents in the long term and lack of regular physical activity should be better publicized and discussed in social media and pediatric dental care. (AU)

La encuesta pone de relieve la atención sobre el hecho de que se sabe poco acerca de la influencia de los cambios cardíacos en la salud del niño y sus implicaciones para el tratamiento dental. factores primarios tales como la obesidad, las concentraciones de sodio en los alimentos, la dieta poco saludable y la inactividad en estos días, la creación de un nuevo estilo de vida. El propósito de este estudio fue monitorear los signos vitales en niños y adolescentes sometidos a distintos tratamientos en odontología pediátrica. Una revisión sistemática de la literatura se realizó para evaluar si los procedimientos dentales en los niños son capaces de provocar cambios en la presión arterial.. En cuanto a la revisión sistemática cinco artículos cumplieron los criterios de inclusión, la búsqueda electrónica en las bases de datos: lilas, PubMed, Web of Science y Scopus, y resulta que hay evidencia moderada de cambios en la presión arterial en niños sometidos a procedimientos dentales. Posteriormente fue elaborado um segundo artículo medición de los cambios en el cuerpo en frente de los niños en los procedimientos de odontología pediátrica y su perfil social, dividido en dos fases. Fase I: Clinica y fase II cuestionarios. Em La fase de exame clínico fueron examinados 64 niños y adolescentes en atendidos em La clínica de odontología pediátrica de la Faculadad de Odontología de la Universidad Federal de Río de Janeiro.divididos en 2 grupos: 32 pacientes procedían de Revisión (Grupo R) con la presión arterial, la frecuencia cardíaca y la saturación periférica de oxígeno antes y después del procedimiento dental. El otro (grupo A), de 32 pacientes también se sometió a anestesia para el tratamiento, y se mide la presión arteriall, ritmo cardíaco y oximetría de pulso al comienzo del tratamiento, después de la anestesia y el final de tratamento.Os responsable de los pacientes de ambos grupos recibido el cuestionario para los datos de salud, hábitos alimenticios, actividad física y el estatus socioeconómico. La frecuencia cardíaca fue significativamente diferente (p <0,001) entre el inicio y el final del tratamiento en ambos grupos. No hubo aumento en la presión arterial sistólica y diastólica en 28,8% del grupo R y el 38,4% del grupo A, retornando a la normalidad en 96,8% de los pacientes. Los cambios de elevación de la presión arterial se producen en la etapa inicial del procedimiento. Podemos suponer que la ansiedad inicial y factor miedo que contribuye a esta fase alteração. En la fase II (cuestionario) alto consumo de galletas (79,7%) y bebidas no alcohólicas (84,4%) durante la semana por los participantes en el estudio y la práctica actividad física (37,5%) una vez por semana, fueron hallazgos relevantes y preocupantes en esta investigación. El presente estudio demostró pequeños cambios en parámetros cardíacos evaluados en dos grupos, con el retorno a la normalidad después de que el final del procedimiento fueron verificados. Una mayor atención a los malos hábitos alimenticios pueden producir anomalías cardíacas en niños y adolescentes en el largo plazo y la falta de actividad física regular debería estar mejor difusión y debate en los medios de comunicación y consultorios Odontopediatricos. (AU)

Preoperative analgesics for additional pain relief in children and adolescents having dental treatment.

BACKGROUND: Fear of dental pain is a major barrier to treatment for children who need dental care. The use of preoperative analgesics has the potential to reduce postoperative discomfort and intraoperative pain. We reviewed the available evidence to determine whether further research is warranted and to inform the development of prescribing guidelines. This is an update of a Cochrane review published in 2012. OBJECTIVES: To assess the effects of preoperative analgesics for intraoperative or postoperative pain relief (or both) in children and adolescents undergoing dental treatment without general anaesthesia or sedation. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 5 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 12), MEDLINE via OVID (1946 to 5 January 2016), EMBASE via OVID (1980 to 5 January 2016), LILACS via BIREME (1982 to 5 January 2016) and the ISI Web of Science (1945 to 5 January 2016). We searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials to 5 January 2016. There were no restrictions regarding language or date of publication in the searches of the electronic databases. We handsearched several specialist journals dating from 2000 to 2011.We checked the reference lists of all eligible trials for additional studies. We contacted specialists in the field for any unpublished data. SELECTION CRITERIA: Randomised controlled clinical trials of analgesics given before dental treatment versus placebo or no analgesics in children and adolescents up to 17 years of age. We excluded children and adolescents having dental treatment under sedation (including nitrous oxide/oxygen) or general anaesthesia. DATA COLLECTION AND ANALYSIS: Two review authors assessed titles and abstracts of the articles obtained from the searches for eligibility, undertook data extraction and assessed the risk of bias in the included studies. We assessed the quality of the evidence using GRADE criteria. MAIN RESULTS: We included five trials in the review, with 190 participants in total. We did not identify any new studies for inclusion from the updated search in January 2016.Three trials were related to dental treatment, i.e. restorative and extraction treatments; two trials related to orthodontic treatment. We did not judge any of the included trials to be at low risk of bias.Three of the included trials compared paracetamol with placebo, only two of which provided data for analysis (presence or absence of parent-reported postoperative pain behaviour). Meta-analysis of the two trials gave arisk ratio (RR) for postoperative pain of 0.81 (95% confidence interval (CI) 0.53 to 1.22; two trials, 100 participants; P = 0.31), which showed no evidence of a benefit in taking paracetamol preoperatively (52% reporting pain in the placebo group versus 42% in the paracetamol group). One of these trials was at unclear risk of bias, and the other was at high risk. The quality of the evidence is low. One study did not have any adverse events; the other two trials did not mention adverse events.Four of the included trials compared ibuprofen with placebo. Three of these trials provided useable data. One trial reported no statistical difference in postoperative pain experienced by the ibuprofen group and the control group for children undergoing dental treatment. We pooled the data from the other two trials, which included participants who were having orthodontic separator replacement without a general anaesthetic, to determine the effect of preoperative ibuprofen on the severity of postoperative pain. There was a statistically significant mean difference in severity of postoperative pain of -13.44 (95% CI -23.01 to -3.88; two trials, 85 participants; P = 0.006) on a visual analogue scale (0 to 100), which indicated a probable benefit for preoperative ibuprofen before this orthodontic procedure. However, both trials were at high risk of bias. The quality of the evidence is low. Only one of the trials reported adverse events (one participant from the ibuprofen group and one from the placebo group reporting a lip or cheek biting injury). AUTHORS' CONCLUSIONS: From the available evidence, we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in using preoperative analgesics prior to orthodontic separator placement. The quality of the evidence is low. Further randomised clinical trials should be completed with appropriate sample sizes and well defined outcome measures.

Comparative evaluation of diffusion hypoxia and psychomotor skills with or without postsedation oxygenation following administration of nitrous oxide in children undergoing dental procedures: A clinical study.

BACKGROUND: Diffusion hypoxia is the most serious potential complication associated with nitrous oxide. It occurs during the recovery period. Hence, administration of 100% oxygen is mandatory as suggested by many authors. AIM: The aim of this study is to evaluate the occurrence/nonoccurrence of diffusion hypoxia in two groups of patients undergoing routine dental treatment under nitrous oxide sedation when one group is subjected to 7 min of postsedation oxygenation and the second group of the patients is made to breathe room air for the similar period. MATERIALS AND METHODS: A total of sixty patients within the age group of 7-10 years requiring invasive dental procedures were randomly divided into two groups of 30 each using chit method. In the control group, patients were administered 100% oxygen postsedation, whereas, in the study group, patients were made to breathe room air postsedation. Various parameters (pulse rate, respiratory rate, blood pressure, and oxygen saturation [SpO2]) were recorded pre- and post-operatively. Data were collected and then sent for statistical analysis. RESULTS: The mean postoperative SpO2 at measurement times 1, 3, 5, and 7 min in both the groups was higher than the mean preoperative SpO2. This increase was statistically significant. No significant difference was found between the Trieger test scores. CONCLUSION: This study proves that clinical occurrence of diffusion hypoxia is not possible while following the routine procedure of nitrous oxide sedation.

Perfil socioeconômico dos usuários e motivo de procura de uma clínica de ensino / Perfil socioeconómico de los usuarios y motivos por los que buscan atención dental en clínicas de enseñanza / Socioeconomic profile of users and reasons why they seek dental care in teaching clinics

Introdução: as instituições de ensino têm compromisso com a formação profissional qualificada, devendo estar preparada para atuar na sociedade. Objetivo: conhecer o perfil socioeconômico dos usuários da Clínica de Cariologia, identificando os motivos de procura do serviço. Métodos: estudo transversal e quantitativo, analisado dos prontuários da Clínica de Cariologia de uma IES. Foram analisados todos os 313 prontuários no período de 2011 a 2013. Os dados coletados foram: variáveis sociodemográficas (idade, gênero, renda familiar, escolaridade materna e paterna) e motivos da procura pelo serviço. Esses dados foram trabalhados descritivamente, sendo submetidos ao teste estatístico qui-quadrado considerando significativo no nível de 5 por cento. Resultados: os usuários tinham idade média em 6 ± 7,81 anos, havendo distribuição homogênea entre os sexos, feminino (50,2 por cento) e masculino (49,8 por cento). A maioria dos pais e mães estudou mais de oito anos, sendo 67,35 por cento e 70,43 por cento, respectivamente. Cerca de 37,75 por cento dos pais e 43,9 por cento das mães com mais de oito anos de escolaridade procuram a Clínica para realização de tratamento, enquanto 29,6 por cento de pais e 26,53 por cento das mães, o motivo foi a prevenção. Observou-se relação entre escolaridade paterna e motivos pela procura do serviço (p= 0,01). Quanto à renda, 49,9 por cento relatou não ter renda familiar, 39,8 por cento recebem até um salário mínimo e 10,4 por cento recebem mais de um salário. Das famílias sem renda, 37 por cento buscam o serviço para a realização de tratamento, e 12,7 por cento para prevenção. Conclusão: O perfil da população que procurou a clínica foi aquela mais vulnerável socioeconomicamente e o motivo para consulta foi o tratamento(AU)

Introducción: las instituciones educativas se dedican a la formación profesional cualificado, debe estar preparado para actuar en la sociedad. Objetivo: conocer el perfil socioeconómico de los usuarios de Cariología Clínica, identificar las razones de la demanda del servicio. Métodos: estudio transversal y estudio cuantitativo, se analizaron los registros clínicos de cariología de una Institución de Educación Superior. 313 registros fueron analizados en 2011-2013. Los datos recogidos fueron: variables sociodemográficas (edad, sexo, ingreso familiar, la educación materna y paterna) y las razones de la búsqueda de tratamiento. Estos datos se trabajaron, de forma descriptiva y se sometieron a la prueba de chi-cuadrado estadística se consideró significativo al 5 por ciento. Resultados: los usuarios tenían edad media de 6 ± 7,81 años, con una distribución uniforme entre los sexos, las mujeres (50,2 por ciento) y hombres (49,8 por ciento). La mayoría de los padres y madres estudiaron más de ocho años, y 67.35 por ciento y 70.43 por ciento, respectivamente. Aproximadamente 37,75 por ciento de los padres y el 43,9 por ciento de las madres con más de ocho años de escolaridad acuden a la Clínica para realizar el tratamiento, mientras que 29,6 por ciento de los padres y el 26,53 por ciento de las madres, la razón era para prevenir. La relación observada entre la educación y los motivos de la demanda del servicio de los padres fue: p= 0,01. En cuanto a los ingresos, el 49,9 por ciento informó que no hubo ingresos de la familia, 39,8 por ciento recibe hasta un salario mínimo, y 10,4 opr ciento gana más de un cheque de pago. Las familias sin ingresos, el 37 por ciento buscan el servicio para llevar a cabo el tratamiento, y el 12,7 pr ciento para la prevención. Conclusión: el perfil de la población que buscó asistencia en la clínica fue el más vulnerable socioeconómicamente y el motivo de consulta fue el tratamiento(AU)

Introduction: educational institutions are in charge of training qualified professional personnel who must be prepared to act in society. Objective: describe the socioeconomic profile of dental clinic users and identify the reasons why they make use of the service. Methods: a cross-sectional quantitative study was conducted of clinical cariology records from a higher education institution. 313 records were analyzed in the years 2011-2013. The data collected were sociodemographic variables (age, sex, family income, parents' schooling level) and reasons why they seek care. Data were treated descriptively and subjected to chi-square statistical tests, where 5 percent was considered significant. Results: users' mean age was 6 ± 7.81 years with an even distribution between the sexes: female 50.2 percent and male 49.8 percent. Most parents had attended school for more than eight years: fathers 67.35 percent and mothers 70.43 percent. Around 37.75 percent of the fathers and 43.9 percent of the mothers with more than eight years of schooling go to the clinic for treatment, whereas 29.6 percent of the fathers and 26.53 percent of the mothers seek preventive care. The relationship found between education and reasons why parents seek care was p= 0.01. As to family income, 49.9 percent reported that the family did not receive any, 39.8 percent receive minimum wages and 10.4 percent get more than one paycheck. Among no-income families, 37 percent attend the service in search of treatment and 12.7 percent seek preventive care. Conclusion: the population seeking care at the clinic was the most vulnerable socioeconomically and the reason for attending consultation was treatment(AU)

Acupuncture Reduces Pain and Autonomic Distress During Injection of Local Anesthetic in Children: A Pragmatic Crossover Investigation.

OBJECTIVES: Stimulation of acupoint LI4 has been shown to result in analgesic effects in patients experiencing acute pain. We aimed to study the effectiveness of LI4 stimulation for pain relief in children receiving an injection of a local anesthetic (LA). MATERIALS AND METHODS: Children scheduled for dental treatment using LA received bilateral acupuncture at LI4 using indwelling fixed needles. During the treatment, the parents of the patients stimulated the needles by massage. Two different treatment regimes were compared: a standardized LA injection given 5 minutes after acupuncture, and an LA injection without acupuncture. The order of treatment was randomized, with the 2 treatments performed in a crossover manner on different days. Pain intensity during LA injection, assessed by the patient with the Verbal Rating Scale or Faces Pain Scale (0 to 10), was used as the primary endpoint. Parent-assessed and dentist-assessed pain intensity and agitation, heart rate, and the patients' satisfaction with the therapy were also recorded. RESULTS: Data were obtained from 49 patients (22 female; mean age 10 y). Patients reported less pain when acupuncture was used: mean 2.3 (95% confidence interval, 1.5-3.1) versus 3.9 (95% confidence interval, 3.0-4.7); P<0.001. The patients' heart rate remained low throughout the dental treatment after LI4 stimulation, when compared with treatment without acupuncture (P<0.05). LI4 stimulation was safe and increased satisfaction levels in both the patients and their parents, when compared with LA injection alone (P<0.05). DISCUSSION: Stimulation of acupoint LI4 reduces pain and autonomic distress in children during LA injection in dental procedures.

[Dental treatment in children with dystrophic form of epidermolysis bullosa].

The aim of the study was to summarize the experience for providing oral health care in children with epidermolysis bullosa (EB) treated in Central Research Institute of Dentistry and Maxillofacial Surgery in 2013-2014. Seven EB patients (5 female and 2 male aged 5-17) with dystrophic form of EB were included in the study. Oral status was recorded (oral hygiene, presence of enamel hypoplasia and intraoral soft tissue lesions). Dental treatment provided included teeth extractions under conscious sedation (6 cases), teeth treatment (both conventional and ART methods) (5 cases) and preventive program (5 cases). All 7 dystrophic EB patients presented with generalized enamel hypoplasia in both primary and permanent dentition. In these patients one should consider using non-adhesive face dressings and careful suction pipe positioning as well as applying liniments on cotton rolls not to cause both intraoral and extraoral soft tissue lesions. Sixteen milk teeth were extracted under conscious sedation, in 3 cases the procedure caused significant vestibular scarring. Twelve teeth were treated mostly by ART method (n=1 0) as limited mouth opening made conventional treatment impossible. Dental treatment in dystrophic EB is a real challenge for pediatric dentist. This group of patients requires a special dental rehabilitation plan as they present with generalized enamel hypoplasia and have significant risk of intraoral lesions.

Local anesthetic calculations: avoiding trouble with pediatric patients.

Local anesthetic systemic toxicity (LAST) is a rare but avoidable consequence of local anesthetic overdose. This article will review the mechanism of action of local anesthetic toxicity and the signs and symptoms of LAST. Due to physiologic and anatomic differences between children and adults, LAST occurs more frequently in children; particularly when 3% mepivacaine is administered. The calculation of the maximum recommended dose based on mg/lb body weight, Clark's rule, and the Rule of 25 in order to prevent LAST will also be reviewed, as well as the appropriate treatment procedures for a local anesthetic overdose.

Preformed crowns for decayed primary molar teeth.

BACKGROUND: Crowns for primary molars are preformed and come in a variety of sizes and materials to be placed over decayed or developmentally defective teeth. They can be made completely of stainless steel (know as 'preformed metal crowns' or PMCs), or to give better aesthetics, may be made of stainless steel with a white veneer cover or made wholly of a white ceramic material. In most cases, teeth are trimmed for the crowns to be fitted conventionally using a local anaesthetic. However, in the case of the Hall Technique, PMCs are pushed over the tooth with no local anaesthetic, carious tissue removal or tooth preparation. Crowns are recommended for restoring primary molar teeth that have had a pulp treatment, are very decayed or are badly broken down. However, few dental practitioners use them in clinical practice. This review updates the original review published in 2007. OBJECTIVES: Primary objectiveTo evaluate the clinical effectiveness and safety of all types of preformed crowns for restoring primary teeth compared with conventional filling materials (such as amalgam, composite, glass ionomer, resin modified glass ionomer and compomers), other types of crowns or methods of crown placement, non-restorative caries treatment or no treatment. Secondary objectiveTo explore whether the extent of decay has an effect on the clinical outcome of primary teeth restored with all types of preformed crowns compared with those restored with conventional filling materials. SEARCH METHODS: We searched the following electronic databases: Cochrane Oral Health Group Trials Register (to 21 January 2015), Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, 2014, Issue 12), MEDLINE via Ovid (1946 to 21 January 2015) and EMBASE via Ovid (1980 to 21 January 2015). We searched the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials and Open Grey for grey literature (to 21 January 2015). No restrictions were placed on the language or date of publication when searching the databases. SELECTION CRITERIA: Randomised controlled trials (RCTs) that assessed the effectiveness of crowns compared with fillings, other types of crowns, non-restorative approaches or no treatment in children with untreated tooth decay in one or more primary molar teeth. We would also have included trials comparing different methods of fitting crowns.For trials to be considered for this review, the success or failure of the interventions and other clinical outcomes had to be reported at least six months after intervention (with the exception of 'pain/discomfort during treatment and immediately postoperatively'). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the title and abstracts for each article from the search results. and independently assessed the full text for each potentially relevant study. At least two authors assessed risk of bias and extracted data using a piloted data extraction form. MAIN RESULTS: We included five studies that evaluated three comparisons. Four studies compared crowns with fillings; two of them compared conventional PMCs with open sandwich restorations, and two compared PMCs fitted using the Hall Technique with fillings. One of these studies included a third arm, which allowed the comparison of PMCs (fitted using the Hall Technique) versus non-restorative caries treatment. In the two studies using crowns fitted using the conventional method, all teeth had undergone pulpotomy prior to the crown being placed. The final study compared two different types of crowns: PMCs versus aesthetic stainless steel crowns with white veneers. No RCT evidence was found that compared different methods of fitting preformed metal crowns (i.e. Hall Technique versus conventional technique).We considered outcomes reported at the dental appointment or within 24 hours of it, and in the short term (less than 12 months) or long term (12 months or more). Some of our outcomes of interest were not measured in the studies: time to restoration failure or retreatment, patient satisfaction and costs. Crowns versus fillingsAll studies in this comparison used PMCs. One study reported outcomes in the short term and found no reports of major failure or pain in either group. There was moderate quality evidence that the risk of major failure was lower in the crowns group in the long term (risk ratio (RR) 0.18, 95% confidence interval (CI) 0.06 to 0.56; 346 teeth in three studies, one conventional and two using Hall Technique). Similarly, there was moderate quality evidence that the risk of pain was lower in the long term for the crown group (RR 0.15, 95% CI 0.04 to 0.67; 312 teeth in two studies).Discomfort associated with the procedure was lower for crowns fitted using the Hall Technique than for fillings (RR 0.56, 95% CI 0.36 to 0.87; 381 teeth) (moderate quality evidence).It is uncertain whether there is a clinically important difference in the risk of gingival bleeding when using crowns rather than fillings, either in the short term (RR 1.69, 95% CI 0.61 to 4.66; 226 teeth) or long term (RR 1.74, 95% CI 0.99 to 3.06; 195 teeth, two studies using PMCs with conventional technique at 12 months) (low quality evidence). Crowns versus non-restorative caries treatmentOnly one study compared PMCs (fitted with the Hall Technique) with non-restorative caries treatment; the evidence quality was very low and we are therefore we are uncertain about the estimates. Metal crowns versus aesthetic crownsOne split-mouth study (11 participants) compared PMCs versus aesthetic crowns (stainless steel with white veneers). It provided very low quality evidence so no conclusions could be drawn. AUTHORS' CONCLUSIONS: Crowns placed on primary molar teeth with carious lesions, or following pulp treatment, are likely to reduce the risk of major failure or pain in the long term compared to fillings. Crowns fitted using the Hall Technique may reduce discomfort at the time of treatment compared to fillings. The amount and quality of evidence for crowns compared to non-restorative caries, and for metal compared with aesthetic crowns, is very low. There are no RCTs comparing crowns fitted conventionally versus using the Hall Technique.

Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.

Orthodontic treatment for disabled children: a survey of parents' attitudes and overall satisfaction.

BACKGROUND: Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities. METHODS: The parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed. RESULTS: Parents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children. CONCLUSIONS: Among parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.

Assessment of occlusion after placement of stainless steel crowns in children - a pilot study.

Many stainless steel crowns (SSCs) disrupt the occlusion in children, but stabilisation appears to occur within a short period post-placement. The extent and mechanism of these short-term occlusal changes in children are unknown. This study sought to determine whether placement of a SSC changes the maximum intercuspation position (MIP) in children, whether the MIP returns to normal within 4 weeks and whether local anaesthesia had an effect on the child's ability to achieve MIP. The T-Scan(®) III was used for the measurement of occlusal contacts. Reliability and reproducibility of the system was determined using a calibration exercise where MIP recordings were taken of eleven children not undergoing any dental treatment. For the main study, the percentage of total occlusal force on each tooth was recorded in 20 children preoperatively, after local anaesthesia, after SSC placement and 4 weeks postoperatively. There was no significant difference in MIP (P = 0·435) preoperatively and post-administration of local anaesthesia. There was a significant difference between the preoperative force on a tooth and the reading after crown placement (P = 0·0013, Wilcoxon test). By 4 weeks, there was no significant difference overall between post-SSC placement and the preoperative value for the tooth (P = 0·3). Administration of local anaesthesia did not affect the ability of a child to attain MIP. Maximum intercuspation position was disturbed by the placement of a SSC in seven of 20 cases. When MIP was disturbed, in most cases, it returned to preoperative status within 4 weeks of crown placement.

'I felt weird and wobbly.' Child-reported impacts associated with a dental general anaesthetic.

AIM: This qualitative study sought to obtain children's accounts of having dental extractions under general anaesthesia (GA). The aim was to gain greater understanding of the physical and psychological impacts from a child's perspective. METHOD: Ten children, aged 6-11 years, maintained a video diary to document their feelings and experiences before, and following their hospital admission. Two semi-structured home interviews supplemented the video diary data and analysis was guided by narrative approaches. RESULTS: This research revealed new insights into children's experiences of having teeth removed under GA. Several of the post-operative impacts correlated with those previously reported by parents/carers. These were notably nausea, bleeding and tiredness, although children used different terminology. However, additional physical and psychological outcomes, both positive and negative, emerged from the children's narratives. Negative aspects included hunger, disturbed eating, being scared/worried and experiencing discomfort from the IV cannula. Interestingly, pain was not a strong theme. Positive outcomes were also reported, such as satisfaction with the resolution of their dental problem and receipt of rewards and attention from family members. CONCLUSION: These accounts have implications for improving patient experiences and outcomes throughout the dental GA care pathway. A review of pre-operative fasting protocols should be a priority.