Treatment of space loss caused by submerged maxillary second primary molar.

J Indian Soc Pedod Prev Dent. 2007 Mar;25(1):36-8

Authors: Karacay S, Guven G, Basak F

Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present the treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 12-year-old girl was referred to the pediatric dentistry clinic. The intra-oral examination revealed that right maxillary second primary molar was localized buccal side of posterior maxillary alveolar process, being almost completely covered by gingiva and adjacent teeth inclined closing the space of the related teeth completely. Periapical radiograph demonstrated that maxillary second premolar was impacted. Based on clinical and radiographic findings, maxillary primary second molar was extracted. Headgear was used for the distalization of maxillary right first molar in order to create space for the impacted second premolar. Eruption begun spontaneously 6 months later.

PMID: 17456966 [PubMed - indexed for MEDLINE]

Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update.

Pediatrics. 2006 Dec;118(6):2587-602

Authors: , , Coté CJ, Wilson S,

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age- and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children.

PMID: 17142550 [PubMed - indexed for MEDLINE]

The transmission of BANA-positive periodontal bacterial species from caregivers to children.

J Am Dent Assoc. 2006 Nov;137(11):1539-46

Authors: Lee Y, Tchaou WS, Welch KB, Loesche WJ

BACKGROUND: The purpose of the authors' study was to use the N-benzoyl-DL-arginine-2-naphthy-lamide (BANA) test (BANAMet LLC, Ann Arbor, Mich.) to obtain information regarding the prevalence of an enzyme unique to certain periodontal pathogens in plaque samples of children, as well as the potential transmission of these pathogens from caregivers to children. METHODS: The authors tested 218 subjects (3 to 10 years old) and 195 care-givers at four pediatric dentistry clinics in Taipei, Taiwan. RESULTS: Forty-four percent of the children had at least one plaque sample that tested positive and/or weakly positive. Positive results were more frequent in the mixed dentition, as well as in children with gingivitis (P < .001). A logistic regression model showed that if the BANA test results for the care-giver were positive, the odds of the child's also having positive test results were 55 times greater (P < .001; confidence interval [CI] = 14 to 224) than those for a child whose caregiver had negative BANA test results. Other predictors were the presence of a mixed dentition (P < .001; odds ratio [OR] = 11; CI = 3.5 to 33.5) and the children's papillary bleeding scores (P < .001, OR = 3.1, CI = 2.0 to 4.7). CONCLUSION: The BANA test results were positive for almost one-half of the children. A positive reaction was associated with gingivitis, a mixed dentition, a BANA-positive caregiver or a caregiver with a history of periodontal disease in the family. CLINICAL IMPLICATIONS: The authors propose an anaerobic periodontal infection risk model in which children with a mixed dentition who have gingivitis and a caregiver with a history of periodontal disease would undergo the BANA test.

PMID: 17082280 [PubMed - indexed for MEDLINE]

Fluoride knowledge and prescription practices among dentists.

J Dent Educ. 2006 Sep;70(9):956-64

Authors: Narendran S, Chan JT, Turner SD, Keene HJ

The purpose of this study was to assess dentists' knowledge about fluorides as well as their prescription practices. The study population consists of all general and pediatric dentists in Houston, and the sample consists of 360 general and forty-one pediatric dentists. Data were collected with a self-administered mail questionnaire, which consisted of thirteen open-ended and twenty-nine precoded items. After three mailings, the effective response rate was 46.4 percent. Respondents had been in practice on an average of 18.9 +/-6.6 years; the majority were male. More than 75 percent of respondents believed fluoride level in drinking water is an important determinant of fluoride supplement prescription, and 29 percent felt the same about a patient's weight. The correct ages at which to begin (six months) and to discontinue (sixteen years) the fluoride supplements to children were identified by 14.7 and 14.9 percent of the respondents, respectively. Only 6.7 percent of those prescribing fluoride supplements routinely tested the fluoride level in the patient's drinking water. Even though pediatric and general dentists differed in certain items, the two groups did not differ significantly in prescribing fluorides (OR=2.4, 95% CI=0.94, 6.27). Deficiencies and ambiguity in respondents' fluorides knowledge as well as prescription practices indicated a need for educational interventions.

PMID: 16954417 [PubMed - indexed for MEDLINE]

Estimated impact of competing policy recommendations for age of first dental visit.

Pediatrics. 2005 Apr;115(4):906-14

Authors: Jones K, Tomar SL

OBJECTIVE: To compare levels of dental utilization and untreated dental decay among children aged 1 to 3 years that are likely to occur under 2 potential guidance policies: (1) pediatricians refer all toddlers to dentists for screening (consistent with American Academy of Pediatric Dentistry and the American Dental Association recommendations; DENT), and (2) pediatricians receive training in caries risk assessment, screen toddlers, and refer at-risk children to dentists (consistent with American Academy of Pediatrics recommendations; PED). METHODS: Using decision analysis, we estimated the impact of PED and DENT assuming alternately unlimited dental capacity for Medicaid-insured patients and fixed Medicaid dental capacity. Results With unlimited capacity, if DENT were implemented, then dental utilization is estimated to increase from 27% under the status quo to 65% and untreated decay to decrease from a mean of 0.60 surfaces to 0.52 surfaces per child. If PED were implemented, then dental utilization and untreated decay would decrease from status quo levels to an estimated 11% and 0.47 surfaces, respectively, assuming that diagnostic sensitivity and specificity both equaled 1; they would decrease to 13% and 0.53 surfaces, respectively, if sensitivity equaled 0.76 and specificity equaled 0.95. With fixed capacity, under DENT, untreated decay is estimated to increase to 0.63 surfaces because low-risk private-pay patients would crowd out at-risk Medicaid-insured children, whereas under PED, untreated decay would still be less than under the status quo. CONCLUSIONS: Implementing PED will decrease untreated decay under most plausible scenarios, whereas switching to DENT will increase the burden of disease if Medicaid dental capacity is limited.

PMID: 15805363 [PubMed - indexed for MEDLINE]

Evaluation of an oral preventive protocol in children with acute lymphoblastic leukemia.

Pesqui Odontol Bras. 2003 Apr-Jun;17(2):147-50

Authors: Costa EM, Fernandes MZ, Quinder LB, de Souza LB, Pinto LP

This study was designed to assess the effectiveness of a preventive oral protocol in children receiving antineoplastic treatment for acute lymphoblastic leukemia (ALL) before initiating a larger intervention study. During a seven month period, fourteen children from two to ten years old with a diagnosis of ALL were evaluated. Patients with ALL who received a 0.12% chlorhexidine mouth rinse (seven children) were compared to a control group of patients who were not given the same preventive treatment (seven children) as to the occurrence of oral mucosal complications. Children in both groups received daily oral hygiene care, and were examined daily by the pediatric dentistry team until discharge. A significant decrease in the incidence of oral mucositis and ulceration was observed in the children who received a 0.12% chlorhexidine mouth rinse (p < 0.05 by Fisher's exact test). The findings obtained in the present trial are encouraging, and suggest that the systematic application of a preventive protocol reduces the incidence of oral complications in children with ALL receiving chemotherapy.

PMID: 14569357 [PubMed - indexed for MEDLINE]

Children's oral health in the medical curriculum: a collaborative intervention at a university-affiliated hospital.

J Dent Educ. 2003 Mar;67(3):338-47

Authors: Graham E, Negron R, Domoto P, Milgrom P

The purpose of this study was to 1) describe the structure of the oral health program in a university-affiliated hospital; 2) evaluate staff's knowledge and attitudes toward oral health; and 3) propose ways to strengthen the incorporation of oral health prevention for children into clinical medical education. Qualitative methods were used to evaluate the program. Structured interviews with seventeen medical center personnel were conducted, and clinic utilization reports provided ICD-9 diagnostic frequency and visits. Clinic staff, pediatric residents, dental and pediatric faculty, hospital administrators, and clinic directors were interviewed. The themes identified during these interviews were motivation, roles, operational and organizational issues, and integration into the larger medical care system. Integration of an early childhood caries prevention program into the clinical medical education curriculum can be accomplished. After implementation of the oral health program described in this paper, dental caries became the eleventh most common diagnosis seen in the clinic when previously it did not appear in the top forty. However, institutional and organizational barriers are significant. Barriers identified were 1) lack of clarity in defining leadership and roles regarding oral health, 2) time and work overload in a busy pediatric clinic, 3) a tracking system was not available to quickly determine which children needed caries prevention procedures and education, and 4) billing and medical record form changes could not be fully established prior to starting the program.

PMID: 12665063 [PubMed - indexed for MEDLINE]

Perception of orthodontic treatment need: opinion comparisons of orthodontists, pediatric dentists, and general practitioners.

J Orthod. 2002 Dec;29(4):287-91; discussion 277

Authors: Berk NW, Bush HD, Cavalier J, Kapur R, Studen-Pavlovich D, Sciote J, Weyant RJ

AIM: To determine the relationship between treatment need assessment scores of orthodontists, general practitioners, and pediatric dentists. STUDY DESIGN: Observational. SAMPLE: Ten general dental practitioners, 18 orthodontists and 15 pediatric dentists reviewed 137 dental casts and recorded their opinion on whether orthodontic treatment was needed. RESULTS: We found a high level of agreement between pediatric dentists, orthodontists and general practitioners (Kappa range 0.86-0.95). Between the groups, the amount of agreement was lower. CONCLUSIONS: Orthodontists, general dental practitioners, and pediatric dentists in this sample exhibit high levels of agreement on orthodontic treatment need.

PMID: 12444269 [PubMed - indexed for MEDLINE]

General and dental characteristics of Bloch-Sulzberger syndrome. Review of literature and presentation of a case report.

Med Oral. 2002 Jul-Oct;7(4):293-7

Authors: Dom&#xED;nguez-Reyes A, Aznar-Martin T, Cabrera-Suarea E

A case report of Bloch-Sulzberger Incontinentia Pigmenti is presented, in which the dental symptoms are considered as a base, not just for a review of this disorder within the scope of Integrated Paediatric Dentistry, but also in order to establish an adequate dental treatment for the affected children. There should be interdisciplinary coordination, leading to better treatment and therefore an improved quality of life for these patients.

PMID: 12134130 [PubMed - indexed for MEDLINE]

Good occlusal practice in children's dentistry.

Br Dent J. 2001 Dec 22;191(12):655-9

Authors: Davies SJ, Gray RJ, Mackie IC

The difference between paediatric dentistry and most other branches of dentistry is that in the child the occlusion is changing. Consequently 'Good Occlusal Practice' in children is a matter of making the right clinical decisions for the future occlusion. The clinician needs to be able to predict the influence that different treatment options will have on the occlusion when the child's development is complete.

PMID: 11792110 [PubMed - indexed for MEDLINE]

Use of fissure sealant retention as an outcome measure in a dental school setting.

J Dent Educ. 2001 Sep;65(9):861-5

Authors: Mascarenhas AK, Moursi AM

The purpose of this study was to describe and assess the use of fissure sealant retention as a quality measure of the delivery system for pediatric dentistry. The Pediatric Dentistry Section at the Ohio State University College of Dentistry adopted Sealant retention as a measure of quality. Sealant retention in first and second molars was evaluated at each six-month recall appointment. Sealants were categorized as satisfactory or unsatisfactory. Two hundred five sealants were evaluated between March 1998 and March 1999. The mean age of the patients at the time of sealant evaluation was 14.0 +/- 2.9. Mean sealant retention period was 29.8 +/- 23.2 months, with a range of 0.9 to 148 months. Median sealant retention period was 23.2 months. Overall, 75.6 percent of the sealed teeth were classified as satisfactory. Use of this data in making improvements is discussed. Our results indicate that the use of sealant retention is a suitable measure for quality of care in pediatric dentistry.

PMID: 11569601 [PubMed - indexed for MEDLINE]

It's only teething...a report of the myths and modern approaches to teething.

Br Dent J. 2001 Jul 14;191(1):4-8

Authors: Ashley MP

Paediatric dentistry is not my usual field of work. I am now based almost entirely in restorative dentistry and it is five years since I worked in the dental department of a children's hospital. An essay on teething would appear to be an unusual choice of topic. With the current professional climate of 'general professional education' and 'lifelong learning' I can easily justify my time and effort studying a subject somewhat removed from my regular work. However, to be completely honest, I have reached that age when many of my friends, relatives and colleagues are enjoying the sleepless nights that accompany expanding families. Add to this the fact that I have recently married into a family of midwives, health visitors, nurses and new mothers. I was not sure that I was giving the best, most up to date advice when asked about teething. So some reading around was required. If only it were that simple. I now feel equipped to give a little more help than simply saying, "It's only teething..."

PMID: 11491477 [PubMed - indexed for MEDLINE]

Oral and dental aspects of child abuse and neglect. American Academy of Pediatrics. Committee on Child Abuse and Neglect. American Academy of Pediatric Dentistry. Ad Hoc Work Group on Child Abuse and Neglect.

Pediatrics. 1999 Aug;104(2 Pt 1):348-50

Authors:

In all states, physicians and dentists recognize their responsibility to report suspected cases of abuse and neglect. The purpose of this statement is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This statement also addresses the oral manifestations of sexually transmitted diseases and bite marks, including the collection of evidence and laboratory documentation of these injuries.

PMID: 10429025 [PubMed - indexed for MEDLINE]

Chloral hydrate sedation: the additive sedative and respiratory depressant effects of nitrous oxide.

Anesth Analg. 1998 Apr;86(4):724-8

Authors: Litman RS, Kottra JA, Verga KA, Berkowitz RJ, Ward DS

The combination of chloral hydrate and nitrous oxide (N2O) is often used for sedation in pediatric dentistry. The purpose of this study was to determine the extent to which N2O increases the level of sedation and respiratory depression in children sedated with chloral hydrate. Thirty-two children, 1-9 yr, received chloral hydrate, 70 mg/kg (maximum 1.5 g), and then received N2O (30% and 50%). Hypoventilation (maximal PETCO2 > 45 mm Hg) occurred in 23 (77%) children during administration of chloral hydrate alone, in 29 (94%) breathing 30% N2O (P = 0.08 versus control), and in 29 (97%) breathing 50% N2O (P = 0.05 versus control). Mean PETCO2 was increased during 30% (P = 0.007) and 50% (P = 0.02) N2O administration. Using chloral hydrate alone, 8 (25%) children were not sedated, 10 (31%) were consciously sedated, and 14 (44%) were deeply sedated. Using 30% N2O, 2 children (6%) were not sedated, 0 were consciously sedated, and 29 (94%) were deeply sedated (P < 0.0001). Using 50% N2O, 1 child (3%) was not sedated, 0 were consciously sedated, 27 (94%) were deeply sedated, and 1 (3%) had no response to a painful stimulus (P < 0.0001). We conclude that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children. Implications: Pediatric sedation in the dental office often consists of nitrous oxide (N2O) after chloral hydrate premedication. We found that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children.

PMID: 9539591 [PubMed - indexed for MEDLINE]

A multidisciplinary approach to oral rehabilitation with osseointegrated implants in children and adolescents with multiple aplasia.

Eur J Orthod. 1996 Apr;18(2):119-29

Authors: Bergendal B, Bergendal T, Hallonsten AL, Koch G, Kurol J, Kvint S

Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.

PMID: 8670924 [PubMed - indexed for MEDLINE]

OBSERVATION OF CHILDREN'S TEETH AS A DIAGNOSTIC AID: A REVIEW. I. DENTITION IN THE ASSESSMENT OF DEVELOPMENT.

Can Med Assoc J. 1964 Jan 11;90:70-5

Authors: GIBSON WM, CONCHIE JM

PMID: 14104154 [PubMed - indexed for MEDLINE]