Does Timing of Eruption in First Primary Tooth Correlate with that of First Permanent Tooth? A 9-years Cohort Study

Extended Reality (XR) in Pediatric Acute and Chronic Pain: Systematic Review and Evidence Gap Map

BACKGROUND

The use of extended reality (XR), including virtual reality (VR) and augmented reality (AR), for treating pain has accelerated in the last 10 years. XR is an attractive biobehavioral intervention that may support management of pain or pain-related disability. Reviews of the literature pertaining to adults report promising results, particularly for acute procedural pain.

OBJECTIVE

This study aimed to (1) summarize the available evidence with respect to feasibility, safety, and effectiveness (pain intensity) of XR for pediatric acute and chronic pain; (2) summarize assessment tools used to measure study outcomes; and (3) identify gaps in evidence to guide future research efforts.

METHODS

This study is a systematic review of the literature. Multiple databases (CINAHL, Cochrane Central, Embase, MEDLINE, PsycINFO) were searched from inception until March 2023. Titles, abstracts, and full-text articles were reviewed by 2 team members to determine eligibility. Articles were included if the (1) participants were aged 0 to 18 years; (2) study intervention was VR or AR; (3) study outcomes included safety, feasibility, acceptability, or effectiveness on the outcome of pain; and (4) study design was observational or interventional. Data were collected on bibliographic information; study characteristics; XR characteristics; outcome domains; outcome measures; and study findings pertaining to safety, feasibility, and effectiveness.

RESULTS

We included 90 articles in the review. All included studies used VR, and 93% (84/90) studied VR in the context of acute pain. Of the 90 studies, 74 studies were randomized trials, and 15 studies were observational. Safety was assessed in 23 studies of acute pain, with 13 studies reporting no adverse events and 10 studies reporting events of low concern. Feasibility was assessed in 27 studies. Of the 84 studies of acute pain, 62% (52/84) reported a positive effect on pain intensity, 21% (18/84) reported no effect, and 13% (11/84) reported mixed effects. All 6 studies of chronic pain reported a positive effect on pain intensity. An evidence gap map was used to illuminate gaps in specific research areas stratified by subtypes of pain. Risk of bias assessment revealed 67 studies had a moderate risk of bias, 17 studies had a high risk, and 5 studies were deemed to be low risk.

CONCLUSIONS

The current body of literature around XR for pediatric pain is focused on acute pain with promising results of safety and effectiveness on pain intensity. The literature pertaining to chronic pain lags behind, limiting our ability to draw conclusions. The risk of bias in studies is problematic in this field, with the inherent challenge of blinding participants and researchers to the intervention. Future research should aim to measure effectiveness beyond pain intensity with a consistent approach to measuring key outcome domains and measures. Current efforts are underway to establish expert consensus on best research practices in this field.

TRIAL REGISTRATION

Prospero CRD42022307153; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022307153.

Effect of early tooth eruption on the development of dental caries in children: a cross-sectional study

BACKGROUND

Evidence on the association between early tooth eruption and a high incidence of dental caries is scarce and mixed. Therefore, this study aimed to assess the relationship between the timing of tooth eruption and development of dental caries in 229 children from six dental clinics in Qassim, Saudi Arabia.

METHODS

This was a descriptive, cross-sectional study involving 229 children from six dental clinics in Qassim, Saudi Arabia. The study was conducted in fluoridated area. Information regarding a child's age, sex, relevant medical history, maternal diseases, and medications administered during pregnancy was collected through in-person interviews. The eruption time of the first primary tooth was the main exposure variable, representing the potentioal predicator, whereas the decayed, missing, and filled surface (World Health Organization dmfs index) scores of primary teeth were the outcome variables, as they provided the necessary outcome measurements for assessing dental caries. Caries examinations were conducted by five calibrated dentists, and the dmfs scores were calculated. Analyses were conducted using Spearman correlation, and additional analyses were performed using the Kruskal-Wallis test.

RESULTS

Most participants started teething at the age of 6 months (29.7%; mean, 7.81 ± 2.59 months; range, 4-17 months), and no statistically significant correlations were found between the dental caries experience and time of eruption of the first tooth in the oral cavity.

CONCLUSIONS

These results provide further evidence on the weak association between dental caries and early tooth eruption. However, further prospective, longitudinal, and randomised studies with a large sample are necessary to validate these findings.

Early onset of enamel formation in Baka pygmy's deciduous canines

OBJECTIVE

Our aim was to evaluate by enamel microstructure analysis two hypotheses that would explain the early dental eruption in the Bakaparticularity, a shorter crown formation time and/or earlier onset of crown formation.

DESIGN

Deciduous canines corresponds to the best teeth to perform the analysis of enamel microstructure. Longitudinal ground sections of 21 deciduous canines from 12 individuals were studied with transmitted light microscopy. Cross-striations, striaes of Retzius (SR) and the neonatal line (NNL) enable to establish the prenatal crown formation time (preCFT), the postnatal crown formation time (postCFT), the crown formation time (CFT) as well as the daily secretion rate (DSR) and the enamel extension rate (EER) and their variation along crown formation.

RESULTS

The DSR and the EER in the Baka are similar than in other populations with an average DSR of 3.26 µm and EER of 18.18 µm. The preCFT was 154 days, the postCFT 265 days and CFT 419 days. Comparison with other population does not show difference in CFT. However, the preCFT and the postCFT differ, the first is higher and the second lower in the Baka than in other populations. Furthermore, the number of prenatal areas of enamel was greater in the Baka.

CONCLUSION

Our analysis suggests that the Baka does not distinguish by a different CFT but the onset of crown formation is earlier than in other groups. Therefore, the early dental eruption in the Baka results from an earlier onset of crown formation.

Reducing Dental Anxiety in Children Using a Mobile Health App: Usability and User Experience Study

BACKGROUND

Dentistry interventions cause common anxiety and fear problems in children (6-11 years), and according to scientific evidence, this causes a decrease in their quality of life. Therapies mediated by IT-based tools have been shown to positively influence children's mood based on distraction as well as relaxing activities, but there is no evidence of their use to reduce dental anxiety in children.

OBJECTIVE

The aim of this study was to answer the following research question: Does our new children-centered codesign methodology contribute to achieving a usable mobile-based product with a highly scored user experience?

METHODS

A mobile health app was developed to reduce dental anxiety in children using rapid application development following the usage-centered design methodology. Structured interviews were conducted to test the usability and user experience of the app prototype among 40 children (n=20, 50%, boys and n=20, 50%, girls; age 6-11 years) using a children-adapted questionnaire and the 7-point Single Ease Question rating scale. The Smiley Faces Program-Revised questionnaire was used to assess the level of dental anxiety in participants.

RESULTS

There were no significant differences between girls and boys. The task completion rate was 95% (n=19) for children aged 6-8 years (group 1) and 100% (n=20) for children aged 9-11 years (group 2). Group 1 found watching the relaxing video (task C) to be the easiest, followed by playing a video minigame (task B) and watching the narrative (task A). Group 2 found task C to be the easiest, followed by task A and then task B. The average time spent on the different types of tasks was similar in both age groups. Most of the children in both age groups were happy with the app and found it funny. All children thought that having the app in the waiting room during a dental visit would be useful.

CONCLUSIONS

The findings confirmed that the app is usable and provides an excellent user experience. Our children-adapted methodology contributes to achieving usable mobile-based products for children with a highly scored user experience.

General correlation between neonatal factors, primary and permanent tooth eruption and their interrelation in a population in german orthodontic practices

BACKGROUND

The purpose of the study was to determine the possible relationship between the eruption of primary and permanent teeth and neonatal factors in German children according to gender.

METHODS

A cross-sectional survey study was performed in 10 German orthodontic practices. Using a questionnaire information about gender, time of birth (week of pregnancy), birth weight (g) and height (cm), and the age of first primary and first permanent tooth eruption (months/years) of 405 children (230 girls and 175 boys) were collected. A Mann-Whitney U-test was used for group comparisons, and correlations were verified using a Pearson test.

RESULTS

No correlation was found between neonatal factors (time of birth, birth weight, and birth height) and primary tooth eruption for male participants. However, for females a low correlation was found between the eruption of the first primary tooth and birth weight (r = -0.18, CI: -0.30 to -0.042, p = 0.011) and birth height (r = -0.19, CI: -0.32 to -0.054, p = 0.006). No correlations between neonatal factors and the eruption of the first permanent tooth were found for either gender. A moderate correlation was found between the first primary and first permanent tooth eruption (females: r = 0.30, CI: 0.16 to 0.43, p < 0.001; males: r = 0.22, CI: 0.059 to 0.35, p = 0.008).

CONCLUSIONS

An earlier eruption of the primary teeth can be assumed with greater body weight and height at the time of birth for girls. For boys, the tendency is the opposite. However, there seems to be a catch-up growth effect due to the missing differences between both permanent tooth eruption times. Nevertheless, the first primary and the first permanent tooth eruption correlates in a German children population.

Novel Genetic Determinants of Dental Maturation in Children

Dental occlusion requires harmonious development of teeth, jaws, and other elements of the craniofacial complex, which are regulated by environmental and genetic factors. We performed the first genome-wide association study (GWAS) on dental development (DD) using the Demirjian radiographic method. Radiographic assessments from participants of the Generation R Study (primary study population, N1 = 2,793; mean age of 9.8 y) were correlated with ~30 million genetic variants while adjusting for age, sex, and genomic principal components (proxy for population stratification). Variants associated with DD at genome-wide significant level (P < 5 × 10-8) mapped to 16q12.2 (IRX5) (lead variant rs3922616, B = 0.16; P = 2.2 × 10-8). We used Fisher's combined probability tests weighted by sample size to perform a meta-analysis (N = 14,805) combining radiographic DD at a mean age of 9.8 y from Generation R with data from a previous GWAS (N2 = 12,012) on number of teeth (NT) in infants used as proxy of DD at a mean age of 9.8 y (including the ALSPAC and NFBC1966). This GWAS meta-analysis revealed 3 novel loci mapping to 7p15.3 (IGF2BP3: P = 3.2 × 10-8), 14q13.3 (PAX9: P = 1.9 × 10-8), and 16q12.2 (IRX5: P = 1.2 × 10-9) and validated 8 previously reported NT loci. A polygenic allele score constructed from these 11 loci was associated with radiographic DD in an independent Generation R set of children (N = 703; B = 0.05, P = 0.004). Furthermore, profiling of the identified genes across an atlas of murine and human stem cells observed expression in the cells involved in the formation of bone and/or dental tissues (>0.3 frequency per kilobase of transcript per million mapped reads), likely reflecting functional specialization. Our findings provide biological insight into the polygenic architecture of the pediatric dental maturation process.

Eruption Timing and Sequence of Primary Teeth in a Sample of Romanian Children

Teething is considered a significant event in the growth and development of the child by parents and especially by paediatric dentists and forensic scientists. They constantly need an “up-to-date mirror” of its variability for different geographic regions. The aims of the current study were to determine the timing and sequence of primary tooth emergence, and to establish a correlation between tooth eruption and general growth and external parameters in a sample of Romanian children. This study included 70 healthy children (53% girls and 47% boys), and the analysed data resulted from the questionnaires completed by parents during the whole process. General and specific data on primary teeth eruption were obtained. The differences between sexes were insignificant, except for the maxillary and mandibular canines (p = 0.047 and p = 0.018) and lower temporary second molars (p < 0.001), which were significantly increased in boys. The differences found between the two hemiarches were insignificant (p = 0.197). The mean age of eruption of the first tooth erupted was 7.07 ± 1.990 months. The unpaired t-test was used for comparison of the timings of eruption of the first primary teeth, according to the number of previous births and type of diet, and it was insignificant (p = 0.665 and p = 0.983 respectively).

RANKL is associated with persistent primary teeth and delayed permanent tooth emergence

BACKGROUND

Tooth eruption is a process that is not fully understood.

AIM

To evaluate whether genetic polymorphisms for RANK/RANKL/OPG are associated with delayed tooth emergence. To evaluate whether the relative expression of this genes is associated with persistent primary teeth.

DESIGN

To evaluate whether genetic polymorphisms for RANK/RANKL/OPG could be involved in delayed tooth emergence, saliva samples from 160 children, aged 6-13 years old, were analysed. To test if there is correlation between gene expression of RANK/RANKL/OPG in children with delayed tooth emergence and persistent primary teeth, periapical tissue from 15 children with persistent primary teeth and from 15 control subjects were collected for qPCR analysis.

RESULTS

Fifty-six children with delayed tooth emergence (35%) had at least one permanent tooth with delayed emergence. The T allele in RANKL (rs9594738) increased the risk of delayed tooth emergence (P = 0.02; OR = 1.71, 95%CI 1.09-2.75). The relative gene expression for RANKL and the ratio RANKL/OPG in children with delayed tooth emergence and persistent primary teeth were lower compared to controls (P = 0.02 and P = 0.005, respectively).

CONCLUSIONS

Data suggest that the polymorphism rs9594738 in RANKL is associated with delayed permanent tooth emergence. Moreover, reduced relative gene expression of RANKL in periapical tissue is associated with persistent primary teeth.

Predictive accuracy of Demirjian's, Modified Demirjian's and India specific dental age estimation methods in Odisha (Eastern Indian) population

This study is aimed at finding the predictive accuracy of Demirjian's (D), modified Demirjian's (MD) and India specific age estimation methods (AA) Indian specific age estimation methods in 522 healthy children of Odisha population among 3-18 years. Correlations between chronological age (CA) and derived age (DA) by above mentioned methods were evaluated by Wilcoxon signed rank test and Pearson's correlation analysis. Analysis of mean absolute error concluded that D and MD predicted the CA with fair accuracy, whereas, AA had lower accuracy in Odisha children. Odisha specific polynomial regression formula, derived in this study is showing a strong correlation with CA (r=0.84). Comparison of mean absolute error of D, MD, AA and Odisha specific method indicated a better predictive accuracy of Odisha specific method.

The relationship between children's media habits and their anxiety and behaviour during dental treatment

OBJECTIVE

The existing evidence suggests that media habits may have moderating role on children's psychological adjustment in the dental setting. The aim of this study was to investigate the relationship between children's media habits and their anxiety and behaviour management problems (BMP) during dental treatment.

MATERIALS AND METHODS

A total of 289 children aged 3-6 years old were included. Dental anxiety (DA) and BMP were assessed using Clinical Anxiety Rating Scale and Frankl's Rating Scale during the dental treatment. The parents reported their own DA, educational level and economic status; and the children's and also their own daily hours of using media. The data were analysed with the Mann-Whitney U, Kruskal-Wallis, Chi-square or Fisher exact tests, Spearman's correlation coefficient and logistic regression.

RESULTS

The children with DA had significantly higher amount of watching TV, playing e-games and surfing the Internet, and total amount of using electronic media than those without DA. The amount of watching TV and the total amount of using electronic media were significantly higher in the children with BMP than those without BMP. DA and BMP were significantly correlated with the children's hours of watching TV and total media time.

CONCLUSIONS

There was a significant relationship between the amount of electronic media usage and DA and BMP in 3- to 6-year-old children.

Polymorphism in emergence of deciduous dentition: A cross-sectional study of Indian children

AIM

The aim of the present study was to evaluate the timing and sequence of the eruption of deciduous teeth in Indian children.

METHOD

This cross-sectional study focused on children aged 5-36 months. One hospital was randomly selected from four geographic zones of the city. A total of 400 children from each hospital, fulfilling the inclusion criteria, constituted the sample. The examination was carried out by a single, trained examiner. The tooth was recorded as "present" or "absent" on the day of examination. The mean age of emergence was calculated using a probit model. Independent sample t-test was used to assess the statistical significance of differences in the mean age of tooth emergence.

RESULTS

The deciduous mandibular central incisor was the first tooth to erupt in the oral cavity (8.15±1.69 months). Girls showed delayed eruption compared to boys; however, no interarch variation was observed in the mean age of tooth eruption. There was also no difference in the sequence of eruption of deciduous teeth, as reported in other studies.

CONCLUSIONS

The present study establishes a chronological table for the eruption of deciduous teeth in Indian children. There was delayed eruption of deciduous teeth when compared to the reference ranges of Western populations.

Can galvanic skin conductance be used as an objective indicator of children's anxiety in the dental setting?

Background

Assessment of procedural distress is essential at assisting children during invasive dental treatments. This study aimed to determine the validity and reliability of galvanic skin response as a measure for assessment of dental anxiety in children.

Material and Methods

151 children, aged 5-7 years, participated in this study. Similar dental treatments were rendered to all subjects. At the beginning and end of the session, modified child dental anxiety scale (MCDAS), clinical anxiety rating scale (CARS) and galvanic skin response (GSR) were used to determine children’s anxiety.

Results

GSR was significantly correlated with both MCDAS (rs=0.62, p=0.02) and CARS (rs=0.44, p=0.032). The correlation between MCDAS and CARS was also significant (rs = 0.9, P<0.001). Anxiety decreased during the session in both GSR (rs=0.52, p=0.001) and MCDAS scales (rs=0.77, p=0.001). CARS also showed a reduction between the initial and second assessment, but it was not statistically significant (rs=0.12, P=0.36).

Conclusions

The findings suggest that GSR is a reliable and valid measure for assessment of children’s dental anxiety in the clinical context. GSR may help to identify clinically anxious children before dental treatment to provide appropriate interventions.

Key words:Dental anxiety, reliability, validity, galvanic skin response.

Premature primary tooth eruption in cognitive/motor-delayed ADNP-mutated children

A major flaw in autism spectrum disorder (ASD) management is late diagnosis. Activity-dependent neuroprotective protein (ADNP) is a most frequent de novo mutated ASD-related gene. Functionally, ADNP protects nerve cells against electrical blockade. In mice, complete Adnp deficiency results in dysregulation of over 400 genes and failure to form a brain. Adnp haploinsufficiency results in cognitive and social deficiencies coupled to sex- and age-dependent deficits in the key microtubule and ion channel pathways. Here, collaborating with parents/caregivers globally, we discovered premature tooth eruption as a potential early diagnostic biomarker for ADNP mutation. The parents of 44/54 ADNP-mutated children reported an almost full erupted dentition by 1 year of age, including molars and only 10 of the children had teeth within the normal developmental time range. Looking at Adnp-deficient mice, by computed tomography, showed significantly smaller dental sacs and tooth buds at 5 days of age in the deficient mice compared to littermate controls. There was only trending at 2 days, implicating age-dependent dysregulation of teething in Adnp-deficient mice. Allen Atlas analysis showed Adnp expression in the jaw area. RNA sequencing (RNAseq) and gene array analysis of human ADNP-mutated lymphoblastoids, whole-mouse embryos and mouse brains identified dysregulation of bone/nervous system-controlling genes resulting from ADNP mutation/deficiency (for example, BMP1 and BMP4). AKAP6, discovered here as a major gene regulated by ADNP, also links cognition and bone maintenance. To the best of our knowledge, this is the first time that early primary (deciduous) teething is related to the ADNP syndrome, providing for early/simple diagnosis and paving the path to early intervention/specialized treatment plan.