A 10-year retrospective study of paediatric emergency department visits for dental conditions in Montreal, Canada

BACKGROUND

Trends of paediatric emergency visits (ED) for dental conditions have been broadly discussed; however, little has been published in the Canadian context.

AIM

To describe the utilization of ED for dental conditions among children and to investigate demographic characteristics influencing its use.

DESIGN

A comprehensive review of records of all children aged 1-17 years who attended the ED service of a paediatric hospital in Montreal, Canada, for dental conditions over a 10-year period (2004-2013) was completed. Information on the child's principal dental diagnosis, sociodemographic data, and source of referral was obtained.

RESULTS

A total of 10 905 paediatric ED visits were seen during the study period. Among the children, 54.7% were male and the majority was younger than 6 years old. Dental caries constituted the most common reason for ED presentation comprising close to 43% of total visits for a dental complaint. Females, teenagers, and self-referred children were more likely to experience ED visits due to non-traumatic dental conditions.

CONCLUSIONS

The utilization of ED for dental conditions has increased among pre-school children in the last decade and was mostly due to caries-related dental problems. Effective preventive strategies are needed to improve the oral health condition of children.

Pachyonychia Congenita Associated with a Novel Variant of KRT17 Presenting Unusual Oral Manifestations

Pachyonychia congenita (PC) is a rare autosomal dominant condition caused by heterozygous mutation in one of five keratin genes. The purpose of this paper is to report a five-day-old infant with PC whose initial presentation revealed multiple malformed natal teeth and gingival lesions on the alveolar crest. Further investiga- tions led to genetic molecular testing of the child and his parents, which revealed a de novo and novel missense variant of KRT17 (c. 307C>T, p. Arg103Cys), resulting in a non-conservative amino-acid substitution and a diagnosis of PC. This case high- lights the need for multidisciplinary care and the relevance of molecular investigations for patients with multiple natal teeth. (J Dent Child 2019;86(1):61-3)<br/> Received September 26, 2018; Last Revision November 19, 2018; Accepted November 19, 2018.

Oral Health Status of Refugee Children in Montreal

This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31-11.1) and child age (OR = 2.17; 95% CI = 1.04-4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers.

Ectopic Eruption of the Permanent Maxillary First Molar: Predictive Factors for Irreversible Outcome

PURPOSE

The purpose of this study was to determine the rate of self-correction and predictive factors for irreversible outcome of mesial ectopic eruption of permanent maxillary first molars (EE), in a sample population where no interceptive treatment was initiated.

METHODS

Charts of patients diagnosed with EE were reviewed, and radiographs were analyzed for predictive factors reported in the literature.

RESULTS

Sixty-five EE were included in the study; 46 (71 percent) self-corrected, of which one-third occurred after age nine years. Space loss, with an average of approximately three mm, occurred in 18 EE (28 percent). Increased magnitude of impaction, degree of resorption of the primary second molar, severe lock, and bilateral occurrence were positively correlated with irreversible EE. Multiple regression analysis was positive for increased magnitude of impaction when adjusted for gender and bilateral occurrence.

CONCLUSION

Spontaneous self-correction occurred in 71 percent of permanent maxillary first molars with ectopic eruption; one third of self-corrections occurred after nine years of age. Delaying treatment of ectopic eruption of permanent maxillary first molars may be a viable option when the outcome is uncertain. Increased magnitude of impaction was the most reliable predictor associated with irreversible outcome.

Association of onabotulinum toxin A treatment with salivary pH and dental caries of neurologically impaired children with sialorrhea

BACKGROUND

Sialorrhea is a common manifestation of several neurological disorders. The use of intraglandular onabotulinum toxin A (OBTXA) injection has been recognized to effectively treat sialorrhea. As OBTXA injection reduces salivary flow rate and alters salivary quality, its use may have a detrimental effect on oral health.

AIM

To examine the effect of OBTXA injection on caries experience and salivary pH of neurologically impaired children with sialorrhea.

DESIGN

Twenty-five children receiving OBTXA treatment and 25 control children were enrolled in the study. Whole saliva was collected to determine salivary pH. All participants underwent an interview on their dietary habits. Dental clinical examinations were carried out to evaluate caries experience and oral hygiene level.

RESULTS

Overall, mean salivary pH value was significantly lower in the OBTXA group (6.92 ± 0.77) compared with the control group (7.36 ± 0.70). Caries activity was significantly higher in the OBTXA group (P = 0.01). The regression analyses showed a significant association between OBTXA treatment and salivary pH value (P = 0.03). Results from the logistic regression show that dental caries was significantly associated with OBTXA treatment (OR = 1.73, CI = 1.14-27.3).

CONCLUSIONS

The study showed an intricate relationship between OBTXA treatment and oral findings. Hence, special dental care should be given to children receiving OBTXA treatment.

Clinical complications in the revascularization of immature necrotic permanent teeth

The purpose of this case series was to report on the use of a technique of revascularization for necrotic immature permanent teeth, several problems encountered, and solutions to those problems. Eighteen pulp revascularizations were performed in 2009 using the original protocol of revascularization (adapted from the AAE/AAPD joint meeting in 2007 in Chicago). The protocol consisted of opening the canal and disinfecting it with sodium hypochlorite, sealing in a triple antibiotic paste for 2-6 weeks, re-opening, re-irrigating, creating a blood clot in the canal, and sealing with an MTA barrier over the clot. Three problems were encountered during the treatment: (1) bluish discoloration of the crown; (2) failure to produce bleeding; and (3) collapse of the mineral trioxide aggregate (MTA) material into the canal. Modifications to solve these problems included: changing one of the antibiotics, using a local anesthesia without epinephrine, and adding collagen matrix to the blood clot.