In vitro remineralization of adjacent interproximal enamel carious lesions in primary molars using a bioactive bulk-fill composite

BACKGROUND

Surface remineralization is recommended for the management of active non-cavitated interproximal carious lesions in primary teeth. According to the American Academy of Pediatric Dentistry, a recently recognized category of materials called bioactive restorative materials can be used for remineralization. This study aimed to evaluate the release of fluoride (F), calcium (Ca) and phosphate (P) ions from Predicta® Bioactive Bulk-fill composite compared with EQUIA Forte® and Filtek™ Z350 and to determine the remineralization effect of these 3 restorative materials on adjacent initial interproximal enamel carious lesions.

METHODS

The release of F, Ca and P ions from 3 groups ((n = 10/group) (Group 1- Predicta®, Group 2- EQUIA Forte® and Group 3- Filtek™ Z350)) was determined at 1st, 4th, 7th and 14th days. After creating artificial carious lesions, human enamel samples were randomly assigned into 3 groups (n = 13/group) which were placed in contact with occluso-proximal restorative materials and exposed to a 14-day pH cycling period. Surface microhardness was determined using a Knoop microhardness assay at baseline, after artificial carious lesions formation and after pH cycling. The difference in the percentage of surface microhardness recovery (%SMHR) among groups was compared. Mineral deposition was analyzed with energy-dispersive x-ray spectroscopy (EDS) and the enamel surface morphology was evaluated with scanning electron microscopy (SEM). Kruskal-Wallis's test with Dunn's post hoc test and one-way ANOVA with Tukey's post hoc test were used for data analysis.

RESULTS

EQUIA Forte® released the highest cumulative amount of F and P ions, followed by Predicta® and Filtek™ Z350. Predicta® released higher amount of Ca ions than EQUIA Forte® and Filtek™ Z350. Predicta® demonstrated the highest %SMHR, followed by EQUIA Forte® and Filtek™ Z350. There was a significant difference in the %SMHR between Predicta® and Filtek™ Z350 (p < 0.05). However, EQUIA Forte® demonstrated the highest fluoride content, followed by Predicta® and Filtek™ Z350. The SEM images of EQUIA Forte® and Predicta® revealed the greater mineral deposition.

CONCLUSION

Predicta® demonstrated a marked increase in surface microhardness and fluoride content of adjacent initial interproximal enamel carious lesions in primary molars compared with Filtek™ Z350. Predicta® is an alternative restorative material to remineralize adjacent initial interproximal enamel carious lesions in primary molars, especially in high-risk caries patients.

Comparing the relative influence of obesity and ancestry on timing of dental development

INTRODUCTION

The dentition is one of the most accurate features for age estimation in children. However, there is some evidence that timing of dental development varies across populations. Recent research suggests that dental development may also be susceptible to influence by environmental factors, such as obesity. Given that there are also population differences in average body mass, it is possible that this may be a confounding variable that was not accounted for in prior work. We aim to compare the relative association between body mass index (BMI) and ancestry with timing of dental development.

METHODS

A retrospective cross-sectional chart review was undertaken using panoramic radiographs of 6- to 12-year-olds (n = 281). Age, ancestry, sex, height, and weight were obtained. Dental development was assessed using the Demirjian method, and chronological age was subtracted from estimated dental age to determine relative timing of dental development (ΔAge). BMI was calculated based upon recorded height/weight within 6 months of time of radiograph.

RESULTS

We found no difference in timing of dental development (accelerated/delayed) across ancestry groups (African-American, Euro-American, Hispanic, Asian; P = .15). Overweight/obese subjects had statistically significantly advanced (precocious) dental development (P < .001). Compared to normal-weight subjects, children who were overweight's age were overestimated by 5.76 months (0.48 years) and children with obesity by 5.97 months (0.49 years) on average.

CONCLUSIONS

BMI appears to have a greater impact on relative timing of dental development than ancestry in this population. Our results support other findings that obesity results in accelerated growth and development.

Articaine Infiltration Versus Lidocaine Inferior Alveolar Nerve Block for Primary Mandibular Molars: A Double-blind Randomized Controlled Clinical Trial

Purpose: To compare the effectiveness of articaine local infiltration with lidocaine inferior alveolar nerve block (IANB) for restorative treat- ment of primary mandibular molars (PMMs). Methods: In this double-blind, parallel-design, randomized, controlled, clinical trial, participants were enrolled according to specified inclusion criteria (four to 10 years of age, need of PMM restorations, Frankel four behavior) and randomly assigned into either an articaine or lidocaine group. One investigator administrated all local anesthesia (LA). Nineteen trained and calibrated exam- iners, blinded to LA type, evaluated participants' reactions during LA administration and treatment using Modified Behavioral Pain Scale (MBPS). Participants rated their experiences using Wong-Baker FACES Pain Rating Scale (WBFS). The subjects' blood pressure and pulse were recorded throughout procedures. Statistical analysis employed Mann Whitney-U test, repeated measures analysis of variance (P<0.05), and Cohen's kappa. Results: A total of 110 participants (n equals 55 per group; mean age equals 6.42 years; 60 percent males) were enrolled. The mean MBPS rating during LA administration was higher for lidocaine IANB (3.89) compared to articaine infiltration (2.24; P<0.001). The mean MBPS rating through- out treatment was higher for the lidocaine group (2.51) compared to articaine group (1.69; P=0.012). The lidocaine group had a mean WBFS score of 1.64, while for the articaine group WBFS was 0.872 (P=0.089). All physiological measurements were within normal limits with no difference between groups. Conclusions: This study demonstrated that local infiltration with articaine was less distressing upon administration and may be considered safe and effective alternative to lidocaine IANB for restorative treatment in PMMs.

Vaso-occlusive Pain Crisis Mimicking Mandibular Abscess in an Adolescent with Sickle Cell Disease

In people with sickle cell disease (SCD), oral abscesses are concerning clinical conditions and carry a high risk of postoperative sickle cell complications. We present an unusual case of a 14-year-old girl with SCD whose initial presentation of facial swelling, headaches, jaw pain, and paresthesia mimicked an odontogenic abscess. She was diagnosed with vaso-occlusive crisis in the mandibular bone and successfully managed noninvasively. This is among the youngest cases of paresthesia in the lower lip in SCD, which provided a clue that postponing invasive aspiration or biopsy was possible under empiric antibiotics and close observation.

Prevalence of Radiographically Identifiable Dental Anomalies in Children and Association with Health Status

Purpose: The purpose of this study was to describe the prevalence of radiographically identifiable developmental dental anomalies (DDA) in a university-based pediatric dental clinic and to assess for associations between DDA and health status. Methods: Retrospective data, obtained from the electronic dental records of a three-year pediatric patient cohort, were evaluated by two trained and calibrated examiners. Strict inclusion/ exclusion criteria were applied. A validated image quality grading system was used for radiograph assessment, and the physical status classification of the American Academy of Anesthesiology was utilized. A chi-square test and bivariate logistic regression were used for statistical analysis. The inter- and intraexaminer reliability was assessed using Cohen's Kappa. Results: A total of 1,478 subjects (69 percent medically healthy) were enrolled. DDA were identified in 25 percent of the subjects, with hyperdontia, hypodontia, and microdontia being more common. A statistically significant association was found between the presence of DDA and health status (P<0.001) and between DDA and asthma (P=0.035). Patients with systemic disturbances showed 2.12 times greater odds of having DDA (P<0.001, 95 percent confidence interval equals 1.7-2.7). Conclusions: The prevalence of developmental dental anomalies was high, with one in four patients affected. DDA in number were the most common. Patients with systemic disturbances had greater odds of having DDA.

Nitrous Oxide for Dental Procedures in Pediatric Patients with Sickle Cell Disease: A Pilot Study

Purpose: The purpose of this pilot study was to evaluate the safety of nitrous oxide (N₂O) during dental procedures in pediatric patients with sickle cell disease (SCD). Methods: Patients three to 15 years of age received N₂O with oxygen (N₂O:O₂) during their dental procedure in a university pediatric dental clinic between March 2019 and December 2020. Blood oxygen levels were monitored via pulse oximetry throughout the visit. Caregivers received a follow-up call to assess for postoperative complications. Results: Twenty-three patients were enrolled. The duration of N₂O sedation was 20 to 50 minutes. Oxygenation levels during (P<0.001) and after (P=0.004) the procedure were higher than for baseline. No adverse effects were reported in the three days after N₂O use. Conclusions: Following dental guidelines for sedation, treatment with up to a 50:50 mixture of nitrous oxide with oxygen increased blood oxygen levels and did not cause postoperative complications in children with sickle cell disease. This is the first formal study confirming the safety of nitrous oxide use in the dental care of SCD patients.

Articaine Infiltration Versus Lidocaine Inferior Alveolar Nerve Block for Anesthetizing Primary Mandibular Molars: A Randomized, Controlled, Double-Blind Pilot Study

Purpose: The purpose of this study was to compare the effectiveness of articaine local infiltration to lidocaine inferior alveolar nerve block (IANB) for restorative treatment of primary mandibular molars (PMM). Methods: Four- to 10-year-old children who needed PMM restorations were enrolled according to inclusion criteria and randomly allocated into the articaine or lidocaine group. One operator administered all local anesthesia. Using the Modified Behavioral Pain Scale (MBPS), 15 trained and calibrated examiners, blinded to LA type, evaluated the subjects' reactions during LA administration and treatment. Children rated their experience using the Wong-Baker FACES Pain Rating Scale (WBS). Subjects' blood pressure and pulse throughout the visits were recorded. Statistical analysis included independent t-tests, Mann Whitney-U, and repeated measures analysis of variance (P<0.05). Examiner reliability was determined by Cohen's kappa score. Results: Thirty subjects (53 percent male; mean age: 6.3 years) participated. While the mean total scores for articaine (2.13 MBPS; 0.53 WBS) were better than for lidocaine (3.07 MBPS; 1.33 WBS), there were no statistically significant differences between groups. All physiological measurements were within normal limits. Conclusions: This pilot study indicated that articaine infiltration might be as effective as a lidocaine inferior alveolar nerve block for restorative treatment of primary mandibular molars; however, a larger sample is required to confirm these findings.

Oral Health Implications of Risky Behaviors in Adolescence

Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.

Caregivers' Comfort Answering Sensitive Questions About Themselves and Their Children in a Pediatric Dental Setting

Purpose: The purpose of this study was to explore caregivers' comfort levels and preferences for answering sensitive questions about themselves and their children in a pediatric dental setting. Methods: An electronically delivered survey was completed by 206 caregivers in the waiting area of a dental school's pediatric clinic. The survey items assessed were demographic, general health, behavioral health, oral health, and living conditions. A factor analysis was conducted for each set of questions, and a mean comfort level was calculated for each factor. Comfort levels were assessed on a five-point Likert scale, with one being least comfortable and five being most comfortable. Results: The questions caregivers were less comfortable answering about themselves were concerning traumatic events, stress, coping (mean equals 3.39), and living conditions (mean equals 3.24) versus demographics (mean equals 3.84) and physical and oral health (mean equals 3.99; P<0.001). They were also less comfortable answering questions about their children's trauma, stress, coping (mean equals 3.65), and experiences with violence and sexual activity (mean equals 3.13) than about demographics/general health (mean equals 4.11) and oral health (mean equals 4.21; P<0.001). The main reasons for the discomfort were the questions' sensitive nature and their belief that they had any relationship to their children's oral health. Conclusion: This study provides knowledge of caregivers' lower comfort levels discussing sensitive topics in a dental setting and provides context for interventions focused on how dentists can better communicate with caregivers about their own adverse experiences as well as their children's.

Female Caregivers' Depression Risk Affects Children's Attendance to Dental Appointments: A Pilot Study

Purpose: This pilot study aimed to evaluate the association between women's depression risk and their children's return for dental treatment. Methods: A total of 175 female caregivers of children presenting for an initial dental examination between May and October 2019 at a university clinic answered demographic questions and a validated survey on depression risk. An analysis of caregiver's depression risk relative to children's attendance at the next treatment appointment was made. Results: One hundred and eight female caregivers were included in the analysis. Average age was 33 years (standard deviation ± 6.5 years), and 52 percent were Hispanic. The rate of risk for depression was 17.5 percent. Most women at risk lived at least 20 miles away, had an income of less than $29,999, were unemployed or employed part-time, and had no help with childcare. White caregivers were more likely to fail to attend their child's appointment (chi-square [X²] = 7.80, P=0.02) while Hispanic women were more likely to return (X² = 4.10, P=0.04). Caregivers with low depression risk were more likely to return for the child's scheduled appointment (X² = 13.37, P<0.001). Thus, there was a positive association between high depression risk and failed appointments (r=0.474, P<0.01). Conclusion: Children of women at risk for depression are more likely to fail to attend their dental appointment.

Characteristics and Professional Development Needs of Pediatric Dentistry Chairs in the United States and Canada

Purpose: To describe the demographics of pediatric dentistry department chairs in the United States and Canada, characterize the skills and abilities required for the job, understand how they spent their time, and identify their professional development needs. Methods: An electronic survey was sent to 88 department chairs about personal demographics, leadership, management and personal qualities important for the job, and professional developmental needs. The data were analyzed using descriptive statistics. Results: The response rate was 62.5 percent. The respondents' mean age was 54.5 years (±8.9 years standard deviation); 68.2 percent of respondents were male, and 57 percent were Caucasian non-Hispanic. Most obtained their dental degree and specialty training in the USA, and 85 percent were board certified. They worked an average of 49.4 hours a week, spending a lot of time dealing with communications, teaching, and administrative materials. More than 80 percent lacked clear job expectations provided to them or they were only reviewed verbally. A minority (10.8 percent) was dissatisfied or very dissatisfied with the job. Conclusions: Most chairs were Caucasian, male, challenged by faculty and administrative issues and received no clear expectations for the job but were satisfied overall. Developing leadership and mentorship skills were important for the job execution.

Effect of Overlying Material on Final Setting of Biodentine ® in Primary Molar Pulpotomies

Purpose: The purpose of this study was to evaluate and compare in vitro the effect of overlying materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC), and stainless steel crowns (SSC) cemented with glass ionomer cement (GIC), on the setting of Biodentine ® (BD) used as a pulpotomy agent in primary molars that were restored definitively in a single visit. Methods: Forty extracted primary molars were prepared to replicate pulpotomy procedures. The teeth were randomly allocated to four restorative groups: (1) BD, ZOE, SSC; (2) BD, RMGIC, SSC; (3) BD, SSC; (4) BD only (control). All samples were incubated for 24 hours, sectioned mesial-distally, and polished. BD setting was measured as a function of Knoop hardness value (HK) using a Leco Microhardness Tester. Each sample was tested in three zones with 50 gf load force and 30 seconds dwell time and at one, two, and three mm distance from the BD-material interface. A one-way analysis of variance was used to determine statistical significance between groups (P<.05). Results: There was no statistically significant difference between the mean HK value among the four groups and three zones. Conclusions: Overlying materials, including zinc oxide eugenol, resin-modified glass ionomer, and stainless steel crowns cemented with glass ionomer cement, showed no effect on the BD final set. This in vitro study found no evidence against immediate definitive restoration of Biodentine ® pulpotomies.

Caretakers' Self-Selected Oral Health Goals: Self-Efficacy, Perceived Compliance, and Effect on Recall Attendance

PURPOSE

The purpose of this study was to describe caretakers' self-selected pediatric oral health goals, self-reported compliance, perceived self-efficacy, and perceived barriers to goal accomplishment. The effect of self-management plans on recall attendance was also evaluated.

METHODS

Fifty caretaker-patient pairs who presented for examinations at a university pediatric dental clinic were assigned to an intervention group. Fifty age-matched subjects were assigned to the comparison group. At baseline both groups completed a demographic survey. The intervention group developed a self-management plan and selected oral health goals. Follow-up surveys were administered to the intervention group two weeks and six months later.

RESULTS

The most frequently selected oral-health goals were brush twice daily (21 percent) and toothbrush before bed (17 percent). At the two-week follow-up, 39 percent of contacted caretakers recalled their chosen goals correctly, compared to 26 percent at six months. Approximately half of the participants in both groups attended the six-month follow-up visit. The difference in recall attendance between intervention and comparison group was not significant (P=0.80).

CONCLUSIONS

Caretakers most frequently selected goals that were associated with toothbrushing. They initially reported high confidence levels; however, recall and compliance with self-selected oral-health goals decreased significantly over the course of six months.

Social Determinants of Pediatric Oral Health

Social determinants of health are defined as conditions in which people are born and live and the role these conditions play on health outcomes. Research indicates that risk factors and their interactions are far more complex than originally thought. This article outlines social determinant constructs and their role in understanding oral health promotion. Due to the complex interactions, oral health must be promoted using a multilevel chronic disease model or common risk factor approach. An understanding of social determinants is particularly important for the pediatric population because optimum oral health and general health in adulthood are heavily influenced by childhood.

Association Between Childhood Traumatic Stress and Behavior in the Pediatric Dental Clinic

PURPOSE

The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment.

METHODS

Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale.

RESULTS

A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006).

CONCLUSIONS

Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior.

Oral Health-related quality of life in pediatric patients with cystic fibrosis

PURPOSE

To compare the oral health-related quality of life (OHRQoL) of 8- to 12-year-old children and 13- to 17-year-old adolescents diagnosed with cystic fibrosis (CF).

MATERIALS AND METHODS

Participants were recruited from a Midwest CF center. Parents provided demographic information and their assessment of the child's health. Patients completed the Child Oral Health Impact Profile (COHIP).

RESULTS

Thirty-nine child-parent pairs participated. Fifty four percent of the patients were male, 87% Caucasian, and 56% adolescent, with 66% of families reporting an annual income of over $100,000. Excellent or very good health, including oral health, was reported by 67% of the patients. Individuals taking 10 or more medications reported better OHRQoL while Caucasians reported better oral health and total scores than other races. Adolescents had poorer total COHIP, social-emotional well-being, and self-image scores.

CONCLUSION

Although most patients reported good or excellent oral health, adolescents reported a poorer OHRQoL than younger patients.

Eat or heat? The effects of poverty on children's behavior

In 2011, there were 46.2 million people in the US in poverty (15 percent of the population). The rate for children under 18 years of age was 22 percent, the highest of all age groups. Poverty is strongly linked to adverse socio-emotional outcomes and poor health in children, which influence adult socioeconomic advancement. It affects specific neurocognitive processes disproportionately such as working memory, cognitive control, and especially language and memory. Poor children are frequently exposed to household chaos, maternal depression, neighborhood violence, food insecurity and housing instability. They also experience little social support and have parents who are less responsive, more authoritarian and less involved in school activities than those of higher socioeconomic levels. Their diet is rich in sugar, which may contribute to behavioral disturbances. Children from a disadvantaged background have a poor ability to cope with stress and tend to show aggressive, withdrawn and anxious/depressive behaviors as well as poor academic outcomes. Dental professionals who care for poor children must understand they live under stressful physical and emotional conditions, which will impact their behavior in the dental office.

The impact of sickle cell disease on oral health-related quality of life

PURPOSE

The purpose of this study was to characterize the impact of sickle cell disease (SCD) on oral health and examine its impact on quality of life.

METHODS

Fifty-four study subjects were recruited from the sickle cell clinic and 52 control subjects from the adolescent medicine clinic at Nationwide Children's Hospital, Columbus, Ohio. A dental exam was performed to determine each participant's caries burden. The Child Oral Health Impact Profile survey was used to assess their oral health-related quality of life (OHRQoL).

RESULTS

Most subjects in both the SCD and control groups rated their overall health and oral health as "good" or "excellent." There was no statistically significant difference in OHRQoL between these groups. Additionally, no significant relationship was found between white blood cell count, medication intake, or the number of sickle cell crises as related to the caries burden. Statistically significant differences were detected in caries burden between the control group and the sickle cell hemoglobin C disease (HbSC) group (P<.02) and between the sickle cell anemia and HbSC subjects (P=.04).

CONCLUSIONS

Adolescents with sickle cell hemoglobin C disease had fewer caries than peers with sickle cell anemia or controls, though the cause of this finding is not clear.

The effects of poverty on children's development and oral health

According to the US Census Bureau, the poverty rate for children under 18 years of age increased to 22% in 2010. Poverty leads to adverse health outcomes in children and adolescents such as harmful effects on learning, psychosocial development, physical health, productivity and family life. Because the citizens and residents of a country are its most valuable assets, it is unwise to allow housing instability, food insecurity and hunger to continue to exist at its current levels. Reducing poverty is likely to prevent illnesses, decrease hospitalizations, and lead to lower health care costs. There is also a need for intervention strategies to ensure equitable access to healthy foods across the world. Children who are food insecure are more likely to be in poor health and to have poor nutritional outcomes. Poverty may lead to poor dental health due to malnutrition or incorrect diet and it may also have an effect on the child's behavior in the dental office. An understanding of poverty will lessen the anger, frustration and prejudice that pediatric dentists may feel when working with low-income families. This manuscript presents a concise overview of the effects of poverty in children's lives.

Osteoporosis: an increasing concern in pediatric dentistry

Increasing numbers of children are being affected by low bone density and osteoporosis. Bone fractures are the main reason for hospitalization between 10 and 14 years of age and, over the past 3 decades, there has been an increase in the incidence of fractures in children. Childhood factors such as lifestyle, diet, chronic illness, and medications have a vital short-term impact on bone health and a long-term effect on the achievement of peak bone mass, with the potential for morbidity in adulthood. The primary forms of osteoporosis consist of rare inherited conditions, but the secondary forms are becoming more common given that chronically ill children are surviving longer. This subject should be of interest to pediatric dentists, because low mineral density and osteoporosis, together with drugs used to treat them (eg, bisphosphonates), may cause adverse effects in the oral cavity. Furthermore, the pediatric dentist is an important health care professional to counsel patients about healthy lifestyles that can help prevent the condition from an early age.

Old drugs, new uses

Advances in pediatric health care have prolonged lives and improved the quality of life for children and adolescents. These advances include not only high-tech devices and new medications but also re-application of available medications to take advantage of unexpected benefits which may not have been known previously or even side effects that can have therapeutic value for diseases and conditions refractory to other treatment. This review describes new uses for anti-epileptic medications, thalidomide, intravenous immunoglobulin, hydroxyurea, methotrexate, botulinum toxin, bisphosphonates, and aspirin in the medical care of children. Methods of action and concerns for the pediatric dentist are described for children benefiting from these new applications.

Dental and oral care for chronically ill children and adolescents

Dental care is the most unmet health care need of children and adolescents who have chronic conditions and diseases. Because advances in therapy and medical technology have extended the lives of this population, it is very likely that these children will seek care in general dental practices. It is extremely important for dental practitioners to be knowledgeable about their patients' history and medical treatment to deliver care safely. This article reviews four chronic diseases of childhood (asthma, cystic fibrosis, cancer, and sickle cell disease) and discusses recommendations for oral and dental treatment.

Maxillary melanotic neuroectodermal tumor of infancy

The melanotic neuroectodermal tumor of infancy (MNTI) is a rare benign neoplasm of neural crest origin most commonly found in the anterior region of the maxilla. The tumor almost always develops during the first year of life, although in some cases it can be present at birth. MNTI’s present as a rapidly growing, painless expansile, partly pigmented mass. They are usually unencapsulated, with a tendency to occur as a single lesion. Local excision is the treatment of choice and is usually curative. Main sites for recurrences are the maxilla (57%) and the skull/brain (28.6%). Malignant transformation has been noted in approximately 6.5% of all cases and in 2% of maxillary tumors. The case of a 3-month old boy who presented with a loose primary maxillary left central incisor is discussed. The diagnostic and clinico-pathological features as well as tumor management and importance of a timely diagnosis are reviewed.

Gender preferences in the choice of a pediatric dental residency program

The goal of this study was to investigate whether men and women applying for graduate training in pediatric dentistry placed different emphasis on the same factors and program characteristics upon making their final ranking decision. A questionnaire was mailed to the first-year resident class in the United States in 2005 containing both multiple-choice and open-ended questions covering six sections: 1) candidate's background, 2) the application process, 3) program characteristics, 4) nonclinical factors, 5) clinical factors, and 6) the interview process. In sections three through six, respondents ranked factors and characteristics from "not important" or "no influence" to "critical." The response rate was 69.2 percent (180/260), with approximately 57.8 percent females (104/180) and 61.4 percent non-Hispanic white respondents (110/180). Statistically significant differences between genders were as follows: 1) men were older (29.4 years versus 28.1, p<0.05); 2) men applied to more programs (9.9 vs. 8.1, p<0.05); 3) women preferred programs affiliated with their own dental school (p=0.046); 4) women preferred university-based programs (p=0.049); 5) women preferred programs that offered a high amount of patient care under general anesthesia (p=0.040); and 6) women placed more importance on the salary/stipend amount offered by the programs (p=0.045).

Factors influencing pediatric dental program directors' selection of residents and demographics of current directors

The primary goal of this study was to examine the criteria that influence rankings of candidates by advanced education program directors in pediatric dentistry. Secondary objectives were to obtain information on the resident selection process and to explore demographics of current program directors. A survey was sent in 2005 to all sixty-three program directors of pediatric dentistry residency programs accredited within the United States for the graduating class of 2007. The survey had a response rate of almost 78 percent (49/63). Respondents were requested to rank the importance of eleven factors that are typically included in the selection criteria for pediatric dentistry residents. Factors were rated on a scale of critical, very important, fairly important, somewhat important, and not important. The four highest ranked criteria by program directors were the following, in order: National Board scores, dental school clinical grades, class rank, and grade point average (GPA). Other factors ranked in descending order of perceived importance were the following: dental school basic science grades, experience in pediatric dentistry, extracurricular activities, completion of a general practice residency or advanced education in general dentistry program, the application essay, a publication or professional presentation, and private practice experience. All directors ranked personal interviews as very important to critical. Letters of recommendation from a pediatric dentistry department chairperson or faculty member were viewed more favorably than letters from dental school deans and non-pediatric dentistry faculty. Fifty-seven percent of the directors responding (28/49) were male, and 81 percent (40/49) were white, non-Hispanic. Fifty-nine percent of the directors (29/49) graduated from a residency program over twenty years ago, with 39 percent (19/49) having been a director for less than five years.

An overview of chronic oral graft-vs-host disease following pediatric hematopoietic stem cell transplantation

Hematopoietic stem cell transplant (HSCT) is the treatment of choice for many hematologic, genetic, oncologic, and immunologic diseases. It is also one of the most aggressive treatments among the different cancer therapies, however, and is associated with severe conditioning-related toxicity, profound neutropenia, a high level of prophylactic immunosuppression and graft-vs-host disease (GVHD). Even with GVHD prophylaxis, chronic GVHD remains a significant complication of HSCT and is a frequent reason for nonrelapse morbidity and mortality following allogeneic HSCT. It primarily targets the skin, gastrointestinal tract, and liver. Approximately 20% of patients who receive matched sibling transplants and 40% of matched unrelated donor recipients will develop chronic GVHD. Risk factors include: (1) history of acute GVHD; (2) hemotologic malignancy; (3) female donor to male recipient; (4) use of total body irradiation; (5) donor age of > or = 5 years; and (6) recipients >10 years of age. The purpose of this paper was to review the pathogenesis, prevention, and treatment of pediatric chronic graft-vs-host disease, with a focus on its oral manifestations and the dental management of affected children and adolescents.

Factors influencing candidates' choice of a pediatric dental residency program

The goal of this study was to identify the factors and program characteristics that influenced the program ranking decisions of applicants to pediatric dentistry residency programs. A questionnaire was sent to the first-year resident class in 2005 with a response rate of 69.2 percent (n=260). Approximately 55 percent were female (104/180) and 61 percent were non-His-panic white (110/180). The respondents reported that they applied to an average of nine programs, of which five were ranked. Most applicants were interested in a program that had a hospital component with a duration of two years. A program's ability to prepare the resident for an academic career was a minimal influence for 48.6 percent (87/179), and 57.5 percent (103/179) were not interested in a master's or Ph.D. degree. Factors associated with program ranking included modern clinical facilities, high ratio of dental assistants and faculty to residents, availability of assistants for sedation and general anesthesia cases, availability of a salary or stipend, and amount of clinical experience. Important non-clinical factors included hospitality during the interview, geographic location, and perceived reputation of the program. Opportunity to speak with the current residents in private, observing the interaction between residents and faculty, and touring the facilities were also highly considered. These findings may help program directors tailor their interviews and programs to suit the needs of applicants.

Head and neck extramedullary disease as the initial presentation of acute myelogenous leukemia in a child

The purpose of this paper was to describe a child with a noncontributory medical history who sought an emergency dental appointment due to a significant facial and neck swelling. The clinical and radiographic exams revealed no odontogenic infection, and the patient was subsequently diagnosed with acute myelogenous leukemia by the hematology/oncology service. This report underscores the important role pediatric dentists can play in an early referral for further workup of a suspected malignancy, which may initially present as extramedullary disease in the head and neck.

Severe gingival recession and early loss of teeth in a child with chronic graft versus host disease: a case report

Graft versus host disease (GVHD) occurs after a hematopoietic stem cell transplantation (HSCT) when the donor's immune system rejects the recipient's body, leading to significant morbidity and mortality. Increased numbers of chronic GVHD (c-GVHD) patients are likely to be seen by dental professionals because of the advances made in transplantation. The oral cavity may be the primary or the only site of c-GVHD and may have persistent lesions after resolution has occurred in other areas. Approximately 80% of patients with extensive c-GVHD present some type of oral involvement, including xerostomia, oral pain and lesions. Dental and oral care can be challenging for these patients. This paper discusses the manifestations and treatment of oral c-GVHD and presents the case history of a 15-month-old girl who developed severe oral GVHD with an unusual periodontal presentation and early loss of primary teeth.

Extraction of "killer" teeth: the case of two Somali siblings

Many cultures present several intriguing ethnic dental practices. Therefore, in a multiethnic society, health care professionals have to be attuned to the patients' cultural values and traditions because they impact their attitude in seeking care and the implementation of the professionals' recommendations. Before seeking medical or dental care in the formal health system, families may rely first on an elder or healer for advice and interventions. In East Africa, the unerupted primary canines may be extracted in the first days or months of life because it is believed that they cause persistent fever, vomiting, diarrhea, weight loss, dehydration, infectious diseases and death. The practice is done using nonsterilized instruments leading to harmful localized and systemic sequelae, including fatalities. The purpose of this manuscript was to discuss the case of two Somali siblings who had tooth buds enucleated at a young age, leading to significant dental problems.

The Use of Botulinum Toxin-A in the Treatment of Severe Bruxism in a Patient with Autism: A Case Report

This case report describes an alternative method for reducing bruxism in a special needs patient who was not a candidate for an intraoral appliance. Bruxism is often seen in patients with special needs and can result in excessive dental wear, temporo-mandibular joint pain, avulsion of teeth and other problems. Current methods of management are not typically effective in this population because most require patient compliance. An 11-year-old male diagnosed with autism and Bannayan-Zonana syndrome received bilateral injections of botulinum toxin type-A (Botox Allergan Pharmaceuticals, Irvine CA) in the masseter muscle. The patient's condition was followed up via post-operative telephone interviews with the parents for 60 days. A reduction in the frequency and severity of bruxism was reported. The only side effects noted were soreness at the injection site and mild, temporary drooling. Although further research is required to determine the optimal doses and injection frequency, botulinum toxin type-A appears to be an alternative method for controlling bruxism in the special needs population.

Dental care of the pediatric cancer patient

Although the rate for childhood cancer has remained relatively stable for the past 2 decades, there have been drastic declines in mortality due to early diagnosis and improvements in therapy. Now over 75% of children diagnosed with cancer survive more than 5 years. The pediatric dental professional plays an important role in the prevention, stabilization, and treatment of oral and dental problems that can compromise the child's health and quality of life before, during, and after the cancer treatment. This manuscript discusses recommendations for the dental care of the pediatric oncology patient.