Evaluation of proximal slicing in primary maxillary incisors with proximal caries- a retrospective cohort study

BACKGROUND

Modern management of dental caries should be more conservative and include early detection of lesions and active surveillance, in order to apply preventive measures and carefully monitor for signs of arrest or progression. Proximal slicing was suggested for nonrestorative caries treatment for primary incisors. The aim of the study was to examine the success of proximal slicing in primary maxillary incisors in arresting caries progression.

METHODS

A retrospective cohort study. Data were collected from medical records of patients who had undergone proximal slicing in primary maxillary incisors with a follow-up period of at least 6 months. Treatment was considered a success when no further invasive clinical intervention was required within the follow-up period of at least 6 months. Treatment was considered a failure when further invasive clinical intervention was needed during the follow-up period (restoration, crown, or extraction). Additional variables included were the patient's gender, treated tooth, treated surface, age during their first visit to the clinic, age during slicing treatment, follow-up period, number of follow-up visits, and number of fluoride applications and additional slicing during follow-up.

RESULTS

Seventy-one patients were included in the study. Proximal slicing was successful in 76% of participants with a follow-up of at least 6 months. Success was associated with older age at the first dental visit (3.5yo vs. 2.5yo, p = 0.0011) and age when proximal slicing was performed (4yo vs. 3yo, p < 0.001).

CONCLUSION

Proximal slicing may successfully arrest proximal caries in primary maxillary incisors.

Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits

Managing the anxiety of children during dental care is a major aspect of a pediatric dentist's work. Only a sparse body of literature is available regarding anxiety during dental care over consecutive visits. The purpose of the study was to investigate anxiety over three consecutive visits for pediatric dental treatment using an electrodermal activity (EDA) device. We also investigated how patient age, gender, the type of dental care performed and previous dental experience, exerted effect on anxiety.This was an observational cohort study. Anxiety was assessed during treatment, using an EDA device. We also recorded Frankl's behavior rating, previous dental experience, behavior guidance technique, heart rate and the type of dental care. Our cohort included 30 healthy children aged 4-6 years who needed dental care over at least three visits. Frankl scale scores, EDA values and heart rate did not differ significantly between visits. Behavior and anxiety during treatment did not differ significantly according to gender and age. At the second visit, the Frankl score was higher in children who received pulp treatments and crowns than those who received restorations (p = 0.012). At the third visit, children who received pulp treatments and crowns had higher heart rates than those who received restorations (p = 0.011). Heart rate was significantly higher in children who had negative dental experiences when compared to those with positive experiences (p = 0.030). The levels of anxiety in children aged 4-6 years did not change significantly over three consecutive dental treatments. Therefore, varied and meticulous behavior management methods should be maintained throughout consecutive visits.

Panoramic errors in pediatric patients with special needs

This study aimed to analyze the types and frequencies of panoramic technical errors in pediatric patients with special needs, as compared to matching images of patients with normal developmental patterns. Panoramic images of 100 pediatric patients, with equal numbers of either special needs or healthy controls, referred to our Oral Maxillofacial Imaging unit, were retrospectively examined by four blinded observers for the presence of four common technical errors: palatoglossal air space, movement, positioning errors, and foreign bodies appearance. In addition, they subjectively determined the image quality on an ordinal scale. The statistical examination included inter-observer correlation and correlations between demographic factors (age, gender, developmental status) and the number and types of errors. The frequencies of demonstrated errors were, in descending order: movement, positioning, palatoglossal air space, and foreign bodies' appearance. The special needs group images showed significantly more errors and were rated as low-quality radiographs. Younger patients in both groups showed more movement and positioning errors. Technical errors in panoramic images of patients with special needs were more frequently found. Therefore, increased awareness of the staff and appropriate pre-imaging instructions to the patients, are required when imaging pediatric patients, especially those with special needs.

Distraction With Virtual Reality Goggles in Paediatric Dental Treatment: A Randomised Controlled Trial

AIM

The aim of this study was to examine whether screening content through virtual reality (VR) goggles can diminish pain perception during local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in routine paediatric dental treatment.

MATERIALS AND METHODS

This is a crossover study of healthy 4- to 12-year-old children who were scheduled to receive local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in 2 visits. The participants were randomly assigned to undergo 1 treatment performed with Oculus GO VR goggles and the other treatment without. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Modified Behavioral Pain Scale (MBPS).

RESULTS

The study group included 29 children with a mean age of 8.29 years (SD, 1.96). Whilst administering local anaesthesia, no significant difference was observed in the Wong-Baker FACES Pain Rating Scale and in MBPS movements between visits with and without the VR goggles. However, significantly lower pain perception was observed in the other parameters of MBPS when using the VR goggles: Face (P = .007) and Cry (P = .046). During placement of a rubber dam, significantly less pain was reported by the patients (P = .005) and observed by the assessor (Face [P = .005], Cry [P = .029], and Movement [P = 0.028]) when the VR goggles were used.

CONCLUSIONS

VR can decrease pain perception during rubber dam placement in children, but it has limited benefit during administration of local anaesthesia.

Promoting oral and dental health in early childhood - knowledge, views and current practices among paediatricians in Israel

Early childhood dental caries is the most prevalent disease in childhood. Paediatricians are considered by parents as the main authority on prevention and treatment of all the health requirements of their infants.

AIM

The aim of this study was to evaluate the knowledge and practice of paediatricians in promoting oral and dental health among young patients (under age 36 months) and their parents.

MATERIALS AND METHODS

145 anonymous questionnaires were distributed among paediatricians, 130 of them were 90% or above answered and were suitable for analysis for this study.75% of the questionnaires were distributed during the national convention of the Israeli Association of Clinical Paediatrics, 10% in paediatric ambulatory clinics and 15% in paediatric departments in hospitals. Questionnaires were distributed between 2018 and 2020. The inclusion criteria were physicians specialists in paediatrics or residents in paediatrics, all have Israeli licences to practice in Israel. exclusion criteria were partially filled questionnaires. The questionnaire was validated in a pilot study during the years 2010-2012. In addition to demographic variables that included medical training, post-graduate education and clinical practice the questionnaire included 42 questions. Eleven questions on demographics and amount of dental training during academic and clinical training 31 questions belonged to several sections that referred to the participants' awareness of the AAP guidelines regarding oral and dental health and knowledge of oral health. In each section paediatricians were asked to answer or give an opinion on a specific issue, their answers were coded to scores on a scale of 0-5 and summed per section. Correlations between different variables were analysed. The t-test and Mann-Whitney U test were performed for comparing two variables. For comparing more than two variables, we used the Kruskal-Wallis one-way analysis of variance test or ANOVA.

RESULTS

The response rate was 89% (130 questionnaires out of 145). The survey showed that most paediatricians (80%) recognized their role in maintaining the oral and dental health of their young patients. Nevertheless, most admitted that they do not perform simple procedures on a regular basis, like dental examinations (64.6%), or asking parents about feeding habits (59.2%) or teeth brushing (75.4%). Only 21% of the participants expressed adequate knowledge of dental care for children younger than age 3 years. Fifty-eight percent of the participants never had any dental training during their entire paediatric medicine training, including medical school. Paediatricians in private or baby clinics received higher scores in practicing caries prevention, 24.15 ± 5.17 (SD), than paediatricians in hospitals, 2.79 ± 0.54 (SD) (p = 0.006). Caries prevention practice was not found to correlate with paediatricians' knowledge or attitudes regarding oral and dental caries prevention.

CONCLUSION

Oral and dental knowledge should be incorporated into the paediatric medicine curriculum. With their heavy workload, paediatricians generally do not implement dental caries risk assessment and counselling.

Characterization of the Oral Microbiome Among Children With Type 1 Diabetes Compared With Healthy Children

Aim: Current microbiome profiling of type 1 diabetes mellitus (T1D) patients is mostly limited to gut microbiome. We characterized the oral microbiome associated with T1D in children after the onset of the disease and explored its relationship with oral physiological factors and dental status. Methods: This cohort study comprised 37 children aged 5-15 years with T1D and 29 healthy children matched in age and gender. Unstimulated whole saliva was collected from diabetic and non-diabetic children, in the morning after brushing their teeth and a fasting period of at least 1 h before sampling. 16S rRNA gene-based analysis was performed by Powersoil Pro kit by Qiagen and Phusion High-Fidelity PCR Master Mix. Oral physiological and dental parameters studied included decayed, missing, and filled teeth index, salivary flow rate, and salivary pH, glucose, calcium, phosphate, and urea levels. Results: Of the identified 105 different genera and 211 different species, the most abundant genera were Streptococcus, Prevotella, Veillonella, Haemophilus, and Neisseria. Streptococcus was more abundant in T1D children. The diabetes group had 22 taxa at the genus level and 33 taxa at the species level that were not present in the control group and the control group exhibited 6 taxa at the genus level and 9 taxa at the species level that did not exist in the diabetes group. In addition, Catonella, Fusobacterium, and Mogibacterium differed between healthy and T1D subjects. Eight species and eight subspecies were significantly more abundant among healthy children than in T1D children. Porphyromonas and Mogibacterium genera were significantly correlated with salivary parameters. We found similarities between taxa revealed in the present study and those found in gut microbiome in type 1 diabetes mellitus according to gutMDisorder database. Conclusions: Salivary microbiome analysis revealed unique microbial taxa that differed between T1D children and healthy subjects. Several genera found in the saliva of T1D children were associated with gut microbiome in T1D individuals.

Zinc Oxide Zinc Sulfate versus Zinc Oxide Eugenol as Pulp Chamber Filling Materials in Primary Molar Pulpotomies

The long-term effect of Zinc oxide zinc sulfate (Coltosol^®) dressing material on pulpotomy success and tooth survival has not yet been studied. This study compared the success rates of Zinc oxide zinc sulfate and zinc oxide eugenol as coronal dressing materials post radicular pulp amputation in primary teeth pulpotomies. This study included healthy two- to ten-year-old children who had pulpotomies on primary molars between 2012 and 2018 at the Pediatric Dentistry Clinic of the School of Dental Medicine. Data were analyzed at several follow-ups of up to 60 months. Kaplan-Meier survival curves were used to estimate survival probabilities of Zinc oxide zinc sulfate versus zinc oxide eugenol. In the 107 children included in this study, 54 teeth were filled with Zinc oxide zinc sulfate and 53 were filled with zinc oxide eugenol. Follow-up ranged from 12.2 to 73.3 months. Overall survival of Coltosol^® vs. IRM filled teeth was 87.1% and 79.3%, respectively. Overall survival probabilities for Coltosol^®-filled teeth at 15.5, 24 and 45 months were 95%, 89.8% and 79.7%, respectively, while for IRM they were 93.7%, 83% and 67.7%, respectively. Treatment failure rates and type of treated teeth did not differ between boys and girls (p-value = 0.77 and 0.87, respectively). Zinc oxide zinc sulfate and zinc oxide eugenol exhibited comparable high long-term success rates of up to five years (p = 0.16).

Parental and Dentist Satisfaction with Primary Anterior Zirconia Crowns: A Case Series Analysis

This retrospective cohort study evaluated overall parental satisfaction of zirconia crowns (ZC) placed on primary maxillary anterior teeth with that of two independent, blinded dentists. 131 ZC placed in 37 children, aged 24.8-62.2 months (mean = 42.8), who had at least one recall visit a minimum of 6 months after placement were rated (average = 13.3). Crown colour match, crown contour and crown durability were evaluated by parents and compared to photographic evaluations of two independent raters. Overall parental satisfaction was also evaluated. The overall retention rate was 99.7% and parental satisfaction was 100%. Colour match was rated excellent by 84% of parents and 36% of dental evaluators. Crown contour was rated excellent by 97% of parents and 55% of dental evaluators. The length of follow-up had no effect on colour match or crown contour. ZC comprises an aesthetic and durable option for restoring carious primary maxillary incisors and were well-accepted by parents. Parents were less critical than dental evaluators of crown appearance.

Oral Health Care Delivery for Children During COVID-19 Pandemic-A Retrospective Study

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.

Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.

Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

Outcomes of Calcium Hydroxide with Iodoform Pulpectomies in Primary Teeth

Purpose: To assess retrospectively the success rate of calcium hydroxide with iodoform as a filling material in pulpectomies of primary molars with irreversible pulpitis or pulp necrosis, and to evaluate factors that affect outcomes.<br/>Methods: This study consisted of records of 73 patients with primary molars treated with pulpectomy with high quality radiographs. Treatment was considered successful clinically if the tooth was not extracted and radiographs showed a decrease or no change in preexisting pathologic radiolucent defects.<br/>Results: Follow-up ranged from three to 39 months (median: 21.5 months). The success rate of teeth restored with a stainless steel crown (SSC) on the same appointment (88.9 percent) was higher than for teeth that received a temporary restoration (P =0.001). There was no statistically significant difference between the success rate and the extent of resorption of root canal filling material. Primary second molars had a higher success rate than first molars (P =0.018). No difference was found between the level of pulpectomy filling and treatment success (P =0.17).<br/>Conclusion: Pulpectomies done with calcium hydroxide and iodoform had an overall success rate of 74 percent. If restored with an SSC, the success rate increased to 88.9 percent. Resorption of the paste did not affect the success rate.

Clinical activity of brigatinib in ROS1-rearranged non-small cell lung cancer

BACKGROUND

Brigatinib is a potent ROS1 inhibitor. The existing data on its clinical activity in ROS1-rearranged non-small cell lung cancer (NSCLC) are limited to four cases.

METHODS

Six patients with ROS1-rearranged advanced NSCLC treated with brigatinib were identified through search of the internal databases of four participating cancer centers. Four additional patients were selected by PubMed and Google Scholar search. The objective response rate (ORR), progression-free survival (PFS) (RECIST v.1.1), duration of treatment (DOT), and safety were assessed.

RESULTS

Of eight patients evaluable for response assessment (crizotinib naive-1, crizotinib resistant -7), three patients demonstrated a partial response (ORR-37%). One crizotinib-naive patient had an ongoing response at 21.6 months. Of seven crizotinib-resistant patients, two patients demonstrated a partial response (ORR-29%), and one patient (14%) had stable disease. PFS, available in four crizotinib-resistant patients, was 7.6 + , 2.9, 2.0, and 0.4 months. In crizotinib-resistant patients, DOT was 9.7 + , 7.7 + , 7.6 + , 4.0, 2.0, 1.1, 0.4 months, and was not reported in two patients. Genomic profiling in one responder revealed no ROS1 alteration, suggesting that the response was attributable to "off-target" brigatinib activity. In two patients with progressive disease, genomic profiling demonstrated a cMET exon 14 mutation + KRAS G12A mutation in one case, and a persisting ROS1-CD74 fusion + TP53 K139N, FGFR2 E250G, ATM G2695D, and NF1 R2258Q mutations in the other. No grade 3-5 toxicity was observed.

CONCLUSION

Brigatinib demonstrated modest activity in crizotinib-resistant ROS1-rearranged NSCLC. Its intracranial and systemic activity should be assessed in correlation with the underlying molecular mechanism of crizotinib resistance.

Does preoperative paracetamol reduce pain after dental treatment? A randomized controlled double-blind study

OBJECTIVE

The present study compared the efficacy of preoperative administration of paracetamol and placebo in reducing postoperative pain after routine dental treatment in children. The primary objective was to compare postoperative pain level between the groups. The secondary objective was to identify other factors that can influence postoperative pain.

METHOD AND MATERIALS

A prospective, placebo-controlled parallel-group trial was conducted on two groups of children aged 5 to 12 years. One hundred and two children participated in the study, 51 in each group, 58 boys (56.9%) and 44 girls (43.1%). The average age was 7 ± 1.72 years, with no difference in age and sex between the groups. The study group received paracetamol (15 mg/kg) and the control group received placebo 15 minutes before dental treatment. Pretreatment baseline anxiety was recorded. Postoperative data were collected immediately at the end of the treatment, and by phone 2.5 hours after taking the remedy.

RESULTS

The groups showed no difference in postoperative pain immediately after the treatment and 1.5 hours after treatment. The pain score was higher among children who received stainless steel crowns and combinations of crowns, pulpectomy, and extractions.

CONCLUSION

Preoperative use of paracetamol has the same preemptive analgesic effect as placebo in pediatric patients who receive routine dental treatment.

CLINICAL RELEVANCE

Postoperative pain can influence the willingness of children to receive consecutive treatments. Dental practitioners should prevent postoperative pain and recommend analgesia when necessary. Pain is expected after performing stainless steel crowns, pulpectomies, and extractions. The current study confirms that preoperative paracetamol has no beneficial effect.

Combined cancer patient-reported symptom and health utility tool for routine clinical implementation: a real-world comparison of the ESAS and EQ-5D in multiple cancer sites

Background

We assessed whether the presence and severity of common cancer symptoms are associated with the health utility score (hus) generated from the EQ-5D (EuroQol Research Foundation, Rotterdam, Netherlands) in patients with cancer and evaluated whether it is possible pragmatically to integrate routine hus and symptom evaluation in our cancer population.

Methods

Adult outpatients at Princess Margaret Cancer Centre with any cancer were surveyed cross-sectionally using the Edmonton Symptom Assessment System (esas) and the EQ-5D-3L, and results were compared using Spearman correlation coefficients and regression analyses.

Results

Of 764 patients analyzed, 27% had incurable disease. We observed mild-to-moderate correlations between each esas symptom score and the hus (Spearman coefficients: -0.204 to -0.416; p < 0.0001 for each comparison), with the strongest associations being those for pain (R = -0.416), tiredness (R = -0.387), and depression (R =-0.354). Multivariable analyses identified pain and depression as highly associated (both p < 0.0001) and tiredness as associated (p = 0.03) with the hus. The ability of the esas to predict the hus was low, at 0.25. However, by mapping esas pain, anxiety, and depression scores to the corresponding EQ-5D questions, we could derive the hus using partial esas data, with Spearman correlations of 0.83-0.91 in comparisons with direct EQ-5D measurement of the hus.

Conclusions

The hus derived from the EQ-5D-3L is associated with all major cancer symptoms as captured by the esas. The esas scores alone could not predict EQ-5D scores with high accuracy. However, esas-derived questions assessing the same domains as the EQ-5D-3L questions could be mapped to their corresponding EQ-5D questions to generate the hus, with high correlation to the directly measured hus. That finding suggests a potential approach to integrating routine symptom and hus evaluations after confirmatory studies.

The effect of the waiting room's environment on level of anxiety experienced by children prior to dental treatment: a case control study

Background

In addition to visit purpose, one of the environmental factors that can cause anxiety prior to dental treatment includes the waiting room experience, specifically the amount of time spent awaiting treatment and the waiting room environment. The purpose of this study was to compare the effect of the waiting room’s environment on the level of anxiety experienced by children in multisensory and traditional waiting rooms.

Methods

Case control study. Test group waited for treatment in a multisensory waiting room, which consisted of a lighting column that children could touch and climb; as well as, rhythmic music played on loudspeakers. Control group waited for treatment in a traditional waiting room. Study participants were asked to answer the “Venham Picture Test”, a dental anxiety scale, while in the waiting room prior to entering the treatment room. Chi-squared, Fisher’s Exact tests, and linear regression were utilized. A p-value less than 0.05 was considered statistically significant.

Results

No significant difference in dental anxiety scores was found between the test and control groups according to waiting room type (p > .05). Dental anxiety was significantly higher in patients who had longer waiting time prior to treatment (p = 0.019). In addition, dental anxiety was significantly associated with visit purpose (p < .001): children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment.

Conclusions

A sensory adapted waiting room environment may be less important in reducing children’s anxiety prior to dental treatment. Children’s dental anxiety can be reduced by preventing emergency treatments, scheduling routine dental visits and decreasing waiting time.

Trial registration

TRN NCT03197129, date of registration June 20, 2017.

A Randomized Controlled Clinical Trial Comparing Tricalcium Silicate and Formocresol Pulpotomies Followed for Two to Four Years

Purpose: Tricalcium silicate (Biodentine), a new synthetic inorganic restorative cement, has shown a high rate of success in pulpotomy treatments, with few side effects. The purpose of the present randomized clinical control trial was to evaluate the long-term success of pulpotomies in human primary molars using tricalcium silicate versus formocresol. Methods: Healthy two- to 10-year-olds were treated with pulpotomies on primary molars as part of their scheduled regular dental treatment. Pulp dressing alternated randomly between tricalcium silicate and formocresol. Data were analyzed at follow-up periods up to 48 months. Results: Thirty-seven (51.4 percent) teeth with tricalcium silicate and 35 (48.6 percent) teeth with formocresol in 58 healthy children (31 boys and 27 girls) were studied. The overall success rate of the pulpotomies in this study was 94.4 percent. Tricalcium silicate was successful in 97.3 percent (36 out of 37) of the cases, and formocresol in 91.4 percent (32 out of 35). No association was found between success and type of tooth or time range from treatment to last follow-up. Conclusion: Tricalcium silicate shows a higher (though not statistically significant) success rate than formocresol in human primary molars pulpotomies followed for two to four years.

Epidemiology and Clinical Management of Early Childhood Caries in Israel

Aim: The aim of the present review is to describe the current status of early childhood caries (ECC) in Israel in aspects of epidemiology, prevention, and management.

Methods: PubMed search was performed using the words caries, children, Israel. Demographic data was collected from the Israeli Central Bureau of Statistics.

Results: The decayed, missing, and filled teeth index was 2.72 in 1992 and 2.56 in 2016. The proportion of restored teeth has increased. A number of preventive programs are ongoing but a general preventive program is lacking at the national level. From 2010, every child in Israel is eligible to receive free dental treatment.

Conclusion: The gaps in understanding of the epidemiological profile of ECC in Israel is a call for more research conduct on ECC in the country.

Obesogenic habits among children and their families in response to initiation of gluten-free diet

Initiation of a lifelong, gluten-free diet (GFD) in children with celiac disease (CD) influences the child's life in many ways. The aim of this study was to assess the influence of GFD on the child and his/her family's eating habits and lifestyle behaviors. To study this, we asked children and their parents completed the Family Eating and Activity Habits Questionnaire (FEAHQ) at the time of diagnosis of CD and at least 6 months after initiation of GFD and a questionnaires assessing symptoms related to CD and adherence to the GFD diet. We analyzed questionnaires from 40 children with CD and their families. There were 21 females, ranging in age from 4 to 15.7 years (median age 7.4 years±2.8 years). The control group comprised 15 healthy children. After initiation of GFD the family ate more junk food including snacks and candies (p = 0.05), with the significant change reported by children and fathers (p = 0.001 and 0.03 respectively). All family members in the control group had significantly less snacks. Parents and children reported a significant increase in obesogenic eating styles, such as eating from the cooking pot and eating while doing other activities (mothers, p = 0.001; fathers, 0.02; and children, 0.02 respectively).

CONCLUSIONS

Our study shows that initiation of GFD in children with CD leads to changes in eating habits and staple food eating that may lead to a more obesogenic environment. Care givers, pediatricians, gastroenterologists, and dieticians alike should be aware of these implications and educate families towards a healthier lifestyle and diet beyond the GFD itself. What's Known: • Gluten-free diet has been shown to affect various psychosocial aspects of children with celiac disease. • Obesity and celiac are associated. What is New: • Initiation of gluten-free diet led to increased eating of junk food both in the patient and his/her family. • After initiation of GFD pro-obesogenic eating habits is increased.

Adherence to Infective Endocarditis Prevention Guidelines by Israeli Dentists Who Treat Children

PURPOSE

To examine the rate of adherence of Israeli dentists who treat children and their rate of adherence, in 2010-2011 and in 2016, to changes made to the 2008 American Heart Association (AHA) guidelines for endocarditis prevention.

METHODS

A questionnaire on adherence to AHA guidelines was handed out in two consecutive continuing education courses in 2010-2011 and again in 2016. Data were analyzed using student's t test, chi-square, and analysis of variance.

RESULTS

Response rates were 62 percent in 2010 -2011 and 73 percent in 2016. Residents and pediatric dentists adhered more to the guidelines than general dentists (P=.036 and P=0.034 in 2011 and 2016, respectively). Knowledge of guidelines for dental procedures that required antibiotic prophylaxis was better than for medical conditions (52.8 percent and 79.6 percent, respectively, in 2011; 64 percent and 80 percent, respectively, in 2016). Lowest adherence was scored for prophylaxis in moderate-risk patients (32.8 percent in 2010 to 2011, 26 percent in 2016; P=.151), which was a pivotal change in the updated guidelines. Participants chose to consult with either a pediatrician or a cardiologist in 77.4 percent and 62.2 percent of the listed medical conditions in 2010 to 2011 and in 2016, respectively (P=.055).

CONCLUSIONS

Approximately a third of dentists who treat children in Israel did not follow the AHA guidelines' fundamental changes. Most dentists tended to consult physicians prior to prophylaxis administration for moderate- and high-risk groups.

Post-and-Core Restoration of Severely Damaged Permanent Posterior Teeth in Young Adolescents

PURPOSE

This retrospective study evaluated the survival rates of postendodontic severely decayed posterior permanent teeth in young adolescents.

MATERIALS AND METHODS

A total of 48 teeth (patient age range: 8.8-16.9 years) restored with a Kurer post- and core-system (Anchor System, Kurer K4) were assessed. Follow-up appointments 1 to 6 years posttreatment included radiographs and a clinical examination.

RESULTS

A total of 5 teeth (10.4%) were extracted, and 13 restorations (27%) required repair. Average restoration-to-failure time was 27 months (SD 12.2 months).

CONCLUSION

In view of these findings, clinicians should consider post-and-core restorations an alternative to extractions of endodontically treated severely damaged teeth in adolescents.

Deep caries due to Pre-eruptive intracoronal resorption in a newly erupted primary molar

CASE REPORT

This report describes a rare case of a 19-month-old girl with pre-eruptive intracoronal resorption in the lower left first primary molar which had erupted a few weeks earlier and had deep caries. The treatment is described.

CONCLUSION

Dentists who treat children must take into consideration the possibility of pre-eruptive lesions in the primary dentition that may cause involvement of the pulp, either before or shortly post-eruption.

Overcoming the oral aspects of -self-mutilation: description of a method

BACKGROUND/AIM

Self-injurious behavior (SIB) is a serious and chronic condition frequently seen in special needs populations, affecting 10% to 17% of individuals diagnosed with intellectual and/or developmental disabilities. A 2.5-year-old infant with SIB, whose presenting symptoms were severe tongue and lip lacerations accompanied by much hemorrhage, is presented here to illustrate the problem and to show how this may be prevented.

MATERIALS AND METHODS

An appliance is described which effectively limits the damage caused by SIB and permits rapid healing of existing injuries.

RESULTS

The method provides for a stable, retentive, and comfortable device on the infant's undererupted and largely nonretentive crowns of the deciduous teeth as well as for all permanent teeth in children, adolescents, and adults.

CONCLUSIONS

The appliance has been successfully employed for the past 10 years in patients with SIB who have attended for treatment in the Special Needs Clinic in our Department.

The incidence and nature of complaints against dentists for the treatment of children in Israel from 1992-2011

OBJECTIVES

Medical literature lacks information about complaints against dentists who treat children. The present study aimed to evaluate the reports filed to Medical Consultant International (MCI) regarding paediatric dentistry in 1992-2011.

BASIC RESEARCH DESIGN

Most dentists in Israel (85%) are obliged by their professional liability insurance policy to report adverse events to MCI. Reports were analysed using a structured form that included demographic details of the treating dentist, patients and parents, type of treatment, the result and the dentist's attitude. MCI dental consultants' decisions were evaluated by two specialists in paediatric dentistry.

RESULTS

The number of complaints per year is increasing. Complaints involved maltreatment (33%), case mismanagement (25%) and complications that required additional treatment (26%). Communication was problematic in 60% of cases. Only 16.7% of complaints developed into an actual lawsuit. Most complaints were against female general practitioners and against dentists who worked in community dental clinics located in peripheral areas. Treating permanent teeth increased to 3.6 times the probability of developing into a lawsuit. 59% of event records had missing data. Seventy-five percent of the cases rose from elective treatments while 25% concerned emergency treatments. One third of the cases required additional treatment in a hospital i.e. abscess drainage, foreign body swallowing or other physical damages.

CONCLUSIONS

Better case selection and documentation, better training of dentists who treat children and more appropriate attitude toward patients and parents, are likely to reduce the number of complaints.

Dental pulp therapy for primary teeth in children undergoing cancer therapy

BACKGROUND

Childhood cancer treatment negatively affects the immune system, increasing the risk for bacteremia and septicemia. As the oral cavity is a major entry portal for pathogens into the bloodstream dental care in such children tends to be radical, favouring tooth extraction over less drastic treatments such as pulpotomy, the amputation of infected dental pulp. The present study aimed to compare pulpotomy treatment success rate in children with cancer receiving immunosuppressive therapy with that of healthy children, and investigate if unsuccessful pulpotomy treatment in oncologic patients may lead to systemic complications.

PROCEDURE

Twenty-six medical records of children from a paediatric oncology referral centre who had dental pulpotomy treatment (in 41 teeth) while receiving active cancer care during the years 2006-2012 were compared with records of 41 randomly selected healthy children who had undergone pulpotomy treatment (41 teeth) in the same institute during these years. Clinical and radiographic data were collected during treatments and at the end of the follow-up period (six months post dental treatment).

RESULTS

No statisticaly significant difference was found between pulpotomy success rate amongst the two groups. Treatments success rates in the study and control groups were 82.9% (± 5.9) and 90.2% (± 4.7), respectively. No patient in the study group suffered from sepsis from a dental origin during follow-up period.

CONCLUSIONS

Pulpotomy in paediatric cancer patients did not increase the risk for bacteremia or systemic complications from oral origin. We therefore recommend the re-evaluation of the current protocol for treating paediatric oncology patients.

Renal agenesis in Kallmann syndrome: a network approach

Kallmann syndrome (KS) is defined by the combination of isolated hypogonadotrophic hypogonadism (IHH) and anosmia, with renal agenesis occurring in 30% of KS cases with KAL1 gene mutations. Unlike other KS-related disorders, renal agenesis cannot be directly associated with mutations in the KAL1 gene. We hypothesized that protein interaction networks may suggest a link between genes currently known to be associated with KS on the one hand and those associated with renal agenesis on the other hand. We created a STRING protein interaction network from KS-related genes and renal-agenesis-associated genes and analyzed it with Cytoscape 3.0.1 network software. The STRING protein interaction network provided a conceptual framework for current knowledge on the subject of renal morphogenesis in Kallmann syndrome. In addition, STRING and Cytoscape 3.0.1 software identified new potential KS renal-aplasia-associated genes (PAX2, BMP4, and SOX10). The use of protein-protein interaction networks and network analysis tools provided interesting insights and possible directions for future studies on the subject of renal aplasia in Kallmann syndrome.

Are there metallic traces in black extrinsic dental stain?

OBJECTIVE

The detection of ferric ions in samples of black extrinsic dental stain led to the idea that it is comprised of insoluble ferric compounds. The present study examined the chemical composition of black extrinsic dental stain.

METHOD AND MATERIALS

Plaque was collected from 17 children with black extrinsic dental stain (study group A) and from 15 children without black extrinsic stain (control group), using sterile graphite curettes; and from 4 children with black extrinsic stain (study group B), using a standard sterile metal curette. Samples were analyzed with a scanning electron microscope (SEM) and subjected to quantitative chemical analysis (energy dispersive spectrometry).

RESULTS

Except for calcium and phosphorus levels, no significant differences were found between the chemical composition of black extrinsic dental stain and dental plaque. Metallic ions were not detected in samples collected with a graphite curette (study group A), but were detected in samples collected with a metal curette (study group B).

CONCLUSION

Metallic ions do not seem to be the origin of black extrinsic dental stain. Previous reports of the presence of metallic ions are probably due to contamination of the samples by the collection method.

Conservative management for an entero-adnexal fistula at initial presentation of advanced ovarian carcinoma

Gastrointestinal fistulae can occur in ovarian cancer patients, usually in the setting of advanced relapsed disease. Treatment typically involves immediate surgery.Here, we describe a case of an abscess resulting from an intestinal fistula as the first manifestation of advanced epithelial ovarian cancer, and we review the current literature on this subject. The patient was successfully treated with a combination of chemotherapy, antibiotics, and delayed surgery. Optimal debulking was achieved without a need for bowel resection.This report is the first of conservative management of a fistula in an ovarian cancer patient in the chemotherapy-naïve setting.

Salivary bacteria and oral health status in medicated and non-medicated children and adolescents with attention deficit hyperactivity disorder (ADHD)

OBJECTIVES

Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder. Studies have shown that children with ADHD are more prone to caries than those without. The study investigated children diagnosed with ADHD, both with and without pharmacological intervention, and the following: DMFT\dmft, plaque index (PI), mutans streptococci (MS) levels, lactobacilli (LB) levels, salivary flow, salivary buffer capacity, oral hygiene, and diet.

STUDY DESIGN

DMFT/dmft index, PI, MS and LB levels, salivary flow, and salivary buffer capacity were examined in three groups of children: ADHD1-diagnosed with ADHD with no pharmacological intervention (N = 31), ADHD2-treated with medications for ADHD (N = 30), and a healthy control group (N = 30). Diet and oral health habits were assessed through questionnaires completed by parents.

RESULTS

There were no differences in the DMFT/dmft index, MS and LB counts, salivary buffer capacity, and parent reported diet and oral health behavior between the three groups. Children with ADHD demonstrated a higher plaque index.

CONCLUSIONS

Although children with ADHD did not report different diet and oral health behavior from children without ADHD, this group had significantly higher levels of plaque than the control group, which combined with hyposalivation may be a risk factor for caries at an older age.

CLINICAL RELEVANCE

Medicated and non-medicated ADHD children were similar to control children in their caries rate, MS and LB counts, salivary buffer capacity, and diet and oral health behavior. They differed in the amount of plaque found on their teeth. As a group, ADHD children demonstrated hyposalivation compared with the control.

A brain abscess of probable odontogenic origin in a child with cyanotic heart disease

The purpose of the present report was to present a rare case of a brain abscess in a child with heterotaxy syndrome, severe cardiac anomalies, and extensive dental caries. The pathogen was Streptococcus intermedius isolated from the cerebrospinal fluid. The source of the pathogen was probably an infection of a primary molar with a dentoalveolar abscess involving the bud of the permanent successor. After a long course of antibiotic regimens followed by a craniotomy with abscess drainage, a shunt, and comprehensive dental treatment, the patient was discharged from the hospital without any neurological sequel. At home, she completed an additional 3 months of oral antibiotics. This is the only known documented case of a toddler with a brain abscess of probable odontogenic origin without previous dental intervention. It emphasizes the importance of collaboration between cardiologists and pediatric dentists, especially in referring children with congenital heart defects for early dental checkups.

Effects of amorphous calcium phosphate stabilized by casein phosphopeptides on enamel de- and remineralization in primary teeth: an in vitro study

PURPOSE

Amorphous calcium phosphate, stabilized by casein phosphopeptides, has been found to enhance remineralization of subsurface lesions in permanent teeth. The purpose of the present in vitro study was to evaluate the potential of GC Tooth Mousse to enhance remineralization of initial demineralized enamel sites in primary teeth.

METHODS

Forty-four demineralization sites were created in 22 extracted primary teeth. Samples were randomly assigned to 6 treatment groups (GC Tooth Mousse covering, GC Tooth Mousse covering and demineralization, and control groups). The mineral content of each sample was evaluated using energy dispersive X-ray analysis, performed from the enamel surface of each lesion inwards. The results were analyzed using analysis of variance, with a significance level P<.05.

RESULTS

Samples treated with GC Tooth Mousse demonstrated an increase in the calcium-phosphate ratio by approximately 2% near the surface, a minimal increase of 1% at a depth over 60 μm, and no change at a depth from 40 to 60 μm, with no statistically significant differences (P>.05).

CONCLUSION

This study demonstrates a minimal increase in the subsurface calcium-phosphate ratio following GC Tooth Mousse treatment, especially in demineralized enamel tissue.

Oral health status, salivary flow rate and salivary quality in children, adolescents and young adults with ADHD

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder that presents in 3-7% of school-age children. Studies have shown that children, adolescents and young adults with ADHD are more prone to caries than those without.

AIM

The study investigated a possible relationship between the oral health status of children, adolescents and young adults diagnosed with ADHD, both with and without pharmacological intervention, and the following: salivary flow rate, oral mucosal pH, plaque index (PI), oral hygiene and dietary behaviour.

STUDY DESIGN

DMFT/dmft index (D;d-Decay, M;m-Missing; F;f-Filled,T;t-teeth), plaque index, oral mucosal pH and unstimulated whole salivary flow (USF) were examined in three groups of children, adolescents and young adults: those diagnosed with ADHD with no pharmacological intervention (N=31), those treated with medications for ADHD (N=30), and a healthy control group (N=30). Diet and oral health habits were assessed by means of questionnaires completed by parents.

RESULTS

Mean USF values were 0.72, 0.85 and 1.13 ml/min for participants with ADHD and without medication, with ADHD and with medication, and without ADHD, respectively (p=0.016). There were no differences in the DMFT/dmft index and in parent reported diet and oral health behaviour between the three groups. Children with ADHD demonstrated a statistically significant higher plaque index (p<0.05).

CONCLUSIONS

The ADHD group, with or without pharmacological intervention, showed higher plaque index and lower USF, but no difference in DMFT/dmft. The ADHD group did not differ from the non-ADHD group in their diet or oral health behaviour as assessed by parent reports.

Unsweetened ice popsicles impart a positive feeling and reduce self-mutilation after paediatric dental treatment with local anaesthesia

AIM

The purpose of the current study was to assess whether an unsweetened ice-popsicle imparts a positive feeling to children after dental treatment in which local anaesthesia is administered, and whether it reduces the tendency of children to self-mutilate (bite the lip, cheek or tongue) after the administration of local anaesthesia.

DESIGN

Crossover study of 31 children aged 4-11 years old who needed similar dental treatments on both sides of the mandible or maxilla under local anaesthesia. At the end of each appointment the child received a toy or an ice-popsicle especially made for this study. Patients and parents answered a questionnaire regarding the children's behaviour and feeling immediately after the treatment, and 10 and 30 min after receiving the ice-popsicle or toy.

RESULTS

Children who received ice-popsicles after dental treatment under local anaesthesia felt less discomfort and suffered less soft tissue trauma than they did when they received a toy. Reduction in soft tissue trauma was evident 10 min after receiving the ice-popsicles.

CONCLUSION

Licking of an ice-popsicle after dental treatment with local anaesthesia reduces the feeling of discomfort and the biting of soft tissue and self- mutilation.

Salivary bacteria and oral health status in children with disabilities fed through gastrostomy

OBJECTIVES

This study examined caries level, amount of calculus, and oral microbial environment in gastrostomy tube (GT)-fed children compared with healthy children and children with disabilities orally fed (PO).

STUDY DESIGN

The study group consisted of 12 GT-fed children and the two control groups consisted of 16 children with disabilities orally fed and 17 healthy children. DMF-T/dmf-t index, calculus index, Mutans Streptococci (MS), Lactobacilli (LB) levels and salivary buffer capacity were examined.

RESULTS

DMF-T/dmf-t index was significantly lower in the tube-fed group. Calculus index was highest in the tube-fed group. MS and LB levels were the lowest in the tube-fed children. Correlation was found between MS and DMF-T/dmf-t.

CONCLUSIONS

Tube-fed children demonstrated significantly higher calculus levels and less caries, MS, and LB levels then healthy children or children with disabilities eating PO.

Long-term follow up of root canal treated primary molars

BACKGROUND

Root canal treatment (RCT) is commonly performed to preserve primary molars with an infected or necrotic pulp.

AIM

This study evaluates the long-term effects of RCT in primary molars on the development and eruption of their permanent successors.

METHODS

This is a retrospective study of treatment of pulpectomised primary molars in a public dental clinic. All teeth were treated by the same operator using the same material (Endoflas F.S.) and the same method. Records of 194 patients with 242 pulpectomised primary molars (124 in 97 boys and 118 in 97 girls) met the inclusion criteria. The children's age at the time of treatment ranged from 5 to 11 years (mean 6.72). Follow-up time ranged from 6 to 113 months (mean 33.5).

RESULTS

Eight (3.3%) of the 242 primary molars presented a new radiolucent defect or enlargement of existing periapical radiolucency. Of the 106 molars followed until eruption of the permanent successor, none had radiographic pathological signs. Of 17 permanent teeth evaluated clinically, three were erupted into a rotated alignment, and one premolar presented hypocalcified defect in the enamel.

CONCLUSIONS

Failure of root canal treatment in primary molars may be evident from development of new radiolucent defects or enlargement of existing defects. No relationship was found between RCT in the primary molars and the appearance of enamel defects or the ectopic eruption of following permanent teeth.

Replantation of an immature permanent central incisor following pre-eruptive traumatic avulsion

Tooth avulsion represents 0.5-16% of traumatic injuries. Avulsion of a pre-eruptive left permanent maxillary incisor in a 6-year-old boy is presented. The immature tooth was replanted after rinsing with saline following 10 min dry extra-oral time. This case report describes treatment and a 2-year follow-up of the tooth. During the follow-up period, continuation of root development, pulp revascularization, and irregular dentin formation were demonstrated. The tooth is vital, functional, and esthetic. To the best of our knowledge, no such case of replantation of a pre-eruptive tooth has been reported previously.

Compliance of children and youngsters in the use of mouthguards

The purpose of the study was to examine the compliance of children wearing their mouthguards, and to evaluate socio-environmental factors that impact upon the usage of the device. Eighty children attending the student clinic of the Hadassah School of Dental Medicine received mouthguards free of charge. One year later, 69 participants and their parents answered a survey aimed at gaining information regarding compliance and comfort when wearing the mouthguard correlated with gender, ages of parents and child, number of siblings, position of child in the family, socio-economic status, education of parents and past dental injuries of siblings or parents. Twenty-nine percent of the children never wore the mouthguard, 32% wore it sometimes, 15.9% wore it when necessary at the beginning but stopped after one month and 23.2% wore the mouthguard whenever needed. About 68% of the participants still possessed the mouthguard one year after receiving it, 44.9% reported that they did not wear the mouthguard because they forgot and 42% reported that the reason for not wearing the appliance was because it was not comfortable. Seventy-seven percent of the parents were not aware of the existence of this appliance prior to this study. In addition, 47.9% stated that dentists had not offered such treatment to them in the past, 20.8% indicated that their child had never possessed a mouthguard before due to its significant expense and 39.6% stated that they would not invest in this treatment in the future because their child would not wear the appliance. Boys were more comfortable wearing the mouthguard than girls. The younger the child and the later s/he was in the sibling order of the family, the more likely s/he was to lose the mouthguard.

The use of popsicles after dental treatment with local anesthesia in pediatric patients

The purpose of the study was to assess how children felt after dental treatment when receiving apopsicle or a toy Each patient received either a popsicle or a toy after dental treatment on the first visit, and the other on the second visit. A significant difference (p = 0.0235) was found 10 minutes and thereafter 30 minutes after dental treatment. More children reported feeling better when they received a popsicle than when they received a toy.

Dental management of a child with trisomy 9 mosaicism: a case report

This case report presents the dental management of a 13-year-old girl with mosaic trisomy 9. She had: (1) severe psychomotor retardation; (2) short stature; (3) progressive microcephaly; (4) flat feet; (5) genu valgum; and (6) severe kyphoscoliosis. Dysmorphic facial features included: (1) maxillary prognathism; (2) narrow high-arched palate; (3) short philtrum; (4) small low posterior dysplastic ears; and (5) down slanting palpebral fissures with right eye ptosis. The case report describes initial treatment under general anesthesia and further treatments using conscious sedation. Emphasis was placed on the need to adjust the treatment to patient's skeletal malformations and respiratory problems by adjusting her ability to sit in the dental chair in an upright position. Supernumerary premolars and opalescent changes of the maxillary incisors might be part of the clinical features related to trisomy 9 mosaic syndrome.