Prevalence, Severity, and Description of Dental Anomalies in Children Treated for Acute Lymphoblastic Leukemia.

Purpose: To assess the prevalence and severity of and describe dental anomalies in children treated for acute lymphoblastic leukemia (ALL) under recent Dana-Farber Cancer Institute (DFCI) protocols. Methods: Patients aged between 14 and 25 years old having received a diag- nosis of ALL before the age of 11 years and after September 2000 received clinical and radiographic oral examinations. Results: Dental anomalies were observed in 26 (51.0 percent) of 51 subjects. Microdontia was the most prevalent dental defect (39.2 percent). Impacted permanent second molars were observed in five (9.8 percent) patients. Being age five years or younger at diagnosis significantly increased the prevalence and severity of dental anomalies (P<0.001). Conclusions: Recent DFCI protocols showed a decreased prevalence of dental disturbances. The anomalies observed may still alter the development of the dental arches and occlusion in pediatric ALL survivors. Further research is needed to confirm the association between ALL treatment and permanent second molar impaction.

Effects of a Virtual Reality Game on Children's Anxiety During Dental Procedures (VR-TOOTH): Protocol for a Pilot Randomized Controlled Trial.

BACKGROUND: Dental fear and anxiety (DFA) is a condition that affects approximately one-quarter of children and adolescents. It is a significant cause for pediatric patients to avoid dental care later in adulthood. Lack of patient cooperation due to DFA can create an environment of stress, often obligating dentists to end appointments prematurely and consider alternative pharmacological treatment options. Virtual reality (VR) use during dental care, providing an immersive experience through sensory stimuli, is potentially an additional nonpharmacologic tool to better manage DFA in children with special health care needs (SHCN) undergoing dental procedures. OBJECTIVE: This pilot study aims to assess the feasibility and acceptability of VR immersion as a tool to reduce DFA in pediatric special needs patients undergoing dental procedures. The study also aims to gain insight on parent and health care provider perspectives on the use of VR during dental appointments. METHODS: This pilot randomized controlled trial study will follow a parallel design including 2 groups: a control group (clinic's standard care using a wall TV) and an experimental group (using a VR game). We will randomize 20 participants to either group. Recruitment will be carried out at the dental clinic of the Centre Hospitalier Universitaire Sainte-Justine, a tertiary-quaternary care center that mostly serves pediatric patients with SHCN. The primary outcome will be patient recruitment rates and completion rates of planned procedures. DFA in children will be assessed using both an observation-based proxy assessment with the Venham Anxiety and Behavior Rating Scale and physiological assessments using parameters such as change in heart rate and levels of salivary alpha-amylase as a stress biomarker before and 10 minutes after the procedure. Sociodemographic characteristics, measures of the levels of parent and health care professional satisfaction, occurrence of side effects, and any deviation from normal procedure length will also be collected. Descriptive statistics, nonparametric tests, and effect sizes will be used for demographic and clinical variables and to present parent and health care professional satisfaction levels as well as procedural time. RESULTS: This study will be conducted from May 2023 to May 2024, with results expected to be available in December 2024. CONCLUSIONS: The pilot study will provide insight on the feasibility and acceptability of VR use in clinical dentistry to reduce DFA for pediatric patients with SHCN. This study will guide future research on VR use in pediatric dentistry and can serve as a framework for a larger randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT05898100; https://classic.clinicaltrials.gov/ct2/show/NCT05898100. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49956.

Bond strength of a sealant to permanent enamel: evaluation of 3 application protocols.

PURPOSE: The purpose of this study was to compare sealant-enamel bond strengths of 3 application protocols. METHODS: Sixty extracted third molars were randomly distributed into 3 groups according to the sealant's application protocol. The enamel was conditioned with: phosphoric acid in group 1; phosphoric acid and a single-bottle dentin bonding agent in group 2; and a self-etching adhesive in group 3. The specimens were thermocycled and tested in a shear mode at a cross-head speed of 1 mm/minute until fracture. Groups were compared using Kruskall-Wallis one-way analysis of variance and Mann-Whitney U tests. RESULTS: No statistically significant difference was observed between groups 2 and 3 (P=.96), but both groups showed significantly higher bond strength than group 1. Group 3 appeared to be the most reproducible application protocol as shown by its coefficient of variation (27). CONCLUSIONS: Self-etch adhesives are potentially attractive because of the easier clinical protocol required, provided that they have similar bond strengths compared to other products. The bond strength tests used in this study suggest that self-etch adhesives are equivalent to those using a separate bonding agent. Long-term clinical trials should be performed to assess performance of self-etch adhesives before definitive conclusions can be drawn.

Lip biting in a pediatric dental patient after dental local anesthesia: a case report.

Self-inflicted lip trauma is a potential complication of dental treatment involving local anesthesia of the inferior alveolar nerve, particularly among children. Children presenting with this self-limiting condition are often times misdiagnosed as having a localized bacterial infection. In some extreme cases, children have been unnecessarily hospitalized and treated with systemic antibiotics or surgical interventions. This case report describes a child who bit his lip after a dental appointment and was subsequently hospitalized for monitoring. Pediatric nurses are in a unique position to help parents and primary care physicians properly diagnose and manage this benign condition palliatively.

Marginal microleakage of a sealant applied to permanent enamel: evaluation of 3 application protocols.

PURPOSE: The purpose of this in vitro study was to investigate and compare the microleakage-occurring after the placement of a light-curing sealant-to unground permanent enamel which had been previously conditioned using 3 different application protocols. METHODS: Sixty-three molars were randomly distributed in 3 different groups according to the application protocol of the sealant: (1) conditioning of the enamel with 38% phosphoric acid (group 1); (2) conditioning with phosphoric acid and single-bottle dentin bonding agent (group 2); or (3) conditioning with a self-etching adhesive (group 3). Samples were: (1) thermocycled; (2) stained; (3) sectioned; and (4) examined for marginal microleakage. RESULTS: No dye penetration was noted for 25%, 59%, and 40% of cases for groups 1, 2, and 3, respectively. CONCLUSIONS: Placement of a bonding agent layer prior to the sealant allows significantly less microleakage than the traditional conditioning of enamel with phosphoric acid alone. The self-etching adhesive used here seems to be an attractive alternative to the acid-etch and adhesive technique for sealant application in young children, since it would simplify the procedure. Clinical trials should be performed to assess the performance of these products before definitive conclusions can be formulated.