Korean clinical practice guidelines for diagnostic and procedural sedation.

Safe and effective sedation depends on various factors, such as the choice of sedatives, sedation techniques used, experience of the sedation provider, degree of sedation-related education and training, equipment and healthcare worker availability, the patient's underlying diseases, and the procedure being performed. The purpose of these evidence-based multidisciplinary clinical practice guidelines is to ensure the safety and efficacy of sedation, thereby contributing to patient safety and ultimately improving public health. These clinical practice guidelines comprise 15 key questions covering various topics related to the following: the sedation providers; medications and equipment available; appropriate patient selection; anesthesiologist referrals for high-risk patients; pre-sedation fasting; comparison of representative drugs used in adult and pediatric patients; respiratory system, cardiovascular system, and sedation depth monitoring during sedation; management of respiratory complications during pediatric sedation; and discharge criteria. The recommendations in these clinical practice guidelines were systematically developed to assist providers and patients in sedation-related decision making for diagnostic and therapeutic examinations or procedures. Depending on the characteristics of primary, secondary, and tertiary care institutions as well as the clinical needs and limitations, sedation providers at each medical institution may choose to apply the recommendations as they are, modify them appropriately, or reject them completely.

Impaction of multiple dilacerated primary incisors: a case report.

Dental complications such as defective alveolar bone development, delayed eruption, and tooth impaction are related to neonatal oral intubation. This case report presents an example of potential complications that occur in children who have undergone oral intubation as neonates. A 20-month-old girl visited our pediatric clinic. We observed delayed, non-erupted teeth #51, #71, and #81 and determined a history of intubation during the neonatal period as a related factor. After 22 months of observation, tooth #71 erupted spontaneously. After 40 months of monitoring, teeth #51 and #81 were extracted surgically, and normal permanent teeth erupted six months later. This study is helpful for pediatric anesthesiologists, pediatricians, and dentists who diagnose and treat eruption disorders of the primary dentition.

Prediction Model for Future Success of Early Orthopedic Treatment of Class III Malocclusion.

This study aimed to identify predictors for successful post-treatment outcomes in early orthopedic class III malocclusion treatment with a facemask and hyrax expander appliance. The study was performed on lateral cephalograms from 37 patients at the start of treatment (T0), post-treatment (T1), and a minimum of three years after treatment (T2). The patients were grouped as stable or unstable according to the existence of a 2-mm overjet at T2. For statistical analysis, independent t-tests were used to compare the baseline characteristics and measurements of the two groups, considering a significance level of < 0.05. Thirty variables of pretreatment cephalograms were considered during logistic regression analysis to identify predictors. A discriminant equation was established using a stepwise method. The success rate and area under the curve were calculated, with AB to the mandibular plane, ANB, ODI, APDI, and A-B plane angles as predictors. The A-B plane angle was the most significantly different between the stable and unstable groups. In terms of the A-B plane angle, the success rate of early class III treatment with a facemask and hyrax expander appliance was 70.3%, and the area under the curve indicated a fair grade.

Effectiveness of Human-Artificial Intelligence Collaboration in Cephalometric Landmark Detection.

Detection of cephalometric landmarks has contributed to the analysis of malocclusion during orthodontic diagnosis. Many recent studies involving deep learning have focused on head-to-head comparisons of accuracy in landmark identification between artificial intelligence (AI) and humans. However, a human-AI collaboration for the identification of cephalometric landmarks has not been evaluated. We selected 1193 cephalograms and used them to train the deep anatomical context feature learning (DACFL) model. The number of target landmarks was 41. To evaluate the effect of human-AI collaboration on landmark detection, 10 images were extracted randomly from 100 test images. The experiment included 20 dental students as beginners in landmark localization. The outcomes were determined by measuring the mean radial error (MRE), successful detection rate (SDR), and successful classification rate (SCR). On the dataset, the DACFL model exhibited an average MRE of 1.87 ± 2.04 mm and an average SDR of 73.17% within a 2 mm threshold. Compared with the beginner group, beginner-AI collaboration improved the SDR by 5.33% within a 2 mm threshold and also improved the SCR by 8.38%. Thus, the beginner-AI collaboration was effective in the detection of cephalometric landmarks. Further studies should be performed to demonstrate the benefits of an orthodontist-AI collaboration.

Clinical diagnosis and treatment of temporomandibular disorders in children and adolescents: a case series.

The early diagnosis of temporomandibular disorders (TMDs) in children and adolescents is important because they can affect oral and maxillofacial growth and development. This case series introduces patients with various clinical features of TMDs and demonstrates how symptoms were reduced through appropriate interventions in collaboration with oral medicine specialists and pediatric dentists. TMDs symptoms in children are often mild and difficult to express accurately; therefore, diagnosis through clinical evaluation is important. Pediatric dentists should be aware of TMDs in children and adolescents, and should diagnose, treat, and refer to specialists in a timely manner.

Management of Severely Aberrant Permanent First Molars in Molar Root-Incisor Malformation Patients: Case Series and a Guideline.

Recently, a new type of dental anomaly, a molar-incisor malformation or molar root-incisor malformation (MRIM), was recognized. The disease phenotype is now relatively well characterized; however, its etiology and disease-mechanism need to be elucidated. The affected teeth do not respond well to conventional treatment because of severe malformation and an unusual root structure. In this study, we present the treatment of MRIM cases with the extraction of severely aberrant permanent first molars (PFMs) and suggest that the PFM extractions are performed when it is clear that third molars will develop. The purpose of this report was primarily to present amendments to the guidelines for the treatment of patients with MRIM.

Dental Management of Congenital Granular Cell Lesion and Neonatal Teeth: A Case Report.

Congenital granular cell lesion (CGCL) is a rare benign oral cavity tumor in infants. Neonatal teeth are also rare dental anomalies that appear during the first month of life. This report describes a case of eruption of neonatal teeth after surgical excision of CGCL. Surprisingly, residual neonatal teeth erupted after extraction of the neonatal teeth. If neonatal teeth are mobile, they should be carefully extracted with curettage of the underlying tissues of the dental papilla; failure to curette the socket might result in eruption of odontogenic remnants. If neonatal teeth were exfoliated, parents should be informed of the need for regular checkups with a dentist due to possibility of development of residual neonatal teeth.

Risk Factors for Early Childhood Caries: An Umbrella Review.

Purpose: The purpose of this umbrella review was to summarize and evaluate the available evidence concerning risk factors for early childhood caries (ECC). Methods: Literature searches were performed until July 2020 in Medline, Web of Science, and EMBASE databases. Systematic reviews were selected, and their methodological qualities were assessed using the AMSTAR 2 tool (16 items). Results: A total of 977 articles for possible inclusion were identified, and 15 studies were finally selected for qualitative analysis. In these 15 studies, the risk of bias varied from critically low to high. The included studies reported risk factors for ECC such as dietary factors, mutans streptococci, low maternal education, maternal age, low family income and parental education level, low social class, enamel defects, obesity, the presence of dentinal caries, presence of Candida albicans, moderate to late preterm birth, and prenatal maternal cigarette smoking. Conclusions: The potential risk factors for early childhood caries are enamel defects, high levels of mutans streptococci, the presence of dentinal caries, increased consumption of soda, daily intake of sugary snacks, and obesity. In the future, longitudinal studies are needed to explore the potential relationship between these risk factors and ECC.

Dentist Job Satisfaction: A Systematic Review and Meta-analysis.

OBJECTIVES: Because of the heterogeneous nature of the evidence regarding dentists' job satisfaction, an overview was necessary to examine dentists' level of job satisfaction and to determine related work environmental factors. MATERIALS AND METHODS: A literature search was conducted using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic database searches of PubMed/MEDLINE, EMBASE, and Web of Science were performed until March 1, 2020. Two independent authors collected data and assessed the methodological quality of primary studies using the Newcastle Ottawa Scale. RESULTS: Nine studies were included from the 1987 initially retrieved. Among the included studies, 5 exhibited a neutral level of satisfaction and originated from China, South Korea, Egypt, and the United States, and 3 studies from Canada, Lithuania, and the United States showed a high level of satisfaction. Only 1 study did not report the mean job satisfaction score. According to bias evaluation, 9 studies were considered low risk. CONCLUSION: The findings showed that dentists were satisfied with their jobs at a moderate to high level, and specialists were more satisfied than general dentists. Regarding work environmental factors, the 6 most satisfied factors were patient relationships, respect, delivery of care, staff, professional relationship, and professional environment. Five of the least satisfied factors were personal time, stress, income, practice management, and professional time. However, longitudinal studies would be required to identify changes in these factors. Further studies should be performed in middle- and low-income countries using the Dentist Satisfaction Survey, including stress evaluation.

Influence of mouth breathing on atopic dermatitis risk and oral health in children: A population-based cross-sectional study.

BACKGROUND/PURPOSE: Previous studies have suggested that mouth breathing has harmful effects on atopic dermatitis (AD) and oral health in children, but the evidence has been insufficient. To investigate the association of mouth breathing with AD and oral health in Korean schoolchildren aged 8-11 years. MATERIALS AND METHODS: Cross-sectional data were obtained from March to April 2016. A questionnaire was used to investigate children's mouth breathing habits and personal/family histories related to allergic disease. Oral health status was determined through a clinical oral examination. Data were analyzed with multivariable logistic regression. RESULTS: In total, 1507 children were included. A moderate relationship was observed between mouth breathing and AD (adjusted odds ratio, 1.05; 95% confidence interval, 1.00-1.10; p-value, 0.035), whereas no association was found between mouth breathing and dental caries in children. Mouth breathing during sleep (MBS) was closely related to allergic diseases and other respiratory diseases. Furthermore, mouth breathing was associated with child's tonsillitis and was identified as a possible risk factor for class II dental malocclusion. CONCLUSION: We confirmed the positive association between mouth breathing (especially during sleep) and allergic diseases, including the AD in school-aged children. The influence of mouth breathing on dental caries remains uncertain. An intervention trial is required to evaluate whether the prevention of mouth breathing can reduce the risk of allergic diseases.

Multiple Idiopathic Internal Root Resorption in an Adolescent: A Case R Multiple Idiopathic Internal Root Resorption in an Adolescent: A Case Report.

Internal root resorption (IRR) refers to a slow or rapid progressive resorption process that occurs in the pulp cavity of the tooth or the dentin of the root. IRR occurs as result of odontoclast action; in many cases, the pulp tissue exhibits chronic inflammation, and odontoblasts and predentin do not appear on the dentin wall near the pulp. Exact predisposing factors have not been clearly elucidated; therefore, it is difficult to identify reliable data on the prevalence of IRR because of its scarce occurrence and pathology. Reports have indicated that IRR is more common in the primary than in the permanent teeth. This case report discusses a 17-year-old girl with multiple idiopathic internal root resorptions of anterior permanent teeth in a short period of a time and its management.

Treatment of pre-eruptive intracoronal resorption: A systematic review and case report.

BACKGROUND/PURPOSE: Pre-eruptive intracoronal resorption (PEIR) is usually detected accidently in radiographs. However, treatment modality is still not reported systematically. The current study aimed to conduct a systematic review of the treatment modality of PEIR case reports and to report a case on the preservation of a vital pulp with surgical exposure in permanent maxillary canine. MATERIALS AND METHODS: We systematically searched case reports from PubMed/MEDLINE, EMBASE, and Web of science databases. The treatment modality, suspected etiology, and follow up periods were collected from each study and reviewed by two authors independently. RESULTS: The initial search identified 100 studies. After the title/abstract screening, 37 articles received a full-text reading; and finally, 24 articles (29 patients and 37 affected teeth) were selected for the final review. Among the 24 unerupted teeth, surgical opening and restoration treatment of PEIR was chosen as a high priority for treatment options (n = 9, 36%). Among the 13 erupted teeth, restoration was applied for the prevention such as developing in size and fracture (n = 4, 31%). CONCLUSION: According to this systematic review, treatment modalities were based on the progressive nature of the lesion size and eruption state to establish the optimal approach for each patient. Clinicians should take into account the eruption status, lesion progression, the size of the lesion, and the degree of pulp involvement.

Factors Associated with Molar-Incisor Hypomineralization: A Population-Based Case-Control Study.

Purpose: The purpose of this case-control study was to investigate the relationship between molar-incisor hypomineralization (MIH) and pre-, peri-, and postnatal conditions of children and mothers in South Korea. Methods: The Korean Academy of Pediatric Dentistry con- ducted this study to examine factors associated with MIH among six- to 13-year-olds. The European Academy of Pediatric Dentistry criteria and self-administered questionnaires associated with MIH were used. Results: In multivariable logistic regression analysis, the odds ratio (OR) of MIH for children whose mothers used health supplements during pregnancy was 0.65 (P=0.009). Also, children with more than three hours of out- door activities per day tended to have a lower MIH (P=0.03) than did those with zero hours of outdoor activity. Additionally, the OR of MIH for children whose mothers smoked during pregnancy was 2.37 (P=0.019) and the MIH found to be 1.33 times more frequent in children with respiratory infections during the first three years of life (P=0.048). Conclusions: Maternal smoking during pregnancy and child's pediatric respiratory infection suffered within three years after birth are factors associated with the MIH among Korean children. Further study is needed because the prevalence of MIH in children whose mothers taking health supplements (vitamins or folic acid or iron) during pregnancy is low.

Use of the Hall technique by specialist paediatric dentists: a global perspective.

Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.

The Effect of Probiotics on Halitosis: a Systematic Review and Meta-analysis.

Although several studies have evaluated the inhibitory effect of probiotics on halitosis, findings are inconsistent. This systematic review and meta-analysis of randomized clinical trials (RCT) was conducted to summarize the evidence on the effect of probiotics on halitosis. RCT on any type of probiotic treatment with at least 2-week duration were identified through electronic databases (PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials) and hand searched between 1946 and January 17, 2017. Primary outcomes were organoleptic (OLT) scores and volatile sulfur compounds (VSC). Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. Meta-analysis was conducted to synthesize the evidence. Of the 153 articles identified, three met the inclusion criteria. Meta-analysis revealed that OLT scores (SMD = - 1.93, 95% CI - 2.85 to - 1.02, P < 0.0001) were significantly lower in subjects who received probiotics than in placebo groups, but no significant difference was observed at the VSC concentration (SMD = - 0.02, 95% CI - 2.12 to 2.07, P = 0.98). Current evidence is supportive of recommending probiotics for the management of halitosis. Based on this review, transient (average of 2 weeks) dosing with probiotics (mainly Lactobacillus strains) has a moderate effect on halitosis regarding OLT scores, but we could not confirm the effects of probiotics on the VSC reduction. The available evidence is quantitatively and qualitatively insufficient for further recommendations, especially with regard to administration strategies and pretreatment. Future studies should aim for longer follow-up and standardized administration methods to prove or refute the effect of probiotics on halitosis.

The Influence of Parenting Style on Child Behavior and Dental Anxiety.

Purpose: Previous studies provide mixed and inconclusive evidence for an effect of parenting style on children's dental anxiety and behavior. The purpose of this study was to analyze the association between parenting style and children's dental anxiety and behavior and assess the methodological quality of published literature. Methods: PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for articles published up to November 1, 2017. The children's dental anxiety score and behavior score were the primary outcomes. The modified Newcastle-Ottawa score was used to assess methodological quality. Of the 983 articles identified, eight cross-sectional studies, with a total of 1,611 participants, met our inclusion criteria. Results: We observed significant differences in children's dental anxiety and behavior, according to parenting style, in studies of preschool children without dental experience or a history of dental phobia. Conversely, no differences were seen in studies of school-aged children with previous dental experience or who were referred to a dentist. Conclusions: The evidence supports a relationship between parenting style and children's dental anxiety and behavior. However, this association was limited to preschool children with no dental experience or dental phobia.

Association Between Breastfeeding and Childhood Breathing Patterns: A Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review aimed to evaluate the association between breastfeeding and breathing patterns in children. MATERIALS AND METHODS: We searched PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials for publications from inception to October 1, 2017. The breastfeeding duration and period of exclusive breastfeeding were selected as primary outcomes. The odds ratio (OR) and 95% confidence interval (CI) were calculated. A meta-analysis was conducted to synthesize the evidence. The Newcastle-Ottawa Score was used for quality and comparability assessment. RESULTS: Of the 54 articles identified, three observational studies met the inclusion criteria for this meta-analysis, representing 1,046 participants. The results of the meta-analysis revealed that the prevalence rate of mouth breathing (OR = 2.04; 95% CI, 1.26-3.31; p = 0.004) was significantly higher in subjects who were breastfed for less than 6 months, but no significant difference was observed within the periods of exclusive breastfeeding (6 months or less) (OR = 1.27; 95% CI, 0.73-2.21; p = 0.40). CONCLUSION: We found only limited evidence about the association between breastfeeding and breathing patterns. However, the current evidence supports the association between breastfeeding and childhood breathing patterns. Based on this review, we found that the frequency of normal nasal respiration increases with the duration of breastfeeding. The methodological quality of the studies included was moderate. Thus, future studies should aim to correct the confounding factors related to breathing patterns, to use standardized diagnostic criteria of mouth breathing, and to conduct a prospective research to reduce the recall bias.

Decompression for Unerupted Primary Mandibular Second Molars Associated with Physical Barriers: Case Reports.

Primary impaction of primary teeth might be due to genetic predisposition or physical disturbance including odontoma, supernumerary tooth, and crowded tooth. Among them, calcific deposit or odontoma is commonly associated with primary dentition. Early diagnosis and treatment is the key to prevent complications. However, results of treatment may vary depending on the condition of unerupted tooth. Here we report two clinical cases of unerupted primary mandibular second molars with physical barriers such as compound odontoma and calcific deposit focusing on diagnostic means and the importance of early treatment of these lesions.

Development of a Web-Based Nationwide Korean Pediatric Dental Sedation Registry.

OBJECTIVE: Finding a balance between sedation efficacy and safety remains an ongoing challenge. In children, the risk of sedation-related complications is relatively high. It is of utmost importance to determine the factors related to improved overall sedation outcomes. However, most previous reports have been based on small samples at single institutions. The Korean Academy of Pediatric Dentistry (KAPD) developed a Korean Pediatric Dental Sedation Registry using a web-based platform. STUDY DESIGN: Specialists in pediatric dental sedation selected the itemized list included within the registry through an extensive literature review. The web-based registry was built into the KAPD homepage to facilitate easy access to the sedation data. All teaching and university hospitals agreed to participate in the Korean Pediatric Dental Sedation Registry. CONCLUSION: This is the first attempt to collect sedation data on a nationwide scale in the field of pediatric dentistry. The sedation database established with the registry may facilitate standardizing and improving pediatric dental sedation clinical practices.

The antibacterial activity of chlorhexidine digluconate against Streptococcus mutans biofilms follows sigmoidal patterns.

The aim of this study was to determine the pattern of the antibacterial activity of chlorhexidine digluconate (CHX) against mature Streptococcus mutans biofilms. Streptococcus mutans biofilms were formed on saliva-coated hydroxyapatite discs and then treated with 0-20% CHX, once, three times, or five times (1 min per treatment) during the period of mature biofilm formation (beyond 46 h). After the treatments, the colony-forming unit (CFU) counts of the treated biofilms were determined. The pH values of the spent culture medium were also determined to investigate the change in pH resulting from the antibacterial activity of CHX. The relationships between the concentration of CHX and the CFU counts and the concentration of CHX and culture medium pH, relative to the number of treatments performed, were evaluated using a sigmoidal curve-fitting procedure. The changes in CFU counts and culture medium pH followed sigmoidal curves and were dependent on the concentration of CHX (R2 = 0.99). The sigmoidal curves were left-shifted with increasing number of treatments. Furthermore, the culture-medium pH of the treated biofilms increased as their CFU counts decreased. The lowest CHX concentration to increase culture-medium pH above the critical pH also decreased as the number of treatments increased. These results may provide fundamental information for selecting the appropriate CHX concentrations to treat S. mutans biofilms.