Lack of assent to dental examination in children with intellectual disabilities: Dentists' practices in Europe and ethical issues.

AIM: (1) To determine the repartition of criteria which can be considered as marks of lack of assent by the child with intellectual disabilities from the dentist's point of view and whether that influences the decision to examine the patient or not. (2) To explain the decision of practitioners and determine the ethical implications of these practices. METHODS: An anonymous and structured questionnaire was distributed online using the scenario of a 9-year-old child with moderate cognitive impairment with eight different oppositional behaviours. The practitioners were asked about their perception of the patient's lack of assent and about their decision to perform the dental examination or not. RESULTS: The proportion of them who performed a dental examination despite the patient's refusal represented between 13% and 28.8% of the population of respondents. CONCLUSION: There was an ambivalence among the practitioners who carried out a dental consultation when children were uncooperative. They adopted a teleological point of view. It calls for us to reflect on the ethical principles of autonomy and beneficence.

Oral findings in children with congenital cholestatic disease: A systematic review of case reports and case series.

Multiple causes of congenital neonatal cholestasis have been identified, and are classified as extrahepatic or intrahepatic. Biliary atresia (BA), Alagille syndrome (AGS), and progressive familial intrahepatic cholestasis (PFIC) are the most common of these. Many factors associated with cholestatic diseases are known to degrade the oral health of these children. What are the oral manifestations associated with these diseases in the pediatric population? The aim of this article was to evaluate the impact of congenital cholestasis on oral health in pediatric patients. A systematic review of case reports and case series was carried out in PubMed, the Cochrane Library, and the Web of Science to identify relevant articles in French and English published up to April 2022. The review included 19 studies, 16 case reports, and three case series. Only studies dealing with BA and AGS were found. These studies showed an impact on jaw morphology, dental structure, and periodontal health. The facial dysmorphism observed in AGS was specific. Exposure to high levels of bilirubin during the period of dental calcification led to particular coloration. Regarding periodontal status, gingival inflammation was common in these patients, probably resulting from the use of certain treatment-associated drugs and poor oral hygiene. Cohort studies are needed to confirm the classification of these children as being at high individual risk of caries. Many major oral manifestations are found in children with AGS and BA, confirming the need to include a dentist in the care team of patients with congenital cholestatic disease as early as possible. It appears necessary to carry out individual prospective studies of each phenotype in order to confirm and better describe the oral impact of these cholestatic diseases and provide adequate medical care.

Early childhood caries: Detection, prevention, and referral. A questionnaire study of general medical practitioners and pediatricians in the south of France.

INTRODUCTION: Early childhood caries (ECC) is an illness defined as the presence of one or more decayed, missing after caries, or filled tooth surfaces in any primary tooth in a child under the age of 6 years. It has a negative impact on the physical and the psychological development of children. General medical practitioners (GPs) and pediatricians, the first professionals involved in the follow-up of young children, are on the frontline of detecting and referring patients with caries or individual high-risk of carious lesions. The aims of this study were (1) to assess the current state of knowledge of pediatricians and GPs in the south of France regarding ECC detection and prevention, and (2) to understand whether there are difficulties in referring young patients for the early detection of carious lesions. METHODS: A semi-structured questionnaire was circulated to GPs and pediatricians working in the Provence-Alpes-Côte d'Azur region (France). The questionnaire was divided into three parts related to the characteristics of the participants, to the current skill and knowledge of practitioners in detecting ECC (using clinical vignettes) and advising preventive measures, and to the dental examination and any difficulties in referring patients. RESULTS: There were 97 participants in the study. Many oral hygiene measures were known but only just over half of the dietary risk factors were recognized. Participants seemed to be involved in detecting ECC, the majority very often examined teeth during their consultations. Practitioners recognized a carious lesion in only one of two cases. The lack of knowledge of the recommended age for the first consultation could be a barrier in referring patients to a dentist, for which pain remains the main reason for referral. CONCLUSION: GPs and pediatricians should play a key role in the detection and prevention of ECC. Participants showed great interest in the topic of oral health. For better management, it would be beneficial to provide training resources with quick and efficient access to information.

Microabrasion in the management of enamel discolorations in paediatric dentistry: a systematic review.

Structural abnormalities of the anterior teeth could be aesthetically compromising in young patients. The dentist must provide solutions while preserving dental tissue. Microabrasion approach can be a solution. We conducted a systematic literature review to evaluate whether microbrasion treatment in paediatric dentistry can improve aesthetic in cases of pre- or post-eruptive discolorations on tooth enamel. 741 articles published up to September 2021 were selected from 3 databases using the key word "microabrasion". 11 prospective studies including 6 randomized were relevant to the inclusion criteria. Microabrasion appears to be an effective and reliable technique for the management of pre and post enamel discoloration in paediatric dentistry, especially in fluorosis. More high-powered, well-conducted randomized studies with complete evaluation criteria are needed for other types of spots. Standardization of criteria for assessing treatment success and of the protocol required should be explored.

Management of idiopathic sleep bruxism in children and adolescents: A systematic review of the literature.

AIM: Primary sleep bruxism (SB) affects between 6 and 30% of children and adolescents. Its frequency increases with age, reaching a peak at 10-14 years of age, after which it drops until adulthood. The treatment of SB has not been extensively documented, resulting in a lack of reference points and legitimate concerns for dentists in their everyday practice. The aim of this literature review was to summarize the available evidence on the management of SB in children and adolescents and the efficacy of the different approaches. METHOD: A systematic literature search was conducted according to PRISMA guidelines from January 2006 to December 2020 using the PubMed, The Cochrane Library, Science Direct, and Google Scholar databases. All types of SB treatment were accepted. Eight studies were selected for their protocol quality, according to the PICOS tool. RESULTS: Several treatment methods were assessed from the eight clinical studies selected, such as occlusal splint, palatal expansion, and pharmacological treatment. Assessment of the treatment methods was difficult because only eight studies were selected, and both the treatment methods and the study protocols used were different. The therapeutic strategies found in the literature were based on the general condition of the case. Treatment approaches were distinguished into treatments for isolated SB and those for SB associated with ventilatory disorders. CONCLUSION: The current study shows the need to define diagnostic criteria adapted to SB in children in order to improve epidemiological surveys and subsequently clinical practice. To overcome the difficulties related to SB diagnostic criteria, a multidisciplinary approach, involving pediatricians, otorhinolaryngologists, and dental practitioners, is essential for a better management and follow-up of young patients. A case-by-case approach, taking into account the specificities of each young patient, seems the most appropriate management today.

Inequalities in treatment planning for children with intellectual disabilities: A questionnaire study of dentists in Europe.

BACKGROUND: Children with intellectual disabilities experience major inequality in the field of oral health, including a higher number of extracted teeth. The literature explains this difference in terms of higher levels of dental disease but does not mention the possibility of inequality in the treatment options offered these children. AIM: The aim is to investigate whether the same treatment options are offered by practitioners to children with and without intellectual disability in equivalent clinical circumstances. DESIGN: A scenario involving a clinical dental situation was developed, with one varying parameter: the patient described was a child with or without cerebral palsy. RESULTS: One hundred and thirty-nine dental specialists from France and Europe were recruited. A large number of practitioners (68%) chose the same treatment for both patients, but 32% declared modifying the dental treatment planning in the case of the child with cerebral palsy. The most frequently chosen treatment for the scenario of irreversible pulpitis for the child without disability was conservative endodontic treatment (73%) whereas the most frequently chosen treatment for the child with intellectual disability was tooth extraction (54%). DISCUSSION: These results are discussed in terms of beneficence, fear of restorative failure, lack of guidelines, practitioner experience and the implications for equity in healthcare.

Ethical issues and dentists' practices with children with intellectual disability: A qualitative inquiry into a local French health network.

BACKGROUND: The provision of dental care for children with intellectual disability raises many ethical questions. OBJECTIVE: The aim of this qualitative study was to explore approaches to dental treatment in an anxious child with intellectual disability and the ethical dilemmas that ensue. METHODS: Semi-structured interviews were conducted between February and May 2012. A clinical scenario was used to establish a starting point for a discussion of the clinical approach and lead to an ethical reflection. Four topics were discussed: first contact with the patient, information, attitude towards the patient and outcome from the practitioner's viewpoint. The coding procedure used thematic content analysis. RESULTS: Most practitioners fetched the patient from the waiting room personally, greeted them, gave them special attention, and either began the consultation at once, or used distraction to relax the patient. Verbal language and tell-show-do were most often used to provide information. Anxiety and pain were evaluated using parental assessment and standardized scales. A reassuring attitude was adopted. An ethical dilemma arose if the patient refused care or had to be restrained. Practitioners reported sacrificing ethical values (patient autonomy, beneficence and non-maleficence) when making a clinical decision. CONCLUSIONS: There is a wide range of practices but no consensus. This study shed some light on the different perspectives of dentists, most of whom adopted a utilitarianist viewpoint. In this context, ethical reflection is necessary to avoid a detached attitude or, worse, abuse. Further study would enrich this reflection.