Dental needs and conditions of individuals with Lowe syndrome: An observational study.

INTRODUCTION: Lowe syndrome (LS) is an uncommon condition that affects the brain, kidneys, nervous system, and eyes, predominantly in males. The aim of this study was to examine dental conditions, dental treatments, and access and/or barriers to care for those with LS compared to healthy individuals. METHODS: Surveys assessing dental conditions, dental treatments, and access and/or barriers to care were administered to families in the Lowe Syndrome Association and families with healthy children who had dental appointments at the Tufts University School of Dental Medicine (TUSDM) pediatric dental clinic. One parent or a guardian of pediatric patients with LS or not at TUSDM was asked to complete an online survey. RESULTS: One hundred and eight surveys were obtained (n:58 from the LS group and n:50 from the healthy group). The LS group was significantly more likely (p < .05) to report "crooked/misaligned teeth," "difficult time chewing," "bad breath," and "mouth cysts" and was significantly less likely to report 6-month examination, "cleaning," and "filling." The LS group reported significantly greater difficulty locating a dentist. CONCLUSION: The findings of this study indicate that individuals with LS are more vulnerable to developing severe dental conditions and experiencing difficulties in accessing dental care than healthy individuals. Additionally, those who present with this syndrome may be less likely to receive specific necessary dental treatments. As a result, it is essential to offer appropriate dental care and support to individuals with LS to guarantee they achieve optimal oral health.

Attitudes and opinions of telehealth in the dental school environment: A survey study.

PURPOSE: The objective of this study was to assess provider attitudes and opinions regarding telehealth in the dental school environment. METHOD: A survey was developed and validated and was sent to 849 predoctoral students, postdoctoral students (residents), and faculty at a single dental school. It consisted of 13 questions regarding the participants' professional backgrounds, opinions, and attitudes toward telehealth. The survey opened on November 16, 2021, and remained open for 6 weeks. RESULTS: Of 849 survey recipients, 163 (19%) responded. Among 161 usable surveys, 90 (56%) were predoctoral students, 42 (26%) were postdoctoral students, and 29 (18%) were faculty. Fifty-four percent reported having completed at least one telehealth visit. Among this subset, 80% strongly agreed or agreed that telehealth is a good adjunct in providing care; 74% strongly agreed or agreed that telehealth has improved communication with patients. CONCLUSION: Most dental providers reported positive opinions and attitudes regarding telehealth's ability to improve communication and serve as an adjunct to providing care. PRACTICAL IMPLICATIONS: In the right circumstances, telehealth offers an alternative to traditional oral healthcare delivery methods. Based on the perceptions of dental providers, the use of telehealth may also be beneficial in combination with traditional approaches in the dental school environment.

Mandibular Regional Odontodysplasia in a Toddler.

Regional odontodysplasia (ROD) is a rare developmental anomaly with distinctive clinical, radiographical and histological findings, affecting both primary and permanent dentitions. The teeth with ROD have an atypical morphology and are usually discolored, with either delayed eruption or complete failure to erupt. Radiographically, the affected teeth have a "ghostly" appearance, with marked radiolucency and decreased radiodensity, showing a thin outline of enamel and dentin, which appear hypomineralized histologically, with poorly structured dentinal tubules and enamel prisms. Calcifications are frequently found in the pulp chambers of the affected teeth. This case report discusses a three-year-old girl who presented with ROD in her mandible as well as the clinical and radiographical features, and treatment of the condition.

Retention of Zirconia Crowns Compared to Stainless Steel Crowns: An Ex-Vivo Study.

PURPOSE: The purpose of this study was to compare the retention of 3M stainless steel crowns™ (SSCs), Kinder Krowns® zirconia crowns (ZCs), and EZCrowns ZCs on extracted primary mandibular second molars ex-vivo. METHODS: A total of 45 extracted primary mandibular second molars were allocated randomly to either of the three groups. All teeth were mounted in Dentsply acrylic molds and then prepared for crown cementation. Crowns were cemented with glass ionomer cement (GIC). Retention testing was performed using Instron 5566A. Differences in retention between the groups were tested via Welch's analysis of variance (ANOVA), and post hoc comparisons were performed with the Games-Howell test. RESULTS: Welch's ANOVA resulted in statistically significant differences between the three groups (P<0.001). The mean±SD force in Newtons (N) for the SSC group, Kinder Krowns® group, and EZCrowns group were 337.0±137.1 N, 89.4±53.6 N, and 106.5±77.7 N, respectively. Post hoc comparisons with the Games-Howell test presented that the SSC group had significantly higher retention than both the ZC groups (P<0.001). There was no significant difference between the ZC groups (P=0.76). CONCLUSIONS: Within the limitations of this ex-vivo study results, due to their statistically significant higher retention, stainless steel crowns should be selected over zirconia crowns when in need of a full coverage restoration. But if esthetics are a concern, dentists can choose freely between either of the ZCs tested in this study.

Shear Bond Strength of Different Restorative Materials to Primary Tooth Dentin Treated with Silver Diamine Fluoride.

Purpose: To investigate shear bond strength (SBS) of three restorative materials on primary dentin after silver diamine fluoride (SDF) application.
Methods: Thirty primary teeth were randomized into three groups of 10 teeth. Each tooth was split mesiodistally and randomized into experimental (artificial caries plus SDF) and control (sound dentine without SDF) groups. Glass ionomer cement (GIC), resin-modified bioactive resin (ACTIVA), and composite resin (CR) restorations were tested for SBS and mode of failure (MF).
Results: All SDF groups exhibited significantly lower SBS compared to the control (CR: P =0.001; ACTIVA: P =0.001; GIC: P =0.004). For the SDF group, the compa- rison of materials was statistically significant (P =0.006); posthoc tests showed significance only between CR and ACTIVA (P =0.009) and between ACTIVA and GIC (P =0.020). The lowest mean value was obtained for ACTIVA (1.4 MPa) and the highest mean value was obtained for CR (3.3 MPa). For the control group, Welch's F test was statistically significant (P =0.044), but all posthoc tests were not. For MF, SDF exhibited a significantly greater percentage of adhesive failures with ACTIVA and CR than with GIC. In the control group, a mixed MF was more dominant with no significant differences.
Conclusion : The SDF group had significantly lower SBS.

Accuracy of Cone-beam Computed Tomography and Extraoral Bitewings Compared to Intraoral Bitewings in Detection of Interproximal Caries.

AIM AND OBJECTIVE: The purpose of this study is to evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) and extraoral bitewings in the detection of interproximal caries compared to intraoral bitewings. MATERIALS AND METHODS: Seven preserved cadaver heads with 106 teeth (molars, premolars, and canines) including 183 proximal surfaces were used. Five r adiographic modalities were studied: intraoral bitewings, extraoral bitewings, iCAT 3D, ProMax 3D high r esolution, and ProMax 3D low r esolution. Seven pediatric dental r esidents were r ecruited and calibrated as observers and asked to evaluate each proximal surface. Teeth were extracted, mounted, drilled, caries detection dye was applied, and the surfaces were examined under the light microscope. Interexaminer r eliability, sensitivity, specificity, and area under the curve values were compared. RESULTS: No significant differences were found in sensitivity, specificity, and area under the curve values between the five r adiographic modalities. R estorations may influence the accuracy of caries diagnosis. CONCLUSION: Cone-beam computed tomography radiographs and extraoral bitewings showed similar accuracies in detecting interproximal caries compared to intraoral bitewings. This suggests that with proper training and experience, CBCT and extraoral bitewings could be comparable to intraoral bitewings in detecting interproximal caries. CLINICAL SIGNIFICANCE: Cone-beam computed tomography and extraoral bitewings could potentially serve as alternatives to intraoral bitewings to diagnose proximal caries, especially when the CBCT study is needed for a specific diagnostic purpose.

Effectiveness of interprofessional oral health program for pediatric nurse practitioner students at Northeastern University, United States.

BACKGROUND: Interprofessional education (IPE) is an important part of the landscape of modern education. However, there is a significant deficiency of studies that evaluate IPE in dentistry. The aim of this article is to evaluate the effects of an oral health educational program on the dental knowledge, awareness, attitude, confidence, and behavior of pediatric nurse practitioner (PNP) students and to emphasize the importance of IPE for PNP. METHODS: First-year pediatric nurse practitioners from Northeastern University participated in an IPE oral health education seminal and practical session as a pilot study. Several tests were used to evaluate the effectiveness of the educational program. The post-test assessed the knowledge, awareness, attitude, confidence, and behavior of the students immediately after attending the lecture; again immediately after hands on experience; and finally at a follow-up approximately a month after attending the training module. The training module consists of prevention and anticipatory guidance; caries process and management; trauma and dental emergencies. Differences in score items were evaluated between 4 time points. Friedman's, Wilcoxon signed-rank and McNemar's tests were used to analyze the results. RESULTS: Knowledge score was determined based on the number of correct responses to seven questions, while awareness score was based on the median of eight questions. Fifteen confidence, attitude, and behavior questions were used. The total sample size was 16 students with a mean age 33.31 ± 7.52. The majority were females (87.5%). Significant improvement was seen in all subjects' overall knowledge of oral health topics. The confidence, attitude, and behavior scores were differed by time of test (P < 0.01). It was the highest after post-test and the lowest in pre-test. CONCLUSION: Our study suggests that introducing an Interprofessional education program for pediatric nurse practitioner students can provide them with adequate knowledge, awareness, confidence, and attitude regarding oral health issues. It also can help them in changing behavior, prevention and ongoing dental surveillance.

Bottle-Weaning Recommendations Among Pediatricians and Pediatric Dentists.

Purpose: The purpose of this study was to determine how pediatricians (MDs) and pediatric dentists (PDs) interpret professional associations' guidelines for weaning of bottle-fed infants and assess ensuing provider recommendations. Methods: A survey was sent to 11,479 MDs and PDs. Results: 721 MDs and 1,005 PDs responded, yielding an overall response of 1,726 (15 percent). MDs (88 percent) and PDs (87 percent) responded that weaning is a transitional time period with both a start and a finish. Most MDs (76 percent) and PDs (62 percent) selected 12 and 15 months, respectively, for finishing weaning. Both MDs (91 percent) and PDs (89 percent) answered that complete bottle unavailability represented weaning cessation. MDs (71 percent) and PDs (84 percent) strongly agreed on importance for a pediatrician's weaning recommendations, with MDs more frequently giving recommendations (two to three visits) than PDs (one to two visits). Conclusions: Guidelines relating to bottle-fed infants are not uniformly understood by MDs and PDs. Bottle-weaning recommendations of MDs and PDs vary. There are well-documented risks of prolonged bottle use. Thus, development of clear, preventive guidelines that address the timely and complete removal of a bottle are warranted.

Modifying dietary risk behaviors to prevent obesity and dental caries in very young children: results of the Baby Steps to Health pediatric dental pilot.

OBJECTIVES: To describe the design, feasibility, and acceptability of a theory-informed obesity and dental caries prevention pilot study, Baby Steps to Health, conducted in an academic dental clinic among a primarily Asian immigrant population. METHODS: Baby Steps used self-determination theory and behavioral motivation strategies for a caregiver/child (6-36 months) nutrition and oral health behavior change intervention implemented in a pediatric dental clinic. Caregivers completed a dietary practice assessment to identify risk behaviors and potential courses of action. With assistance from dental providers, caregiver responses were matched to customized dietary behavioral guidance and a behavior change goal to reinforce caregivers' autonomous motivation to improve feeding practices. A 1-month, post-visit phone caregiver interview assessed adherence to the behavioral goal(s) and solicited qualitative input for further program development. RESULTS: Fifty caregivers (82 percent Asian) participated in the initial visit, and 46 (92 percent) participated in the follow-up interview. Reported obesogenic/cariogenic risk behaviors were prevalent: 57 percent of bottle-fed children consumed non-water beverages in bottles to aid sleep and 38 percent of parents offered snacks ad libitum. At follow-up, 93 percent of caregivers who selected goals reported positive behavior change and 91 percent said they would participate in a similar future program. CONCLUSIONS: Tailored guidance delivered in a program that uses self-determination theory may represent a strategic use of the dental encounter to impart actionable information and motivate health-related behavior change for families with very young children. Partnerships between dental and nutrition professionals offer opportunities to address key dietary behaviors that may prevent obesity and improve oral health, particularly among at-risk children.

Radiographic Effectiveness of Resin Infiltration in Arresting Incipient Proximal Enamel Lesions in Primary Molars.

PURPOSE: The purpose of this split-mouth, randomized, prospective clinical trial was to evaluate radiographically the effectiveness of resin infiltration, as an adjunct to standard-of-care preventive measures compared to standard-of-care preventive measures alone, in arresting the progression of non-adjacent, incipient, proximal enamel lesions in primary molars 24 months after treatment. METHODS: The study included a total of 45 healthy five- to eight-year-olds who had been diagnosed radiographically with at least two non-adjacent, incipient, proximal enamel lesions in primary molars (90 lesions). Test group lesions were treated using resin infiltration followed by five percent topical sodium fluoride (NaF) application versus five percent NaF alone in the control group. The alpha level was set at 0.05. RESULTS: The children were examined after six, 12, 18, and 24 months. Twenty-five subjects were examined at the 24-month follow-up visit, At which time 10 of the 25 test lesions (40 percent) showed caries progression while 18 of the 25 control lesions (72 percent) showed caries progression (P=0.04). CONCLUSION: Resin infiltration as an adjunct to standard-of-care preventive measures is significantly more effective radiographically in reducing the progression of non-adjacent, incipient, proximal enamel lesions in primary molars compared with standard-of-care preventive measures alone after 24 months.

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports.

A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.

Effectiveness of the D-TERMINED Program of Repetitive Tasking for Children with Autism Spectrum Disorder.

PURPOSE: The purpose of this study was to compare the effectiveness of the D-TERMINED Program with standard behavior guidance techniques (SBGTs) used for children with autism spectrum disorder (ASD) in a private dental setting. METHODS: A retrospective data analysis was performed from records of children with ASD who received treatment using either the D-TERMINED program or SBGTs at two private dental practices. Data were analyzed using chi-square, Fisher's exact, Wilcoxon Signed Rank, and Mann-Whitney U tests and logistic regression. RESULTS: Forty-four charts (22 in each group) were selected from office visits between 1999 and 2012. Children in the D-TERMINED group were significantly younger (P=0.01). There were no significant differences between groups regarding gender and dental care characteristics. Patients treated with the D-TERMINED program showed a significantly greater improvement in behavioral scores compared to the control group (P=0.03). Additionally, children treated with the D-TERMINED program had significantly lower referrals for dental treatment under general anesthesia (P=0.04). CONCLUSION: The D-TERMINED program may help children with ASD learn the cooperation skills necessary to receive treatment in a dental practice, which might impact health care cost effectiveness.

Saudi and U.S. dental student attitudes toward treating individuals with developmental disabilities.

This study was conducted to compare the attitudes of senior dental students at the Faculty of Dentistry at King Abdulaziz University (KAU) in Jeddah, Saudi Arabia, and at Tufts University School of Dental Medicine (TUSDM) in Boston, Massachusetts, about providing dental care to individuals with developmental disabilities (DD). Two subsequent classes of senior dental students at both universities were surveyed using a pretested, validated, online questionnaire. The students' demographic and educational data were collected, along with information about their experience, training, and attitudes toward this population. Two hundred and fourteen students responded to the online survey, for a response rate of 35 percent (51 percent for KAU students and 21 percent for TUSDM students). Students at TUSDM had more training, more experience, and more positive attitudes toward individuals with DD compared to KAU students (p<0.05). Students who reported having previous experience with individuals with DD had more positive attitudes than students who reported no experience with these individuals (p<0.05). Students who reported being prepared to treat individuals with DD had more positive attitudes than students who reported not being prepared (p<0.05). These findings suggest an association between predoctoral education in the treatment of individuals with special needs and having positive attitudes toward providing oral health care to individuals with DD.

Effect of the DentalVibe injection system on pain during local anesthesia injections in adolescent patients.

PURPOSE: The purpose of this study was to compare the pain rating scale measurements from an exposure group (injections with the aid of DentalVibe Injection Comfort System) and control group (traditional injection without the aid of the DentalVibe) in adolescent patients using self-reported pain during administration of local anesthetic injections. METHODS: This was a randomized, controlled study. Subjects consisted of 36 10- to 17-year-old patients who required local anesthesia for dental treatment on both sides of the maxilla or mandible. All subjects received a conventional injection (control) and an injection using DentalVibe (experimental). A pain rating for each injection was obtained from subjects using the Wong-Baker FACES Pain Rating Scale. RESULTS: Statistical analysis using a Wilcoxon signed rank test found a significant reduction in pain ratings for injections with the DentalVibe when compared to control injections. There was a positive correlation between the pain rating for control injection and the difference between the two types of injection, indicating that subjects who reported a higher pain score with the control injection had a greater reduction when DentalVibe was used. CONCLUSION: When compared to a conventional approach, DentalVibe significantly lowered self-reported pain during local anesthesia injection for adolescent subjects in this study.

Inferior alveolar nerve block and third-molar agenesis: a retrospective clinical study.

BACKGROUND: Children often receive inferior alveolar nerve blocks (IANBs) when their third molars are just beginning to develop. The location of the third-molar follicle is close to where the needle penetrates during an IANB. The authors examined the possible association between IANBs and missing third molars. METHODS: The authors examined 439 potential sites of third-molar development for evidence of third-molar follicles on panoramic radiographs of randomly selected children 7 years and older. The authors conducted a statistical comparison of the incidence of missing third-molar follicles in a control group of children who had no history of receiving IANBs with children in a test group who had a definitive history of receiving IANBs by means of generalized estimating equations. RESULTS: The authors found a statistically significant greater incidence of missing third-molar follicles in mandibular quadrants that had a definitive history of receiving IANBs compared with mandibular quadrants that had no history of receiving IANB. CONCLUSION: IANBs administered to young children when the third-molar tooth bud is immature may stop third-molar development. Owing to the significant clinical implications, further research is needed to verify these results. PRACTICAL IMPLICATIONS: Dentists inadvertently may be stopping the development of third molars when administering IANBs to children.

Aciduric microbiota and mutans streptococci in severe and recurrent severe early childhood caries.

PURPOSE: Severe early childhood caries (ECC) results from bacterial acid production in an acidic environment. The purpose of this study was to determine Streptococcus mutans, Streptococcus sobrinus, and acid-tolerant counts in severe early childhood caries. METHODS: Two- to 6-year-olds with severe-ECC (N=77) or who were caries-free (N=40) were examined. Plaque samples from teeth and the tongue were cultured anaerobically on blood, acid, and S. mutans selective agars. Severe-ECC children were monitored post-treatment for recurrent caries. RESULTS: Severe-ECC and caries-free children were balanced by household income and education level. Carious lesions were observed in 75% maxillary incisors and >80% molars in severe-ECC. At baseline, S. mutans, and S. sobrinus counts and proportions of S mutans were higher in severe-ECC than caries-free children. Acid and blood counts were elevated only in anterior samples of severe-ECC children. Baseline counts of S. sobrinus, but not S. mutans, were higher in children with recurrent compared with no recurrent caries. S. mutans counts were lower following treatment than pretreatment, particularly for children without caries recurrence. Other counts did not differ between before and after therapy. CONCLUSIONS: Severe and recurrent early childhood caries was better explained by mutans streptococci than the aciduric microbiota. Streptococcus mutans did not predict children with recurrent caries.

Marginal microleakage of triage sealant under different moisture contamination.

PURPOSE: Glass ionomer sealants (GISs) are promoted in pediatric dentistry for their moisture-friendly properties. This study's purpose was to investigate the marginal leakage of a glass ionomer sealant (Fuji Triage) under different moisture environments. METHODS: Eighty extracted teeth were distributed into 4 groups: (1) control; (2) saliva contamination with 1-second air-thinning; (3) saliva contamination with 10 seconds of air-drying; and (4) saliva contamination with reconditioning. Sealants were placed after contamination. All extracted teeth underwent thermocycling followed by 1% methylene blue dye and distilled water wash. All extracted teeth were then sectioned buccolingually into 3 cross-sections and examined at 60X under a stereomicroscope. Microleakage was assessed using a dye penetration scoring system (score=0-3). Data were analyzed with Kruskal-Wallis and Mann-Whitney tests. RESULTS: The control group showed significantly lower marginal leakage than the other 3 groups (P<.02). There was no statistically significant difference among the 3 contaminated groups (P>.34). CONCLUSIONS: Fuji Triage sealant had the least marginal leakage under a moisture-controlled environment. When saliva was introduced during the application of the material, microleakage significantly increased. When contamination occurred, 1-second air-thinning of the saliva, 10-second air-drying of the saliva, or reconditioning before sealant application did not show a difference in decreasing microleakage.

Behaviour guidance in dental treatment of patients with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder - not otherwise specified (PDD-NOS) and Asperger syndrome. AIMS: To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization. DESIGN: The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used. RESULTS: Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution. CONCLUSIONS: Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified.

The caries experience and behavior of dental patients with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. The authors conducted a study to evaluate the demographics, caries experience and behavior of patients with ASD and compare these characteristics with those of patients without ASD (unaffected patients). METHODS: The authors reviewed patients' charts and identified a group of 395 patients with ASD and a group of 386 unaffected patients. They obtained the following patient data for analysis: primary diagnosis, age, sex, residence (home versus institution or group home), presence of seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behavior or pica), medications, caries prevalence, caries severity and behavior. RESULTS: The ASD group had a male:female ratio of 4:1, and patients had a diagnosis of autism, pervasive developmental disorder-not otherwise specified or Asperger syndrome. Sex distribution was equal in the unaffected group, which was younger and had a higher decayed, missing and filled teeth (DMFT) score than did the ASD group. When the authors controlled for age and sex, they noted a statistically significant association between ASD and dental caries prevalence. A significantly higher percentage of patients with ASD than unaffected patients were uncooperative and required dental treatment to take place under general anesthesia. Caries prevalence and severity in patients with ASD were not associated with institutionalization, presence of seizure disorder or additional diagnosis. CONCLUSIONS: People with ASD were more likely to be caries-free and had lower DMFT scores than did their unaffected peers. Significantly more patients with ASD than unaffected patients were uncooperative and required general anesthesia to undergo dental treatment.