Oral hygiene practice and home-care challenges in children with autism spectrum disorder in San Francisco: Cross- sectional study.

INTRODUCTION: Autism spectrum disorder (ASD) is characterized by challenges in social interaction, communication, and stereotypical patterns of behavior. They are more likely to have tooth brushing issues and need help with routine dental care. Children with ASD could face difficulty in accessing dental care as the parents have a challenging task in finding a dentist that would treat the child with special needs. As a result, dental care is often neglected. The aims of this study are to evaluate oral hygiene practices and challenges in children with ASD and compare it with typically developing peers (TDP). METHOD: The sample size of the study was 60. Parents of children aged 3-10 were recruited and divided in 2 groups with 30 in each group. Age and gender of children were matched. ASD group included children with medical diagnosis of ASD only and no other co-morbidities. Children in TDP group had no diagnosis of ASD, and reported no disability, or any other diagnosis. Parents were asked to complete the questionnaire which asked about their demographic information, child's oral care regimens, and their knowledge about dental care. Chi-squared tests and t-test were used for statistical analysis. A p-value of .05 was used for determining statistical significance. RESULTS: Many children with ASD (47%) had to travel more than 20 miles for their dental home compared to 13% with TDP (p < .05). Only 60% of children with ASD brushed twice a day with 70% of parents reporting that it is difficult to brush their child's teeth compared to TDP with 93% of children brush twice daily (p < .05). Significantly a smaller number of children with ASD (47%) allowed their parent to brush their teeth as compared to 93% of TSD children (p < .001). CONCLUSION: Parents of children with autism spectrum disorder travel longer distance to find a dental home and face more difficulty in maintaining their child's daily oral hygiene.

Opioid and Multi-Drug Pediatric Dental Sedation: A Narrative Review.

Pharmacological behavior guidance has long been a mainstay of pediatric dental care. Behavioral limitations of very young children and dental fear in adolescents and children with special health care needs have made sedation and general anesthesia important to quality care delivery for these populations. The purposes of this review are to provide a broad perspective on the historical and contemporary use of sedation in pediatric dentistry, summarize available data on the safety and efficacy of opioid and multi-drug moderate sedation protocols, and consider the growing role of minimal intervention dentistry and the importance of patient and medication selection.

Sedation and Anesthesia for the Adolescent Dental Patient.

This article focuses on sedation/anesthesia of adolescent patients in the dental setting. Preoperative evaluation, treatment planning, monitoring, and management are critical components to successful sedation. The authors discuss commonly administered agents and techniques to adolescents, including nitrous oxide/oxygen analgesia. The levels and spectrum of sedation and anesthesia are reviewed. Common comorbidities are also presented as they relate to sedation of the adolescent dental patient.

Stress and coping strategies in pediatric dental residents.

PURPOSE/OBJECTIVES: This study examines the amount and sources of stress, as well as coping strategies, exercise, and alcohol use, among pediatric dental residents in the United States. METHODS: One hundred fifty pediatric dental residents (n = 76 postgraduate year [PGY] 1; n = 74 PGY2) in 2-year residency programs responded to an anonymous survey that included demographic questions, the Perceived Stress Scale (PSS), Graduate Dental Environment Stress Scale (GDES), Tactics For Coping With Stress Inventory, and questions about alcohol consumption and exercise. RESULTS: Stress scores were moderate (mean PSS = 16.7 ± 7.1; GDES = 61.7 ± 16.0). The largest sources of stress were research requirements, program/clinic issues, and finances. There were no significant differences in amount and sources of stress between PGY1 and PGY2 residents (P ≥ 0.10). Residents from western programs (based on AAPD districts) reported less stress than those in other areas (PSS, P = 0.04; GDES, P = 0.09). Number of negative coping tactics used was positively correlated (PPS, P < 0.0001; GDES, P = 0.0004), while number of positive coping tactics was negatively correlated (PSS, P < 0.0001; GDES, P = 0.0008) with stress scores. Younger residents (< 30yrs) used more coping tactics than older residents (P = 0.0002). Hospital-based residents used more negative coping tactics than those in university-based and combined programs (P = 0.05). Residents exercising > 150 min/wk had lower PSS (P = 0.03) and GDES (P = 0.09) scores. Alcohol consumption was unrelated to stress scores. CONCLUSION(S): Amount and sources of stress do not differ by residency year. Residents utilizing positive coping strategies and exercising had lower stress than those using negative coping strategies. Pediatric dental residency programs should educate and encourage residents to use positive coping strategies and exercise.

Comparing the Efficacy of a Compound Topical Anesthetic Versus Benzocaine: A Pilot Study.

To compare the effectiveness of a combination of 10% lidocaine, 10% prilocaine, and 4% tetracaine versus 20% benzocaine for use as a topical anesthetic agent prior to dental injections. A double-blind randomized prospective clinical trial was conducted with 26 participants receiving a topical anesthetic of 20% benzocaine (control) and 26 participants receiving a compound topical anesthetic mixture of 10% lidocaine, 10% prilocaine, and 4% tetracaine (experimental) prior to a maxillary infiltration injection. The procedure was conducted by 1 operator with the Wand® injection system. Pain was assessed directly with visual analog scale (VAS) scores and indirectly by measuring changes in heart rate at 4 different time points. Complications associated with the application of the topical anesthetics were also assessed. The experimental group had a significantly higher mean VAS score of 19.5 ± 19.7 mm versus 14.2 ± 14.6 mm for the control group (p < .001). No significant differences in heart rate at any of the 4 measured time points compared with baseline were noted for either group. The experimental group had a significantly higher incidence of complications, including tissue sloughing, when compared with the control group (p < .001). Participants in the control group reported significantly lower VAS scores than those in the experimental group. Both types of topical anesthetic showed similar impacts on alterations to heart rate. No benefits were seen with the use of 10% lidocaine, 10% prilocaine, and 4% tetracaine as a topical anesthetic prior to a maxillary infiltration of local anesthetic when compared with 20% benzocaine.

Clinical Performance of the DentalVibe® Injection System on Pain Perception During Local Anesthesia in Children.

Purpose: The purpose of this study was to clinically compare injection pain experience in children using three methods.Methods: This was a randomized clinical trial conducted among 150 children (81 girls, 69 boys), from seven to 14 years of age, who required operative dental treatment. Fifty patients were randomized into one of three groups: DentalVibe®, manual stimulation, or no stimulation (control). During the injection, the pulse rate and perceived pain, using the Wong Baker FACES Pain Rating Scale were recorded. Generalized linear models were used to analyze the data.Results: We found a statistically significant decrease in the FACES score in the DentalVibe® group compared to the control group and the manual stimulation group (P<0.001). Injection type (mandibular inferior alveolar block/long buccal injections versus maxillary infiltration injections) did not differ statistically in pain perception. The heart rate in the DentalVibe® group showed no significant difference compared to the other groups at all time points. Conclusion: The DentalVibe® may reduce pain for pediatric patients receiving dental injections.

Trends in General Anesthesia Utilization by Board-Certified Pediatric Dentists.

PURPOSE: The purpose of this study was to explore the trends and utilization of general anesthesia services among board-certified pediatric dentists practicing in the United States. METHODS: A 26 item survey was sent to 4,216 board-certified pediatric dentists by REDCap or mail. Results were tabulated, and trends were analyzed. RESULTS: A response rate of 31.8 percent was obtained. All American Academy of Pediatric Dentistry districts were represented proportionally. Most respondents (87 percent) reported using general anesthesia (GA) in their practices. Those who used GA, 50.4 percent reported using a hospital setting, and 60.5 percent used a physician anesthesiologist. Endotracheal intubation was the most common (88.5 percent) method of anesthesia delivery. Most diplomates (62.6 percent) favored dental anesthesiology as a recognized specialty by the American Dental Association. CONCLUSIONS: The majority of American Board of Pediatric Dentistry diplomates used general anesthesia in their practice. The preferred modality of delivery is oral/nasal intubation, with most services provided by physician anesthesiologists in a hospital/ambulatory setting. Physician anesthesiologists are inclined to provide care in a hospital-based setting. Dentist anesthesiologists provided care in the dental office. Most respondents support dental anesthesiology as a recognized specialty of the American Dental Association.

Comparison of Two Morphine-Benzodiazepine-Hydroxyzine Combinations for the Oral Sedation of Pediatric Dental Patients: A Retrospective Study.

PURPOSE: To investigate the effectiveness of oral morphine sulfate regimens in sedating pediatric dental patients and assess whether pre-sedation disposition and willingness to take the sedative were related to the outcome of the sedation. METHODS: The sedation records of 271 pediatric dental patients sedated with oral morphine were reviewed. Children were either sedated with regimen one (morphine plus midazolam plus hydroxyzine) or regimen two (morphine plus diazepam plus hydroxyzine). Data gathered included the patient's pre-sedation disposition, willingness to take the sedative, effectiveness of sedation, and occurrence of any adverse event. Data analysis was conducted using descriptive statistics, Pearson's chi-square, and logistic regression. RESULTS: Regimens one and two had an overall success rate of 80 percent (143 out of 178) and 81 percent (75 out of 93), respectively. A positive correlation was observed between the patient's willingness to take his/her sedative medication and the effectiveness of the sedation using both the Pearson's chi-square (P=.004) and logistic regression (P=.028). Adverse events occurred in six percent (17 out of 271) of the cases. CONCLUSIONS: Overall rate of effective sedation using various oral morphine sulfate regimens was above 80 percent. Minimal adverse events occurred. The patient's willingness to take the sedative was positively associated with the outcome of the sedation regimen.

Association between body mass index and dental age in Hispanic children.

The purpose of this prospective cross-sectional study was to determine whether body mass index (BMI) is associated with dental development in Hispanic children when compared to their chronologic age and expected dental development. The study enrolled 265 healthy (American Society of Anesthesiology Class I), 6- to 12-year-old Hispanic children. A BMI was calculated from each child's height and weight, and a panoramic radiograph was taken at the same appointment. Subjects were enrolled into 1 of 2 groups: a control group with BMIs classified as underweight/average (less than 85th percentile) and a group with BMIs classified as overweight/obese (85th percentile or greater). Dental age was determined using both panoramic radiographs and the Demirjian dental maturity scale to examine the stage of root development in the dentition. Chronologic age was obtained from each child's birthdate. Results showed a high correlation between chronologic and dental ages (P < 0.001), although dental age was significantly greater in the total sample. The mean difference in dental age among all children was 7.4 months, but the difference was significantly greater (P < 0.001) in children who were overweight/obese (11.7 months) than in underweight/average subjects (3.4 months). Overweight/obese Hispanic children were approximately 3.5 times more dentally advanced. The older the chronologic age, the greater the difference.

Orthodontic Services Provided by Pediatric Dentists in California.

A survey was conducted in 2013 to document trends in orthodontic treatment provided by members of the California Society of Pediatric Dentistry (CSPD). A 21-item survey was mailed to all active members of CSPD. Active members of CSPD spent less time and treated fewer orthodontic conditions in their practice.

Oral Sedation Postdischarge Adverse Events in Pediatric Dental Patients.

The study investigated patient discharge parameters and postdischarge adverse events after discharge among children who received oral conscious sedation for dental treatment. This prospective study involved 51 patients needing dental treatment under oral conscious sedation. Each patient received one of various regimens involving combinations of a narcotic (ie, morphine or meperidine), a sedative-hypnotic (ie, chloral hydrate), a benzodiazepine (ie, midazolam or diazepam), and/or an antihistamine (ie, hydroxyzine HCl). Nitrous oxide and local anesthesia were used in conjunction with all regimens. After written informed consent was obtained, each guardian was contacted by phone with specific questions in regard to adverse events following the dental appointment. Out of 51 sedation visits, 46 were utilized for analysis including 23 boys and 23 girls ranging from 2 years 2 months to 10 years old (mean 5.8 years). 60.1% of patients slept in the car on the way home, while 21.4% of that group was difficult to awaken upon reaching home. At home, 76.1% of patients slept; furthermore, 85.7% of patients who napped following the dental visit slept longer than usual. After the appointment, 19.6% exhibited nausea, 10.1% vomited, and 7.0% experienced a fever. A return to normal behavior was reported as follows: 17.4% in <2 hours, 39.1% in 2-6 hours, 28.3% in 6-10 hours, and 15.2% in >10 hours. Postdischarge excessive somnolence, nausea, and emesis were frequent complications. The time to normality ranged until the following morning demonstrating the importance of careful postdischarge adult supervision.

Materials used to restore class II lesions in primary molars: a survey of California pediatric dentists.

PURPOSE: The purpose of this study was to determine which materials were most commonly used by pediatric dentists in California to restore Class II lesions in the primary dentition. METHODS: A questionnaire consisting of 18 multiple-choice questions was mailed to all 440 active members of the California Society of Pediatric Dentistry (CSPD). The questions related to the practitioners' material of choice for restoring Class II lesions in primary molars. RESULTS: A 66% response rate was received. For 57% of the respondents, amalgam was the material of choice for restoration of Class II lesions in primary molars. Twenty-nine percent selected composite, 5% glass ionomer, 6% compomer, and 1% (1 practitioner) stainless steel crowns. Sixty-eight percent responded that amalgam has historically proven to be a safe, reliable, and affordable material. The main reasons cited for using composite resin were "patient preference" (86%) and "better esthetics" (78%). Most practitioners used either a single-step (fifth-generation) or 2-step (fourth-generation) bonding agent (53% and 35%, respectively). When using a nonamalgam restorative material, 49% of practitioners used a traditional Class II amalgam preparation. The role of dental literature in treatment decision-making was not significantly related to the restorative material used. CONCLUSIONS: While amalgam was the most common material used for Class II restorations, nonamalgam materials were significantly popular among California pediatric dentists.