Dental caries and developmental defects of enamel in cerebral palsy: A meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to compare the occurrence of dental caries and developmental defects of enamel (DDE) in individuals with and without cerebral palsy (CP). MATERIALS AND METHODS: We conducted searches across five databases and the grey literature. Data were organized using EndNote 20. Reporting followed the MOOSE checklist. A random-effects model meta-analyses were conducted using RStudio, presenting results as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The risk of bias of studies was analyzed using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using GRADE. RESULTS: Among 1336 identified records, 25 studies involving 59,997 participants (mean age: 11.1 years) were included. Data of 12 were pooled into meta-analyses. No significant differences were found between CP and non-CP individuals across indices: DMFT (k = 7) (MD = 0.31; 95% CI [-0.42-1.05]), dmft (k = 4) (MD = 0.31; 95% CI [-0.50-1.14]), DMFS (k = 2) (MD = -0.61; 95% CI [-20.56-19.33]), dmfs (k = 3) (MD = 0.54; 95% CI [-1.09-2.17]), and DDE (k = 3) (OR = 0.80, 95% CI [0.09-7.31]). The certainty of evidence was very low. CONCLUSION: Individuals with CP do not appear to differ significantly from those without CP in terms of dental caries experience and DDE.

Relationships among Cortisol, Perceived Stress, and Dental Caries Experience in Adolescents and Young Adults.

INTRODUCTION: Stress can impact mental and physical health, especially during adolescence and young adulthood, but the extent of its contribution to dental caries is poorly understood. The present study assessed the association between perceived stress, cortisol levels (in hair and saliva), and overall caries experience of adolescents and young adults aged 15-25 years. METHODS: Hair and saliva samples were obtained from 93 participants free of periodontal disease. Cortisol in hair and saliva was determined using a competitive enzyme-linked immunosorbent assay. Participants completed a perceived stress questionnaire and underwent full-mouth oral examination by a calibrated examiner. Dental caries experience was based on the decayed, missing, and filled teeth (DMFT) index. Sociodemographic variables were also recorded. RESULTS: There were significantly higher hair cortisol levels and perceived stress scale (PSS) scores in individuals with dental caries experience (DMFT≥1) than in those without (DMFT = 0). However, there was no significant difference in salivary cortisol concentration. A binary logistic regression revealed that higher hair cortisol levels and greater scores on the perceived stress scale were associated with increased odds of having experienced dental caries. In contrast, no significant association was found between salivary cortisol concentration and dental caries. Using multivariable regression models, caries experience was found to be significantly associated with both hair cortisol levels and PSS scores. These associations remained statistically significant even after adjusting for sociodemographic variables. CONCLUSION: Hair cortisol levels and perceived stress have a significant association with dental caries experience, whereas salivary cortisol concentrations do not.

COVID-19-Related School Closures and Caries Risk in Canadian Children.

BACKGROUND: Despite increased efforts to improve the health of those with temporomandibular disorder (TMD), the focus remains on medical knowledge rather than patients' opinions and needs regarding quality of treatment and pain management. OBJECTIVES: We aimed to identify what TMD patients want their dentists to know and do. METHODS: Open-ended questions were used to understand the perspectives of 6 TMD patients. Two researchers examined the transcripts using interpretive phenomenological analysis. FINDINGS: TMD participants consistently stressed the need for their dentists to listen and provide them with more advice and information to cope with TMD conditions. They also noted the need for dentists to be skilled in communications, particularly maintaining respectful doctor-patient relations and interpersonal communication. CONCLUSIONS: Health care providers must acquire practical communication skills and expand their knowledge of TMDs to better support their patients. Improving relations between doctors and their TMD patients could result in positive health outcomes. The implications of this study will be to decrease medical crises and expensive interventions, provide better assistance to patients and refer them to other necessary health care professionals, an approach that will lead to lower care costs, more satisfaction and higher quality of life.

Extrinsic tooth staining potential of high dose and sustained release iron syrups on primary teeth.

BACKGROUND: Iron in the form of oral supplements is routinely prescribed to children to help fight anemia, however tooth staining is a commonly reported complication. This study tests in vitro, the staining potential of two different forms of iron syrup on primary teeth. METHODS: Forty caries free primary central incisors were divided into four groups of ten teeth each. The control group comprised of ten teeth immersed in artificial saliva, while the test solutions were comprised of different forms of iron mixed with vitamins such that the iron content of each solution was approximately 100 mg (from 100 to 101.1 mg). The test solutions used iron syrup (Ferrose®, SPIMACO, Jeddah, Saudi Arabia) with iron in the form of ferric oxide polymaltose (FOP), slow release formula (Ferroglobin®, Vitabiotics ltd., London, UK) containing ferrous fumarate (FF and a combination of the two (FOP + FF). All the teeth were then immersed for 72 h and subjected to a protocol developed by Lee et al. to test staining. Color changes were measured using a wave dispersion spectro-photometer (Color-Eye 7000A, X-Rite Gmbh, Regensdorf, Switzerland) on the exposed labial surface at 4, 8, 24, 48 and 72 h. Two-way ANOVA with Scheffe's post hoc test was used to determine significance of difference in shade, while the Kurskull-Wallis test used to determine the significance of difference in clinical staining (∆E > 3). RESULTS: While all three iron groups showed some amount of staining, the combination of the two forms of iron (FOP+FF) showed significantly lower incidence of clinical staining than the other two groups at the end of 72 h. At the end of 72 h the (FOP) had significantly higher ∆E than ferrous fumarate (FF ) while the combination (FOP+ FF) had a significantly lower ∆E than either group. CONCLUSION: In an in vitro model, combining different forms of iron seems to elicit a lower intensity of staining than equivalent doses of a single form of iron.

Knowledge and attitude of Saudi teachers of students with attention-deficit hyperactivity disorder towards traumatic dental injuries.

BACKGROUND AND AIM: Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood mental disorders that manifest with difficulties in staying focused and hyperactivity. Such children have been reported to have a higher incidence of traumatic dental injuries. The aim of this article was to study the knowledge and attitude of Saudi teachers of children with ADHD towards the management of traumatic dental injuries and compare them to their counterparts in mainstream schools. MATERIAL AND METHODS: A four-part structured Arabic questionnaire was administered to 281 teachers of children with ADHD and 384 teachers in mainstream schools. The questionnaire recorded the demographic data, type of children taught, experience of the teacher in dealing with traumatic dental injuries, the teachers' perceived importance of managing traumatic dental injuries and their knowledge of emergency management of these injuries. The difference in knowledge and attitude between teachers of mainstream schools and schools for children with ADHD was assessed. RESULTS AND CONCLUSIONS: The results of the study indicate that teachers of children with ADHD have a greater experience of witnessing traumatic dental injuries and place significantly more importance towards the management of these injuries than their counterparts in mainstream schools. The influence of demographic variables on knowledge seen in teachers from mainstream schools is absent in those teaching children with ADHD.

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Compliance of Saudi dental students with infection control guidelines.

The aim of this study was to investigate compliance of dental students in a Saudi dental school with recommended infection control protocols. A pilot-tested questionnaire concerning various aspects of infection control practices was distributed to 330 dental students. The response rate was 93.9% (n = 311). About 99% of students recorded the medical history of their patients and 80% were vaccinated against hepatitis B. The highest compliance (100%) with recommended guidelines was reported for wearing gloves and use of a new saliva ejector for each patient. Over 90% of the respondents changed gloves between patients, wore face masks, changed hand instruments, burs and handpieces between patients, used a rubber dam in restorative procedures and discarded sharp objects in special containers. A lower usage rate was reported for changing face masks between patients (81%), disinfecting impression materials (87%) and dental prosthesis (74%) and wearing gowns (57%). Eye glasses and face shield were used by less than one-third of the sample. The majority of students were found to be in compliance with most of the investigated infection control measures. Nevertheless, further education is needed to improve some infection control measures including vaccination for Hepatitis B virus (HBV), wearing eye glasses, gowns and face shields and disinfecting impression materials and dental prostheses.

Intersection of the iADH undergraduate curriculum in special care dentistry and the association of Canadian faculties of dentistry competencies framework.

AIMS: To map the International Association of Disability and Oral Health (iADH) curriculum to the Association of Canadian Faculties of Dentistry (ACFD) competencies framework to develop a strategy for teaching special care dentistry (SCD) using the International Classification of Functioning, Disability, and Health (ICF). To review the literature to identify educational methodologies that support teaching SCD competencies. METHODS: The 20 subdomains of the ACFD competencies framework were mapped to the 18 subdomains of the iADH competency matrix. A literature review of methods, techniques, or innovations used to teach SCD was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool. RESULTS: The iADH curriculum was mapped to the ACFD competencies in the areas of patient care, professionalism, communication and collaboration, practice information management, and health promotion. A total of 176 articles from PubMed and 10 resources from MedEdPortal were identified in the literature search. Eleven articles met the inclusion and exclusion criteria. The overall quantity and quality of studies was low. Experiential learning in either a dental school or hospital-based program seemed to improve knowledge of SCD and to incite greater willingness to treat patients requiring SCD. CONCLUSIONS: Case-based learning, computer-based modules, standardized patients, and clinical practice are educational strategies for teaching SCD competencies. The integration of SCD into the undergraduate dental curriculum seems feasible, as most required competencies are transferable to all dental disciplines. Furthermore, the ICF provides a functional model that is a patient-centered approach and is applicable to dentistry beyond SCD.

The Impact of COVID-19 on Parental Perception of Oral Health-Related Quality of Life of Children: A Comparison of a Sample from Saudi Arabia and Kuwait.

Materials and Methods: OHRQoL was measured using a a validated Arabic version of the Child Oral Health Impact Profile (COHIP). Parents of children aged between 5 and 9 years were administered questionnaire during the COVID-19 pandemic. The responses were compared across the different domains of the questionnaire between the two countries using the Mann-Whitney U test. Differences were also tested between the parents of males and females separately in each city. The correlation of the COHIP scores with the age of the child was done using the Spearman's rho. Results: No significant differences in overall COHIP scores were found between the parents in Riyadh and Kuwait City (p > 0.05). There were significant gender differences observed across domains in Kuwait (p = 0.030) but not in Riyadh (p = 0.295). There was also a significant negative correlation between the different COHIP domains in Kuwait but not Riyadh. Conclusion: There is a greater gender difference and age correlation of OHRQoL among the population studied in Kuwait City when compared to those in Riyadh.

Neighborhood-Level Inequalities in Dental Care of Adolescents and Young Adults in Southwestern Ontario.

We examined whether the association of neighborhood-level socioeconomic status (SES) with the cost of dental care and dental care outcomes differs between adolescents and young adults. A total of 2915 patient records were split into two groups: adolescents (15 to 17 years of age) and young adults (18 to 24 years of age). Three dental care outcomes-routine oral evaluation (OEV-CH-A), utilization of preventive services (PRV-CH-A), and dental treatment services (TRT-CH-A)-were determined according to the Dental Quality Alliance (DQA) criteria. Associations of neighborhood SES and other sociodemographic variables with dental care outcomes and the cost of dental care were assessed using binary logistic and univariate linear regression models, respectively. Young adults had significantly lower PRV-CH-A and higher TRT-CH-A scores when compared to adolescents. We observed a significant negative association between TRT-CH-A and median household income in both adolescents and young adults. Utilization of dental treatment services was positively associated with the cost of care in both age groups, whereas utilization of preventive services was inversely associated with the cost of care in young adults, but not in adolescents. Neighborhood-level income was inversely associated with increased TRT-CH-A in both young adults and adolescents. In summary, young adults showed significantly worse preventive and treatment outcomes when compared to adolescents. Moreover, individuals from neighborhoods with a lower household income showed a significantly higher cost of dental care, yet worse treatment outcomes.

The Impact of COVID-19 on Dental Treatment in Kuwait-A Retrospective Analysis from the Nation's Largest Hospital.

BACKGROUND: The COVID-19 pandemic has changed the way dentistry has been practiced the world over. This study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait through comparisons with data from the year prior to the pandemic. METHODS: A total of 176,690 appointment records from 34,250 patients presenting to the AlJahra specialist hospital in Kuwait for dental treatment from April 2019 to March 2021 were analyzed. The types of procedures and the departments in which they presented were analyzed, and the patterns of attendance before and during the pandemic were compared. RESULTS: While there was a significant reduction in the number of orthodontic, endodontic, and periodontal procedures, there were no impacts on oral surgery, restorative procedures, or pediatric dentistry. CONCLUSIONS: There has been a return in the number of patients obtaining dental treatment; however, there has been a definite shift in the use of certain dental procedures.

Factors Influencing the Survival of Preformed Zirconia Crowns in Children Treated under General Anesthesia.

AIM: This study aimed to retrospectively evaluate the success of zirconia crowns placed in the anterior teeth of children and evaluate the impact of pulp therapy of the tooth on the rate of failure. MATERIALS AND METHODS: A total of 70 anterior teeth of 20 children aged between 3 and 5 years who had undergone the placement of zirconia crowns under general anesthesia were followed up for 24 months. Kaplan-Meier Survival curves were plotted for the estimation of two-year survival time. The outcomes for teeth that had received pulp therapy were compared to those that had not received pulp therapy. RESULTS: Kaplan-Meier survival analysis of 70 crowns observed over a two-year period showed that mean survival time for the crowns was 38.7 months with a confidence interval ranging from 38.1 months to 39.3 months. When the survival of the crowns was observed based on the presence or absence of symptoms, it was observed that only 4 out of the 70 crowns were symptomatic (with or without crown loss) at the end of two years, giving a success rate of 94.3%. The mean survival time was also increased to 39.5 months (confidence interval 39.15-39.98 months). CONCLUSION: Zirconia crowns provide an acceptable level of success and longevity. Crowns placed on teeth after pulp therapy are more likely to fail than those placed on teeth without pulp therapy.

Neighborhood Contexts and Oral Health Outcomes in a Pediatric Population: An Exploratory Study.

AIMS: This study aimed to explore the impacts of neighborhood-level socioeconomic contexts on the therapeutic and preventative dental quality outcome of children under 16 years. MATERIALS AND METHODS: Anonymized billing data of 842 patients reporting to a university children's dental over three years (March 2017-2020) met the inclusion criteria. Their access to care (OEV-CH-A), topical fluoride application (TFL-CH-A) and dental treatment burden (TRT-CH-A) were determined by dental quality alliance (DQA) criteria. The three oral health variables were aggregated at the neighborhood level and analyzed with Canadian census data. Their partial postal code (FSA) was chosen as a neighborhood spatial unit and maps were created to visualize neighborhood-level differences. RESULTS: The individual-level regression models showed significant negative associations between OEV-CH-A (p = 0.027) and TFL-CH-A (p = 0.001) and the cost of dental care. While there was no significant association between neighborhood-level sociodemographic variables and OEV-CH-A, TRT-CH-A showed a significant negative association at the neighborhood level with median household income and significant positive association with percentage of non-official first language (English or French) speakers. CONCLUSION: Initial analysis suggests differences exist in dental outcomes according to neighborhood-level sociodemographic variables, even when access to dental care is similar.

Reliability of mobile phone teledentistry in dental diagnosis and treatment planning in mixed dentition.

INTRODUCTION: The aim of the study was to test the reliability of mobile phone teledentistry in the diagnosis and treatment planning of dental caries of children in mixed dentition. METHODS: A total of 57 cases, aged 6-12 years, among six examiners were used yielding 342 comparisons. The patients were examined by a dentist who was calibrated in the recording of oral findings in children using the World Health Organization (WHO) oral health assessment form for children (version 2013), which served as the gold standard for diagnosis. Six paediatric dentists calibrated using the same WHO form served as the teledentistry group and made their diagnoses using only the images sent to them without the use of radiographs. The pictures obtained were stored on an online cloud platform (Google Drive). The sharing links for these pictures were forwarded to participating dentists using a social media application (WhatsApp Messenger, Facebook Corp., Mountain View, CA). RESULTS: This study showed greater sensitivity than specificity, and though both sensitivity and specificity were constantly above 80%, it can be stated that the current model has a higher chance of false positive results than false negative results. The reliability of teledentistry in this study is greater in primary teeth than in permanent teeth. DISCUSSION: Although the use of teledentistry without radiographs is not as accurate as clinical examination, mobile phone teledentistry offers acceptable reliability for the initial diagnosis of caries in children.

The efficacy of two different oral hygiene regimens on the incidence and severity of oral mucositis in pediatric patients receiving hematopoietic stem cell transplantation: A prospective interventional study.

AIMS: This prospective interventional study aimed to assess the efficacy of supersaturated calcium phosphate rinse and the use of an extra-soft toothbrush twice a day when added to the existing oral hygiene protocol regimen (0.12% chlorhexidine gluconate + 3% sodium bicarbonate + nystatin 5000 U/mL) in reducing the severity of oral mucositis among pediatric patients receiving chemotherapy for the hematopoietic stem cell transplant. METHODS: Forty-five patients that received chemotherapy for the hematopoietic stem cell transplant were randomly allocated to three groups of 15 patients each. Group A was advised to follow the existing oral hygiene protocol regimen (Control), group B was advised to brush their teeth twice daily using an extra-soft toothbrush and to follow the control regimen, and lastly group C was advised to use supersaturated calcium phosphate rinse and to follow the control regimen. Oral mucositis was recorded according to World Health Organization criteria from the day of admission (day 1) to the day of discharge (day 28). The incidence of oral mucositis between the three groups was compared using the Kruskall-Wallis test while the severity of oral mucositis between the three groups was compared using a one-way ANOVA test. RESULTS: The results of the study showed no significant difference in the incidence of oral mucositis between the three groups; however, there was a lower severity of oral mucositis in the supersaturated calcium phosphate rinse group when compared to the control group or the group who used an extra-soft toothbrush with the control regimen. CONCLUSION: Although marginally fewer cases and lower severity of oral mucositis was observed in the group using supersaturated calcium phosphate rinse, the lack of statistical significance suggests that the evidence for their use is not conclusive. The results of this study also showed that the introduction of an extra-soft toothbrush into the oral hygiene regimen did not significantly reduce the incidence of oral mucositis and may actually be responsible for an increase in the severity of oral mucositis.

Color Stability of Glass Ionomer Cement after Reinforced with Two Different Nanoparticles.

AIM: This study aimed to compare the staining characteristics of a commercially available restorative glass ionomer cement to a formulation reinforced by the addition of carbon nanotubes and another formulation reinforced by the addition of silver nanoparticles to the powder of the same cement. Methodology. Twenty samples each of a control glass ionomer cement (PULPDENT® Glass Fill®, Pulpdent Corp. Watertown, MA, USA), control cement reinforced with 0.0006 gm (0.03% by weight) of carbon nanotubes (Sigma Aldrich, St Louis MO, USA), and control cement reinforced with 0.2 gm (10% by weight) of silver nanoparticles (Nanocyl™, Nanocyl SA, Sambreville, Belgium) were immersed in a staining solution. Color evaluations were carried out after 1 h, 24 h, and 1 week. Color change values were calculated. RESULTS: The results indicated that carbon nanotube reinforced specimens exhibited less color stability when compared to controlled glass ionomer cement specimens; however, both samples had significantly greater color stability than silver nanoparticle reinforced glass ionomer samples. CONCLUSION: It can be concluded within the limitations of this study that carbon nanotube reinforced glass ionomer cements have better color stability than silver nanoparticle reinforced glass ionomer cements.

Drooling of saliva in children with cerebral palsy-etiology, prevalence, and relationship to salivary flow rate in an Indian population.

The prevalence of drooling, the impact of various etiological factors on its severity, and its relationship to salivary flow rate were assessed in 113 individuals with cerebral palsy (CP). In this study, there were 74 males and 39 females with an age range of 6-18 years who were attending a special school in Chennai, India. The severity of drooling was assessed by visual examination; demographics and data regarding severity and control of drooling were collected via a questionnaire. Data regarding the type of CP and drugs taken by the children were obtained from the medical records maintained by the school. The unstimulated salivary flow rate of these children was determined through a passive method. The overall incidence of drooling was 48.7%, with 17.7% having severe drooling. Individuals with athetosis had the least severe amount of drooling. There was a significant relationship between ability to close the mouth and the severity of drooling. The severity of drooling was reduced with age. There was no significant difference in the mean salivary flow rate of those children who drooled and those who did not.

Impressions in cleft lip and palate--a novel two stage technique.

Though the field of presurgical orthopedics for the management of children with cleft Lip and Palate (CLAP) has made great advances over the past few decades, little is found in literature regarding the imressions required to fabricate these appliances. The purpose of this paper is to describe a novel two stage technique utilizing greenstick compound and addition silicone impression material to provide a safe, economical and accurate method for recording impressions in children with cleft lip and palate.

Drooling of saliva and its effect on the oral health status of children with cerebral palsy.

OBJECTIVE: The purpose of this study was to assess the prevalence of drooling in individuals with cerebral palsy and assess the effect these factors have on these individuals oral health. MATERIALS: A total of 113 individuals with cerebral palsy between the age of 5 and 18 years were examined. The incidence and severity of drooling were determined using the index given by Blasco et al and the oral heath was recorded using a modified WHO performa. The data was then subjected to statistical analysis. RESULTS: While drooling may not predispose the individual to dental caries individuals with drooling have a poorer oral hygiene score than those without. CONCLUSIONS: There is no significant difference in the Dental caries status, Orthodontic findings or the debris component of the Oral Hygiene Index of individuals who drool saliva and those who do not.

The Relationship between Salivary Total Antioxidant Capacity and Dental Caries in Children: A Meta-Analysis with Assessment of Moderators.

OBJECTIVE: There has been variation reported in literature examining the relationship between dental caries and total antioxidant capacity (TAC) of saliva in children. This study aimed to systematically review the literature and conduct a meta-analysis of the association between dental caries and TAC in children. METHODOLOGY: A systematic review of literature was done using the PubMed, Medline, and EBSCO libraries. Of the total of 68 records found, 11 studies were qualitatively assessed in the final analysis. These studies yielded a total of 13 comparisons to be included in the meta-analysis. The type of dentition of the child and the test used to measure TAC were assigned as moderators. A meta-analysis was done of the mean TAC levels, while a meta-regression was formulated using the moderators. All analyses were performed using OpenMetaAnalyst™ meta-analysis software (Brown University, RI, USA). RESULTS: The meta-analysis showed significant increase in TAC in children with dental caries when compared to their caries-free counterparts (P < 0.001). The meta-analysis showed high levels of heterogeneity (I 2= 99.48). The meta-regression revealed that, while the type of dentition was a significant moderating factor (P = 0.002), the method used to assess the TAC was not (P = 0.053). CONCLUSION: There is a significant increase in TAC in children with dental caries when compared to their caries-free counterparts.