Diagnosis and initial management of children presenting with premature loss of primary teeth associated with a systemic condition: A scoping review and development of clinical aid.

BACKGROUND: Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists. AIMS: To identify systemic conditions associated with PLPT and develop a clinical aid. DESIGN: OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English-language full text. RESULTS: Seven hundred and ninety-one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty-one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon-Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach. CONCLUSIONS: A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral.

An exploration of the use of photobiomodulation for management of oral mucositis in children and young people undergoing cancer treatment in the UK.

PURPOSE: Oral mucositis affects up to 80% of children and young people (CYP) receiving chemotherapy. This can result in pain, reduced oral intake and, in severe cases, hospitalisation for parental nutrition and pain relief. Photobiomodulation is recommended by multiple bodies for mucositis management for those undergoing cancer treatments. The current use of photobiomodulation within the UK, and the barriers and facilitators to implementation is unknown. METHOD: An online mixed-methods survey was administered to representatives from the Children's Cancer and Leukaemia Group (CCLG) between October 2021 and March 2022. This explored: use of photobiomodulation, planned future use, barriers and facilitators to implementation and dental assessment. Quantitative data underwent descriptive statistics. Barriers and facilitators to the implementation of photobiomodulation were analysed using the Theoretical Domains Framework (TDF). RESULTS: All UK CCLG centres responded (n = 20, a response rate of 100%). Two units in Scotland were delivering photobiomodulation. A further four units were planning to implement a service. Most units, 65% (n = 13) utilised specialist Paediatric Dentistry services for dental assessment. In the TDF analysis, five domains were most frequently populated: knowledge, skills, environmental context and resources, social influences, and social/professional role and identity. CONCLUSION: Photobiomodulation was only available in Scotland in two children's cancer units. Lack of knowledge and skills, and insufficient environmental resources were identified as barriers. Collaboration with paediatric dental services was identified as a facilitator. The establishment of a national network of Paediatric Dentists and Oncologists would promote collaboration to standardise protocols and to address the identified barriers to wider implementation of photobiomodulation.

Traumatic and non-traumatic dental presentations to the paediatric emergency departments of two UK children's hospitals: A multi-centre evaluation.

BACKGROUND: Dental attendances to paediatric emergency departments (PEDs) represent suboptimal use of resources of an unknown scale. AIM: To evaluate dental attendances at two PEDs in the UK and compare traumatic dental injury (TDI) and non-traumatic dental conditions (NTDCs). DESIGN: Retrospective data were collected for a 12-month period including demographics, attendance pattern, assessment, and management. Maxillofacial conditions were excluded, and attendances were grouped as TDI and NTDC. RESULTS: Of 667 attendances, 35.1% (n = 234) were TDI and 64.9% (n = 433) NTDC. Nineteen children reattended. Proportionately, more TDI attenders were male, White British, of lower mean age, and resided in less deprived areas than NTDCs. Over half (52.3%, n = 339) of attendees resided in the 10% most deprived UK areas. Saturday and Monday were modal attendance days; attendance peaked in summer. Over half (56.4%, n = 376) attended out of hours. A majority (74.8%, n = 499) self-referred and half accessed no other service prior to PED attendance. No PED dental input was received for 38.7% (n = 258), and dental treatment was received for 12.4% (n = 83). Antibiotics were provided for 42.1% (n = 281), and 15.4% (n = 103) were admitted. CONCLUSION: Dental abscesses and toothache accounted for half of attendances, many of these children may be managed in primary care. Improved signposting to alternative dental services for non-urgent conditions may better allocate resources to those with urgent need.

Interventions to reduce the risk of side-effects of cancer treatments in childhood.

INTRODUCTION: Childhood cancers as a group affect around 1 in 500 children but each individual diagnosis is a rare disease. While research largely focuses on improving cure rates, the management of side effects of treatment are high priority for clinicians, families and children and young people. AREAS COVERED: The prevention and efficient management of infectious complications, oral mucositis, nausea and vomiting and graft-vs-host disease illustrated with examples of implementation research, translation of engineering to care, advances in statistical methodologies, and traditional bench-to-patient development. The reviews draw from existing systematic reviews and well conducted clinical practice guidelines. EXPERT OPINION: The four areas are driven from patient and family priorities. Some of the problems outlined are ready for proven interventions, others require us to develop new technologies. Advancement needs us to make the best use of new methods of applied health research and clinical trial methodologies. Some of the greatest challenges may be those we're not fully aware of, as new therapies move from their use in adult oncological practice into children. This will need us to continue our collaborative, multi-professional, multi-disciplinary and eclectic approach.

Speaking up for balance: analysis of the gender of invited speakers at UK dental conferences.

Introduction Across healthcare, there is an urgent call to action to address systematic gender bias impeding equity for women. Gender imbalance exists for speakers at medical conferences. This research presents the first descriptive analysis of gender balance of speakers at dental conferences.Objectives Describe the gender balance of invited speakers at UK conferences of the dental specialties and general dentistry in a two-year period. Consider the findings in relation to gender balance of dental and specialist registrants.Method Gender, presentation length and professional role were extracted from conference programmes. Acceptable gender balance was pre-specified as 40-60%. Gender data were extracted from the GDC registration report.Results Of 352 invited speakers, 39.8% (n = 140) were identified as female and 60.2% (n = 212) as male. Gender was acceptably balanced in 21.4% (n = 3) of conferences. Gender balance of specialist speakers varied, as does gender distribution within the specialties themselves. Only 38.5% (n = 5) of specialties had a specialist speaker gender balance representative of their speciality.Conclusion There is a call for further research to drive equity in the characteristics of invited speakers and to determine whether there is correlation with representation in the composition of conference organising committees, leadership, professional roles and the workforce. Conference organisers are encouraged to strive proactively and prospectively towards representative programmes.

Quality of available internet information regarding IV sedation for dental treatment.

Aim Evaluate the content and quality of internet information for patients regarding intravenous sedation in dentistry.Methodology Google was queried with predefined search terms that might be chosen by patients wishing to seek information: 'dental IV sedation OR dental intravenous sedation OR dental sedation'. The first hundred search results were identified. Invalid hyperlinks and duplicates were excluded. Providers, format and location of information were extracted. For webpages detailing treatment options, the DISCERN instrument and JAMA benchmark were used to determine the quality of the information provided.Results Of the first hundred search results, 89 webpages met the initial inclusion criteria. A majority (79%) originated from dental providers. Information was commonly presented as patient information leaflets. Of the 78 webpages detailing treatment options, 3% of webpages received a maximum DISCERN score of 5 and 64% a score of 1. No webpages fulfilled all JAMA criteria and 89% met only one criterion. Secondary care providers scored higher in both scales; however, this represents only 5% of the information available.Conclusion The internet is a commonly accessed information resource for patients. The quality of internet information available regarding intravenous sedation in dentistry is suboptimal. There is a need for more high-quality information resources.