Associations between child abuse and neglect, and dento-alveolar injuries in a Children's hospital population.

BACKGROUND/AIM: The purpose of this study was to identify social variables common to children with dento-alveolar trauma (DAT) and child abuse and neglect (CAN) in a large children's hospital population. METHODS: Emergency department data from an urban trauma Level 1 children's hospital were queried between December 02, 2017 and September 30, 2022 to identify children with both DAT and CAN. Patients with DAT and CAN were compared to DAT-only children in a case-control study design. Descriptive statistics were used to report characteristics of children in case and control groups. Chi-Squared and Fisher's exact tests were used to compare cases and controls. The level of significance was set at p ≤ .05. RESULTS: In total, 14 children who had DAT and CAN reported simultaneously comprised the case group. A total of 42 children with DAT-only, age/sex matched with cases, comprised the control group. Mean (SD) age of cases was 10.4 (±4) and controls was 10.1 (±3.9) years-old. Eight cases (57.1%) and 24 controls (57.1%) were female. No statistical differences (p = .05) were present for language, race, insurance coverage, parental custody, legal guardianship, and type of residence for cases versus controls. Five (35.7%) cases had a special need versus 4 (9.5%) controls and was statistically different (p = .03). Nine (64.3%) cases had behavioral problems versus 13 (31%) controls (p = .05). Cases were more likely to have facial injuries than controls (74.3 vs. 31%), however no significant differences were present for total number of injured teeth, head injury or neck injury between cases and controls. In half of cases, the perpetrator reported was the sibling. CONCLUSIONS: Demographics did not predict CAN in children with dental injuries. Sibling violence should be considered in suspected CAN children.

Risk of concomitant traumatic brain injuries in children with traumatic dental injuries in a pediatric emergency department: A case-control study.

BACKGROUND: Children with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs. METHODS: Children (≤ 18 years) who sought treatment at the emergency department of a major children's hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models. RESULTS: Of 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI. CONCLUSIONS: The total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting. PRACTICAL IMPLICATIONS: In an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.

Characteristics, treatment outcomes and direct costs of tooth avulsion in children treated at a major hospital.

BACKGROUND/AIMS: Avulsion of a permanent tooth is one of the most severe traumatic dental injuries, comprising an estimated 0.5%-16% of all dental injuries. The aim of this study was to estimate the direct financial costs of tooth avulsion in children based on stage of root maturity and the occurrence of ankylosis and to report patients' characteristics and outcomes of treatment. MATERIALS AND METHODS: A retrospective review of the dental records of children ages 6-18 who sustained a permanent tooth avulsion from 2010 to 2020 was completed. Relative Value Units (RVUs) were used to calculate the estimated cost of dental trauma care over the 2-year post-injury period for five different scenarios of avulsed teeth based on the stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted. RESULTS: There were 452 avulsed permanent teeth in 348 patients. Of those, 157 teeth were included in the cost analysis. Overall, the average direct dental cost of avulsion was 46.4 RVUs equal to $1619 USD based on the 2021 conversion rate ($34.89 per RVU). Direct costs ranged between 40 RVUs ($1396) and 52.8 RVUs ($1842) depending on the root maturation and ankylosis status or whether the tooth was replanted; however, ANOVA test did not show any statistically significant differences between the mean RVUs of different groups (p = .85). Patients returned 9.5 times on average over the 2-year study period for dental trauma care after avulsion. CONCLUSION: The average direct cost of tooth avulsion within the limits of this study was $1619 USD. On average, patients returned for 9.5 follow-up visits after the avulsion. The stage of root maturity, the occurrence of ankylosis and whether the tooth was replanted or not were not significantly associated with the direct cost of dental care.

Comparison of Spanish-Speaking Parental Understanding Using Two Alternative Consent Pathways.

Purpose: The purpose of this study was to assess the understanding of Spanish-speaking caregivers consenting to dental care using general anesthesia (GA) utilizing two consent-delivery pathways. Methods: Seventy-eight parents of children who never had GA were randomly assigned to one of two groups: (1) interpreter; or (2) video; they completed a survey to evaluate comfort level with GA and comprehension of areas of informed consent. Results: Most parents in both groups understood the risks associated with GA (89 percent in the interpreter group and 90 percent in the video group). The majority of families had difficulty understanding indications for GA (64 percent in the interpreter group versus 60 percent in the video group). Overall, 97 percent of participants believed they sufficiently understood the information presented about GA. The mean score for comfort level with GA was 7.03 for the interpreter group and 6.82 for the video group. Conclusion: Consent pathways used in this study were not significantly different for risk understanding and acquisition of consent-related knowledge.

A 3-Year retrospective study of traumatic dental Injuries to the primary dentition.

BACKGROUND/AIMS: Traumatic dental injuries (TDIs) in the primary dentition are a significant public health problem, which has been neglected worldwide. Despite its high prevalence, limited studies address this injury. The aim of this study was to determine the characteristics and treatment modalities of TDIs affecting primary teeth, along with accompanying medical co-morbidities and attendance at follow-up appointments. MATERIAL AND METHODS: This retrospective analysis included all TDIs affecting primary teeth from January 2014 to January 2017. Data abstraction included demographics, time lapse prior to arrival at hospital, trauma etiology, classification of TDIs, soft tissue and supporting bone injuries, medical co-morbidities, emergency treatment, follow-up appointments and prognosis. RESULTS: Records of 283 children with 536 traumatized primary teeth were reviewed. The median age was 2 years and the maxillary right central incisor (35.1%) was the most frequently injured tooth. Almost half the patients, 46.3%, sought treatment after 24 h. Periodontal tissue injuries (97.2%) predominated TDIs for which fall accidents (82.0%) were the most encountered cause. Most patients (177/283) had accompanying soft tissue/supporting bone injuries and 67.2% had multiple traumatized teeth. Seventy percent of the patients were examined only or were prescribed medication. Survival time following TDIs was unknown in 67.7% of traumatized teeth due to non-attendance at follow-up appointments. Most patients (55.1%) did not attend the follow-up appointments. CONCLUSIONS: TDIs occurred in the primary dentition with the predominance of periodontal tissue injuries. When TDI was the presenting problem to hospital, accompanying systemic injury was rare. Treatment modalities were mostly limited to examination or extraction. The follow-up appointments were poorly attended.

The Effects of Primary Canine Loss on Permanent Lower Dental Midline Stability.

Purpose: The purpose of this study was to compare changes in the lower dental midline position after premature unilateral loss of a primary mandibular canine with dental midline position after normal primary mandibular canine exfoliation. Methods: Dental casts were identified from growth studies at the University of Iowa and the University of Toronto. Two groups of dental casts were identified: (1) premature unilateral loss; and (2) normal asymmetric exfoliation of a single primary mandibular canine. The first set of casts displaying unilateral primary canine loss (time one) and the second set of casts displaying full permanent dentition (time two) were collected. The palatal rugae and palatal raphe were used to construct a median palatal plane (MPP). Dental midline position at each time point was measured from the MPP. Results: A total of 56 cases (15 premature, 41 normal) were identified. The mean lower dental midline changes from time one to time two for the premature and normal loss groups were 1.32±0.83 mm and 0.97±0.91 mm, respectively. This difference was not statistically significant regarding group (P=0.62), gender (P=0.91), or the interaction effect of group and gender (P=0.85). Conclusions: There was no significant difference in midline shift between the 15 individuals with premature unilateral primary canine loss and the 41 individuals with normal, asymmetric unilateral loss of a primary canine.

Parental Attitudes Toward Advanced Behavior Guidance Techniques Used in Pediatric Dentistry.

PURPOSE: To re-examine parental attitudes toward advanced behavior management techniques in pediatric dentistry and determine whether cost, urgency, and amount of treatment influence parental preferences. METHODS: Parents viewed previously validated videotaped clinical vignettes of four advanced behavior guidance techniques: (1) passive immobilization; (2) active immobilization; (3) general anesthesia; and (4) oral sedation. The study was conducted in a children's hospital dental clinic and a suburban private pediatric dentistry office. Parents rated overall acceptance of the techniques, and acceptance under specified conditions using an anchored visual analogue scale. RESULTS: One hundred five parents completed the survey; 55 from the children's hospital and 50 from private practice. Oral sedation was rated as the most acceptable technique, followed by general anesthesia, active immobilization, and passive immobilization. As urgency, convenience, and previous experience increased, parental acceptance of the technique increased. As cost of treatment increased, parental acceptance decreased. Ratings between the children's hospital group and private practice group differed, as did the demographic variables of insurance, income, and race. CONCLUSIONS: The hierarchy of parental acceptance of advanced behavior guidance techniques is changing with increasing approval of pharmacological management and decreasing approval of physical management. The health care delivery system, urgency, convenience, previous experience, and cost all influence parental acceptance.

Correlating parenting styles with child behavior and caries.

PURPOSE: This study evaluated the relationship between parenting style, sociodemographic data, caries status, and child's behavior during the first dental visit. METHODS: Parents/legal guardians of new patients aged three to six years presenting to Nationwide Children's Hospital dental clinic for an initial examination/hygiene appointment completed the Parenting Styles and Dimensions Questionnaire (PSDQ) to assess parenting style and a 15-question demographic survey. Blinded and calibrated expanded function dental auxiliaries or dental hygienists (EFDA/DH) performed a prophylaxis and assessed child behavior using the Frankl scale (inter-rater reliability was 92 percent). A blinded and calibrated dentist performed an oral examination. RESULTS: 132 parent/child dyads participated. Children with authoritative parents exhibited more positive behavior (P<.001) and less caries (P<.001) compared to children with authoritarian and permissive parents. Children attending daycare exhibited more positive behavior compared to children who did not (P<.001). Patients with private dental insurance exhibited more positive behavior (P>.04) and less caries (P>.024) compared to children with Medicaid or no dental insurance. CONCLUSIONS: Authoritative parenting and having private dental insurance were associated with less caries and better behavior during the first dental visit. Attending daycare was associated with better behavior during the first dental visit.

Diagnosis of an unusual finding in the primary dentition: a case report.

Patients may present to the dental office with unusual findings that have no obvious etiology. The purpose of this paper is to report the case of a two-year old female patient who presented with a foreign body mimicking pathosis. Diagnosis and treatment are discussed.

Gender shifts and effects on behavior guidance.

UNLABELLED: Women's presence in pediatric dentistry has dramatically increased over the past several decades. Women now comprise almost 50 percent of AAPD membership and almost 75 percent of new members. PURPOSE: The purpose of this investigation was to determine differences between male and female pediatric dentists relative to practice patterns and use of behavior guidance techniques (BGTs). METHODS: A web-based survey was sent to 511 pediatric dentists who had been recruited by the AAPD to participate in a series of surveys related to pediatric dentistry. RESULTS: Fifty-nine percent of dentists responded. Fifty-two percent of the respondents were male and 48 percent were female. Female respondents were significantly younger than male respondents. Males were more likely to own a practice and hold leadership positions in dentistry while females were more likely to work as faculty, staff dentists, or part-time in private practice. No significant differences were noted between the genders relative to the use of BGTs, though females tended to involve parents more and were more likely to report the use of protective stabilization in selected situations. Both genders reported that parenthood had an effect on their behavior guidance styles.

Case series: management of immature permanent teeth with pulpal necrosis: a case series.

The management of immature permanent teeth with necrotic pulps has changed in recent years from apexification techniques to regenerative endodontic procedures, which enable apexogenesis with physiologic maturation of the roots. This regenerative technique lies squarely in the endodontist's scope of practice, but children presenting with necrotic immature incisors may pose behavior management problems that endodontists are untrained and unwilling to handle. Treatment of these immature permanent teeth provides an excellent opportunity for collaboration and shared patient management between pediatric dentists and endodontists that can yield optimal clinical outcomes. The purpose of this paper was to report a series of 32 regenerative endodontic cases in 28 children treated at the Nationwide Children's Hospital, Columbus, Ohio. The report describes procedural and patient management issues and the need for a collaborative relationship between pediatric dentists and endodontists in tackling these challenging cases.

Overview of trauma management for primary and young permanent teeth.

This overview covers diagnosis and management of the most common dental injuries in children and identifies those children at greatest risk. Crown fractures and luxation injuries in both the primary and permanent dentition are discussed and treatment options based on current international guidelines are detailed.

Children presenting with dental trauma are more hyperactive than controls as measured by the ADHD rating scale IV.

PURPOSE: Previous studies in the dental traumatology literature have proposed an association between incidence of dental trauma and attention deficit/hyperactivity disorder (ADHD). The purpose of this study was to evaluate the incidence of comorbid dental trauma and ADHD in children presenting for both trauma-related and routine dental care. METHODS: An Institutional Review Board-approved case group series study examined both populations using the attention deficit hyperactivity disorder rating scale IV (ARS). RESULTS: Data were collected from 161 children. There were no differences in overall ARS score or in the inattentiveness subscale. Children with a confirmed recent history of dental trauma did score higher on the hyperactivity/impulsivity subscale (P<.001). There was no difference in subjects scoring above the 90th percentile on the ARS based on group. CONCLUSION: Children presenting with dental trauma scored a higher baseline level of hyperactivity/impulsivity.

Continued care of children seen in an emergency department for dental trauma.

PURPOSE: The purpose of this retrospective study was to determine the rate of continuing care for dental trauma patients seen after-hours in a hospital emergency department (ED) and identify predictors for and barriers to seeking continuing care. METHODS: Records of 856 patients treated at Nationwide Children's Hospital (NCH) ED for dental trauma between September 2003 and December 2007, were screened for avulsion, luxation, and intrusion injuries. A qualifying cohort (QC) of 175 patients was included based on injury and root development. A quality assurance survey was conducted with 96 parents of these patients to determine barriers and predictors for follow-up treatment. RESULTS: Patients averaged 2.5 follow-up visits at NCH. The most commonly reported barriers to receiving treatment were: having to miss school (21%), taking time off of work (17%), and costs associated with dental care (13%). No statistical significance (P=.22) was found between number of follow-up visits and the patient retaining the injured tooth. The number of follow-up visits was not significantly different between patients with private and public insurance. CONCLUSIONS: School, work, and costs associated with ongoing trauma management affect follow-up compliance irrespective of payment source.

Pulpotomy to stainless steel crown ratio in children with early childhood caries: a cross-sectional analysis.

PURPOSE: This study's purpose was to determine the pulpotomy-to-crown ratio (PCR) in a high-early childhood caries patient population and factors associated with choice of pulpotomy and crown treatments. METHODS: This was a retrospective quality assurance chart review. Five calibrated examiners (kappa=0.86) rated radiographic caries from available films. Demographic data, including age, health status, medications, and pain score, were collected along with pulpotomy- and crown-related treatment characteristics of location of tooth, treatment site, and level of operator skill. RESULTS: The record review of 521 patients (mean age=5.1 ± 1.9 years old) revealed 1,365 stainless steel crowns (SSCs) performed with 461 pulpotomies in a 6-month period, in both operating rooms (1,043 SSCs) and ambulatory settings (322 SSCs). The mean PCR was 0.34, with PCR decreasing with increasing patient age. Pulpotomy and crown treatments increased with radiographic caries severity with a significant association between pulpotomy and radiographic severity (P<.001). More severe pain was associated with greater likelihood of pulpotomy (P<.001). Age, operator type, and site of treatment did not affect choice of pulpotomy. CONCLUSIONS: The mean pulpotomy-to-crown ratio in this high-early childhood caries pediatric population was 0.34. Pain, the American Society of Anesthesiologists classification system, and radiographic caries severity were predictors of pulpotomy, but operator type and location of treatment were not.