Oral and Dental Aspects of Child Abuse and Neglect: Clinical Report.

In all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico, pediatricians, dental professionals, and other physicians are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this clinical report is to review the oral aspects of abuse and dental neglect in children and the role of pediatricians, dental professionals, and other physicians in evaluating such conditions. This clinical report addresses recommendations on the evaluation of bite marks, as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Some physicians may have received less education pertaining to oral health, dental injury, and oral disease. These physicians may not detect the mouth and gum findings possibly related to abuse or neglect as readily as abuse injuries involving other areas of the body. Therefore, pediatricians, dental professionals, and other physicians are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

Developing content for American Board of Pediatric Dentistry certification examinations using practice analysis.

BACKGROUND: The American Board of Pediatric Dentistry (ABPD) conducted a practice analysis to guide the development of its certification examination outlines for assessing the knowledge, skills, and abilities of pediatric dentists. This article describes the systematic approach used by the ABPD. METHODS: The ABPD conducted its practice analysis in 4 phases: (1) preparation, (2) focus group meetings, (3) survey, and (4) examination blueprint development. RESULTS: Phase 2 resulted in 150 job tasks relevant to entry-level pediatric dental practice, organized into 10 domains. In Phase 3, 8,730 pediatric dentists received an electronic survey, with 10% returning a completed survey. Respondents rated tasks in terms of frequency and risk, which were analyzed to determine the combined relevance of each task. Phase 4 organized a final list of tasks within each domain and the recommended weighting of domains by certifying examination. CONCLUSIONS: The ABPD practice analysis created a comprehensive outline of the job tasks an entry-level pediatric dentist is expected to perform. The ABPD plans to use the results to help develop the examination content for continuing certification and will use a similar process every 5 through 7 years to update the examination content blueprints to ensure their continued relevance to the practice of pediatric dentistry. PRACTICAL IMPLICATIONS: The ABPD used a process known as practice analysis to ensure that its examinations and continued competency assessments measure the knowledge, skills, and abilities required for safe and effective clinical practice.

Safety protocols at the American Board of Pediatric Dentistry Oral Clinical Examination during COVID-19.

BACKGROUND: There are continued concerns about holding large group gatherings with the ongoing COVID-19 pandemic. The American Board of Pediatric Dentistry (ABPD) made the decision to cancel the Oral Clinical Examination (OCE) in 2020 with a goal to host the exam in 2021. This cancellation postponed the board certification of over 400 pediatric dentists. There is limited published data on safety protocols for in-person examinations. AIM: To determine if safety protocols utilized in the administration of the 2021 ABPD Oral Clinical Examination (OCE) were reassuring to candidates and examiners, and effective at addressing prevention of COVID-19 infection. DESIGN: An electronic survey was emailed to candidates and examiners following completion of the board examination process. The candidate survey had 784 and the examiner survey had 108 eligible participants. Eight questions overlapped between the two surveys. Descriptive statistics were utilized. p-values < 0.05 were considered significant. RESULTS: Three hundred ninety-four candidates (response rate = 50.3%) and 97 examiners (response rate = 89.8%) completed their respective surveys. The majority of candidates (86.8%) and examiners (94.8%) felt safe participating the OCE, and found COVID-19 protocols reassuring, 69.3% and 89.7%. CONCLUSIONS: Participants agreed that safety protocols enacted by the ABPD kept everyone safe and led to a successful and safely conducted high-stakes oral clinical examination during the COVID-19 pandemic.

Dental Topics for Plastic Surgeons, Part Three: Infection and Trauma of the Dentition.

ABSTRACT: Conditions that affect dental and periodontal structures receive sparse coverage in the plastic surgery literature, yet a working knowledge of this subject matter is important in certain areas of clinical practice and a fundamental understanding is part of plastic surgery competency tested on the in-service and written board examinations. This 4-part series written to provide plastic surgeons with a working knowledge of dental topics that may be relevant to their clinical practice. This section, Part III, covers inflammatory and infectious conditions of the dentition and related structures, as well as dentoalveolar trauma.

Dental Topics for Plastic Surgeons, Part Two: Abnormal Tooth Development, Conditions, and Treatment.

Conditions that affect dental and periodontal structures receive sparse coverage in the plastic surgery literature, yet a working knowledge of this subject matter is important in certain areas of clinical practice and a fundamental understanding is part of plastic surgery competency tested on the in-service and written board examinations. This four-part series written to provide plastic surgeons with a working knowledge of dental topics that may be relevant to their clinical practice. This section, Part II, covers abnormal tooth development and related conditions.

The risk for scurvy in children with neurodevelopmental disorders.

BACKGROUND: Scurvy, the disease resulting from vitamin C deficiency, is perceived as being rare and occurring predominantly in the past. However, scurvy continues to exist and may be encountered in children with medical/developmental conditions and/or restricted diet. Diagnosis can be challenging given the perceived rarity of the condition and nonspecific symptoms, including gingival disease. METHODS: We present a series of two cases of scurvy in which the affected children presented to medical attention with dental complaints. Additional cases of scurvy are described, based on the literature review of case reports/series published in the last 10 years. RESULTS: Literature review yielded 77 relevant case reports published in the English language since 2009. Most affected children had a previous diagnosis of a medical or developmental condition (especially autism spectrum disorder). Intraoral features (gingival swelling, pain, and bleeding) were noted in most of the identified cases of scurvy. Improvement in the oral features of scurvy occurred within days of vitamin C therapy initiation. CONCLUSIONS: Recognizing classic signs and symptoms of scurvy enables prompt diagnosis and avoids invasive investigations. Dentists may be in a unique position to facilitate prompt and accurate diagnosis of a condition that is relatively easy and safe to treat once identified.

Dental Topics for Plastic Surgeons, Part One: Normal Anatomy, Growth and Development.

Normal and abnormal conditions affecting the dentition and the periodontal structures receive sparse coverage in the plastic surgery literature, textbooks, and training programs. Nevertheless, a working knowledge of this subject matter is important in certain areas of clinical practice, and a fundamental understanding is often part of plastic surgery competency tested for in the In-service and written board examinations. This four-part series is written to provide plastic surgeons with a working knowledge of relevant dental topics. Part 1 covers fundamental aspects of normal dental embryology, growth and anatomy.

Oral and Dental Aspects of Child Abuse and Neglect.

In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

Oral and Dental Aspects of Child Abuse and Neglect.

In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

The Oral Bacterial Communities of Children with Well-Controlled HIV Infection and without HIV Infection.

The oral microbial community (microbiota) plays a critical role in human health and disease. Alterations in the oral microbiota may be associated with disorders such as gingivitis, periodontitis, childhood caries, alveolar osteitis, oral candidiasis and endodontic infections. In the immunosuppressed population, the spectrum of potential oral disease is even broader, encompassing candidiasis, necrotizing gingivitis, parotid gland enlargement, Kaposi's sarcoma, oral warts and other diseases. Here, we used 454 pyrosequencing of bacterial 16S rRNA genes to examine the oral microbiome of saliva, mucosal and tooth samples from HIV-positive and negative children. Patient demographics and clinical characteristics were collected from a cross-section of patients undergoing routine dental care. Multiple specimens from different sampling sites in the mouth were collected for each patient. The goal of the study was to observe the potential diversity of the oral microbiota among individual patients, sample locations, HIV status and various dental characteristics. We found that there were significant differences in the microbiome among the enrolled patients, and between sampling locations. The analysis was complicated by uneven enrollment in the patient cohorts, with only five HIV-negative patients enrolled in the study and by the rapid improvement in the health of HIV-infected children between the time the study was conceived and completed. The generally good oral health of the HIV-negative patients limited the number of dental plaque samples that could be collected. We did not identify significant differences between well-controlled HIV-positive patients and HIV-negative controls, suggesting that well-controlled HIV-positive patients essentially harbor similar oral flora compared to patients without HIV. Nor were significant differences in the oral microbiota identified between different teeth or with different dental characteristics. Additional studies are needed to better characterize the oral microbiome in children and those with poorly-controlled HIV infections.

Calcium hydroxide or mineral trioxide aggregate may be used for the apexification of immature teeth.

PURPOSE/QUESTION: To compare the efficacy of mineral trioxide aggregate (MTA) and calcium hydroxide (CH) for the root-end induction of immature teeth. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review and meta-analysis of data. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Grade B: Limited-quality patient-oriented evidence.

The practice and perception of pain assessment in US pediatric dentistry residency programs.

PURPOSE: The purpose of this study was to describe the current practice and perception of pain assessment in US accredited advanced pediatric dentistry residency programs, as reported by directors of these programs. METHODS: A questionnaire was sent out to 68 accredited US pediatric dentistry residency programs. Responses were statistically analyzed to find significant correlations between the actual practice of pain assessment and the perceived usefulness of pain assessment. RESULTS: Forty-four surveys (65% response rate) were completed and returned. Sixty-eight percent of program directors stated that pain is assessed at all types of appointments. A statistically significant correlation exists between program directors who regard pain assessment scales as useful and those who teach the use of such resources in their programs (chi-square = 3.73, P = .05). A statistically significant correlation exists between program directors who regard preoperative pain assessment as clinically beneficial and those who report a need to place more emphasis on pain assessment (chi-square = 6.22, P = .01). CONCLUSIONS: Pediatric dentistry residency program directors generally regard pain assessment as clinically beneficial in patient treatment. Implementing increased pain assessment teaching in pediatric dentistry residency programs could improve the confidence and skills of residents in assessing the pain of young children and those with special health care needs.

The role of pediatric dentistry in multidisciplinary cleft palate teams at advanced pediatric dental residency programs.

PURPOSE: The purpose of this study was to characterize the participation of pediatric dentistry in multidisciplinary cleft palate teams (CPTs) at advanced pediatric dental residency programs. METHODS: A survey was sent to the directors of advanced pediatric dentistry programs across the United States. RESULTS: Of the 60 (90%) surveys returned, 18% of the programs were university-based, 40% hospital-based, and 42% combined programs. Overall, 92% of the programs reported pediatric dentistry's participation in CPTs. Orthodontics, plastic surgery, oral surgery, otolaryngology, and speech therapy, are represented on at least 75% of the CPTs. Nursing and psychology are represented in less than 50% of the CPTs. A higher percentage of combined programs reported providing interceptive orthodontics, while more hospital-based programs reported providing presurgical infant orthopedic appliances (PIOAs). Of the 47% of the programs that reported use of POIA, 64% reported using removable appliances. Seventy-five percent of the programs reported that there has been no change, 22% reported an increase, and 3% reported a decrease in the CPT participation level in the post 5 years. CONCLUSIONS: This study highlights the role of pediatric dentistry as a part of cleft palate team. This role extends from preventive and restorative to infant orthopedics.

Antibiotic prophylaxis for children with sickle cell disease: a survey of pediatric dentistry residency program directors and pediatric hematologists.

PURPOSES: The purposes of this study were to: (1) investigate the current clinical practice regarding the use of antibiotic prophylaxis by pediatric dentistry residency program directors and pediatric hematologists for children with sickle cell disease (SCD) requiring dental treatment; and (2) evaluate the perceived relative risk of bacteremia following specific dental procedures, as defined by pediatric dentistry residency program directors and pediatric hematologists. METHODS: A written survey depicting various clinical scenarios of SCD children requiring common dental procedures was mailed to directors of pediatric dental advanced education programs and distributed to pediatric hematologists attending the 2003 Annual Sickle Cell Disease Association of America conference in Washington, DC. RESULTS: Surveys were returned by 60% (N=34/57) of the pediatric dentistry residency program directors. The surveys were obtained from 51% of pediatric hematologists at the meeting (N=72/140). At least 50% of all respondents recommended prophylaxis for the following clinical situations: dental extractions, treatment under general anesthesia, and status post splenectomy. The perceived risk of infectious complication was highest for extractions, followed by restorative treatment and tooth polishing. Dental residency program directors were more likely (71%, N=24/34) to recommend additional antibiotic therapy for patients taking penicillin prophylaxis if they required an invasive oral surgical procedure. Conversely, only 38% (N=25/66) of pediatric hematologists recommended additional antibiotic therapy (P=.001). Eighty-six percent of dental residency program directors (N=25/29) chose amoxicillin for prophylaxis whereas only 62% of pediatric hematologists (N=36/58) recommended amoxicillin. (P<.05). CONCLUSIONS: There is a lack of consensus on the appropriate use of antibiotic prophylaxis in SCD children undergoing dental treatments. Further research and risk/benefit assessment is needed to create a unified approach.

Dental postoperative pain management in children.

Misconceptions about the need for pain management in pediatric patients have been shown to be wrong. We now understand that children feel pain and respond to pain medication in much the same way as adults. With this new understanding, practitioners must recognize all the factors that affect the feeling of pain. Pain can be variable and each patient brings a unique set of characteristics to be evaluated. The first objective should be to assess the patient's previous treatment history, medical condition, extent of treatment needed, and age. An effective pain management protocol begins with preoperative pain and anxiety control, with the use of agents such as nitrous oxide and local anesthetics. Postoperative pain medication should be given at the correct dosage and time intervals for the appropriate duration. With our commitment to pain management in children, these protocols should easily translate into improved clinical practice.

Failure rates of restorative procedures following dental rehabilitation under general anesthesia.

PURPOSE: The failure rates of restorative procedures for children undergoing dental rehabilitation under general anesthesia, performed by pediatric dental residents in advanced educational programs, were evaluated in order to determine treatment outcomes and best practices. METHODS: Retrospective review of 504 dental records of children receiving comprehensive dental treatment under general anesthesia at children's hospitals in Boston between 1990-1992 and in Washington, DC, between 1994-1998, were undertaken. Data regarding restoration outcomes were evaluated using chi square tests with correction for continuity. Only records of patients who returned for follow-up at least six months after their rehabilitations were evaluated. T-tests were performed on parametric data. RESULTS: Two-hundred and forty-one (48%) of the records were evaluated. Stainless steel crowns (SSCs) had significantly lower failure rates than amalgams (P<0.001, chi2=63). The highest failure rates were seen in composites (P<0.001, chi2=112) and composite strip crowns (P<0.001, chi2=121). CONCLUSIONS: SSCs are the most reliable restorations while composite restorations are the least durable. Failure of restorations appears to be related to follow-up length.