Integration of a Pilot Oral Health Curriculum into a Medical School Pediatric Rotation.

Purpose: The purpose of this study was to assess changes in medical student knowledge, skills, and beliefs in oral health after participating in an oral health curriculum that included an online learning module, shadowing pediatric dental residents, and applying fluoride varnish. Methods: Third-year medical students completed a precurriculum questionnaire. After completing the online module and clinical experience, students completed a postcurriculum questionnaire. Data were analyzed via descriptive statistics, and outcomes were assessed. Results: There was an improvement in knowledge and oral health-related skills questions postcurriculum. All questions on beliefs toward oral health showed a more agreeable response following the oral health curriculum. Conclusion: Interprofessional collaboration and oral health curriculum integration lead to positively changing the knowledge, attitudes, and skills of medical students.

Caregiver acceptance of an anticipated COVID-19 vaccination.

BACKGROUND: The world is hopeful a vaccine will help mitigate the COVID-19 pandemic. The authors conducted a hospital-based study using a questionnaire to examine parental acceptance of an anticipated COVID-19 vaccination. METHODS: A 41-item questionnaire using the Health Belief Model was administered to caregivers of children receiving oral health care in a dental clinic in an urban pediatric teaching hospital. Demographic, health-seeking, and health-behavior questions were assessed. RESULTS: A total of 39.2% of caregivers would not allow their child to receive a COVID-19 vaccination. Whereas 27.8% of caregivers agreed that if their physician recommends a COVID-19 vaccination, they will allow their child to receive it, 52.2% said that a health care professional could influence this decision. CONCLUSIONS: Dentists, intimately aware of the suggested risks of aerosol-generating procedures, can play a critical role in educating the public about the importance of accepting a COVID-19 vaccine. PRACTICAL IMPLICATIONS: Dentists are in a unique position to discuss and advocate for vaccine acceptance. If a COVID-19 vaccine is not widely accepted, risks associated with performing aerosol-generating procedures will remain.

Preferential Use of Stainless Steel Crowns as a Strategy to Minimize Retreatment of Primary Molars under General Anesthesia.

Purpose: The purpose of this study was to investigate whether primary molars treated with composite resins (CRs) and stainless steel crowns (SSCs) during an oral rehabilitation under general anesthesia (GA1) required retreatment at a second oral rehabilitation under GA (GA2). Methods: Records were examined from 296 healthy patients with more than one dental rehabilitation under general anesthesia from June 2012 to January 2019. Data included treatment details and demographic information. Frequencies and means were recorded. An analysis was completed using logistic regression and chi-square for categorical variables. Results: For primary first molars, 43 percent of CRs placed at GA1 were treated with SSCs at GA2. For primary second molars, 35 percent of CRs placed at GA1 were treated with SSCs at GA2. There was no statistically significant difference in retreatment rates by molar type (P equals 0.27). Eight percent of SSCs placed on any molar at GA1 required retreatment at GA2. Conclusions: Primary molars treated with stainless steel crowns using general anesthesia had the lowest percentage of retreatment compared to those treated with composite resins. Strong consideration should be given to the placement of SSCs on primary molars in patients with early childhood caries under general anesthesia. Placement of primary molar SSCs during initial treatment under general anesthesia may reduce the need for additional treatment in the future.

Prevalence of Primary Teeth Injuries Presenting to a Pediatric Emergency Department.

Purpose: The purpose of this study was to assess the prevalence of traumatic dental injuries (TDIs) in the primary dentition that presented to the emergency department (ED) of a level-one trauma center at a children's teaching hospital. Methods: Electronic health records of 1,170 patients with 2,746 traumatic dental injuries who presented to the ED over a 55-month period were reviewed in this retrospective cohort study. A subset of these (541 patients) with multiple injuries in primary teeth were examined. Results: The prevalence of primary tooth injury was 41 percent (1,120 out of 2,746). Most injuries were sustained by males (N equals 311; 57 percent); lateral luxations (N equals 341; 30 percent) were the most common injuries to the primary dentition. The primary maxillary central incisors were the most common teeth to be injured. Concomitant injuries were reported in 50 (4.5 percent) primary teeth. Conclusions: Traumatic dental injuries occurred frequently in the primary dentition, with lateral luxations being reported most often. Over 40 percent of all reported TDIs occurred in the primary dentition. Emergency room providers should be prepared to manage primary tooth TDIs.

A Study of the Relationship of Parenting Styles, Child Temperament, and Operatory Behavior in Healthy Children.

AIM: The purpose of this study was to assess the relationship of the child's temperament, parenting styles, and parents' prediction of their child's behavior in the dental setting. STUDY DESIGN: Subjects were healthy children 4-12 years of age attending a dental clinic. A Parenting Styles and Dimensions Questionnaire (PSDQ) was given to parents to determine their parenting style. Parents completed the Emotionality, Activity, Sociability Temperament (EAS) survey to measure their child's temperament. Parents were asked to predict their child's behavior using the Frankl Scale. RESULTS: Data analysis included 113 parent/child dyads. Parents accurately predicted their child's behavior 58% of the time. Significant correlations were noted between parent's predictions of behavior and emotionality (r = -.497, p < .001), activity (r = -.217, p < .009), and shyness (r = -.282, p < .002) of EAS. Significant correlations were found between actual behavior and emotionality (r = -.586, p < .001), activity (r = -.196, p < .03), and shyness (r = -.281, p < .003). Parenting style scores did not correlate to predicted or actual behavior; however, categories of PSDQ were related to parental predictions of behavior. CONCLUSIONS: Relationships between temperament and parenting may aid in predicting children's behavior in the operatory.

An Algorithm-Based Approach for Behavior and Disease Management in Children.

Pharmacologic behavior management for dental treatment is an approach to provide invasive yet compassionate care for young children; it can facilitate the treatment of children who otherwise may not cooperate for traditional in-office care. Some recent highly publicized procedural sedation-related tragedies have drawn attention to risks associated with pharmacologic management. However, it remains widely accepted that, by adhering to proper guidelines, procedural sedation can assist in the provision of high-quality dental care while minimizing morbidity and mortality from the procedure. The purpose of this paper was to propose an algorithm for clinicians to consider when selecting a behavior and disease management strategy for early childhood caries. This algorithm will not ensure a positive outcome but can assist clinicians when counseling caregivers about risks, benefits, and alternatives. It also emphasizes and underscores best-safety practices.

Dentoalveolar Stabilization of an Endotracheal Tube in Children With Facial Burns.

Every year, children with burn injuries are admitted to burn units throughout the nation. In many of these cases, there are head/neck components of the injuries as well as inhalation injuries. Airway management is a priority of care for all burn victims. Securing and maintaining airways can be challenging. Dental services (sometimes in conjunction with oral and maxillofacial surgery services) play an important role in securing and stabilizing the endotracheal tube. There are a myriad of dentoalveolar stabilization methods. The purposes of this case report were to: (1) provide an overview of various dentoalveolar methods to stabilize an endotracheal tube; and (2) present two clinical cases in which different methods were employed. (Pediatr Dent 2014;36:E100-E103).

Management of dental caries and esthetic issues in the pediatric patient.

Anterior pediatric restorations exhibit a unique treatment challenge. Factors to consider include the child's medical history, level of cooperation, dental age, caries risk, parental preferences and cultural norms regarding esthetics. The goal is to retain the anterior teeth with an esthetic result and allow natural exfoliation without the need to retreat. Anterior restorations are discussed. Rebonding traumatized fractured teeth, pediatric partial dentures, microabrasion, vital bleaching and enamel hypoplasia are also discussed.

Effect of passive smoke exposure on general anesthesia for pediatric dental patients.

The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months-12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events-coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts (P = .03). If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (-) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post-general anesthesia respiratory morbidity in children being treated for early childhood caries.

The comparative morbidities of acute dental pain and acute asthma on quality of life in children.

PURPOSE: The purpose of this prospective cross-section survey study was to examine the comparative burden of acute exacerbations of the two most common chronic illnesses of childhood: acute dental pain and acute asthma. METHODS: All patients came from one of three distinct clinics within Nationwide Children's Hospital, Columbus, Ohio: (1) outpatient dental clinic; (2) urgent medical care unit; or (3) emergency department. Caregivers were asked information about their child's condition and the impact on their daily function. RESULTS: A total of 112 parent-child dyads were included in this study. Children were significantly more likely to be under the care of a physician for asthma than a dentist for caries (P<.001). More caregivers worried about their child's overall health due to dental caries than asthma-related symptoms (P<.001). Two thirds of children had pain due to dental caries, which kept them from sleeping; 45% were prevented from playing; 45% were prevented from going to school; and 68% from eating in the preceding week. CONCLUSION: Acute dental disease had a comparative and, in some aspects, greater impact on a child's quality of life than acute asthma.

Waiting for the pain to get worse: characteristics of a pediatric population with acute dental pain.

PURPOSE: The purpose of this study was to examine how acute dental pain in children is managed. METHODS: A prospective 18-item cross-sectional survey was administered to 300 parent-child dyads seeking care at a large urban tertiary care hospital emergency walk-in dental clinic. RESULTS: The children's mean age was 8 years, 6 months (±3 years, 2 months). The mean duration of pain was 17.7 days. Seventy-six percent of children had been treated with at least 1 dose of over-the-counter pain medication. Acetaminophen was most commonly used (40%), followed by ibuprofen (37%). Regression analysis revealed child age to be significantly correlated with over 40% of pain management behaviors. Younger children were less likely to have received over-the-counter analgesia for dental pain (P<.05). CONCLUSION: Parents delayed seeking dental care for over 2 weeks. Acute dental pain was most commonly managed with acetaminophen. Seeking dental care was delayed more often for older children.

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.

Buccal bifurcation cyst in a 7-year-old: surgical management and 14-month follow-up.

BACKGROUND: The buccal bifurcation cyst (BBC) is a paradental cyst that typically presents on the buccal aspect of mandibular permanent first molars in children 6 to 11 years of age. Histopathologic features are non-specific and closely resemble other inflammatory odontogenic cysts. The aim of this article is to report a case of a BBC and to review the management of such lesions. METHODS: A 7-year-old white male, complaining of lower right tooth pain and swelling, presented to the Nationwide Children's Hospital Dental Clinic. A clinical examination revealed no caries and swelling localized to the area approximating tooth #30 with a 15-mm probing depth on the buccal aspect. Radiographs revealed a radiolucency involving the bifurcation and root area of tooth #30, accompanied by the distal displacement of unerupted tooth #31. Therapy consisted of a simple surgical enucleation of the cyst. RESULTS: A microscopic evaluation revealed a chronically inflamed cyst lined by a non-keratinized stratified squamous epithelium. The immediate postoperative course was uneventful. At 14 months postoperatively, the development of teeth #30 and #31 was noted as normal. Probing depths around tooth #30 were

The effect of local anesthetic on quality of recovery characteristics following dental rehabilitation under general anesthesia in children.

This study is a randomized, prospective, double-blind study to evaluate the effects of the combination of local anesthetics and an intravenous nonsteroidal anti-inflammatory drug (NSAID) vs NSAID alone on quality of recovery following dental rehabilitation under general anesthesia (GA). Twenty-seven healthy children aged 3-5.5 years underwent dental rehabilitation under GA. Fifteen children in the experimental group received oral infiltration of local anesthetic in addition to intravenous ketorolac tromethamine, while 12 children in the control group received intravenous ketorolac tromethamine alone for postoperative pain management. Pain behaviors were evaluated immediately postoperatively using a FLACC scale and 4 hours postoperatively by self-report using various scales. Parents reported perception of child pain and comfort and any occurrences of postoperative cheek biting. The use of intraoral infiltration local anesthesia for complete dental rehabilitation under general anesthesia for children aged 3-5.5 years did not result in improved pain behaviors in the postanesthesia care unit (PACU), nor did it result in improved pain behaviors 4-6 hours postoperatively as measured by the FLACC scale, FACES scale, and subjective reports of parents or a PACU nurse. Those children receiving local anesthesia had a higher incidence of negative symptoms related to local anesthetic administration, including a higher incidence of lip and cheek biting, which was of clinical importance, but not statistically significant. Infiltration of local anesthetic for dental rehabilitation under general anesthesia did not improve quality of recovery in children aged 3-5.5 years.

Local anesthesia affects physiologic parameters and reduces anesthesiologist intervention in children undergoing general anesthesia for dental rehabilitation.

PURPOSE: The purpose of this study was to evaluate the use of intraoperative local anesthetics in pediatric outpatient dental surgery. This study assessed physiologic stability, as defined by fluctuations in end-tidol carbon dioxide, heart rate, and respiratory rate, as well as subsequent anesthesiologist intervention. METHODS: Forty-eight children (mean age = 3.87 years [+/- l.06 SD]) were included in this randomized, parallel-design study. Intervention variables and the research design were validated in a pilot study. Following collection of baseline vital signs, patients were either given local anesthesia before comprehensive dental treatment or not. Vital sign change was recorded 30 seconds after each procedure. RESULTS: In the no local anesthetic group, 2 areas were found to be statistically significant: (1) postextraction end-tidal carbon dioxide; and (2) heart rate. There was a statistically significant relationship between local anesthetic use and anesthesiologist intervention when assessing the pooled data (P = .001). CONCLUSION: Patients who were not given intraoperative local anesthesia were more likely to experience vital sign fluctuation requiring anesthesiologist intervention.

Oral health burden in children with systemic diseases.

Children who have systemic diseases face a burden of disease distinctly greater than their healthy counterparts. Neglect or delay of addressing this burden can lead not only to significant morbidity for the child, but also to family dysfunction. This article addresses issues salient to the understanding of oral health burden in children and families living with systemic disease. Topics include the parent as caregiver, children who have cerebral palsy, juvenile arthritis, developmental delay, and organ diseases.