Oral manifestations of COVID-2019-related multisystem inflammatory syndrome in children: a review of 47 pediatric patients.

BACKGROUND: Although much is still unknown about the full effects of COVID-19, literature from the early stages of the COVID-19 pandemic (spring and summer 2020) supports a postviral immunologic reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms. METHODS: The authors conducted a retrospective review of pediatric patients with COVID-19 who were admitted to the Morgan Stanley Children's Hospital of NewYork-Presbyterian. Patients fulfilling the Centers for Disease Control and Prevention criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared with the presence of oral or oropharyngeal findings. RESULTS: The mean (standard deviation) age of MIS-C patients was 9.0 (5.0) years (range, 1.3-20.0 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) had red or swollen lips, whereas only 5 (10.6%) had a strawberry tongue. Oral or oropharyngeal findings were associated significantly with the presence of systemic rash (P = .04) and conjunctivitis (P = .02). CONCLUSIONS: The presence of oral or oropharyngeal changes may be an early indicator of MIS-C and should be considered suggestive of MIS-C in the setting of COVID-19 infection. PRACTICAL IMPLICATIONS: Dental care providers may play an integral role both in the early detection of oral manifestations of MIS-C and in the identification of oral lesions in hospitalized patients with confirmed MIS-C.

Medicaid Dental Provider Enrollment Processes: National Assessment and Policy Recommendations.

Purpose: This study assessed state Medicaid dentist enrollment processes and identified best practices for state authorities. Methods: A 2018 search of state government websites identified entities involved in enrolling and credentialing dentists. States were classified according to their administrative approach. Results: Twenty-two states administered their dental programs internally, 24 through contracted Medicaid managed care organizations (MMCOs), and five through a combined approach. Thirteen of 22 (59 percent) internally-administered and eight of 24 (33 percent) MMCO-administered states carved out their dental programs to a dental managed care organization. Twenty-one of 22 (95 percent) state-administered but only nine of 24 (38 percent) MMCO-administered programs provided complete enrollment instructions. To serve the entire pediatric Medicaid population in a given state, dentists needed to enroll and be credentialed by one to eight entities. Providers needed to complete an average of one application and one contract in carved-out and internally administered states, three applications and two contracts in dental MCO carved-out states, and five applications and four contracts in MMCO states. Conclusions: Medicaid enrollment complexity varies considerably across states and is highly influenced by managed care. Recommendations to enhance the enrollment process include dentist-specific guidance, online and automated enrollment platforms, streamlined applications, and application consolidation.

Dental Findings and Functional Prosthesis use in Child with Hypohidrotic Ectodermal Dysplasia: A Case Report.

Fabrication of maxillary and mandibular esthetic functional prostheses in a 5-year-old female patient with ectodermal dysplasia is reported. This report presents, clinically and radiographically, the orofacial manifestations of a child diagnosed with hypohidrotic ectodermal dysplasia, along with the construction of removable prosthetic devices.

Knowledge, Attitudes, and Practices of Pediatric Dentists Regarding Speech Evaluation of Patients: Implications for Dental Education.

The aim of this cross-sectional study was to determine pediatric dentists' attitudes about speech evaluation in the dental setting and assess their knowledge of speech development and pathology. In October 2013, members of the American Academy of Pediatric Dentistry were invited to participate in an electronic questionnaire. Categories of questions were demographics, attitudes and confidence in speech pathology, and theoretical and practical knowledge of speech development and speech pathology. Theoretical knowledge was assessed using questions about phonetics and speech milestones. Practical knowledge was determined with three 30-second interview-style video clips. A total of 539 responses were received for a response rate of 10.4%. The majority of respondents reported feeling that speech evaluation should be part of the pediatric dental visit (72.8%) and felt confident in their ability to detect speech issues (73.2%). However, they did poorly on the theoretical knowledge questions (41.9%) as well as the practical knowledge questions (8.5%). There was a statistically significant difference in theoretical score between gender and type of occupation (p<0.05). This difference was not observed when examining practical knowledge. This study suggests that although pediatric dentists are in an ideal position to aid in the detection of speech issues, they currently have insufficient training and knowledge to do so.

Cost-Benefit Analysis of the Age One Dental Visit for the Privately Insured.

PURPOSE: The purpose of this study was to perform a cost-benefit analysis of the age one dental visit for privately insured patients. METHODS: A major insurance company provided claims from various states submitted between 2006-2012. Data provided included numbers of procedures and respective costs from the first visit until age six years. Data was organized into five groups based on age, for which the first D0145/D0150 code was submitted [(1) age younger than one year old; (2) age one or older but younger than two years old; (3) age two or older but younger than three years old; (4) age three or older but younger than four years old; and (5) age four or older but younger than five years old]. The ratio of procedures per child and average costs per child were calculated. RESULTS: Claims for 94,574 children were analyzed; only one percent of these children had their first dental visit by age one. The annual cost for children who had their first dental visit by age one was significantly less than for children who waited until an older age. CONCLUSION: There is an annual cost benefit in establishing a dental home by age one for privately insured patients.

Speech prosthesis in child patient with ectodermal dysplasia. Case report.

Fabrication of several esthetic speech prostheses in a 4-year-old child patient with ectodermal dysplasia is reported. This report details, clinically and radiographically, effects in a child diagnosed with hypohidrotic ectodermal dysplasia, as well as speech device construction.

Utilization of emergency services for non-traumatic dental disease.

PURPOSE: To identify and characterize children who utilize emergency dental services for non-traumatic dental disease. STUDY DESIGN: Caregivers of children under 12 years old who seek out emergency services for the treatment of non-traumatic dental disease will be surveyed regarding their child's current oral health status. Patient's clinical data will be obtained and they will be further followed for a period of 2 months to determine if they follow-up with recommendations for comprehensive dental care. RESULTS: One hundred and ninety-eight people participated in the study (97% response rate). Eighty-three percent of the children were diagnosed with dental caries. Seventy-four percent of patients of record presented with an emergency at least once before and 73% had a history of one or more broken appointments. Patients with a history of previous emergency visits (OR = 3.45, CI = 2.05, 5.81) or a history of missed appointments (OR = 2.21, CI = 1.42, 3.58) were significantly more likely to fail to return for comprehensive care (P < .01). CONCLUSION: This study shows that those who utilize emergency services more than once, or have a history of missed appointments are more likely to continue to utilize emergency dental services as their primary means for dental care.

Early loss of primary incisors due to parafunctional tendency--case report.

Premature loss of primary teeth associated with a parafunctional habit in a 30-month-old child is reported. Report details, clinically and radiographically, these effects in a very young child and reviews diagnostic possibilities. Early detection and scrutiny by the pediatric dentist is important to determine origin and to rule out periodontal disease as a manifestation of underlying systemic disease.

Ocular complications following an inferior alveolar nerve block on a child patient: a review of the literature and report of a case.

A 7-year-old male patient developed palpebral ptosis and paralysis of the extraocular muscles following local anesthetic administration for a major operative procedure on the permanent mandibular left first molar. Complete resolution occurred within approximately 30 minutes. The purpose of this case report was to detail an iatrogenic paresis of the third cranial nerve following local anesthetic delivery on a child patient.

Assessment of an infant oral health education program on resident physician knowledge.

PURPOSE: The purpose of this study was to implement and evaluate the effect of an early childhood oral health education program given to physician residents at Columbia University Medical Center, New York City. It was hypothesized that a short training program in infant oral health would improve the oral health knowledge base of these future physicians and promote the age 1 dental visit. METHODS: A sample size of 92 physician residents participated in this study. A 1-hour seminar describing common dental findings, including poor oral hygiene and early childhood caries (ECC), was presented, and an identical 14 question pre- and post-test were completed. The pre- and post-tests were administered to all participants, and statistical differences between pre- and post-tests were calculated using a paired t-test (P <.05) and SAS 9.1 statistical software. RESULTS: There was an average of 77% correct responses on the pre-test and 90% correct responses following instruction (n=92, P <.001), with a mean improvement in the scores of 2 questions on the post-test. There was a significant improvement in the knowledge base of residents on topics related to ECC and its prevention and fluorides. CONCLUSION: A 1-hour seminar resulted in significantly improved post-test scores for physician residents about infant oral health.

Early childhood caries screening tools: a comparison of four approaches.

BACKGROUND: Early childhood caries (ECC) is prevalent and consequential. Risk assessment tools have been proposed that can be used to identify children who require intensive interventions. In this study, the authors compare four approaches for identifying children needing early and intensive intervention to prevent or minimize caries experience for their accuracy and clinical usefulness. METHODS: The authors screened 229 predominantly low-income Hispanic children younger than 3 years with ECC and 242 without ECC by using the American Academy of Pediatric Dentistry's Caries-risk Assessment Tool (CAT) and the optional screening measure of culturing Streptococcus mutans. The authors compared four approaches (CAT, CAT minus socioeconomic status, CAT minus socioeconomic status plus mutans streptococci [MS] and MS alone) for accuracy and clinical usefulness. RESULTS: The results of the CAT demonstrated high sensitivity (100.0 percent) and negative predictive value (NPV) (100.0 percent) but low specificity (2.9 percent) and positive predictive value (PPV) (49.4 percent). The MS culture alone had the highest combination of accuracy and clinical usefulness (sensitivity, 86.5 percent; specificity, 93.4 percent; PPV, 92.5 percent; NPV, 87.9 percent). When we removed the socioeconomic status element, the CAT's performance improved. CONCLUSIONS: Salivary culture of MS alone in a population of young, low-income Hispanic children outperformed the CAT and variations on the CAT for test accuracy (sensitivity and specificity) and clinical usefulness (predictive values). CLINICAL IMPLICATIONS: Screening for ECC by using salivary MS cultures and variations on the CAT are promising approaches for identifying children who need early and intensive intervention to prevent or minimize caries experience.

Management of a pediatric patient with epidermolysis bullosa receiving comprehensive dental treatment under general anesthesia.

The purpose of this report was to detail clinical considerations and a general anesthetic approach for a 3-year-old pediatric dental patient with epidermolysis bullosa, a group of rare genetic disorders characterized by blister development following minor trauma or traction to the skin or mucosal surfaces. Challenges in providing comprehensive dental treatment and care under general anesthesia are discussed. Early evaluation is vital to preventing the consequences of severe early childhood caries.

Early loss of primary incisors due to parafunctional tendency. Case report.

Premature loss of primary teeth associated with a parafunctional habit in 30-month-old child is reported. Report details, clinically and radiographically, these effects in a very young child and reviews diagnostic possibilities. Early detection and scrutiny by the pediatric dentist is important to determine origin and to rule out periodontal disease as manifestation of underlying systemic disease.

Advances in pediatric dentistry.

This article addresses advances in 4 key areas related to pediatric dentistry: (1) caries detection tools, (2) early interventions to arrest disease progression, (3) caries-risk assessment tools, and (4) trends in pediatric procedures and dental materials.

Evaluation of behavior change goal-setting action plan on oral health activity and status.

This experimental study determined if a "report card-like" oral health action plan was effective in improving oral health behaviors in a sample of 69 patients, ages 1 to 6 years. Participants were divided randomly into control and intervention groups. Data collected included dmft, plaque score, Streptococcus mutans levels and oral health behaviors. Participants in the intervention group received an oral health action plan that included: 1. child's current caries-risk status; 2. identification issues of concern; and 3. one "goal" to improve on for the next visit. All participants returned after two months for follow-up examination and data collection.

Netherton syndrome: dental considerations.

Triads of congenital erythroderma and ichthyosis, hair shaft abnormalities, and immune dysregulation have been recognized as Netherton's syndrome (NS). A pediatric patient with NS is presented. Clinical manifestations are described along with a pertinent review of the literature.

Topical anesthesia for rubber dam clamp placement in sealant placement: comparison of lidocaine/prilocaine gel and benzocaine.

PURPOSE: The purpose of this prospective study was to compare the efficacy of Oraqix to benzocaine while placing a rubber dam clamp during sealant placement on children. METHODS: A sample size of 45 7- to 12-year-old patients who presented for bilateral sealants on permanent first molars participated in this study. A split-mouth design was implemented with Oraqix applied to one side and 20 percent benzocaine gel applied to the other. After placing the topical anesthetic and the rubber dam clamp, patients completed a Feces Pain Scale (FPS) to rate the level of discomfort after clamp placement. RESULTS: Twenty-seven subjects (60%) were female and 18 subjects (40%) were mole; 15 (33%) were younger than 9 years old and 30 (67%) were at least 9 years old. The overall difference in mean FPS ratings was not statistically significant (P = .27). Regarding gender, there was no statistically significant difference in males (P = .65) or females (P = .26). There was also no difference in mean FPS ratings when looking at age groups younger than 9 years old with P=.77 In the 9 years and older age groups, however there was a statistically significant difference, with P = .04. CONCLUSIONS: Application of Oraqix did not reduce discomfort when compared to benzocaine in this small sample size. Oraqix was more effective than benzocaine in the age group 9 and older. A larger sample size is needed to determine its efficacy in children younger than 9years old.

Maternal-child oral health behaviors and caries experience in the child.

OBJECTIVE: This study examined maternal and child oral health behaviors and potential risk factors for dental caries in high-risk children. STUDY DESIGN: Data on oral health practices were collected from surveys of mother/caregivers and the child's dental chart was reviewed. Linear regression and ordered probit regression models were used to examine data. RESULTS: A total of sixty questionnaires were completed. There was a marginally significant relationship (P = .08) between number of times per day a child consumed a sweetened beverage and the dmfs of the child. Mothers who snacked more frequently had a greater probability (24%) that their child snacked 3 times or more. Mothers who drank a sweetened beverage more frequently had a greater probability (40%) that their child drank a sweetened beverage 3 or more times a day. Mothers who brushed their teeth with fluoridated toothpaste had a greater probability (79%) that their child brushed 2 or more times a day with fluoridated toothpaste. CONCLUSIONS: Two maternal variables, reported soft drink consumption and dietary habits, appear promising for caries prediction. Implementation of dietary counseling and oral health programs for mothers and research merit further exploration.

Preferred treatment methods for primary tooth vital pulpotomies. A survey.

This investigation evaluated preferred treatment methods for primary tooth vital pulpotomies. One hundred and thirty surveys were sent to a randomly selected sample of board-certified pediatric dentists practicing in the United States. Ninety-two questionnaires were returned, for a 71% response rate. This yielded a sample group of 92 board-certified pediatric dentists. The most commonly used medicament was formocresol. Seventy-three percent using formocresol said they were not concerned about adverse side effects of formocresol and formaldehyde. Sixty-one percent of respondents used formocresol for primary tooth vital pulpotomies. Twenty-eight percent of respondents used undiluted, and 33% used diluted. The results of this survey suggest that the majority of dentists who used formocresol were not concerned with any adverse effects.

Impacted maxillary anterior supernumerary teeth: a survey of forty-two cases.

The purpose of this retrospective study was to examine the location of impacted maxillary anterior supernumerary teeth that subsequently were removed from pediatric patients at Children's Hospital of New York-Presbyterian. The study population consisted of 42 children diagnosed with impacted maxillary anterior supernumerary teeth. The impacted maxillary anterior supernumerary teeth were surgically removed by one faculty member in the hospital operating room with the aid of general anesthesia between 1994 and 2000. The total number of impacted maxillary anterior supernumerary teeth was 51. All were located palatally on either side of the midline and were surgically removed from a palatal access. In the absence of clear imaging evidence to the contrary, it is recommended that the preferred surgical approach for the removal of impacted maxillary anterior supernumerary teeth should be the palatal approach. Relatedly, the term mesiodens is misleading and is generally inaccurate for describing impacted maxillary anterior supernumerary teeth. Palatodens would be a more appropriate descriptive term.