[Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016]. / Éducation thérapeutique en odontologie pédiatrique : analyse des obstacles et leviers au développement de programmes en France en 2016.

OBJECTIVE: Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives. METHODS: A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry. RESULTS: The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE. CONCLUSION: More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

Accuracy of teledentistry examinations at predicting actual treatment modality in a pediatric dentistry clinic.

Objectives The purpose of this study was to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. Methods A retrospective dental record review was completed of 251 rural pediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a board-certified pediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. Proportions of children who were referred for specific treatment modalities and who completed treatment and proportions of children for whom the treatment recommendation was changed were calculated. Fisher's exact test was used to assess statistical significance. Results The initial treatment modality was not changed for 221/251 (88%) children initially seen for a teledentistry consultation. Thirty (12%) children had the initial treatment modality changed, most frequently children who were initially suggested treatment with nitrous oxide. Based on the initial treatment modality, changes to a different treatment modality were statistically significant (Fisher's exact test, p < 0.0001). Conclusions Our data suggest that the use of a live-video teledentistry consultation can be an effective way of predicting the best treatment modality for rural children with significant dental disease. A live-video teledentistry consultation can be an effective intervention to facilitate completion of complex treatment plans for children from a rural area that have extensive dental needs.

Remoção de mucocele com laser diodo: relato de caso clínico em paciente infantil / Mucocele removal with laser diode: case report on child patient

A mucocele é uma das lesões benignas que mais afeta a cavidade bucal. O laser de diodo de alta potência é uma opção que substitui ou associa procedimentos complementares aos processos convencionais,tendo mais conforto pós-cirúrgico. O objetivo deste trabalho foi relatar o caso clínico de remoção de mucocele de lábio inferior em paciente infantil utilizando laser de diodo de alta potência. Paciente do sexo feminino, 8 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia São Leopoldo Mandic, em Campinas, relatando incômodo no lábio inferior, com a presença de uma “bolinha”. Ao exame clínico observou-se tumefação de consistência mole, flutuante, translúcida, com coloração similar à mucosa bucal. Após diagnóstico, o tratamento baseou-se na remoção cirúrgica com auxílio de laser de diodo de alta potência. Inicialmente foi realizada a anestesia infiltrativa ao redor da lesão, e então a remoção cirúrgica foi conduzida, juntamente com as glândulas acessórias para evitar recidiva, com uso do laser de diodo de alta potência. Ao fim do procedimento foi possível observar que a paciente saiu satisfeita, sendo o prognóstico favorável. No retorno de 30 dias, observou-se que não houve recidiva da lesão. O laser dediodo de alta potência, uma vez que apresenta uma série de benefícios, como excelente hemostasia, sem a necessidade de sutura, redução do edema e dor, cicatrização mais rápida e redução do tempo para realizar o procedimento, parece ser uma opção para remoção de mucocele em Odontopediatria.

Mucocele is a benign lesion that affects the oral cavity. The high power diode laser is an option as anadditional method or as a substitute to conventional procedures, with more post-surgical comfort. The objective of this study was to report a case of lower lip mucocele removal in a child patient using highpower diode laser. A female patient, 8 years old, attended the Clinic of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry in Campinas, reporting discomfort in the lower lip, with the presence of a“ball”. On clinical examination it was observed swelling of soft consistency, floating, translucent, with coloring similar to the buccal mucosa. After diagnosis, the treatment was based on surgical removal with high power diode laser assistance. Initially infiltration anesthesia around the lesion was performed,and then the surgical removal was conducted, along with the accessory glands to prevent recurrence,with high power diode laser use. At the end of the procedure it was observed that the patient leftsatisfied, with a favorable prognosis. At the 30-day post-operative return, it was observed that there was no recurrence. The high power diode laser, since it presents a series of benefits such as excellen the mostasis, without the need for sutures, reduction of swelling and pain, faster healing, reducing the time to perform the procedure, it seems to be an option for removal of mucocele in pediatric dentistry.

Abordagem de pacientes com ansiedade ao tratamento odontológico no ambiente clínico / Management of patients with dental anxiety at clinical environment

Objetivos: Discutir a ansiedade frente ao tratamento odontológico e apresentar as principais escalas disponíveis para a sua mensuração nas crianças e nos adultos. Materiais e métodos: para esta revisão de literatura os artigos foram selecionados na base de dados online PubMed, dentre os publicados entre 1979 até julho de 2015, e que estavam de acordo com os critérios STROBE e CONSORT. Resultados: Foram selecionados 30 artigos e a revisão destes mostrou que a escolha das escalas depende da idade do paciente, de sua capacidade cognitiva, bem como do tempo disponível para a aplicação dos instrumentos. A ansiedade odontológica e a condição em saúde bucal dos pais e dos filhos estão diretamente relacionadas. Conclusão: o Cirurgião-Dentista deve estar atento para diagnosticar e quantificar a ansiedade adequadamente, visando o estabelecimento de estratégias de abordagem comportamental e clínica individualizadas, tornando a consulta odontológica mais eficaz e menos estressante, tanto para o profissional quanto para os seus pacientes.

Objectives: to present the main dental anxiety scales available for children and adults, explainits association between parents and siblings. Methodology: the articles were selected in PubMed, from 1979 until July 2015, chosen studies were according to STROBE and CONSORT. Results: Thirty articles were selected, after their review it was found that the choice of scales depends on patients’ age, cognitive ability, and available time to implement the instruments. Parents’ dental anxiety and oral health conditions interfere directly with those in children. Conclusion: Is mandatory for professionals to diagnose and quantify oral health literacy levels and anxiety, in order to establish clinical and behavioral approach strategies, making a most effective and less stressful dental appointment, for both, the professional and patients.

Children's Toothbrushing Practices Recommended on the Internet by Pediatric Dentistry Associations.

PURPOSE: The purpose of this study was to describe online recommendations by North and South American National Associations of Pediatric Dentistry (NAPD), intended for laypersons, concerning children's toothbrushing practices. METHODS: In February 2015, the International Association of Pediatric Dentistry (IAPD) website and the Latin American Association of Pediatric Dentistry (ALOP) Facebook webpage were searched to identify which countries had NAPD. Attempts were made to obtain the electronic addresses of ALOP national member societies, and Google and Facebook were used to identify NAPD not found using the previous strategies. RESULTS: Of the 35 countries in North and South America, 19 had NAPD that were shown on the Internet, and 11 of them provided data for the study. All NAPD gave advice on fluoride concentrations in toothpaste and when to start toothbrushing; most made recommendations on the amount of toothpaste, toothbrushing frequency, and when to brush, and a few gave advice on toothbrushing supervision and rinsing after toothbrushing. There was no consensus on most of the recommendations that were evaluated. CONCLUSIONS: Only a few National Associations of Pediatric Dentistry from the Americas provide online information for parents and laypersons concerning children's toothbrushing practices. Of the information provided, some are either controversial, outdated or lack scientific evidence.

The evolution of behavior guidance: a history of professional, practice, corporate and societal influences.

Behavior guidance in pediatric dentistry is a composite of influences including expert opinion, historical precedent, scientific studies, and social factors including the law and the media. The early icons of pediatric dentistry injected their personal views on child management, and those often reflected the child-rearing norms of the times. The business of pediatric dentistry with its efficiency and quality orientations also shaped approaches to behavior management. Scientific studies contributed minimally. A major influence on behavior guidelines in recent years has been external scrutiny of techniques prompted by media and other exposure of both private practice and corporate management of children. Changing parenting and reaction of society to authority have also had significant impact on behavior. This paper describes in more detail the evolution of behavior guidance and the subsequent codification of practices into professionally derived guidelines.

[Diagnosis and treatment of supernumerary teeth in the premaxillary region: a literature review].

Supernumerary teeth are more frequently located in the premaxillary region. Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Supernumerary teeth are frequently diagnosed in a random radiograph, or after clinical symptoms appear. The majority of the complications consist of delayed or ectopic eruption of the permanent incisors. It is important for the clinician to be aware of the phenomenon and its implications, in order to diagnose it as early as possible. Extraction of the supernumerary teeth in the late mixed dentition, will minimize the chances of damaging the adjacent permanent teeth, but will reduce the possibility of spontaneous eruption of an impacted permanent incisor. Extraction in the early mixed dentition can expedite the eruption of the permanent incisor, although it may involve sedation or general anesthesia, due to lack of cooperation in the young patient. Because to the risk of uneruption of the permanent impacted incisor, exposure of the teeth and bonding a ligature or bracket at the same procedure, and providing a possibility for the dentist to make the incisor erupt after the first operation, should the incisor not erupt spontaneously. Treating these cases require the cooperation of pediatric dentist, orthodontic and dental surgeon, and sometimes the involvement of an anesthesiologist.

Access to dental care and the capacity of the California dental care system.

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.

A service-learning project to eliminate barriers to oral care for children with special health care needs.

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.