Dental Treatment Considerations for Children with Complex Medical Histories: A Case of Townes-Brock Syndrome.

It is common for oral health and dental care to be considered a lesser priority for children with complex medical histories than other aspects of their health care. Often, these patients are at a high risk for caries and infection due to poor oral health practices at home, special or restricted diets, and no early establishment of a dental home for routine dental care. Unfortunately, many of these patients present to their first dental visits with caries and require aggressive treatment, such as extractions instead of pulp therapy, or crowns instead of fillings, due to their high caries risk and the difficulty in safely managing them medically during treatment. A unique example of this occurred at the Children's Hospital of Michigan, where a patient with Townes-Brock syndrome (TBS) presented to the dental clinic with advanced caries. TBS is a rare autosomal dominant disorder characterized by major findings such as anomalies of the external ear, imperforate anus, renal malformations, and malformations of the hand. Like many medically complex cases, dental anomalies are not a direct consequence of TBS; however, due to the necessity of high calorie and high sugar feeding supplementation, many of these patients are at high risk for advanced dental caries. Due to this high caries risk, a more aggressive treatment plan is necessary to minimize the risk of recurrent decay and infection. It is critical to stress that even if the disease, syndrome, etc., of a patient does not have inherent dental consequences, it is imperative for regular dental care to be part of the comprehensive treatment plan for these patients. This includes the establishment of a dental home at a young age and proper oral health education of the patient's caregivers and their physicians. In the case of the patient with TBS, recommendations for daily brushing, especially after high sugar feedings was stressed, as well as the reduction of any other sweets within the diet.

Facial Dog Bite Injuries of a 19-Month-Old Child: A Case Report.

It is estimated that 4.5 million Americans are bitten by dogs each year, and half of those are children. One in five dog bites results in injuries that require some form of medical attention. Children between 5 and 9 years of age are the most affected age group for this type of injury. A 19-month-old boy was admitted to the emergency department of Children's Hospital of Michigan for treatment of injuries due to a dog attack. Injuries were limited to the face of the child. Dental injuries included avulsion of upper lateral incisors, severe luxation of upper central incisors, and fracture of the facial alveolus bone. Surgical management of facial wounds was accomplished through irrigation, debridement and suturing. Dental treatment included extraction of central incisors and suturing soft tissues.

Comparison of articaine and lidocaine in the pediatric population.

The purpose of this paper was to review the use of articaine in the pediatric dental population. Literature on use of articaine in comparison to lidocaine was reviewed. Many dental procedures on primary molars can be successfully accomplished with infiltration of articaine alone, which would significantly reduce the duration of soft tissue anesthesia, and subsequently may reduce the incidence of the undesirable post-treatment self-inflicted injuries associated with inferior alveolar nerve block (IAN). Articaine is well-tolerated and safe to use in the pediatric dental patient after 4 years of age.

Space maintenance in the primary and mixed dentitions.

Loss of space in the primary dentition is considered one of the main causes of malocclusion in the permanent dentition. The purpose of this paper is to review ond summarize the indications and use of space maintainers in primary and mixed dentitions as preventive measures of future malocclusion. Two main types of space maintainers are used to maintain the space in primary ond mixed dentitions: fixed and removable appliances. Band and loop is the appliance of choice when a primary maxillary or mandibular first molar is prematurely lost. With the premature loss of a second primary molar, Nance or transpalatal (TPA) appliances can be used on the maxillary arch and the lower lingual holding arch (LLHA) for the mandibular arch.

Dental trauma: review of common dental injuries and their management in primary and permanent dentitions.

Management of dental trauma in children can be a challenging problem in dental practices. Knowledge of current trauma guidelines is vital in effectively managing dental trauma so that favorable outcomes are achieved. The purpose of this paper is to review the current guidelines and management strategies of dental trauma in primary and permanent dentitions. When planning emergency treatment for a primary tooth, it is important to consider the lifespan of the tooth, the potential damage to the permanent dentition, and the behavior of the child. After injury to permanent teeth, the treatment strategy is dictated by the concern for vitality of the periodontal ligament and pulp of the injured tooth. The emergency nature of dental trauma requires that the dentist be knowledgeable and readily available during and after office hours to provide care.

High-flow arteriovenous malformations of the mandible and the maxilla: report of 2 cases.

Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to potential massive hemorrhage. AVMs can be subdivided according to the type of vessel involved (capillary, venous, and arterial) and can be categorized, according to hemodynamic features, into high-flow and low-flow lesions. AVM of the jaws is an uncommon disease. Clinical signs and symptoms of AVM may include pain, erythematous gingiva, spontaneous gingival bleeding, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic and frequently have indistinct margins. Computed tomography can demonstrate enhancement of the lesions, while angiography can depict distended feeder vessels and arteriovenous shunts. Magnetic resonance imaging can visualize flow voids in high-flow abnormalities. The purpose of this paper was to present 2 high-flow cases of arteriovenous malformations: one with a large AVM lesion in the mandible that presented clinically as a discoloration on the mucosa and gingiva with loss of lip sensation; and the second with a lesion in the maxilla discovered during an extraction of a root fragment. Management of the lesions was achieved by embolization.

Use of anterior veneered stainless steel crowns by pediatric dentists.

PURPOSE: The purpose of this study was to evaluate the use of anterior veneered stainless steel crowns (AVSSCs) by pediatric dentists. METHODS: A questionnaire was sent to 2,600 active members of the American Academy of Pediatric Dentistry with a follow-up request after 8 weeks. Respondents were asked about the utilization of AVSSCs in their practice and during their graduate training program. In addition, the participants were asked to rank, in order of preference, the type of restorations for treating primary anterior teeth, as well as factors that influenced their choice of treatment. RESULTS: Among 849 respondents, 456 (51%) utilized AVSSCs in their practice; 187 (41%) selected AVSSCs as their first choice for the complete coverage for primary anterior teeth; and 278 (61%) selected extent of caries as the main factor that influenced their restoration choice. The respondents' major concern (73%) was durability of AVSSCs. CONCLUSION: The anterior veneered stainless steel crown is a common restoration to treat primary anterior teeth among pediatric dentists.

Alternatives for hand over mouth exercise after its elimination from the clinical guidelines of the american academy of pediatric dentistry.

PURPOSE: The purpose of this study was to survey the alternative behavior management techniques that might be utilized by pediatric dentists in place of hand over mouth exercise (HOME) after its elimination from the clinical guidelines of the American Academy of Pediatric Dentistry (AAPD). METHODS: A questionnaire was electronically mailed to 2,600 AAPD members. The survey included items related to HOME alternatives after the elimination, concerns with its use, and if the elimination had affected access to care for children. RESULTS: Seven hundred four respondents (30%) completed the survey. Voice control was the first alternative, and minimum/moderate sedation was the second most common. Three hundred fifty respondents (50%) believed that HOME is an acceptable behavior management technique, and 290 (41%) believed it should be continued to be recognized by the AAPD. Only 7% believed that HOME elimination affected access to care for some children. CONCLUSION: Advanced behavior management techniques will be utilized more by pediatric dentists after the elimination of the hand over mouth exercise from the American Academy of Pediatric Dentistry's clinical guidelines.

Factors affecting masticatory performance of Japanese children.

AIM: The aim of this study was to analyse occlusal parameters and body variables to examine the factors accounting for masticatory performance of Japanese children in relation to adults. METHODS: Sixty-six children and 24 adults chewed three pieces of a colour-changeable chewing gum, separately, for 30 s, 60 s, and 90 s. The colour change was measured at 30 s using L* a* b* colour space system. Biting force, occlusal contact areas, and occlusal pressure were recorded by Dental Prescale. Number of strokes, and the height and weight of the subjects were included in the statistical analysis. RESULTS: Within each sample, Student's t-test revealed significant differences among a* values at the three chewing times in which the value of a* (indicator of red) increased as the length of chewing time increased (P < 0.05). Multiple regression analysis showed that the rate of mandibular movement in preschool children has a significant impact on masticatory performance (P < 0.05). In schoolchildren, the rate of mandibular movement, biting force, and body weight were significant factors (P < 0.05). In adults, occlusal contact area, biting force, and the rate of mandibular movement were the significant factors (P < 0.05). CONCLUSION: Factors affecting masticatory performance differ according to the developmental stage of the individual.

Association between early childhood caries and behavior as measured by the Child Behavior Checklist.

PURPOSE: This study's purpose was to use a standardized behavioral assessment instrument to compare the observed behavior of caries-free (CF) with caries-active (CA) children requiring restoration under general anesthesia (GA). METHODS: Healthy 30- to 60-month-olds, either CF or in need of dental restoration under GA, were selected in 4 equal-size cohorts of 30 subjects from both private practice settings and a clinic. Trained assistants administered the child behavior checklist, a standardized, age-appropriate instrument to assess child behavior problems to parents at the time of appointment. RESULTS: The 60 CF and 60 CA subjects did not differ significantly (P<.05) between clinic and private practice for age, gender, and race and were collapsed into groups of 60 CF and 60 CA children (mean ages=41.2 and 45.2 months, respectively). Compared to CF children, CA children had significantly higher (more problems) scores for categories of: anxious/depressed; sleep problems; aggressive behavior; externalizing and total problems; and attention deficit/hyperactivity problems. CA children scores for withdrawn, sleep problems, and attention deficit/hyperactivity problems were also higher than normal, but neither group had scores outside normative ranges. CONCLUSIONS: No significant age, gender, behavior, or race differences were noted for site of care, but caries-active children had significantly more behavior problems than caries-free children.

Physiologic signs during dental treatment in overweight vs normal weight children.

PURPOSE: This study compared physiologic effects of position change on overweight (OW) and normal-weight (NW) children during a preventive appointment. METHODS: A cross-sectional, case-controlled design assigned a convenience sample to either overweight (>85th percentile) or normal-weight groups (25th to 85th percentile) by body mass index (BMI). A trained examiner measured blood pressure (BP), heart rate (HR), oxygen saturation (SpO2), and 5 pulmonary functions in preoperative, upright seated, supine, and postoperative upright seated positions. Anxiety was measured using the Corah Dental Anxiety Scale. RESULTS: NW and OW groups' anxiety scores did not differ (P=.69). Mean BMIs were 20.1 and 39.7 for NW and OW subjects, respectively. Overall, BP between groups was not different (P=.051), although systolic BP for OW subjects tended to be higher. Systolic and diastolic BP dropped for both groups with supine positioning (P< or =.001). During this change, HR did not change for NW, but dropped for OW subjects (P=.001). SpO2 was significantly different between groups following position change, but not within each group. Forced vital capacity and forced expiratory volume were higher in the OW group (P< or =.01), but 2 peak expiratory measures (PEF and PEF25-75 were not (P=.05). CONCLUSION: Heart rate and oxygen saturation respond differently to positional changes in overweight patients.

Sickle cell anemia: a review for the pediatric dentist.

Sickle cell anemia is an inherited defect that affects the structure and synthesis of hemoglobin. In sickle cell trait, the affected individuals carry one gene for the abnormal hemoglobin (HbS). Sickle cell disease, however, is the homozygous state in which the abnormal hemoglobin is predominant in red blood cells, leading to devastating multisystem problems. Complications of the disease in children include: painful crises, stroke, pulmonary disease, delayed growth, osteomyelitis, organ damage and psychosocial dysfunction. Oral and dental manifestations include: orofacial pain, paresthesia of the mental nerve, stepladder appearance of the alveolar bone on radiographs, pulpal necrosis and enamel hypomineralization. The purpose of this manuscript was to review: (1) the pathophysiology of the disease; (2) its manifestations in the craniofacial complex; (3) contemporary medical therapy; and (4) recommendations for dental care.