RESUMEN
BACKGROUND: Child abuse and neglect (CAN) is a widespread social phenomenon encompassing all forms of maltreatment with serious lifelong consequences. Dentists and dental team members are in the unique position to identify the symptoms of CAN often visible in craniofacial region. AIM: To evaluate Croatian dentists' level of knowledge, experience, and attitude towards CAN issue. DESIGN: Investigation was conducted in five major Croatian cities (Zagreb, Varazdin, Osijek, Rijeka, and Split). A previously used questionnaire regarding knowledge and experience in child protection was adopted to Croatian terminology and distributed to 544 dentists. RESULTS: A total of 510 dentists who returned a questionnaire with valid data 26.27% reported to have had suspicion of CAN during professional career and 5.1% reported their suspicion within the last 6 months, mostly to social services and police. Fear of violence towards the child and uncertainty about observations were the most frequently reported barriers towards referring and only 11.4% knew the procedure. About 80% of respondents want further training in identifying and reporting of physical abuse. CONCLUSIONS: Study showed a lack of knowledge and uncertainty in recognizing and reporting CAN cases in Croatian dentists. They expressed the need for undergraduate and post-graduate continuing education on this issue.
Asunto(s)
Actitud del Personal de Salud , Maltrato a los Niños/diagnóstico , Protección a la Infancia , Odontólogos/psicología , Revelación/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Policia , Adulto , Niño , Maltrato a los Niños/psicología , Croacia , Estudios Transversales , Femenino , Humanos , Masculino , Notificación Obligatoria , Persona de Mediana Edad , Rol Profesional , Servicio Social , Encuestas y CuestionariosRESUMEN
BACKGROUND: Postoperative cognitive dysfunction (POCD) is well established in adults but has been underinvestigated in children. As day-case procedures are increasingly common, it is important to establish whether children suffer significant POCD. Pediatric POCD has been associated with several intravenous and inhalation anesthetics, but isoflurane has not been studied. As evidence indicates superior recovery after propofol, the study compared POCD after propofol or isoflurane anesthesia. OBJECTIVES: To compare the effects of propofol versus isoflurane upon children's POCD. METHODS: Fifty-eight children aged 5-14 years were randomized to propofol (total intravenous anesthesia) or isoflurane for day-case dental procedures. Reaction time (RT), verbal and visual memory, psychomotor coordination, and attention were assessed preoperatively, prior to discharge and at 24 h. RESULTS: Reaction time and psychomotor control were impaired postoperatively in both groups but recovered at 24 h. Delayed verbal recall was significantly impaired only after propofol. Both groups had significant impairment of visual memory postoperatively and at 24 h, and of recognition memory postoperatively only. CONCLUSIONS: Propofol and isoflurane exert similar adverse effects on RT, psychomotor coordination, and visual memory. Selective impairment of verbal recall by propofol is consistent with adult evidence of the drug's effect on retrieval. The enduring postoperative impairment of memory has implications for instructions to parents and caregivers for the safety and well-being of children in the 24 h after day-case anesthesia with propofol and isoflurane.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Anestesia Dental , Anestesia General , Anestésicos por Inhalación/efectos adversos , Anestésicos Intravenosos/efectos adversos , Trastornos del Conocimiento/inducido químicamente , Trastornos del Conocimiento/psicología , Cognición/fisiología , Isoflurano/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/psicología , Propofol/efectos adversos , Anestesia por Inhalación , Anestesia Intravenosa , Atención/fisiología , Niño , Restauración Dental Permanente/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Memoria/fisiología , Recuerdo Mental/fisiología , Complicaciones Posoperatorias/epidemiología , Desempeño Psicomotor/efectos de los fármacos , Desempeño Psicomotor/fisiología , Tiempo de Reacción/fisiología , Recuperación de la Función , Extracción Dental/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Non-setting calcium hydroxide (Ultracal XS(®) ) is recommended by the International Association of Dental Traumatology as the initial medicament following avulsion and replantation for mature teeth. There is experimental evidence to suggest Ledermix(®) , placed as an alternative inter-visit dressing may improve periodontal healing. AIM: This study investigated, using a multi-centre randomized controlled trial, the effect of two root canal medicaments, Ledermix(®) and Ultracal XS(®) , on periodontal healing of avulsed and replanted teeth. MATERIAL AND METHODS: Children were recruited if they fulfilled all inclusion criteria. Treatment followed a standardized protocol. Assessment of periodontal healing or ankylosis was made clinically and radiographically by an experienced, 'blinded', clinician at 12months. RESULTS: Over 200 patients were assessed for eligibility at five centres. Twenty-nine patients were eligible for inclusion. Final analysis involved 22 patients with 27 teeth. Ankylosis was detected in four of the 12 teeth in the Ledermix(®) group and nine of 15 in the Ultracal XS(®) group. No significant difference between medicaments was found in the proportion of teeth or patients showing periodontal healing. DISCUSSION: There was no significant difference in periodontal healing between the two medicaments at either a tooth or patient level. The numbers recruited fell short of an estimated power calculation. For patients meeting the inclusion criteria and completing the trial, periodontal healing was seen in 52% of teeth at the 12-month assessment between both groups. The only factor found to significantly influence the periodontal outcome was dry time.
Asunto(s)
Ligamento Periodontal/fisiopatología , Irrigantes del Conducto Radicular/uso terapéutico , Avulsión de Diente/terapia , Reimplante Dental/métodos , Adolescente , Hidróxido de Calcio/uso terapéutico , Niño , Demeclociclina/uso terapéutico , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Tratamiento del Conducto Radicular/métodos , Resorción Radicular/prevención & control , Método Simple Ciego , Anquilosis del Diente/prevención & control , Resultado del Tratamiento , Triamcinolona Acetonida/uso terapéutico , Cicatrización de Heridas/fisiologíaRESUMEN
The management of 66 replanted avulsed permanent teeth in 46 patients over a 4-year period was studied. Treatment was compared with the recommendations in published guidelines for the management of avulsed permanent teeth. For total extra-alveolar times longer than 45 min, the pulps were extirpated in 96% of teeth. Extra-alveolar times longer than 45 min were associated with earlier pulp extirpation (median 16 days) compared with teeth with shorter extra-alveolar times (median 25 days). Endodontic treatment was postponed in teeth with open apices (median 27 days) compared with closed apices (median 15 days). Teeth in which pulps were removed within 10 days post-trauma had a lower prevalence of inflammatory root resorption compared with teeth in which pulps were removed later. Where inflammatory root resorption did occur, onset was significantly delayed when the pulp had been removed within the first 10 days. This study indicates that clinicians are following the guidelines in key areas of endodontic management of traumatized incisors resulting in more favourable outcomes.
Asunto(s)
Pulpectomía/métodos , Avulsión de Diente/cirugía , Reimplante Dental , Adolescente , Niño , Toma de Decisiones , Femenino , Estudios de Seguimiento , Adhesión a Directriz , Humanos , Incisivo/lesiones , Masculino , Odontogénesis/fisiología , Complicaciones Posoperatorias , Guías de Práctica Clínica como Asunto , Tratamiento del Conducto Radicular/métodos , Resorción Radicular/etiología , Factores de Tiempo , Ápice del Diente/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
UNLABELLED: A 9-year-old boy presented with a fused maxillary right permanent central incisor and displacement of the right permanent lateral incisor palatally. An unerupted supplemental maxillary left permanent lateral incisor was noted radiographically. The maxillary fused right permanent central incisor was sectioned under general anaesthesia. The distal portion was extracted as planned; a vital partial pulpotomy was carried out on the distal aspect of the retained portion. Fixed orthodontic treatment commenced after 28 months to align the maxillary anterior segment. After completion, the maxillary right permanent central incisor was built up with composite to resemble the adjacent incisor. CLINICAL RELEVANCE: This case highlights the treatment options of a fused tooth and the need for multidisciplinary planning and treatment.
Asunto(s)
Dientes Fusionados/cirugía , Incisivo/anomalías , Niño , Resinas Compuestas , Restauración Dental Permanente , Dientes Fusionados/rehabilitación , Humanos , Masculino , Maxilar , Ortodoncia Correctiva , Pulpotomía , Extracción Dental , Diente Supernumerario/cirugíaRESUMEN
UNLABELLED: The dental team is well placed to notice signs of child abuse and neglect, yet research shows that UK dentists are unprepared for a role in protecting children at risk. This article describes how to recognize signs of child abuse and neglect and what to do when concerned about a child. It highlights that advice and support are available from colleagues in other health professions and social services. The concept of'safeguarding' children and promoting their welfare in dental practice is introduced. CLINICAL RELEVANCE: All members of the dental team share a responsibility to work with others to safeguard children from abuse and neglect.
Asunto(s)
Maltrato a los Niños/diagnóstico , Atención Dental para Niños , Personal de Odontología , Notificación Obligatoria , Rol Profesional , Niño , Maltrato a los Niños/prevención & control , Contusiones/etiología , Traumatismos Faciales/etiología , Humanos , Derivación y Consulta , Traumatismos de los Dientes/etiologíaRESUMEN
This article aims to provide a practical clinician's guide to assessing and diagnosing dental trauma involving permanent teeth in children and young people, and for carrying out appropriate, guideline supported acute management. Timely referral to specialist paediatric dental services is crucial in more complex trauma presentations and will lead to improved outcomes for the dentition. Appropriate acute management by the primary clinician optimises the prognosis of any traumatised tooth and this article will focus on the emergency treatment of the traumatised permanent tooth.
Asunto(s)
Traumatismos Craneocerebrales/terapia , Atención Dental para Niños/métodos , Tratamiento de Urgencia , Traumatismos de los Dientes/terapia , Adolescente , Niño , Dentición Permanente , Femenino , Guías como Asunto , Humanos , Masculino , Planificación de Atención al Paciente , Pronóstico , Derivación y ConsultaRESUMEN
UNLABELLED: Auto-transplantation can be used to replace missing anterior teeth following traumatic injuries. This technique has the advantage (over other forms of treatment) of maintaining alveolar bone height which allows orthodontic and further restorative intervention by way of implants later in life. Careful restorative management of transplanted teeth is vital to their long-term survival as inadequate maintenance post transplant may result in root resorption and eventual tooth loss. This paper describes the restorative management of two cases following transplantation. CLINICAL RELEVANCE: Dental practitioners should be aware of the option to auto-transplant teeth as part of an overall treatment plan and the subsequent interventions often required.
Asunto(s)
Diente Premolar/trasplante , Incisivo/lesiones , Avulsión de Diente/cirugía , Adolescente , Niño , Femenino , Humanos , Maxilar , Resorción Radicular/cirugía , Extracción DentalRESUMEN
Aesthetic problems in childhood and adolescence can have a significant effect on psychosocial development and interaction with peers. Abnormalities of shape, size, colour and structure of the whole or part of the anterior dentition of children can lead to such problems. This article outlines the most appropriate options for the clinical management of different aetiological categories of aesthetic problems, and develops a hierarchy of intervention that should be pursued in a logical order until a satisfactory cosmetic outcome is achieved. These techniques are readily available to most dental practitioners and there is no reason for a child to have to wait until late adolescence for treatment.
Asunto(s)
Atención Dental para Niños/métodos , Estética Dental , Odontología Pediátrica/métodos , Decoloración de Dientes/terapia , Niño , Preescolar , Coronas con Frente Estético , Microabrasión del Esmalte , Humanos , Incisivo/anomalías , Incisivo/lesiones , Anomalías Dentarias/terapia , Blanqueamiento de Dientes , Traumatismos de los Dientes/terapiaRESUMEN
Child protection is the duty of every single member of the society. Health professionals who work with children, such as members of dental team, are in the unique position to recognize signs of physical, sexual and emotional abuse as well as (dental) neglect. They should report any suspected case where a child is or may be in need of welfare. The professional responsibility is regulated by legal and ethical obligations. In this preliminary work the authors investigate the legal and ethical Acts, and the similarities vs. differences in obligations regarding reporting child abuse and neglect (CAN) cases in four countries: Croatia, United Kingdom, Italy and Canada. In all four countries all health professionals have a duty to report their suspicion if a child is in a harmful situation. All of them who fail to report, or even neglect or delay to report a suspicion, are liable on conviction to a pecuniary fine which varies from country to country. Depending on the country, if a professional has reasonable grounds to suspect that a child is or may be in need of protection, must report to: CAS (children's aid society), to CSS (center for social services), to police, to a Juvenile Court, or to the ombudsman. In all four countries, dentists are not asked to diagnose 'child maltreatment', but simply report the suspicion with supportive evidence. Ethical obligation comes from medical and dental ethical codes regulated by the Chamber or Council of Dentists. In all four countries legal and ethical obligations in reporting CAN are similar. Differences are related mostly to fines for nonreporting or a delay in reporting. Expanded investigation through other European countries and standard operational procedures is needed, in order to harmonize policies and guidelines for reporting CAN and maximize children protection.
Asunto(s)
Maltrato a los Niños/legislación & jurisprudencia , Protección a la Infancia/legislación & jurisprudencia , Odontólogos/legislación & jurisprudencia , Notificación Obligatoria , Canadá , Niño , Croacia , Humanos , Italia , Reino UnidoRESUMEN
Intrinsic green discoloration of teeth is an uncommon condition which mainly affects the primary dentition. Children can be teased about this, resulting in a loss of self-esteem and problems with social integration. The purpose of this paper was to present a case of green pigmentation in the permanent dentition caused by hyperbilirubinemia during infancy and an intermediate restorative approach to mask the esthetic deficiency arising from this.
Asunto(s)
Coronas con Frente Estético , Hiperbilirrubinemia/complicaciones , Decoloración de Dientes/etiología , Atresia Biliar/complicaciones , Niño , Resinas Compuestas/química , Materiales Dentales/química , Dentición Mixta , Estética Dental , Femenino , Humanos , Incisivo/patología , Metacrilatos/química , Decoloración de Dientes/terapiaRESUMEN
The purpose of this study was to investigate the educational experiences of a group of Croatian dental students and to assess their knowledge about child abuse and neglect. In the study, 544 respondents (153 male and 391 female) from all six years at the University of Zagreb School of Dental Medicine completed questionnaires, with a response rate of 74.9 percent. A chi-square test was applied to test the differences among students' answers. Values of p<0.05 were considered statistically significant. Out of the total number of respondents, 33.6 percent had encountered the topic of child abuse and neglect during their lectures. The results show a lack of knowledge of the signs pointing to physical and sexual abuse of children. Students from more senior teaching years showed a greater amount of knowledge related to child abuse and neglect in contrast to students from more junior teaching years. In conclusion, dental students should be better educated and prepared for the important role of helping protect children from abuse and neglect.
Asunto(s)
Maltrato a los Niños , Educación en Odontología , Estudiantes de Odontología , Niño , Maltrato a los Niños/diagnóstico , Maltrato a los Niños/legislación & jurisprudencia , Abuso Sexual Infantil/diagnóstico , Abuso Sexual Infantil/legislación & jurisprudencia , Defensa del Niño/educación , Croacia , Curriculum , Femenino , Humanos , Masculino , Notificación Obligatoria , Sociología/educación , Enseñanza/métodosRESUMEN
INTRODUCTION: There is evidence to suggest that Ledermix, placed as an intervisit root canal dressing, might improve periodontal healing after replantation of avulsed teeth. As a part of a multicenter randomized controlled trial, we aimed to compare the effect of 2 root canal medicaments, Ledermix and Ultracal XS, on the discoloration of replanted teeth. METHODS: Discoloration was investigated by using 3 methods: patient satisfaction with the color of replanted teeth, clinical photographs taken at baseline and 12-month reviews, and estimation of color change by using CIELAB scores for baseline and 12-month photographs. RESULTS: Twenty-two patients (27 teeth) were recruited. Ten patients (12 teeth) were randomized to the Ledermix group and 12 patients (15 teeth) to the Ultracal XS group. At 12 months, 8 patients were concerned with the discoloration of their teeth. Seven came from the Ledermix group and 1 from the Ultracal XS group. This difference was significant (Fisher exact test, P = .009). Standardized photographs were taken for the patients recruited at one center only (17 patients). There was significant discoloration of teeth from baseline with Ledermix, causing a darkening and gray-brown discoloration (mean change from baseline to 12 months, L∗ = -5.1, a∗ = 0.3, b∗ = -1.2, and ΔE = 8.1) and Ultracal XS, causing a yellowing and lightening of teeth (L∗ = 1.9, a∗ = 0.3, b∗ = 3.3, and ΔE = 5.4). There was a significant difference for the L∗ and b∗ variables (independent t test) between the 2 groups. CONCLUSIONS: Both root canal medicaments cause discoloration, with Ledermix proving less acceptable to patients.
Asunto(s)
Irrigantes del Conducto Radicular/efectos adversos , Avulsión de Diente/cirugía , Decoloración de Dientes/inducido químicamente , Reimplante Dental , Hidróxido de Calcio/efectos adversos , Distribución de Chi-Cuadrado , Colorimetría , Demeclociclina/efectos adversos , Combinación de Medicamentos , Humanos , Satisfacción del Paciente , Fotografía Dental , Tratamiento del Conducto Radicular/efectos adversos , Estadísticas no Paramétricas , Triamcinolona Acetonida/efectos adversosRESUMEN
Traumatic dental injuries in children often require multiple follow-up visits to the dentist and may have long-term consequences for the developing dentition. The aim of this audit was to examine age, gender, location, time of year, mechanism of injury and type of injury sustained in relation to dentoalveolar trauma in children attending the paediatric dental trauma clinic at Glasgow Dental Hospital from 2002 to 2004, and to compare our findings with data in the published literature. Males suffered 60% of all dental trauma, 79% of sporting injuries and 85% of assaults. The injuries in males were more severe, representing 65% of enamel dentine and pulp fractures, 100% of crown root fractures and 66% of crown root and pulp fractures. A peak for trauma was seen in the 8-11-year-old group (43%). The majority of injuries in the under four age group resulted from falls (87%). Taken as a whole, falls accounted for 49%, sports related injuries 18%, bicycle and scooter 13%, assault 7%, and road traffic accidents 1.5% of all injuries. They also accounted for a far higher percentage of intrusive luxations (67%). The largest proportion of injuries occurred during the summer months (33%). Sixty-four percent of children suffered trauma to more than one tooth. Fifty-eight percent of injuries involved the dental hard tissues and pulp and the majority of these (82%) were crown fractures. Most subjects (82%) suffered trauma to their periodontal tissues, (26% concussion or subluxation, 26% lateral luxation and 23% avulsion). Injuries to the supporting bone were uncommon. Sixty-six percent of all injuries occurred outdoors. Our findings were similar to a number of published studies, but in contrast to several others. More consistency is required in the collection and reporting of trauma data to be able to draw meaningful conclusions by comparison.
Asunto(s)
Traumatismos de los Dientes/epidemiología , Traumatismos de los Dientes/etiología , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Factores de Edad , Traumatismos en Atletas/epidemiología , Niño , Preescolar , Pulpa Dental/lesiones , Femenino , Humanos , Incidencia , Masculino , Periodoncio/lesiones , Estudios Retrospectivos , Escocia/epidemiología , Estaciones del Año , Factores SexualesRESUMEN
Replacement resorption (ankylosis) may be a significant complication after replantation of avulsed permanent incisor teeth. This report explains the aetiology, diagnosis, management and current treatment options in ankylosis and then describes an alternative surgical technique, intentional luxation and repositioning. This technique, in the presence of an acceptable root length, may be a realistic treatment option in adolescence until osseointegrated implants can be considered at the age of 18-20 years.