[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.

Methodological quality and implications for practice of systematic Cochrane reviews in pediatric oral health: a critical assessment.

BACKGROUND: To ensure evidence-based decision-making in pediatric oral health, Cochrane systematic reviews that address topics pertinent to this field are necessary. We aimed to identify all systematic reviews of paediatric dentistry and oral health by the Cochrane Oral Health Group (COHG), summarize their characteristics and assess their methodological quality. Our second objective was to assess implications for practice in the review conclusions and provide an overview of clinical implications about the usefulness of paediatric oral health interventions in practice. METHODS: We conducted a methodological survey including all paediatric dentistry reviews from the COHG. We extracted data on characteristics of included reviews, then assessed the methodological quality using a validated 11-item quality assessment tool (AMSTAR). Finally, we coded each review to indicate whether its authors concluded that an intervention should be implemented in practice, was not supported or was refuted by the evidence, or should be used only in research (inconclusive evidence). RESULTS: We selected 37 reviews; most concerned the prevention of caries. The methodological quality was high, except for the assessment of reporting bias. In 7 reviews (19%), the research showed that benefits outweighed harms; in 1, the experimental intervention was found ineffective; and in 29 (78%), evidence was insufficient to assess benefits and harms. In the 7 reviews, topical fluoride treatments (with toothpaste, gel or varnish) were found effective for permanent and deciduous teeth in children and adolescents, and sealants for occlusal tooth surfaces of permanent molars. CONCLUSIONS: Cochrane reviews of paediatric dentistry were of high quality. They provided strong evidence that topical fluoride treatments and sealants are effective for children and adolescents and thus should be implemented in practice. However, a substantial number of reviews yielded inconclusive evidence.

Bispectral Index Monitoring: validity and utility in pediatric dentistry.

Reliable and safe provision of sedation and general anesthesia is dependent on continuous vigilance of patient's sedation depth. Failure to do so may result in unintended oversedation or undersedation. It is a common practice to observe sedation depth by applying subjective sedation scales and in case of general anesthesia, practitioner is dependent on vital sign assessment. The Bispectral Index System (BIS) is a recently introduced objective, quantitative, easy to use, and free from observer bias, and clinically useful tool to assess sedation depth and it precludes the need to stimulate the patient to assess his sedation level. The present article is an attempt to orient the readers towards utility and validity of BIS for sedation and general anesthesia in pediatric dentistry. In this article, we attempt to make the readers understand the principle of BIS, its variation across sedation continuum, its validity across different age groups and for a variety of sedative drugs.

Technical communication: the effect of the double mask on anesthetic waste gas levels during pediatric mask inductions in dental offices.

A significant portion of office-based general anesthesia for pediatric patients is performed in dental offices and involves mask inductions with inhaled drugs. This can lead to significant pollution with waste gases. We assessed occupational exposure to anesthetic drugs during pediatric general anesthesia in dental offices and assessed the effectiveness of the "double mask." Nine freestanding dental offices had measurements of anesthetic waste gas levels taken before and immediately after implementation of a double-mask system. Levels of nitrous oxide decreased from a median of 40.0 parts per million (ppm; interquartile range [IQR] = 23.0-46.0 ppm, n = 9) to 3.0 ppm, (IQR = 2.3-4.7 ppm, n = 9, P = 0.0055) and exceeded 25 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. Levels of sevoflurane decreased from a median of 4.60 ppm (IQR = 3.10-7.00 ppm, n = 9) to 0 ppm (IQR = 0-0.39 ppm, n = 9, P = 0.0024) and exceeded 2 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. We demonstrated in our study that the double-mask system, when used with dental "high-volumes" suctions (high-volume evacuators producing approximately 12 m(3)/h) in freestanding dental offices, was sufficient to decrease the exposure to anesthetic waste gas during pediatric mask induction in at least two thirds of offices when compared with the traditional mask.

Comparative evaluation of clinical performance, child and parental satisfaction of Bioflx, zirconia and stainless steel crowns in pediatric patients.

Background: Pediatric dental treatment is challenging in patients with early childhood caries. For clinician its difficult to manage child and provide good work at the same time. Its necessity to have the best equipments as well as materials. Nowadays, aesthetics play an important role in managing decayed teeth. Zirconia crown is better option but requires excessive preparation. As Bioflx is newly developed crown and has combined stainless steel and zirconia properties. Aim: To assess the clinical performance and child and parental satisfaction of Bioflex crowns compared to zirconia and stainless steel crowns. Methods: In this comparative study of Bioflx crowns with zirconia and stainless steel crowns, children aged three to seven years old will be selected, and 72 primary teeth requiring crowns will be randomly distributed into three groups, n = 24: Group I: Preformed stainless steel crown, control; Group II: Preformed Bioflex crown; Group III: Preformed zirconia crown. Crowns will be evaluated for recurrent caries, plaque accumulation, restoration failure, gingival status opposing tooth wear, and clinicians and parental satisfaction at zero, three, six, and 12 months. Results: Bioflx crown will have better clinical as well as parental satisfaction among zirconia and stainless steel crowns. Conclusions: The Bioflx crown can be used as an alternative economical esthetic full-coronal restoration for primary teeth. Trial registration: CTRI registration number: CTRI/2023/05/052256; Date of registration: May 03, 2023. Protocol version: Two; Date: April 22, 2023.

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.

Evaluation of pediatric dentistry guidelines using the AGREE instrument.

PURPOSE: Guidelines are used to inform clinical practice and improve the quality of health care. Poorly developed guidelines may emphasize the incorrect intervention. The purpose of this paper was to evaluate the quality of pediatric dentistry guidelines using the AGREE instrument. METHODS: A search was carried out to identify pediatric dentistry guidelines up to November 2007. Three independent assessors evaluated the guidelines using the AGREE tool. RESULTS: Fifty-seven guidelines produced by 11 organisations were evaluated. Most guidelines assessed were of poor quality, as determined by the AGREE instrument. CONCLUSIONS: Consideration should be given to using the AGREE instrument in the development of new guidelines and review of existing guidelines.

[Prevention of white spots during orthodontic treatment with fixed appliances]. / Wittevleklaesies tijdens orthodontische behandeling: preventief beleid.

Orthodontic treatment with fixed appliances involves a significant risk of enamel demineralization. The aim of this study was three-fold: to gain insight into a) the preventive measures which are applied as standard practice in The Netherlands in orthodontics, b) when the use of fluoride rinses is initiated, and c) which concentrations and frequencies of use are recommended. A questionnaire was sent to all orthodontists in private practice in The Netherlands. Completed questionnaires were returned by 154 of the orthodontists (response rate 81%). A basic practice protocol for preventing demineralization was used at the start of treatment by 93%. The majority (90%) recommended to use fluoride rinse once daily. They generally (85%) recommended to do this in the evening immediately after toothbrushing. The authors recommend rinsing at another moment than after tooth brushing, in order to increase the number of fluoride moments during the day, which enhances the effectiveness of this measure in preventing caries.

Previous radiographic experience of children referred for dental extractions under general anaesthesia in the U.K.

OBJECTIVE: To determine what proportion of children undergo radiographic assessment prior to referral to a dental hospital for extractions under general anaesthesia. BASIC RESEARCH DESIGN: This prospective survey was conducted over a 6-month period. A data sheet was used to record the following information: patient's age; referrer's name and place of work (general dental practice or community dental service); teeth to be extracted (primary dentition and/or permanent dentition) and reported previous radiographic examination. Patients were excluded from the study if, following a clinical examination, radiographs were not actually deemed necessary for diagnosis and treatment planning purposes. Clinical setting A paediatric dentistry clinic within a dental hospital in the North of England. Participants 161 patients with a mean age of six years (SD = 2.2, range = 3-14 years) who were referred to the dental hospital for extractions under general anaesthesia. RESULTS: Overall, 12.4% of children had reportedly undergone a previous radiographic assessment prior to hospital referral. A significantly greater proportion of children referred for permanent tooth extractions had been subject to radiographic examination compared to children referred for primary tooth extractions (46.2% as compared to 6.3%; P = 0.001 chi-squared test). Furthermore, patients referred from the community dental service were significantly more likely to have had previous dental radiographs than children referred from general dental practice (36.9% compared to 9.3%; P = 0.003 chi-squared test). CONCLUSIONS: Radiographs do not appear to be routinely employed for caries diagnosis and treatment planning in young children within general dental practice in the U.K.

Assessment of the quality of reporting of randomized clinical trials in paediatric dentistry journals.

INTRODUCTION: Reporting of randomized controlled trials (RCTs) should be of high quality to support the conclusions reached by the authors. Poor-quality reporting has been associated with an overestimation in intervention efficacy. Within the field of paediatric dentistry, no study has assessed the quality of reporting. OBJECTIVE: The aim of this study was to assess published RCTs in paediatric dental journals between 1985 and 2006 for: (i) whether quality of reporting allows readers to assess the validity of trials; and (ii) whether quality of reporting has improved since the introduction of the Consolidated Standards of Reporting Trials (CONSORT) guidelines. METHODS: Hand search of the main paediatric dentistry journals; inclusion criteria were: the trial was performed on children, and RCT. CONSORT guidelines were made into an operational checklist. Trials published between 1985 and 1997, and between 1998 and 2006 were compared to determine any improvement since the publication of the CONSORT guidelines. RESULTS: One hundred and seventy-three of 5635 articles met the inclusion criteria. Reporting quality was poor overall and showed heterogeneity. It had improved slightly since the publication of CONSORT. Few trials were reported adequately. CONCLUSION: The quality of reporting of clinical trials is poor, and often not adequate to allow readers to assess trial validity. Overall quality of reporting has not substantially improved since the publication of CONSORT.

The future of pediatric dentistry advanced education: the need for change in training standards.

This report describes the background, rationale and process for revision of training standards for advanced educational programs in pediatric dentistry in the United States.

UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars.

This revised Clinical Guideline in Paediatric Dentistry replaces the previously published sixth guideline (Fayle SA. Int J Paediatr Dent 1999; 9: 311-314). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268.

Guideline on oral and dental aspects of child abuse and neglect.

In all 50 states, physicians and dentists are required to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may be suspicious for child abuse or neglect. Physicians receive minimal training in oral health and dental injury and disease and, thus, may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions.

Guideline for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation as well as an appreciation for drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of people to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to presedation level of consciousness before discharge from medical supervision, and appropriate discharge instructions.

[Treatability of children according to Dutch dentists]. / Behandelbaarheid van kinderen gezien door de ogen van de tandarts.

Most dentists find it important to treat the dentition of children; nevertheless cavities often remain untreated. In order to gain insight into the treatability of children, a survey was carried out involving 4,500 dentists of a health insurance company. A representative group answered questions about the necessity of treatment, and treatability of children and about the possibility of referring children to a colleague or a paediatric dentist. According to the questionnaire dentists find it important to treat the dentition of children. Most problems during dental treatment occur in the 0-6 years age group. Dentists are more likely to refer children in this age group to a colleague or pediatric dentist for treatment.

Clinical analysis of molar fissures by Cone-beam tomography.

This study aimed to validate clinical analysis of 20 pediatric dentists on occlusal groove-fossa-system of molar depth comparing to Cone-beam tomography. The 48 sound third molars were visually classified from the shallowest to the deepest. Images were taken from the Accuitomo 3DX. There was a fair correlation between clinical analysis and the tomographic scorings (rs = 0.238; P = 0.103). It was concluded that pediatric dentists were not able to classify the fissures depth by visual analysis correctly.

Do Standard Bibliometric Measures Correlate with Academic Rank of Full-Time Pediatric Dentistry Faculty Members?

The aim of this cross-sectional study was to assess the relationship between quantitative measures of research productivity and academic rank for full-time pediatric dentistry faculty members in accredited U.S. and Canadian residency programs. For each pediatric dentist in the study group, academic rank and bibliometric factors derived from publicly available databases were recorded. Academic ranks were lecturer/instructor, assistant professor, associate professor, and professor. Bibliometric factors were mean total number of publications, mean total number of citations, maximum number of citations for a single work, and h-index (a measure of the impact of publications, determined by total number of publications h that had at least h citations each). The study sample was comprised of 267 pediatric dentists: 4% were lecturers/instructors, 44% were assistant professors, 30% were associate professors, and 22% were professors. The mean number of publications for the sample was 15.4±27.8. The mean number of citations was 218.4±482.0. The mean h-index was 4.9±6.6. The h-index was strongly correlated with academic rank (r=0.60, p=0.001). For this sample, an h-index of ≥3 was identified as a threshold for promotion to associate professor, and an h-index of ≥6 was identified as a threshold for promotion to professor. The h-index was strongly correlated with the academic rank of these pediatric dental faculty members, suggesting that this index may be considered a measure for promotion, along with a faculty member's quality and quantity of research, teaching, service, and clinical activities.